Curbside Consult with Dr. Jayne 4/11/11

There’s been lots of buzz this week about the Care Connectivity Consortium. This initiative by Geisinger Health System, Kaiser Permanente, Mayo Clinic, Intermountain Healthcare, and Group Health Cooperative has been noted everywhere from The New York Times to Yahoo and MSN.

I can’t wait to see how this collaboration unfolds. Those of us who have spent the last several years knee-deep in Health Information Exchange know how difficult it can be to actually make this happen.

I’m interested in seeing details on the pre-work: consent, governance, and ownership. It’s challenging enough to get a productive HIE live that meets the legal hurdles of a single state, let alone meeting those of a disparate group covering Pennsylvania, California, Minnesota, Utah, and Washington (which just represent the headquarters states, not all the states where care is delivered, which will also have to be addressed).

The warm and fuzzy scenario presented in The New York Times piece: “A person walks into a clinic in Phoenix, say, and, with permission, her records from her hometown physician’s office in San Francisco are efficiently summoned with a mouse-click.” If only it were that easy!

Having been involved with attempts to jumpstart a regional HIE, I know that wading through the legalese for the patient consent and trying to fit it on a single page reminded me of the scene in the cult classic The Princess Bride, where the bad guy has a machine that sucks years of your life away.

The consent language for many data exchange projects can be nearly unintelligible for the lay person. I suspect the forms will become “just another form” that patients shuffle through and sign if they want to receive care, whether they understand it or not.

(Kind of like the paperwork in the Emergency Department – do they think patients actually read that? I don’t think so. They sign it because they are sick, hurting, and in need of care. When you just want to see your doctor, you don’t care about the HIPAA Notice of Privacy Practices, Patient Financial Responsibility statement, or anything else other than being treated.)

I’d like to see the details of how they’re going to do this. I’m sure it will be more than the proverbial single click – like documenting the patient’s consent or opt-in status, validating patient identifiers, etc. And once you have the patient identified, how useful will it be? I hope the Consortium goes “all in” with this and uses fully discrete data that can be exchanged and consumed by receiving physicians’ EHRs, not just another view vault application that’s the electronic equivalent of asking physicians to review paper documents from multiple institutions.

I applaud the groups’ ability to work out shared goals among the CEOs before it became too public. Kaiser’s CEO George Halvorson is quoted as saying, “The CEOs had to make sure the CIOs didn’t think this was crazy or impossible.” Probably a good idea, as this may have been a non-starter if too many people were at the table before the basics were agreed upon or if the CIOs opposed it.

But now that the basic agreement is done, what about the CMIOs and the actually physicians and caregivers who will have to use the system on a daily basis? I hope their input will be considered starting immediately, if this has not already happened.

How real-time will it really be? How are they going to handle corrections and errors? What about monitoring and maintenance of potential duplicate patients? Sensitive information, such as drug use, HIV status, sexual history, and the like? Patients who change their opt-in/opt-out status to avoid sharing certain information?

The devil will definitely be in the details. The answers to these questions, coupled with ease of use, will determine the success of this initiative (assuming the technical piece can be carried out in a timely and fiscally responsible way).

The New York Times pointed out that the groups also have insurance products. Collaboration could be seen as an attempt to compete with the lines of UnitedHealth, Aetna, and Wellpoint. Halvorson is quoted as saying, “This is totally focused on care.”

I really want this to work and be successful in a big way. This could pave the way for many other collaborative efforts that could be game-changers for the physicians in the trenches. The groups intend to exchange some data by the end of this year, so it should be fun to watch.

If any of the CMIOs from the Consortium organizations are HIStalk readers, I’d love to chat with you about the gory/geeky details of the project (preferably over a glass of wine and some chorizo fondue, but I’ll settle for Skype). Drop me a note if you’re interested in chatting.

E-mail Dr. Jayne.

Monday Morning Update 4/11/11

From Man on the Street: “Re: Association for Clinical Documentation Improvement Specialists conference in Orlando. They expected 575 attendees for their fourth conference and actual attendance was 660. An overwhelming majority of attendees are either on Epic or say they’re moving to Epic.” MOTS included some photos, which I always like.

From Ogie: “Re: ISH. Acquired by PwC.” Unverified, but I’m really hating those company names. They aren’t universally recognized brands like GE or IBM, so hacking down a perfectly good and understandable name into gibberish doesn’t seem like much of an accomplishment, especially if your name (like that of ISH) results in a scattershot of unrelated Google search hits.

From EMRconsultant: “Re: acquisition. A Minnesota / Louisville-based HIS is being acquired soon.” Unverified.

From The PACS Designer: “Re: Nimbula Director. It’s a new class of cloud infrastructure and services system (IaaS) that provides a flexible and secure public cloud with advanced data center security tools.”

It’s the weekend (at the time I’m writing this, anyway) so that means less formality as I use the “old” format instead of the new one. It feels like Hawaiian Shirt Friday.

My Time Capsule editorial this week, once again from 2006: Do Technology Surveys Rate the Hammer or the House? These are fun reading for me since I wrote them so long ago it’s like reading someone else’s work.

Results of my Quick Poll on the departure of John Gomez from Allscripts: 39% of respondents said it will have little or no long-term company impact, 30% said it will have some, and 31% said it will have a lot. I’ll be running these polls when big news comes up. Poll results plus the usual reader comments will provide a quick and interesting industry reaction to events.

Congratulations to Boston, hereby officially named the Capital of Healthcare IT (as it should be, in my opinion). Perhaps I should start a drive to have it commemorated with a monument or something, maybe on the Meditech campus. New poll to your right: should Medicaid and Medicare require biometric identity verification of patients seeking healthcare services?

Kaiser CEO George Halvorson talks up the new Care Connectivity Consortium it formed with Mayo, Geisinger, Intermountain, and Group Health to share patient data. I’d say it’s more of a demonstration project than a true patient benefit since those organizations probably don’t have many patients in common. Here are some excerpts from George:

We are all using our EMRs to improve care and support the delivery of care. We are all learning how to use that wonderful new tool — and we are all interested in sharing what we are learning with the world … The problem with electronic is that when patients go to different doctors for their care, they still tend to have separate records — and that can create electronic silos instead of paper silos … So we are now committed to creating similar linkages with the new set of elite medical groups to create a process that works first for our patients and then — if we do it well — for the world … This is important work. If someone doesn’t figure out how to create links between electronic medical records, those records will not be linked. It will not be done until someone does it. Who better than us to do it? We are patient-focused and we know what can be done and we know what should be done with an EMR. Almost all other care sites are just getting their toes in the water. Some are getting their feet wet. We are swimming. So this is a good contribution for us to make. Instead of keeping our advances and our learning secret and special only to us, we are sharing what we know because we want care to be better for everyone.

By the way, I can’t find a Web site for Care Connectivity Consortium, which seems strange. I searched and careconnectivityconsortium.com is not registered, although the .org variant was grabbed by an anonymous registrant on the day of the announcement.

I ran across a copy the IRS form for HIMSS for 2008, the newest one on file so far. Steve Lieber’s total compensation: $731K (slightly out-earned by Dave Garets, who was running HIMSS Analytics at the time). I’ll have to remember to check back to see if they file a new form soon. The annual conference represented $19 million of its $41 million total revenue.

Those DoD people just can’t stop disagreeing with decisions made elsewhere, but at least they’re finally willing to make fat cat contractors rich in ways other than developing custom software. The VA announced plans to move forward with developing an open source system to be shared by both organizations, but DoD says they’ll look first at commercial software and will consider in-house development only as a last resort.

Six-campus, 305-bed Central Texas Hospital (TX) chooses inpatient EHR and revenue cycle systems from the US affiliate of Mexico-based eCareSoft, expecting to meet Meaningful Use requirements for 2011-2012. eCareSoft says small hospitals can go live on its products in 120 days.

Merge Healthcare appoints Cheryl Whitaker MD, MPH, FACP as its first chief medical officer. I assume that’s the same Cheryl Whitaker, MD who, along with her physician husband (there’s an interesting story and comments behind that link), is a close friend and advisor of the Obamas, not that there’s anything wrong with that. Merge is in Chicago, a city known mostly for dead people electing ethically challenged politicians, at least until the apotheosis of its junior Senator Obama.

The local paper in Middletown, OH runs down the status of electronic health records in local hospitals: West Chester Hospital, implementing Epic. The Fort Hamilton Hospital, implementing Epic. McCullough-Hyde Memorial Hospital, live on CPSI. Atrium Medical Center, live on Epic. Mercy Hospital Fairfield, live on Epic.

Shares in for-profit hospital operator Community Health Systems gained only 9% from 2008 to 2010, but CEO Wayne Smith’s total compensation nearly doubled in that period, rising to $21 million in 2010.

E-mail Mr. H.

Time Capsule: Do Technology Surveys Rate the Hammer or the House?

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 January 2006.

Do Technology Surveys Rate the Hammer or the House?
By Mr. HIStalk

A disclaimer: I’ve worked at three organizations that were named Most Wired. In no case did we really believe that our IT was any better than anyone else’s, but we sure bragged about our victory at every chance.

The Most Wired survey season is upon us again. Eager candidates yearn for the recognition and improved job prospects they think the award will bring. Past-winner CIOs wake up in a cold sweat after having nightmares of opening the magazine and realizing that they’ve become a Former Most Wired (e.g., loser), while their cross-town CIO competitor bags a spot on the list and waves the rag triumphantly in their face.

I’ve seen the survey encourage the same sort of rationalized fabrication usually reserved for aggressive vendors imaginatively completing RFPs. Said one of my former employees to whom I turfed off completion of the survey form, “The survey’s vague enough that it’s not really about what we’re doing, it’s about how badly you want to win.”

For others, the survey’s detailed questions invite casual answers just to get the damned thing sent off in time. Think of those annoying “qualify for a free subscription” cards that require an hour of your time just to get a worthless rag that you’ll throw out unread anyway.

As I read over the 2006 survey form, I’m encouraged that it asks some really good and meaningful questions. If they’d just spot-check some winners and expose a few frauds, I’d be behind it 100 percent. Still, it is evolving fairly well.

As I remember, the original survey measured what you have. The emphasis was on buying stuff: wireless networks and PCs, for example. The vendor sponsors of the survey aren’t exactly against that concept, and even today, the incessant message is, “Good hospitals spend a lot on IT, bad ones don’t, so which one do you want to be?”

Today’s survey is more along the lines of, “How much of the stuff that you bought gets used?” Better.

Where it hasn’t gone yet is, “Did all that stuff make you better at patient care?”

If technology is something to be admired and honored with awards, then what’s the payoff, other than getting some cool Most Wired shirts? We should see a positive correlation to improved patient outcomes, reduced costs, and a happier work force and medical staff.

Indeed, lots of glossy paper will be sacrificed after the survey trying to prove some frankly questionable premises on why “Most Wired” means “Best” (unconvincingly, if you ask me). Was information technology the cause of the improved outcomes effect, or did they simply coexist in an unrelated way?

Maybe we’re doing this wrong. The hospitals I admire are those with tiny IT departments and budgets who, nonetheless, manage to meet non-IT criteria and instead are best in patient care.

I don’t admire carpenters with cool hammers. I reserve that judgment until I see what they’ve built with them. Maybe a few of the Lesser Wired could teach us all some lessons, after which we could still buy the cool stuff if we’re really convinced it would make us better.

HIStalk Interviews Geoff Brown, CIO, Inova Health System

Geoff Brown is SVP and CIO of Inova Health System of Falls Church, VA.

We crossed paths when I asked you about Inova’s system selection, which is underway. What are the strengths and the weaknesses of the systems that you have and what you’re hoping to gain in considering alternatives?

I would probably start out by saying, as opposed to the strengths and weaknesses of it, I think we were an early adopter after Stark relaxation. We jumped in pretty early with an offering. That was back in the days where people tended to prefer to keep their current practice management solution. EMRs were being thought of a separate component, with some people having the option if they wanted to go with an integrated product. Most were more comfortable with their own scheduling and billing systems, whether they were sourcing that or they were doing it out of their practice and had relationships already going. I think that really goes back to around 2007-ish or somewhere in there.

As we went forward, we found two or three things. First of all, the model to market and drive this to the physician community was certainly a different market for us, in terms of the teams you needed in place to go and meet — not with the physician, the physician would want to have it, and that was a key starting point — but typically a lot of these smaller practices had contracted resources that might come in periodically each week. Others might have a secondary support staff that might be an extension of family or relationships. Others might have formal contracted relationships.

There was a significant amount of education that had to happen. As a result of that, over a period of a couple of years, we really learned really how to go at it and to attack that market with various offerings and solutions.

Somewhere along the middle of this, sometime midway in 2009, we didn’t see any requirements for the EMR component not to be integrated with the practice management solution. After the initial kickoff, we got clinical EMR modules moving forward, interfaced with practice management. People started realizing the benefit of, “If I’m going to do this, I need to make sure I do it with a product or a solution that would allow me to automate my workflow on the scheduling and practice management end of the loop, as well as be certified in a go-forward mode with CCHIT at the time.”

That’s really the front end piece of that. Up until we started doing work around the health reform space, you really didn’t have a real huge need to manage your integrated workflow differently. Ambulatory to EHR, the interface process could work fairly effectively for most people.

What’s really made it more important for us to have an integrated solution in place is that we have a very large physician community network. As a result, we want to make sure that we’re able to have a way to extend out the clinical workflow more effectively than we can do now.

We’ve attacking it from a couple of different spaces. I won’t say it’s a weak point, but we’ve been involved largely with HIEs that will certainly meet the CCD-32 standards around interoperability and exchanging from an interface perspective through our HIE in delivering results back and forth to the practices. That process works good, but what we discovered — and this has been a different tier of maturity for us, having jumped in a little early, at least here in our market — is that you can’t make that data actionable now. As much as everybody talks about the Continuity of Care Document and the exchange process, many other vendors weren’t really doing that at the time.

We’re just now starting to see the practices being on release versions that will support that. We’ve been just doing the push-pull type of results delivery, versus having a really smart bi-directional type of a population of clinical information that can be discrete in nature in that you could put rules around and make it actionable in other ways.

That’s really a desired state we hope to get to. I think there are two tracks to get there. You can do it through the standards that we’re all moving toward — HIE standards that have been put in place — or you could have an integrated solution. That really is what drove it for us, as opposed to vendor weaknesses and strengths in large markets. We will never have a situation, I believe, at least in northern Virginia, where there’ll be just one solution.

When you signed your deal with GE three years ago, you said that would be the only product you would directly support. What did you learn from that experience?

The GE product would be the only one we would put subsidy assistance around. It was the same platform as our inpatient product. That had the promise of further integration and interoperability progression. Had we had another hospital information system platform, that we would have wanted to stay with whoever that vendor was, simply because of the promise that as releases were released out to us from an upgrade perspective, you know they would be tackling more and more of the interoperability gaps. By definition, you would be bringing your base of EMRs forward in that vein. That’s really why we said that. 

Our story to the community has always been that if you worked with a certified EMR, we would work to provide the interfaces to our environment so that you could move to an electronic process with us. We’ve been that way from Day One, but obviously we wanted to press and have at least a certain base of physicians on what our desire tool was, because that certainly would allow us to move a larger piece of the base forward at any given time.

I saw that you just signed what sounded like a pretty big deal with Oracle for business intelligence and that your CEO was saying it will support “value-based personalized healthcare.” What does that mean and what’s the actual nuts and bolts that you’ll need to work with Oracle to make that happen?

We’re doing like many systems are doing. We’re going down a track where we think the future of medicine is your ability to use analytics to help you actually move further and further toward personalizing care, whether it’s through the improvements that are happening in the genomics environment … again, there’s a huge amount of data that you would have to process and then convert into a format that can be used as good information and can be driven by analytics teams around interpreting that information. So that’s one track. 

I think the other area that makes this an important track for us is we are a large system with many disparate applications. As a result of that, we think that there will always be a number of research databases and other applications that fall outside of our traditional transactional systems that are managed through IT. As a result of that, as you’re moving toward better standardization, better evidence-based practice, that you need to pull out … an example of that might be a process we are developing an in-house what we call Inova Broker, which allows us to take data between a disparate environment into our core hospital information system and coded allergy data.

We learned is that allergies are collected at various access points within our organization. However, we had different standards of practice around how comprehensive that was, and when changes were made, how we managed those changes through all of the other key points in our operation. There’s been rigor around how we populate things — how we actually map from one application to another so the data is normalized.

The Oracle HTB project is allowing us to build a repository that has mapped information from each of these applications. We can then write use cases to identify patterns of patients based on certain results. We give our case management folks and others a front-end look at patients we might need to manage across our system, as opposed to waiting until the end of the day and doing queries. We may be able to do some of this identification real-time up front and get a start on making sure we meet some of the quality core measures we may be emphasizing. 

As we build this infrastructure around our partnerships and around the data that we generate or exchange within our HIE framework, that will be a central hurdle for us to manage that. We hope to offer opportunities for our community physicians if they participate and follow certain policies that we hope to establish. For those that like to participate in forms of research or clinical trial work, they’ll be able to be a part of this ecosystem here.

It sounds like the projects that you’re working on are based on strategic organizational decisions at the Inova corporate level. Backing up to that, what are the main elements of Inova’s strategic plan and what IT functions get handed down to you to support them?

We’ve had a number of strategic planning sessions. As a result of that, we have mapped where we needed to be as an organization. Some of the things you see and hear us doing are around just being able to manage the flow of patients more effectively across our continuum of care. We actually were doing that well, but if you were to ask me if it was all connected in a way that would be seamless to patients, be workflow smoothly for our physicians as they’re trying to manage their patients … there are some opportunities for us to improve on the handoffs from the hospital environment out to the various ambulatory care settings that we manage, whether that be the physician practices, whether they be home health, or whether that be even some of the joint ventures partnerships we have where patients flow from one setting. 

They might not be exclusively in an Inova setting. However, the appearance and the workflow is a coordinated workflow. When they get scheduled, maybe there are multiple steps that can be eliminated in that chain if you had an accident or you needed to have an MRI done.

In some settings, you might have to schedule something unless it’s an emergency, a few days later or a week later. However, we’ll give you the ability through this network or this ecosystem to look at other options if you’re willing. We have these resources available across the continuity of care that we manage with our partners and within our organization. We can give patients and physicians options to get people being seen now or same day, same week, etc. based on the convenience factor for them.

It’s really a whole process around just making the healthcare more fluid. Making access for our patients work more effectively, and in doing so, increasing utilization in ways that we would never be able to address.

You’re on the board of Nova RHIO. How important is interoperability on what you’re trying to accomplish at Inova?

We’re doing a pilot project right now in the ED. It really is around patients when they present in the ED. We’re able to go out as they’re being triaged and check their medication list and compare it with what they’ve told us. The importance of that, based on their allergies and other information that we may or may not have or that they presented just now, is to have a much better profile on the front end.

We’re also talking about other projects in the RHIO that are geared toward getting patients online more effectively with versions of their health record. What we found is the community — folks like you and I, we’re close to it, but when you get into certain elements of the community, people have access to all types of services. But it’s very challenging for most of them to really operationalize those things. The RHIO is coming up with a series of electronic solutions that might be a service or benefit to providers, but also have an element that helps drive it in the Northern Virginia community to a point that they’re able to have their information and access it very easily and share throughout the Northern Virginia space.

At a state level, there’s a certain amount of reporting that will need to happen on a monthly basis. Virginia was one of the states with an HIE grant. What we decided to do, at least here in the state of Virginia , is that Virginia will never be an HIE of its own, but it will require any HIE that is doing business in the state to report to them on whatever the cycle will be and that they comply with certain standards and report to those standards. Virginia can then take all of those feeds and then bring them together in a way that will allow us to do one report out for the Commonwealth.

That’s the real direction that we’re headed here in Virginia. The RHIO will be one of many RHIOs. We have three that actually do work now in the state. I won’t mention them by name, but there are three organizations that have been doing some work. We think there are others that are signing folks up now as well. They can go about the business of competing and having the best programs with the providers that they’re able to sign, but we’ll record them through a single series of standards into the state.

The state will then be responsible for getting their information out as the federal reporting or electronic reporting really start to kick in. The Northern Virginia RHIO’s mission s to help the citizens here in Northern Virginia maximize their ability to receive good care and also manage whatever their requirements are.

Any final thoughts?

It’s a very challenging time. What we’ve learned in being early players with some of the commercial products is that there’s a tier process of maturity that needs to happen between a health system and its community of providers — physicians and other relationships. For instance I’ve learned that your best customer sometimes in this EMR arena is someone that has played around with having electronic solutions, regardless of what product they had. They’re much more educated the second time around the workflow requirements, the commitment to the practice, the commitment to the communication and network activities that have to be in place to make the process work effectively and efficiently.

That’s what we’re starting to see now. That informed client or customer or physician group that has been dilly-dallying in the early days of the EMRs or EHRs. Now they’re going in this second pass much more aware of the type of services they need to have in place, the type of technology support they need to have in place, and quite frankly a lot more aligned and around those individual physicians that are looking to modernize and update their practices to take advantage of these new technologies. That’s the one change that I’ve seen, and that didn’t happen overnight. That happened through levels of maturity you get with moving toward any new platform.

Mostashari Named ONC Head

Farzad Mostashari, MD, ScM has been named National Coordinator for Health Information Technology effective immediately, according to an announcement on the ONC Web site and ONC’s Twitter feed. He was Deputy National Coordinator for Programs and Policies under David Blumenthal.

Mostashari was previously with the New York City Department of Health as an assistant commissioner. He holds a medical degree from Yale and master’s in population health from Harvard.

News 4/8/11

Top News

I’ve run reader-provided hints over several months that Allscripts EVP/CTO John Gomez was planning to leave the company. That became official on Wednesday, when Allscripts announced his resignation, effective May 31. He’ll be available to the company for 18 months afterward as a consultant. An internal e-mail from CEO Glen Tullman says that Gomez wants “to focus on a number of areas outside healthcare and perhaps running a company himself.” Allscripts shares dropped 6.8% on Thursday following that news and a downgrade by Auriga, which expressed concerns about his resignation, the level of attrition of Eclipsys employees after the acquisition, and recent KLAS rankings of the Allscripts Enterprise ambulatory product.

I’ve been planning to use quick polls to gauge industry reaction to major news, so here’s your first opportunity to weigh in. Feel free to vote and add your comments.

Reader Comments 

From Year of the Cat: “Re: John Gomez. This could really hurt Allscripts. It’s a very sad day for HIT as one of its most innovative minds exits.” He was arguably their least-expendable employee, at least to anyone interested in the former Eclipsys Sunrise and how it will integrate with other Allscripts products. I hope he’ll stick with the industry in some capacity. It wouldn’t surprise me if he doesn’t start his own company since he’s entirely capable, he has great vision, and his developers have always been able to run circles around just about everybody else’s.

HIStalk Announcements and Requests

I mentioned using polls to get a quick read on industry reaction to major news. I’d also like to get comments from a fixed group of readers like Dr. Jayne does with her Medicine Cabinet. When something big happens, I would e-mail that group and ask for their comments, which I would then run (anonymously) at the next opportunity. If you are a provider CIO, CMIO, or other provider C-level reader and would like to participate, let me know.
I see that CCHIT’s Sue Reber, writing for the organization’s EHR Decisions site, mentions my January 2006 editorial that I ran here recently called CCHIT Should Provide More Information to Purchasers. She even found humor in my making fun of their name almost before the ink was dry on the incorporation papers (“whose phonetic sounding-out always gets yuks from the watercooler crowd”) by adding her own observation that it is “an elegant name with initials not even a mother could love.”

On the Jobs Page: Inside Sales Executive/Telesales, Clinical Software Instructor, Healthcare Implementation Project Manager. On Healthcare IT Jobs: Client Relationship Manager, Healthcare Software Product Manager, Test Analyst.

Acquisitions, Funding, Business, and Stock

MyHealthDirect closes $4 million in a Series B investment round. Arboretum Ventures and Chrysalis Ventures provided the funds, which will be used to expand sales, client services, and technical resources. The company’s Web-based solution allows hospital EDs and other high-acuity providers to search open appointments in the community to generate a patient referral.

CVS Caremark signs a deal with Advocate Health Care and its physician group that will install Advocate physicians as medical directors in 23 MinuteClinic locations in the Chicago area and Bloomington, IN. The organizations will integrate their electronic medical records systems.

CareFusion acquires Vestara for $17 million. The Irvine, CA company offers a drug disposal system that reads drug NDC bar codes and provides advice on how to dispose of the products to conform with all laws and regulations. CareFusion will rebrand the offering as Pyxis EcoStation.

Sales

Henry Ford Health System (MI) selects Health Care Compliance Strategies’ COI-SMART system to manage its conflict of interest disclosure process.

Allscripts will outsource its Sunrise hosting to Xerox subsidiary ACS in a 10-year, $500 million deal. Allscripts expects the business to grow rapidly and needed outside expertise to manage it. My insiders tell me that Allscripts did a good job in being fair to their existing employees so that they’ll be offered their same jobs, pay, and benefits by ACS. While ACS will run the operation, an Allscripts governance team has control. The only casualties so far appear to be some members of the Allscripts remote hosting management team, with a couple of folks already gone. In an interesting twist, Allscripts remote hosting personnel in India are being told they will be let go if they don’t find another position within the company since ACS will not be using offshore resources. I mentioned on January 21 that ACS was being brought in for a role somewhere between oversight and total outsourcing.

Rush University Medical Center chooses Zix for secure e-mail.

Open source software vendor Mirth Corporation launches its InformaCare care management platform for Patient Centered Medical Homes and ACOs. It originally developed the cloud-based product for Pfizer more than ten years ago for Florida community projects and has licensed it back for a wider release.

People

Former Carestream Health GM Todd McNitt joins DICOM Grid as SVP of sales and marketing.

Nuance names Stefan Herm as VP and managing director for Europe, Middle East, and Asia. He comes from McKesson, which of course amused me endlessly since his last name is the same the acronym for Horizon Enterprise Revenue Management.

Insurance company Arcadian Health hires Prudence Kuai as CIO. She was previously with TriZetto.

Government and Politics

“The eHealth boondoggle continues,” according to one Canadian official voicing his objection to the the $673,000 paid to former health deputy minister Ron Sapsford in 2010.

UK Secretary of State for Health Andrew Lansley says fast broadband will improve NHS’s quality and efficiency by enabling greater use of telehealth, mobile computing, and access to information.

Proposed legislation in New York would require Medicaid recipients to have their palms scanned to receive services, saying the identification technology would cost $20 million to implement but would save $5 billion a year while being no more intrusive than electronic toll road payment systems. The state dropped a finger scan requirement in 2009.

Innovation and Research

A four-member Brigham Young University team makes the finals in Microsoft’s Imagine Cup 2011 student competition with their ultrasound application. It allows physicians to download images and them move them to the cloud for collaboration, lowering the cost of medical imaging so that third-world countries can afford to use ultrasound technology. They built their prototype for less than $8,000 using a Microsoft tablet and an ultrasound probe. You can vote for them (or one of the other healthcare-related entrants) here.

Technology

The iPhone is the mobile device of choice for healthcare providers, according  to analysis by the online medical journal Bulletin Healthcare. Almost 30% of healthcare providers access daily medication information with mobile devices and over 90%  of the devices are iPads or iPhones. ER docs and PAs are the biggest mobile device users.

Medicomp has created an online demo of its MEDCIN-powered, browser-based, iPad-ready Quippe EMR documentation system. Sign up and you can play around with it online, provide feedback, and keep yourself busy until the software development kit comes out next month.

Skype has many uses, including for telemedicine and allowing overseas military personnel to watch their babies being delivered stateside. Still, I found this fascinating: police officers are using it from their patrol cars to connect with judges to get warrants issued, especially in time-sensitive cases such as DUI where blood alcoohol levels need to be drawn quickly. One of these days I’m going to sit down and make a list of potential healthcare uses (like checking drugs remotely, walking someone through a procedure, etc.)

Verizon and MEDfx launch a Richmond, VA-area pilot program in which a medical practice scans the paper documentation of diabetic patients and sends it to a physician portal for widespread access. The practice, Dominion Medical Associates, is still paper-based, so the records can be printed and stored in their charts and later migrated to an EHR. The project uses both The Direct Project and NHIN Exchange technologies from ONC.

Other

From KLAS: one out of five community hospitals will switch EMR products within the next couple of years. McKesson and Meditech C/S clients have the highest level of confidence that their vendors will get them to Stage 1 MU by 2013. Healthland and Siemens MS4 clients are the least confident. McKesson was the highest rated vendor, followed by Meditech and Cerner.

Microsoft adds former HHS Secretary Michael Leavitt to the agenda for its Connected Health Conference.

Sponsor Updates by DigitalBeanCounter

• FormFast will host an April 19 Webinar on best practices in hospital process improvement, featuring hospital panelists.
• BridgeHead Software and Laitek Inc. form a strategic partnership that leverages Laitek’s PACS data migration services with BridgeHead’s data and storage management tools.
• Forbes profiles Medicomp Systems and its Quippe tool.
• The University of Kansas Hospital Authority will implement McKesson’s PROmanager-Rx automated medication dispensing system.
• The Ohio State Medical Association (OSMA) will offer Greenway’s PrimeSuite 2011 EHR in its Preferred Partner Program.
• Arkansas Department of Health chooses AT&T’s TotalMobile solution to help gain efficiencies in the transmission of flu vaccination records across the state.
• Health Language signs an agreement with the Chicago-based BCBS Association (BCBSA) to facilitate ICD-10 transition.
• Navicure and the American Academy of Professional Coders (AAPC) form a strategic alliance to educate the industry transition to HIPAA 5010 and ICD-10.
• TeleTracking Technologies joins the American Hospital Association.
• Several 3M products, including ClinTrac and Health Data Management, earn ONC-ATCB certification as EHR Modules.

EPtalk by Dr. Jayne

Dear Dr. Jayne,

Do your patients know or care about IT?

Curious George

Dear George,

Some patients are openly curious about the system we use and how it integrates with the hospital and other offices. I’ve found, though, that many patients just assume that we’re fully integrated, and because we’re computerized, that I can see everything in every chart of every physician they’ve ever visited.

I remember when HIPAA first came to pass how concerned everyone was about the records release provisions.

(Don’t get me wrong, some consultants still play this game. Even though a release is not required for us to collaborate on the treatment of a patient, they demand one before sending consult letters. That’s usually the last time I’ll send a patient to one of those types, unless they are something really special in which case I’ll call them personally and re-educate them on HIPAA and what a pain their staff is causing).

What struck me funny at the time was that patients already thought we had all the information, whether from an active consultant or from an old chart 15 years ago. Many had no concept of what HIPAA was designed to do or how it would impact access to information. When asked to sign releases, they were surprised to learn that we didn’t actually have everything at our fingertips.

If I thought the desire for information sharing was high then, it’s even higher now. With the advent of Web-based patient portals, electronic refill requests, e-visits, and more, the expectation on many fronts is that we have 24×7 access to the patient’s chart.

When seeing colleagues’ patients in the hospital, physicians used to be able to plead ignorance because the paper charts were locked up at the office. Now patients expect cross-covering partners to have in-depth understanding of what’s been going on with their care. Although a bother to some of my peers, personally, I think this is a really, really good thing.

I remember being petrified taking weekend call, having to talk to my partners’ patients and knowing absolutely nothing about them. Now, I can keep my secure VPN connection and pop into the EHR when someone calls at 4:30 a.m. with questions about whether they really need to go to the Emergency Department or whether they can wait until the office opens in the morning. Those of us who use nurse triage services can allow them to have limited access to charts. Reducing the number of people in the Emergency Department who don’t actually need to be there is a significant cost savings, which all of my patients definitely care about.

Ten years ago, I was one of the first in my area to trade e-mails with patients. At that point there wasn’t a tremendous interest in it and we actually ended up stopping. (Despite the Mother of All Disclaimers, patients e-mailed inappropriately about urgent issues and the hospital felt the risk was too great).

These days, many health systems and private practices are marketing their services around technology and improved access to physicians and care teams. And if you’re still not convinced that patients care about IT, check out the video below.

Dr. Jayne

Contacts

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

CIO Unplugged 4/6/11

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

The CIO’s best friends. This is the first in a short series of posts BFFs who are critical in ensuring CIO effectiveness.

The CMIO/CIO relationship: Lennon and McCartney Minus Yoko

The magic key to the Beatles’ success was the convergence of songwriting talent and musical genius from John Lennon and Paul McCartney. While individually gifted, together they created one of the most celebrated musical teams ever. I grew up on these guys and I think I have their entire catalog memorized. My family indulges me in Beatles-themed Rock Band nights. Below is my version of Lennon and McCartney as healthcare heroes.

CIO: To be successful, I need a physician who can innovate and sing tight harmonies with me. I want someone who will tell me when I’m off the beat or flat. Depending on our audience, I might need this person to take the lead, or just play bass. For sure, I need someone I can trust who shares the vision. And I have to have a physician I love to be with. Meet Dr. V.

Dr. V:  Foundations of a great friendship are the hallmarks of a strong and effective CIO-CMIO relationship: mutual respect and trust. Ed and I work well together because we have a deep understanding of and respect for what each brings to the relationship and to the organization.

CIO: How do we accomplish this rich relationship? Spend time together in and outside of the workplace. Our families should mix virtual and physical. Common interests are bonus tracks be they World Cup Soccer, Starbucks, or shared faith. In the workplace, we do interviews together, rigorously debate strategy, lament losses, and present together. We’re to the point we finish each other’s sentences and sometimes ideas. At other times, work is plain fun, like the 45 minutes we spent posing for pictures for a magazine cover. We bantered about taking more photographs together than we had with our wives during our wedding ceremonies. Our diverse backgrounds, talents, and skill sets provide opportunity for creative mash-ups that lead to innovation.

Dr. V: Thanks to a level of transparency only attainable by best friends, we know each other’s strengths and weaknesses intimately. Like brothers, we support one another.

CIO: We fight, too, which makes us more effective in the end. Sometimes it’s over silly things. For example, during video chats, he’ll shut off his camera because his hair is not perfect (I don’t have hair issues). But mostly, our arguments are serious, i.e. the adequate deployment of resources to support the medical staff. Only after a significant debate can we push our organization into new genres. Our sound is not always welcomed, but eventually we’ll even win over the crooners. Synergy at its best.

Dr. V: As healthy friends should, we hold each other accountable for our decisions and for performing at the highest level of our abilities. This sometimes means challenging the other to live up to his full potential, even if that requires putting up with uncomfortable changes.

CIO: To have an effective relationship, we have to lower our guards, be vulnerable, and deliberately set aside time for nonsense … not something typically easy to ask of a cardiovascular surgeon and a Type-A personality. We’ve gotten to the point where we know we won’t be judged for our voices cracking on a high note or for forgetting lyrics. While I receive kudos for use of social media, much of that came from him relentlessly pushing me to try new rhythms and styles. I also know that in a moment of weakness he won’t take advantage of me. Rather, Dr. V will lift me higher. And I do the same for him. I’ve got his back.

Dr. V: A good example of a challenge: Ed encouraged me to assume a matrixed reporting relationship to another leader in the organization. While a logical path to follow, I questioned the wisdom. Ed and I have a great working relationship. Why risk it? Trusting Ed’s vision, I acceded. In retrospect, it was one of the best decisions I’ve made to advance my personal development.

CIO:  Without a doubt, my CMIO makes me stronger. Together we have made an impact larger than either of us could have accomplished on our own. My CMIO gives me confidence that our clinical staff is taken care of and protected and that their interests are heard and acted upon. He gives the clinical staff a voice, and when mixed and played back, it’s music to the ears of our patients.

Dr. V: As the song from the ‘80s goes, “That’s What Friends Are For”

Tips for Building That Foundational Relationship

• Have families over for dinner and parties (significant time together)
• Follow each other on Twitter
• Share on a personal level (requires honesty and transparency)
• Create and give presentations together
• Conduct joint interviews
• Maintain trust by following through on commitments
• We’re still planning trip to Rome together

And like brothers and good friends, we don’t always agree on everything. Case in point: just like the Beatles, only one of us has an affinity for Apple.

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 4/6/11

Top News

Practice Fusion closes $23 million in Series B financing, bringing the company’s total funding to $30 million. This round was led by Founders Fund, an initial investor in Facebook whose managing partner is PayPal founder Peter Thiel.

Five health systems (Geisinger, Group Health Cooperative, Kaiser, Intermountain, and Mayo) are holding a Wednesday morning news briefing to announce that they will share patient information among themselves under the umbrella of Care Connectivity Consortium. I see that Kaiser trademarked that name this past February.

Reader Comments

From Mariann from Brooklyn: “Re: Siemens and Epic. This sign makes me think I’ve discovered a secret partnership being formed in rural Ohio. I thought you might get a kick out of it.” Sometimes Epic Technologies press releases throw me off until I recall that Epic Systems doesn’t issue press releases, but there was a company in the Middle East once actually named Epic Systems that had Inga convinced she had uncovered something important.

From Thera-Pissed: “Re: MDs liking to fix stuff and move on. I have seen 40 years of over-trained, egomaniac, car mechanics hustling as MDs and whipping up their minions with their stethoscope. I say put ’em all on salary and disband the AMA. Let the Nurse Practitioners do all the caring, helping, relationship, boring ‘diabetes and high cholesterol’ stuff.” 

HIStalk Announcements and Requests

Welcome to Capario, sponsoring both HIStalk and HIStalk Practice at the Gold level. The Santa Ana, CA company’s revenue cycle portal provides a validation engine that gets claims paid on the first payer submission 90% of the time. It works with existing practice management and billing systems, allows quick location and resubmission provides workflow and analytics tools to improve cash flow, and offers a dashboard view of the entire revenue cycle. Capario just launched a Customer Resource center with best practices and tools for claims management and revenue cycle management. The company was the highest-rated indirect clearinghouse in KLAS’s 2010 ambulatory clearinghouse report, scored at 88.8 on a 100-point scale by its users. We ran an HIT Moment with CEO Jim Riley on HIStalk Practice a few weeks back, who offered practical information about RCM vendors, 5010, and ICD-10. Thanks to Capario for supporting HIStalk and HIStalk Practice.

Acquisitions, Funding, Business, and Stock

ED charting provider Forerun raises $2 million in Series C financing to bolster its technology development and fund commercial deployment of its FlexChart product.

Cerner Chair and CEO Neal Patterson earned $5.1 million in compensation in 2010, up from a mere $3.3 million the year before. That includes $1 million in salary, $1.3 million in cash-based incentives, and $121,777 in “other compensation.” It’s good to be Neal. And probably Mrs. Patterson.

Allscripts shares hit a 52-week high today, with MDRX closing at $22.71 and a market cap of $4.29 billion. CEO Glen Tullman holds $34 million worth.

Harris closes on its acquisition of Carefx.

iSOFT founder Gary Cohen says he may up the ante to acquire the struggling Australian healthcare software company, hinting that he’ll place his own bid against the $188 million offer of CSC. I interviewed him a year ago at iSOFT’s invitation (they must have liked how it turned out since they ran a copy directly on their site). I thought he was quite frank and cordial and I enjoyed talking to him, although he tried to minimize the effect of NHS on the company’s fortunes and that didn’t seem to be how it turned out.

3M acquires unspecified “intellectual property, trademarks and products” of Zargis Medical, which develops FDA-approved software to analyze heart sounds, one version of which works over the Internet (like a cross between an electronic stethoscope and telemedicine).

Sales

Hamlin Memorial Hospital (TX) selects Prognosis ChartAccess EHR.

Ochsner Health System (LA) announces plans to deploy Epic’s EMR across its eight hospitals and 38 health centers, having hired 60 FTEs for the implementation.

Trinity Mother Frances Hospitals and Clinics (TX) contracts with Epic. Implementation is targeted for mid-2012.

AtlantiCare (NJ) selects the Elsevier/MEDai Risk Navigator predictive analytics solutions for patient population management and clinical and financial tracking.

Central Texas Hospital picks eCareSoft’s inpatient EHR and RCM technology for its 305-bed, six-hospital health network.

Armstrong County Memorial Hospital (PA) chooses the Unity CVIS solution from DR Systems.

People

CareFusion announces the departure of COO Dwight Winstead on June 30. He has held that job CareFusion separated from Cardinal Health in September 2009.

Adventist Midwest Health names Joe Granneman to the newly created position of CIO.

athenahealth names Todd Rothenhaus, MD as its first CMIO. He was previously SVP/CIO of Steward Health Care (the former Caritas Christi).

Announcements and Implementations

Dartmouth-Hitchcock Medical Center (NH) goes live on its $80 million Epic system.

Sutter Health (CA) will invest over $50 million to help independent physicians implement Epic under its Sutter Community Connect program. Sutter will pay up to 85% of the software and implementation costs.

The Colorado RHIO HIE goes live following the first transmission of patient data by Boulder Community Hospital. Four additional organizations have also signed up to share data.

Harris County Hospital District (TX) goes live with the PatientSecure palm vein scanning system, putting out some fun facts from their 3.4 million patient database via Twitter and Facebook: (a) patients share  the same first and last names 249,213 times; (b) over 75,000 first name/last name pairs are shared by more than five patients; (c) two or more patients have the same first name, last name, and date of birth nearly 70,000 times; and (d) 231 patients named Maria Garcia have the same birth date.

Government and Politics

Doctors in Las Vegas are declining to treat chronic pain patients after a DEA task force arrests an internist for prescribing medications that led to a patient’s death in 2007. He’s been charged with murder under a Nevada law that says that covers death caused by “a controlled substance which was sold, given, traded or otherwise made available to a person.” Peers concede the internist made mistakes in prescribing too many drugs for the patient, but argue that it’s not a criminal issue, especially since the DEA based its murder charge on information provided my a lawyer who was suing the doctor for malpractice.

Innovation and Research

Apixio lends it financial support to the Center for Biomedical Informatics Research at Stanford University. Dr. Nigram Shah, an assistant professor of medicine, is investigating the impact of utilizing clinical data to enhance quality of care.

Kaiser Permanente opens the Center for Total Health in Washington, DC. They will use the center, located next door to one of their hospitals, to show off their innovations (including IT) to politicians and the public.

Non-profit healthcare IT incubator RockHealth opens for business in San Francisco with volunteer mentors that include the co-inventor of Guitar Hero and the co-founder of genomics firm 23andMe. Among its partners are Mayo Clinic, California HealthCare Foundation, Microsoft, and Qualcomm, with medical partners Mayo Clinic and Cincinnati Children’s Hospital. Selected startups get a $20K grant, access to capital, mentorship, and Silicon Valley office space. The organization was at SXSW last month.

Technology

CNN Nigeria covers the counterfeit drug trade there, showing local authorities using technology from Sproxil that puts ID numbers on scratch cards attached to the drug package that are texted by cell phone to verify the authenticity of the drug. The drug companies cover the cost of the service since they obviously have an incentive to prevent counterfeit versions of their products.

InVivoLink releases an iPad app that lets orthopedic surgeons analyze their practice patterns, view implant information, and view procedures over a secure network.

Israel-based eWaveMD will debut its new Virtual Medical Consultation platform in Europe this week. The company has previously developed EHR software, a free PQRI software product, and software used by three of four HMOs in Israel.

Other

Healthcare added 36,600 jobs in March, including 10,200 in hospitals. Total hospital employment: 4.7 million.

Texas County Memorial Hospital (TX) CEO Wes Murray complains about having to spend $88K for a GE Centricity upgrade, saying the version they bought in 2007 was not Meaningful Use ready because “GE was developing new versions of the software that they wanted everyone to purchase.” He says 3,200 hospitals are in the same position and that “GE is manipulating the system for their benefit.” The CFO piles on, expressing unhappiness that the new version requires a larger server than that of the hospital’s inpatient system. I don’t mean to be cynical, but surely GE wasn’t promising in 2007 that the then-current Centricity version would meet MU requirements that weren’t released in draft form until December 2009. Nobody likes an unplanned IT capital expense, but I would be surprised if someone at the hospital didn’t misunderstand.

The latest installment of Vince Ciotti’s HIStory.

Laurens County Hospital (SC) warns patients to follow the road signs and not their GPS if they need to get there in a hurry. Reason: city planners disagreed on the demarcation point separating Highway 76 into East and West addresses, so GPS map-makers were equally confused. The hospital says it sometimes gets calls from lost delivery drivers.

Johns Hopkins Hospital will dedicate the most expensive building in Baltimore history next week, its $1 billion clinical structure. It has two towers, one named after the deceased president of the United Arab Emirates and the other after the mother of New York Mayor Michael Bloomberg.

Sponsor Updates

• PatientKeeper names three new regional VPs to its professional services organization, including former Halifax Health (FL) CIO Lori DeLone, former Bassett Health (NY) CIO Joe Diver, and Bill Dwyer, a former manager at SMS/Siemens and Eclipsys/Allscripts.
• Navicure and the American Academy of Professional Coders form a partnership to develop educational resources to help practices practices transition to the HIPAA 5010 standard and ICD-10 code set.
• iMDsoft and its clients report improvements in care and efficiency through the use of iMDsoft’s clinical information systems and the MetaVision Event Manager. Examples: Massachusetts General Hospital saved $700,000 over 16 months through the use of drug optimization prompts during long surgeries. Lehigh Valley Hospital (PA) increased compliance with perioperative temperature management from 60% to 92%. Henry Ford Hospital (MI) increased its organ donation rate from 64% to 86%.
• Baptist Healthcare System (KY) selects T SystemEV for its five hospitals EDs.
• Hayes Management Consulting is hosting an MDaudit software user group meeting April 13 in Orlando.
• Williamson Medical Center (TN) chooses ProVation Order Sets as its electronic order set solution.
• Saint Barnabas (NJ) will replace several legacy medical imaging solutions with McKesson’s Horizon Medical Imaging PACS.
• 3M Health Information Systems releases its Healthcare Data Dictionary and Enterprise MPI as Web-based applications. The products include APIs to integrate with other applications.
• GE Healthcare and AirStrip Technologies team up to put GE’s MUSE Cardiology system onto iPhones and iPads via the Airstrip Cardiology mobile device.
• MED3OOO is ranked 41st on Pittsburgh Business Times Top 100 Privately Held Companies in Pittsburgh, based on 2010 revenue.

Contacts

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

Curbside Consult with Dr. Jayne 4/4/11

Surprise, surprise. At least someone in the federal government agrees with the rest of us that there is a conflict between the two CMS programs for e-prescribing. American Medical News reports that the Government Accountability Office has criticized CMS for “failing to align the two programs.”

Practically speaking, this means that some physicians are buying standalone e-prescribing systems (or using free ones) to avoid a Medicare penalty in the future, even though they may be in the process of implementing a certified EHR to take advantage of the Meaningful Use program. The article covers how various groups are lobbying to have this situation remedied. But in response to a reader question, I also emailed the HIStalk Medicine Cabinet for their thoughts. Thank you to all the members of the Medicine Cabinet who responded with your thoughts on this issue.

Dr. Jayne,

You offered to answer questions about the incentive programs, so here is mine. It may sound complex and obscure, but it is actually relevant to a large number of physicians, so please bear with me.

1. The e-prescribing incentive turns into a penalty in 2012. The penalty is determined by whether or not you use e-prescribing this year. You must use it and report the appropriate code in the first half of 2011 to avoid penalties in 2012-15.
2. The largest portion of the Meaningful Use incentive is earned for 2011.
3. According to CMS, you cannot get both of these payments; if you get the eRx incentive, you cannot get MU, and vice versa.

If you use the G-codes in early 2011 to avoid the penalties in later years, do you eliminate your chance of getting the (much larger) Meaningful Use incentive? Or are you better off not using the eRX codes, taking those penalties over the years, but getting the MU money? It seems that we must make a choice.

Can you offer a solution to this dilemma?

Thanks very much,

Perplexed

Respondent 1

On the question at hand, it’s true that you can’t qualify for both incentives in 2011. However, you can delay the launch of your MU odyssey until 2012 and still qualify for the full MU incentive – it will just be shifted out one year. If you want to maximize the incentives across both programs, go for the eRX incentive in 2011 and start MU in 2012. Just make sure that you don’t let your first MU adoption year slip into 2013 — that’s when you’ll start to see decreases in the total MU payment stream.

Another note: due to a bureaucratic snag, if you choose to go for MU in 2011 and give up the eRX incentive, you still have to check the box on the eRX incentive program in order to avoid the penalties in the out years. Such are the wild and wacky ways of federal government programs!

Respondent 2

Since you can’t receive eRX and MU Medicare payments in the program year same year, I would report on eRx in 2011 to avoid later penalties and then start MU reporting in 2012. Ignoring the time value of money issue, one is still eligible for the maximum MU payment by starting in 2012. This approach assumes that all of the money will be available in the out years of the program (I think it will, but if you don’t think the money will be there, it would then make more sense to skip eRx and just pursue the MU dollars).

Just in case there is some confusion, you can get both eRx and Medicaid payments in the same year. It is only Medicare where you must pick.

Respondent 3

This is a perfect example of the left hand not knowing what the right hand will do.

The real crux of all of this is that you have to being willing to see CMS-sponsored patients (Medicare / Medicaid). The issue I have with both these regulations is that most practices cannot even survive financially if they see the required amount of patients that are needed to fulfill criteria to get the incentive payments.

As a pathologist, the e-prescribing and Meaningful Use do not apply. My wife is a psychiatrist and I spend a lot of time with her IT systems. As a solo practitioner, she has simply opted out. But I think if she were participating, the Meaningful Use payments are more money depending on the volume of patients you see.

My guess is that no one will have the volume required. Now don’t get me wrong, there are valuable other reasons to do e-prescribing or an EMR. My wife is using an EMR and will be switching to e-prescribing now that the Controlled Substances Act has allowed it for electronic submission. Before, it didn’t make sense to be doing manual prescribing for controlled psychiatric meds and electronic for others. She is not using either for incentive programs as she doesn’t qualify for either.

The bottom line: physicians should not chase the money, but do what is right for their patients.

Respondent 4

Meaningful Use incentive — total possible $63,750 for EPs (or thereabouts)

eRx incentive — 2% incentive program (2% of the group practice’s total estimated Medicare Part B Physician Fee Schedule). This falls to 99% of PFS in 2012, 98.5% of PFS in 2013, and 98% of PFS in 2014.

I’d make the assumption that both are not available, since that is the supposition, and calculate which provides the greatest return (this does not take account of cost of compliance both in pure monetary terms as well as disruption / effort / resources).

The numbers will depend on how long you think this lasts or applies, but I would assume at least six years (given the MU current timeline payout).

Respondent 5

The maximum incentives for the e-prescribing program were available in the earlier years of the program, 2009 and 2010 (2% of allowed charges). For 2011, the incentive is 1%.

True, you cannot receive e-rx payment concurrently with EHR incentives. But if you decided to participate in the e-prescribing program and collect incentives and not participate in the EHR program until 2012, that’s OK. You just can’t accept incentives from both in the same year (i.e. participate and collect incentives in e-rx program and EHR program in 2011).

Where it has gotten confusing is that while you cannot "double dip," so to speak, by collecting incentives for both at the same time, you are still required by CMS to report the G codes for the e-rx program during the first six months of 2011 just to avoid the penalty for 2012. It is completely permissible to collect EHR incentives in 2011, report the G code for e-rx for the first six months of 2011 to avoid the e-rx 2012 penalty, AND collect incentives for the EHR program for participation in 2011.

The other thing is there is no registration process for the e-prescribing program, but you must register for the EHR program. If you register for the EHR program and report the G code for the e-prescribing, CMS should know that you intend to collect the EHR incentives.

CMS has a FAQ on this. It doesn’t touch 100% on this, but does to some degree.

So there you have it. Providers should make their decisions based on the facts available at this point in time. It’s not clear whether there will be any regulatory, administrative, or legislative remedy to this any time soon. For those of you who are pediatricians seeing greater than 20% Medicaid patients, or other specialties seen greater than 30%, take your Medicaid incentive checks and run! Be glad you don’t have to deal with this silly business and be kind to the rest of us who do.

E-mail Dr. Jayne.

Monday Morning Update 4/4/11

From Outside Looking In: “Re: Ann Lazerus. The president of the Siemens MS4 division is retiring. MS4 had 500 clients at its height, but Siemens is trying to woo them to the less proven and less stable Soarian. An executive was quoted as saying Siemens will bid Soarian down to 100 beds. MS4 support has been cut back, MS4 executives aren’t even bothering to contact their assigned clients because they’re competing with their Soarian counterparts. ,Once MS4 clients see the price, 90% of them don’t even bring Soarian back as a finalist. If Siemens wants Soarian opportunities from MS4 and Invision clients, they should keep current promises and not make new ones.” Unverified.

From Palomar: “Re: sponsors. Surely you have run across some that were problems. Need to know!” Only one has ever really ticked me off and that was mTuitive in 2006. They begged to have their small Gold sponsorship fee broken down into quarterly payments, then stiffed me after paying one of the four payments due. They were high maintenance to boot, making excuses about not paying, pestering me to sit through a never-ending demo, and even expressing astonishment after they broke our gentlemen’s agreement that I wasn’t giving them enough exposure on HIStalk. I’m nearly always unbiased, but in this case, I’m always happy to ignore their good news and highlight that of their competitors (like Mark Twain said, never pick a fight with a man who buys his ink by the barrel). Other than mTuitive, every company has been great to work with.

From The PACS Designer: “Re: Chrome 10. If you’re a Chrome user, Information Week has published the screen views of the mostly minor changes that improve Chrome 10’s performance. Philips and Siemens are members of the Healthcare IT Workgroup for Chrome 10, Microsoft IE9, and other browsers, along with Cisco and many other IT vendors.” I have to say I like Firefox 4.0 better than Chrome at the moment, but not by much.

From Sick of Snow: “Re: Bayonne Medical Center (NJ). The CIO has been replaced by a hired gun from Network Infrastructure Technology out of New York.” Unverified. Dimitri Cruz was the CIO and still lists the CIO job on his LinkedIn profile.

From MaxPayneUK: “Re: CSC’s purchase of iSoft. What, exactly, will they get? Perhaps a chance to purge the UK management cupboard, a ready-made client base for Lorenzo, and a chance to jettison some of the acquisitions made — and still pocket some change. Nah, can’t be that easy.”

From Seekhau: “Re: [company name omitted]. I heard they’ve signed the agreement to acquire [company name omitted]. Closing will be in the next two weeks.” I already knew about that one and mentioned it (in redacted fashion) previously (since one of the players is publicly traded). I’ll characterize it as somewhat interesting, particularly with regards to the previously signaled strategy of the acquirer.

Two-thirds of respondents said Epic wouldn’t be a good choice for DoD when I ran that poll a few months ago. This time around, 58% said VA/DoD should choose a commercial system instead of building their own open source system. New poll to your right, sure to stir up some civic competition: which city has the strongest claim to call itself the capital of healthcare IT?

Listening: The Kooks, cheery British pop. The heavy Brighton accents (like dialed-back Cockney) annoyed me a little until I realized I should commend them for not adopting fake American ones just for singing, the kind that disappear when talking (Jagger, Robert Plant, and just about everybody else from there trying to cash in with US hits). It balances out, though, as frothy US celebrities like the Michigan-raised Madonna trot out pretentious, comically phony generic Brit accents (at least she lived in London for a while).

Welcome to new HIStalk Gold Sponsor Winthrop Resources of Minnetonka, MN. The company helps organizations make technology financing decisions (operating leases, sale-leaseback, etc.) allowing them to remain independent of technology providers, to refresh technology when needed, and to preserve cash. Winthrop believes that spending cash or expensive bank financing to buy technology assets doesn’t make sense since those assets lose value quickly, require increasing expense to keep running, and need to be upgraded and changed to support organizational goals. The company just earned its HFMA Peer Review Designation and makes its healthcare experts available to help understand the forces in the healthcare and technology markets that affect healthcare strategies. Thanks to Winthrop Resources for supporting HIStalk.

I’ve always wondered why readers send me “hey, did you see this?” news items that I’ve already mentioned prominently. Now I know: they’re speed-reading and missing stuff. I thought I had put in plenty of obvious clues and humor in my “I’m quitting” April Fool’s post to accentuate the joke, but some folks skimmed right over that and e-mailed me to express their sorrow that I’m hanging up my keyboard (or e-mailed Inga to tell her she could do better than to run away with me and my made-up millions — gee, thanks). My summation: (a) I’m not leaving – despite brutal hours and occasional annoyances, I’m having the time of my life; and (b) while Inga is indeed quite the package, when it comes to Mrs. H, to quote the old commercial, I think I’ll keep her. I’m disappointed that nobody seemed to notice that the name of the band Inga and I are starting is an an anagram for “April Fools” (the former chocolate magazine reporter turned healthcare IT expert is true, however). I’ll think positively in assuming that the well-wishing readers were just going along with the gag. Fight the urge to skim HIStalk – it’s not like a newspaper that makes more important articles huge, so you’re guaranteed to miss something important if you just scan down the screen.

Next up in my “time capsule” series of editorials you’ve never seen since they ran in a newsletter you didn’t get: my January 2006 take on the then-new CCHIT. I couldn’t wait to make fun of their name, which I now note happened in the first sentence.

The VA issues an RFP to launch the project to develop an open source replacement for VistA. It seeks a Custodial Agent to create and oversee a structure that will certify the open source code base, certify proprietary software that can work with it (that could be huge), and allow individual users to get their enhancements certified and distributed. The criteria weighting for the award are, in order, technical, price, past performance, and veteran’s involvement. Sounds great in theory, but you can pretty much bet the same dozen or so fat contractors will be elbowing each other at the trough. It looks like the Wisconsin politicians came to the party too late to push Epic as an alternative to custom development.

Saturday’s New York Times has a great article called The Rise of Desktop Medicine, which says it makes sense for doctors to spend time in front of computers as well as patients. It observes that “bedside medicine” identifies and classifies diseases by symptoms and clinical findings, while “desktop medicine” identifies conditions that can be addressed to improve a patient’s health without necessarily calling them diseases. Example: treating high cholesterol even though the patient has no complaints or symptoms. The role of the computer is to look for opportunities for improvement and tap into outcomes information to determine which treatments will work. It cautions, however, that drug companies and others have a vested interest in convincing doctors to treat numbers that really aren’t diseases themselves, so the doctor’s job is to figure out what’s best for the patient. A great quote: “If doctors change simply into some kind of hybrid of a financial analyst risk broker, we will have lost an essential part of what doctors should be doing.”

Epic’s April Fool home page wasn’t quite as good as the classic “our first press release” one from last year, but it was still pretty funny (click to enlarge).

GE gets some not-so-good press for managing to pay zero federal taxes on its $14.2 billion in profit. The New York Times says the company has steadily trimmed its tax percentage to a far lower rate than most companies, using a combination of lobbying, “innovative accounting,” and moving profits offshore to avoid US taxation. “GE’s giant tax department, led by a bow-tied former Treasury official named John Samuels, is often referred to as the world’s best tax law firm. Indeed, the company’s slogan ‘Imagination at Work’ fits this department well. The team includes former officials not just from the Treasury, but also from the IRS and virtually all the tax-writing committees in Congress.”

Elmhurst Memorial Healthcare (IL) chooses Merge Cardio and Merge Hemo from Merge Healthcare for its new hospital.

AirStrip Technologies gets a spot in the first iPad 2 commercial.

It’s getting ugly between WellStar and its fired CEO, as the Georgia health system reacts to its former CEO’s claim that he was unjustly terminated, producing what it says is evidence that he was fooling around with the health system’s EVP and general counsel and refused to stop even after being warned. Some of the evidence involved supposedly coded messages he sent to the EVP, such as “GNSD” (good night, sweet dreams) and referring to her as his “neutron girl” (that doesn’t sound much like a smoking gun to me, but I’m not a judge). The CEO finally had to fire the woman, who then claimed he sexually harassed her and that WellStar sexually discriminated against her. If you sell luxury cars or gated community houses in Atlanta, you might want to stick your flyer under the wiper blades of cars parked outside the law firms involved.

Speaking of Atlanta, Grady Hospital CEO Michael Young leaves to become CEO of PinnacleHealth in Pennsylvania. That impinged on my consciousness only because he e-mailed me a few weeks ago to clarify statements he made about cutting back contractors on Grady’s Epic project, which I had quoted.

Big financial news from Pink Sheets traded PHR vendor MedeFile: the company’s annual revenue was up over 800% (to $134K) and operating expenses were slashed, leaving the company with a loss of only $2.5 million for the year (I was being sarcastic, in case that isn’t clear). It actually looks pretty cool, but nobody’s all that interested in PHRs, even free ones like theirs isn’t.

I seem to be citing The New York Times endlessly today, but here’s another good article on what new doctors want. The answer: predicable hours working salaried jobs for big corporations, specialties like ED that cater to their short attention spans (anything but primary care, quoting one doc in saying, “I like to fix stuff and move on”), and letting hospitalists handle their inpatients instead of being called out.

Don Berwick’s NEJM article about the proposed Accountable Care Organization rules says IT has a central role “in enabling the organization to manage population health and receive feedback at the point of care.”

Mediware will acquires the assets of Atlanta-based alternate care software vendor CareCentric, which include applications for home medical equipment, infusion, and home health. I love this article about CareCentric CEO Darrell Young, who had a long history working for HBO & Company (including a stint as president and CEO) up until McKesson bought it. When he went to CareCentric many years ago, it was such a “train wreck” (his words) that he used the company’s exhibit space at two major trade shows to simply hang an “Under Construction” sign and put out tables and chairs for attendees to eat their lunches. When asked if he thought that would make the company look bad, he answered, “How, exactly, could we look any worse?” When asked about how he would improve the company’s legendary poor customer support, he said, “Well, it has gotten much easier now that we have 700 customers to support instead of 2,500.” I bet he would be a fun interview.

Culbert Healthcare Solutions is profiled in the Boston Business Journal. I don’t have a subscription and therefore can’t read it all, but the part I can see says 2010 revenues were up 77% and headcount by the end of this year will have tripled in two years.

Nuance shares rise after an analyst says the company will be Apple’s voice recognition partner for the next-generation iPhone.

E-mail Mr. H.

Time Capsule: CCHIT Should Provide More Information to Purchasers

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 January 2006.

CCHIT Should Provide More Information to Purchasers
By Mr. HIStalk

I admit that I paid little attention when, more than a year ago, the Certification Commission for Healthcare Information Technology (CCHIT) was born, sprung from the loins of HIMSS, AHIMA, and the group formerly known as NAHIT (now oddly and sinisterly calling itself just “ Alliance” for reasons surely less justifiable than renaming CCHIT itself, whose phonetic sounding-out always gets yuks from the watercooler crowd).

CCHIT came to life in the early, heady days of David Brailer’s rise to national prominence and, with him, an agenda that included certifying EHR products to reduce buyer risk and therefore increase adoption, particularly by that toughest nut to crack — physician offices.

I wasn’t expecting much — maybe a harmless, stuffy new bureaucracy whose core competency was hiring well-connected job seekers. Darned if CCHIT’s work groups didn’t go off and actually get some real work done that will have a significant impact on the industry.

You might mistake its 300-point evaluation tool and test scripts for a well-prepared RFP that addresses three categories: functionality, interoperability, and security and reliability. CCHIT is piloting the certification process now and will be in full certification mode by spring.

Maybe you didn’t know this: CCHIT will certify inpatient EMRs next, cranking up later this year. We aren’t talking about testing just ambulatory EMRs and interoperability. Hospital applications like those from Cerner, Epic, Eclipsys, McKesson, MEDITECH, and other full-blown inpatient EMR vendors are next.

Some vendors are complaining about the cost of certification and interference with their business. I understand their concerns, but I’ll stand by certification. Y2K Darwinism washed out weak physician system vendors, often spare bedroom programmer operations with minimal financial strength or clinical knowledge. I don’t hear much about them being fondly missed today. Vendors who don’t like CCHIT’s work would definitely be unhappy with full-blown FDA oversight similar to that of the drug and medical device industries.

CCHIT could be our industry’s Consumer Reports, just as KLAS and other companies provide our Gallup Poll. The former is an objective measure of how well products work, while the latter is a subjective assessment from customers. Put them together and you’re well on your way to a good product evaluation.

Here’s what I’d like to see CCHIT do, beyond what it has promised:

• Release the individual scoring sheets of the products it evaluates. CCHIT plans to only report whether a product has been certified. It stands to reason that some products will do better on the tests than others. Wouldn’t you like to see how well each product did? Why make new EMR adopters re-invent the wheel?
• Add a category for patient safety. We’ve seen plenty of examples in which new clinical systems harmed patients, either through product deficiencies or poor implementations. We need measurable product standards (and arguably measurable implementation standards, but that’s probably outside of CCHIT’s domain).
• Add criteria for usability. Part of the maturity of any technology is to make it intuitively and correctly usable by a wide variety of users. We expect doctors and nurses to use complex software that has confusing screens, a 500-page manual, and a two-day mandatory training session without making a mistake. Standards exist, but are rarely used by vendors or customers.

We can argue about specific criteria, but I’m looking forward to CCHIT’s results. The discussions they generate should be interesting.

CSC to acquire iSOFT for $188 Million

Computer Sciences Corp. announced this morning that it will acquire Australia-based iSOFT Group Ltd. for $188 million, a 24% premium to its last traded share price on the Australian Stock Exchange. 

Michael Laphen, chairman, president, and CEO of CSC, was quoted as saying the acquisition is a critical step in the expansion of CSC’s global healthcare IT business. “The combination of these companies will further establish CSC as an innovative leader in global healthcare IT,” he was quoted as saying in the announcement.

The 3,300 employee iSOFT, reeling after a series of delays in its Lorenzo platform in the UK’s NPfIT project and the resulting decimation of its share price, is CSC’s subcontractor in NPfIT. The purchase of iSOFT by its largest customer was widely anticipated.

The announcement says that iSOFT’s products are used by 8,000 hospitals and clinics in 40 countries.

The sale is subject to approval by shareholders and regulators in Australia and the UK.

GE Healthcare Names De Witte CEO of Healthcare IT

GE Healthcare announced this morning that Jan De Witte will lead the company’s healthcare IT business as its president and CEO. He replaces Vishal Wanchoo, who has been reassigned to GE India as vice president of growth initiatives.

De Witte was named president and CEO of GE Healthcare’s Performance Solutions division when it was created this past June. He will continue in that role as the company combines its healthcare IT advisory and technology services under a single reporting structure.

John Dineen, president and CEO of GE Healthcare said, “Having a single leader like Jan De Witte lead both businesses sends a visible signal to our customers that GE Healthcare is dedicated to growing its IT and solutions offerings, providing them with a unique partner that can deliver the strategic advice they need with outstanding technology. Jan’s extensive experience with technology across global markets makes him the right fit to lead and develop the growth of these two businesses.”

The Performance Solutions business is GE Healthcare’s 150-employee services arm, which offers process improvement and technology optimization consulting based on Lean and Six Sigma methodologies.

The 46-year-old De Witte was named an officer of GE in 2007. He has a masters degree in management and engineering and a Harvard MBA in marketing and operations management.

News 4/1/11

Top News

HHS posted proposed ACO regulations today. We’re working on an interview that will address the IT implications, but in the mean time, you can review the proposed rule and the HHS fact sheet.

Reader Comments

From Court Jester: “Re: Nebraska Medical Center. I hear they signed with Epic about a month ago and are unplugging GE. The primary reason Epic was selected over Cerner was its interface capabilities. They’ll be kicking things off in May.” UNMC published an announcement on its Web site in November confirming Epic as the vendor of choice.

From Steel Curtain: “Re: MED3OOO. Rich Goldberg is leaving his business development job at TeleTracking to take over as president of MED3OOO division CPU Medical Management Systems.” Unverified, although he’s no longer listed on TeleTracking’s site. The move would not be a huge surprise since MED3OOO has filled its executive team with a number of former Misys VPs over the last couple of years.

From MrSoul: “Re: IE6. This is a great tool as we watch IE6 sloooooowly fade into HIStory.”

From Pescetarian: “Re: Seattle Children’s. Dumping Microsoft Amalga for Tableau Software. The press releases three years apart are eerily similar. The hospital was a lighthouse reference for Microsoft in their own back yard, but implementation was terrible, maintenance was almost impossible, and clinicians hated it.” CIO Drex DeFord didn’t confirm that, but was diplomatic in telling me that they’re still working on Amalga and its small base of users, but are always looking for business intelligence opportunities that will put information into the hands of end users.

From Cray Zee: “Re: Trinity Health CMIO. Mike Kramer, MD has left the building.” Unverified, but the provided memo looks authentic. They wish him well, but immediately pledge undying love to their Cerner-powered Genesis project (seems strange that they would need to defend it). It’s a really ambitious project, not quite Kaiser-sized, but in the neighborhood.

From Art Glasgow: “Re: Duke. Mr. H, I thought I’d confirm your note regarding me joining Duke Medicine. I’m scheduled to start around May 1st and am excited and humbled at the prospect of joining such an esteemed institution.” Art is leaving his Ingenix CTO job to become CIO of Duke Medicine, which we ran as a reader rumor earlier this week. He replaces Asif Ahmad, who left Duke last June to take an EVP job with US Oncology. Thanks for the confirmation.

HIStalk Announcements and Requests

This week on HIStalk Practice: Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative, debuts Pretzel Logic, his new column on technology decision-making in medical practices. Epocrates introduces a mobile and Web-based EHR. HIMSS and MGMA offer a privacy and security toolkit for small provider organizations. A mainstream journalist attempts to explain the EMR industry — and does a pathetically poor job. The success of the ACO-like Atrius Health. Come visit and stay for awhile.

Listening: new from Whitesnake (yes, you read that right). I had mental pictures of hair-transplanted, shirtless-and-Spandex guys in their 60s leaning into a single microphone for yet another round of their coy, unskilled Reagan-era poser ballads, but it actually rocks out quite nicely with excellent production. David Coverdale sounds better now than then (just do yourself a favor and don’t Google his ex-wife and car-gyrating video star Tawny Kitaen for a current picture). Makes me want to load up the Jag with beer and tramp-stamped bleach blondes and head off to Rocklahoma.

Welcome to new HIStalk Gold Sponsor UltraLinq Healthcare Solutions of New York, NY. The company offers a FDA-approved, Web-based ultrasound and image management system that lets physicians review exams from anywhere, including on its iPhone app. The physician does their interpretation using auto-populating review worksheets, the reports are distributed through a variety of ways, everything is stored and universally accessed from a secure Web site, and they handle all the infrastructure. The system is low cost, secure, flexible, and portable. Thanks to UltraLinq for supporting HIStalk.

On the HIStalk Job Board: Social Media Manager, Clinical Business Analyst, Regional Director Centergy Sales. On Healthcare IT Jobs: McKesson PM – CPOE, Application Programmer, Cerner Clinical Analyst, Senior Clinical Analyst IT Implementation. I know the job market is good because my work phone rings off the hook from recruiters.

Make me happy: (a) drop your e-mail in the Subcribe to Updates box to your right so I can tickle your e-mail ivories with HIT love; (b) send me your rumors, news, incriminating photos, and secret documents by clicking the garishly green Rumor Report button; (c) acknowledge the great society that lets you read HIStalk free because of the largesse of sponsors listed to your left, who are more likely to continue that support if you click around a little and maybe buy some stuff from them; (d) find Inga, Dr. Jayne, and me on LinkedIn and Facebook and click the correct buttons to boost our fragile egos; and (e) give yourself one of those pistol-pointing gestures in the mirror for reading and contributing here in whatever way makes you (and me) happy.

Acquisitions, Funding, Business, and Stock

VisualMed Clinical Solutions issues a press release saying it will launch a “new initiative” in the marketing of its EHR product in the US, following a two-year interruption. The company says that the 2008 financial crisis left many institutions without resources to implement systems and “all decision making was entirely suspended.” Its chairman believes that the time is now right for a re-launch, given that the recovery is underway and government incentives are in place. I found the message curious, to say the least, so I did a bit of digging and found a June 2010 press release that bragged of $2.6 million in new orders. At that time, the company credited ARRA for the the boost in sales and market interest. The chairman was quoted as saying, “thanks to the new reforms, our time has come.” Finally, I went back and found a July 2008 press release saying the company had completed restructuring and planned to focus on the “more promising” markets of oncology, Internet, and private clinics. Nothing like having a consistent vision and marketing message.

Sales

Winthrop-University Hospital (NY) signs a seven-year order for cloud-based RIS/PACS and archiving services from Carestream Health.

People

Don Claunch, CIO of Wyoming Medical Center (WY), will take over as interim CFO.

Announcements and Implementations

Marfraq Hospital in Abu Dhabi launches its Cerner EMR following 12,000 hours of training over the last month.

North Kansas City Hospital migrates to Corepoint’s Integration Engine.

Strong Memorial Hospital (NY) at the University of Rochester Medical Center launches Epic EHR. URMC’s Highland Hospital will go live in June. Outpatient services are scheduled for the summer of 2012.

The two big Orlando hospital systems, Florida Hospital and Orlando Health, start a one-year data sharing project via the Central Florida RHIO.

Virginia Commonwealth University Medical Center goes live on the Central Logic ForeFront patient flow system.

Government and Politics

Victoria’s troubled HealthSMART project will need $200 million to finish the job, well over the original $360 million estimate.

Technology

If the rumors prove true, Google will be opting out of the health business. However, Cerner is looking forward to working with Google on its “fiber community” pilot. Google selected Kansas City this week as its pilot for a one-gigabyte-per-second broadband network. Other enthusiastic KC folks include representatives from the University of Kansas Hospital and KU Medical Center, who believe the faster network will help with telemedicine and transmission of medical records.

An editorial by Murray Feingold, MD mentions the mixed reviews of “the menage a trois in the examining room” – doctor, patient, and computer, but says it’s doctors using them incorrectly that make patients feel ignored. He closes with wise advice: “The use of a computer will be successful only if the doctor remembers that the patient is the most important person in the examining room, and not an inanimate computer.”

Other

ICSA Labs awards ONC-ATCB certification to its first three products.

Passport Health Communications becomes the first RCMS solutions company to achieves full accreditation with the HIEAP EHNAC.

A California health clinic that caters to the porn industry announces the possibility of a criminal breach into its medical record database. Personal information on as many as 12,000 current and former adult film performers may have been exposed. The uncovered details include HIV status, STD test results, and the actors’ “real” names. Mr. H, Dr. Jayne, and I are particularly empathetic about the last item.

Mark Rogers MD, a member of the Public Health Trust that oversees the rapidly flat-lining Jackson Health System of Miami, resigns with a warning that the Trust is incapable of saving it from failure. His final recommendations include bringing in an outside CIO.

It’s April Fool’s Day Friday, so I’m wringing my hands in anticipation to see if Epic will come up with another world class spoof on their home page. But to amuse you in the mean time, here’s a phony press release from Concerro. Call me peurile, but I love that stuff when it’s done well.

Sponsor Updates

• Allscripts ED, McKesson’s Horizon Lab, and Design Clinicals’ MedsTracker all earn ONC-ATCB certification. Allscripts ED product qualifies for complete EHR certification, while Horizon Lab and MedsTracker achieve modular certification.
• Congrats to ESD, which celebrates its 21st anniversary on April 1.
• Thomas J. Niehaus joins Encore Health Resources as EVP for client services. He’s the former president of CTG Healthcare Solutions and spent nine years with IBAX. We reported this a month before the announcement.
• Medical Center of Plano (TX) selects ProVation MD Software for gastroenterology procedure documentation and coding.
• Sayre Memorial Hospital (OK) will convert its ED from the T-System’s T-Sheets paper documentation system to T-System’s EHR.
• Blue Cross and Blue Shield Association names Health Language its preferred vendor to help BCBS companies transition from ICD-9 to ICD-10.
• Stephen Newman MD, COO of Tenet, leads a MED3OOO one-hour webinar on physician affiliation.
• Bridgehead Software is conducting its annual Data Management Survey, which looks at data and storage management trends year over year. Random respondents will be chosen to win an iPad, GPS, or Amazon gift cards.
• The Network Health health plan chooses MedVentive as its technology partner for Web-based performance analytics that will enhance its care management, outcomes, and finances.

EPtalk by Dr. Jayne

The American Medical Association announces the 2011 AMA APP Challenge, calling for medical students, residents, and physicians to submit their ideas for “innovative medical apps” to impact clinicians’ daily lives. Ideas will be scored on usefulness; appropriate fit with the AMA and its mission; innovation; suitability for app format; and being representative of the submitter’s expertise. Sorry to all the great coders out there, but you have to be a physician, resident, or student to submit (so go ahead, convince your CMIO or CMO to let you be his/her ghost writer!)

Personally, I’d like to see a knock-off of Urbanspoon , the app where you shake your iPhone to receive restaurant suggestions. You could input symptoms and shake it to view different possible diagnoses. Much more fun that the clinical decision support apps that are out there.

What’s your favorite medical app? Send me suggestions and I’ll check them out and report on the coolest.

Abbott Laboratories receives FDA approval for a blood testing system that transmits results wirelessly, allowing caregivers to remain at the bedside. The device does basic blood chemistry testing and blood counts as well as blood gases. I’m disappointed that future generations of medical students will be denied the opportunity to take the blood gas sample from the patient, place the syringe in a Styrofoam coffee cup filled with crushed ice, and run through the halls of the hospital in the middle of the night to the lab and back.

Wednesday was National Doctor’s Day. I’m sad to say I didn’t get invited to any celebratory lunches in the doctor’s lounge this year (cutbacks, I’m sure). Thanks to Inga for recognizing it on HIStalk Practice! Doctor’s Day has been celebrated on March 30th since 1933, when Eudora Brown Almond, wife of Dr. Cha Almond, commemorated the anniversary of the first use of anesthesia in 1842. She and the ladies of the Southern Medical Association would place flowers on physician graves. The day was officially recognized in 1958 by the US House of Representatives and by President George H.W. Bush in the 1990s. Even though you’ll be a day late, show some love to the docs you love (and be thankful for that anesthesia!)

Reading one of my specialty journals, I was surprised to notice that there were more ads for EHRs and technology products than for drugs. I don’t recall the balance being tipped before. There were also two paid advertisements from CMS – one for Meaningful Use, another for the HIPAA 5010 EDI standards. I wonder how many physicians are familiar with 5010 compared to Meaningful Use? The 5010 is mandatory January 1, 2012. If your billing system doesn’t support it, if you don’t have a plan to test it, or you don’t know what it is, time’s a-wasting.

I’m embedded in a practice this week, which is always interesting. It’s extremely challenging to try to train physicians, let alone having them retain the information. I wish there was a better way to help my colleagues understand the following:

• You actually need to show up for training.
• Checking e-mail or playing on your iPhone does not constitute “participation.”
• Your trainers are professionals who put a lot of blood, sweat, and tears into their efforts. Show them some respect.
• You don’t need an MD behind your name to be able to train EHR. Playing the “no one can understand how complex my specialty is” card just makes you sound whiny.
• If you don’t understand, or need more practice, speak up. Ignorance is NOT bliss where patient care is concerned.
• The EHR is not going away and complaining about it is not constructive. Your trainers didn’t select it, but they do have a vested interest at helping you use it the most efficient way possible.
• Yes, we did bring all this food, primarily to get you to show up. Apparently many physicians still operate under Residency Rules: see a donut, eat a donut. You know who you are.

A Special HIStalk Update from Mr. H – 4/1/11

It’s harder than it looks to continually create HIStalk. I’ve worked on it several hours each day, seven days a week since 2003. It has been my hobby, my passion, and my unintended business for all these years. It defines me more than anything I’ve done, maybe because the time and energy it requires precludes me from doing anything else. For that reason, I always thought I’d just keep doing it forever.

I was wrong. It’s time for me to move on.

I’m weary of the grind. I write from the time I get home until bedtime, rush home to conduct interviews after work, and spend the whole weekend doing everything from browser debugging to invoicing. I’m tired of the never-ending criticism about the site layout, the number of sponsors I have, and my perceived bias for or against certain vendors. Unlike every other blogger in history, I’m not allowed to help an out-of-work friend or make a music recommendation because someone is sure to launch off on me for daring use a couple of dozen words about something that doesn’t fit their personal interest profile.

I started HIStalk as a place I could muse and amuse a little. It’s become so serious that I’m not having fun any more.

Timing is everything. I can’t legally divulge details, but a certain member organization that runs a big conference reached out, wondering if I’d be interested in being acquired. I always say no, but they caught me in a weak moment. Their offer was, to say the least, significant (I can’t divulge the number, but it has six zeroes and the first number is bigger than a one). I think you would do the same if presented the opportunity to be set for life and to be free to do whatever the heck you want instead of what someone else demands.

You’ll see the changes coming here soon. I’m here for the transition until that "wish him well in future endeavors" announcement is made. In the mean time, I’m planning the next chapter in my life and I can’t wait.

Inga really is a woman, as I’ve had to defend to skeptics more than once. In fact, she’s a wonderful woman. Our relationship has grown from terse, pure-business e-mail exchanges to a lot more, resulting in full-on passion at HIMSS. We never meant for it to happen, but we were destined for each other, it seems. I can think of nothing but having her as my soul mate. Mrs. H and I will be parting ways so that Inga and I can head off to the beaches of Mexico to start a new life together, where we’ll be forming the band we’ve always dreamed about, the Frail Loops (think Pink Martini meets Insane Clown Posse). We’re still trying to loosen up Dr. Jayne to get her to join us down there.

We’ll keep reading HIStalk, of course. My replacement is an esteemed industry reporter who won an award for hard-hitting industry analysis at her last job at a chocolate magazine. The site will finally receive that big makeover everybody wants, fancying it up and loading it down with industry-sponsored podcasts and white papers so it looks more credible. There will be no more objectionable material for readers to complain about, like pithy dismissive asides, scandalous reader comments, or contrarian conclusions. The new HIStalk will offend no one.

We may do a little bit of consulting if the acquisition money runs low. Inga is working on a design deal with Jimmy Choo and considering starting a tequila brand like Sammy Hagar did, calling hers Ingatini. We may run a for-profit HIStalkapalooza in our trademarked counterculture way — you’ll have to bring us cash, liquor, food, and iPads to be allowed in. We’ve kept quiet about a planned member organization we may start with the working name of Have Electronic Records, but Sacrificed Solvency (HERSS).

But it won’t be anything like the work we’ve been doing all these years. Like Hollywood types, we need a break from being wealthy, adored celebrities (of the anonymous kind, in our case). Inga’s going to be a great mom to those babies from Cambodia we’re adopting next week. We’re naming them Neal and Judy.

It’s been a great eight years. The record shows I took the blows and did it my way. Thanks for the memories.

Contacts

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

HIStalk Interviews Bruce Cerullo, CEO, Vitalize Consulting Solutions

Bruce Cerullo is CEO of Vitalize Consulting Solutions of Kennett Square, PA.

Tell me about yourself and about Vitalize.

Vitalize has been around since 2002, when it was founded by my current partners. The founders are Mary Pat Fralick, who’s been out there in the industry with Elumen Solution and CTG, and Danny Arnold, who’s also of the industry.

I got involved back in very late 2007 where my little start-up company called Lucida — which is where I originally connected with you — was coming head to head with Vitalize everywhere we went. You know, if you can’t beat them, buy them, so we raised a bunch of money from private equity and we rolled Lucida into Vitalize and recapitalized the company. We have been on a wonderful growth trajectory since then.

Vitalize has nine different business units — we call them practices — organized around either software vendors or market segments. Like ambulatory, for example, or product management.

We recently acquired a Minnesota- based strategic consulting firm called Validus. Validus has a very, very strong reputation in some of the important strategic services capabilities that were a little upstream from the traditional Vitalize offerings. They actually do project leadership of Epic and other major software vendors and have done it well at places like Stanford Medical and Grady and Tampa General and the like. What we were looking to do was to continue to improve our service offerings to our hospital clients, so, it was a natural fit.

The Validus partners and founders are all now part of Vitalize and investors in Vitalize. I found that if your key leadership have a chance to invest real money, you get great alignment of objectives and everybody pulls to build an even better company together.

You describe the company as people-centric and team-centric. How’s that different than how businesses usually work?

First of all, we’re organized around individual practices. Instead of having 500 people who all report to this fellow named Cerullo, we have built strong business units within the Vitalize umbrella. You hang around with people like you. If you’re an Epic consultant, you have access to a hundred and something Epic consultants. You’ve got an Epic leadership structure who you identify with and work with and touch on a daily, weekly, monthly basis.

One of the fine arts to your business or mine, no matter how big you get, is to continue to try to feel small. By organizing around the unique people, skill sets, and market dynamics of the different sectors or sub-sectors of healthcare IT, that’s one of ways we do it — organizing around people like you. 

At the level of all of our employees, we do welcome baskets when people join us. We send out surprise Amex gift cards a couple of times a year and allow people to take their loved ones out to dinner. Coming up in early April, we’ll have 500-plus people all flying in to Austin, Texas for four days of fun and learning. It will cost us close to a million dollars to bring everybody in, but to us, it’s the glue. It’s the one time during the year where everybody gets to look everyone else in the eye and connect and bond and talk and laugh and have fun. We call it The Extravaganza, but it’s really a part training, part learning, part fun gathering of all our folks. We do that every year. It’s part of the people-centric aspect. It’s expensive, but it’s absolutely worth it.

Has the economy changed the quantity and quality of the resumes you’re getting?

The economy has provided the stimulus to hospitals to further invest in their information technology systems and people. It’s caused a lot of client demand for the kinds of consulting services firms like Vitalize offer. With that has created career portability and career growth opportunities for healthcare IT professionals.

Whether you work in a hospital system or Vitalize, human beings are motivated to build their careers and their resumes and to experience economic gain. The rebound in the economy certainly, and the stimulus dollars dedicated to healthcare IT, have created a lot of new job opportunities and growth for consultants. That’s the good news.

The challenge embedded in your question is making sure that we as a company can recruit and retain way more than our fair share of those seasoned consultants. I got statistics in the other day that said more than 70% of our consultants are former clinicians. They have that added value, if you will, when they parachute into the hospital having walked in the shoes of the people who are actually going to be the user community some day.

The average age is north of 40. The average level of work experience is more than 15 years in the clinical space where we have them aligned in our organization. We go after the senior folks.  We’ve been given our growth and blessed with having more than our fair share of them come to us and want to stay with us.

What are the big areas that customers are looking for help in?

Epic’s winning a ton of business. As a result, we’re getting a lot of new EMR install opportunities. Every vendor is active, whether they’re selling a lot of new stuff or not. There’s a lot of work around Meaningful Use and there is increasing amounts of work around 5010 and ICD-10. That’s happening across vendors.

Somewhere north of 60% of our current engagements are around an installation of a new EMR or a new EMR module. Twenty percent is optimization work, and another 20% is strategy and product management.

Are hospitals really doing anything with strategy or are they just executing the plan that the government pushed on them?

Well, here’s the good news. Hospitals that had a thoughtful strategic plan were already well down the path to Meaningful Use, so that’s good. Those who didn’t, they had one handed to them by the government.

However, what we’re seeing smart CIO of today focused on is back to their strategic plan of implementing good systems to manage quality and capture data and to get reimbursed by somebody. Very few are just trying to chase Meaningful Use. They are returning to a plan that is forward-looking beyond Meaningful Use. While we are doing a lot of Meaningful Use-related work now, hospitals are focused on getting the tools in place that will sustain them, regardless of  the next hurdle you have to clear for the government.

If you’re getting 60% new EMR installations now, then hopefully you’ll transition that to the optimization down the road, so your level of business won’t just be hump that goes away.

My personal opinion is that we’re in a hump. This hump is going to last well into 2013 — the initial work around installing next-generation software. To follow will be an acceleration in optimization work, for two reasons. Those who did it well in the install want to make it work even better going forward. Sadly, I think there will be a bunch of work around “optimization,” but it’s really fixing systems that were slammed in to try to get the Meaningful Use dollars and to avoid the penalties. I see a second wave hitting in 2013 to 2015, if you’re asking me to venture a guess.

Your acquisitions raised the headcount to over 450. Is that the next level of opportunity and challenge when you get that many folks?

Having scaled a very large company — Cross Country, a medical staffing company — there are inflection points, particularly in the services business. Typically north of 100 is an inflection point, north of 250, and north of 500.

The trick is to invest in the systems to support these fine people. You know, the billable folks. Having done this before — and this isn’t an ego statement — it’s just that we at Vitalize have invested in and we score in the 95, 96, 97% on all those key statistics in our yearly employee satisfaction survey that someone like me cares about. 

Consultant jobs are not easy. They’re on a plane on a Monday. They’re away from their family until Thursday night, and they get home exhausted and if their flights go off on time. A lot of the infrastructure when you get to be as big as we now are is geared to making the consultant’s life as easy on the road as we possibly can. A lot of money goes into that, with good results.

You did quite a few acquisitions in Cross Country. Do you see that continuing to happen at Vitalize?

Not nearly on the magnitude. For one thing the scale in the healthcare IT consulting sector is probably a tenth what the scale is in medical staffing. You’ve got 3 million nurses, you got 750,000 doctors, you got almost a million therapists. Those numbers are a lot larger, so there’s not the same scale opportunity.

Quite frankly, this is a much more highly specialized business than the world I originally came from. It’s nichey for good reasons. If you look at the landscape of companies like us in the early 2000s, Healthlink had been acquired or was being acquired by IBM. FCG and ACS … you know, the whole alphabet soup is huge now. They’re all half a billion to a billion-plus organizations. 

Then there’s a huge breakpoint between that level and MaxIT and us, because we’re the two roughly same-sized organizations in that middle market space. Everyone else is five, ten, 15 million in revenue. There’s a couple of up-and-comers who may be a little north of that, so there’s just not a ton of quality targets. 

Two, the really good firms and really happy doing their own thing and have created quite a lot of value on their own. They’re not easily acquired.

And, three — and this is probably the most important point — my belief a sign of a healthy organization is one that grows organically. If you’re growing just by acquisition, chances are there’s a reason for it, whereas our growth has been more than 80% organic and with 20% acquisitions of our three health partners back in March of ’09 and then Validus in January of ‘11. We’re not in a hurry, and finding quality partners is not an easy thing.

You mentioned that it’s a nichy-type business, but it’s a niche that everybody wants to play in. It looks like the pendulum has swung back where the big companies in slow-growth industries want to buy into consulting again. What’s your assessment of what’s going on there?

I think you hit that exactly on the head. I can’t speak for my competitors who sit in my chair, but we get two calls a week — more than that — from private equity firms who are dying to invest in our space, and for what you would broadly characterize as a strategic player who may be very strong in IT services, but not strong in healthcare at all. Or, maybe strong in “staffing,” but have no presence in IT.

There’s a lot of interest in our space. I predict there will be an acceleration in M&A activity. We’re stimulating it in our own and are looking to bring on additional capabilities or other big players trying to work their way in.

Two calls a week is interesting. Somebody builds a little consulting company, turns it into a big enough one to get some attention, sells it out, and then goes out and does it again.

Go back and do it again, right. In fact, you know the Encore people, Ivo and Dana. They’re a perfect example of what you just said. They had created something of great value, got absorbed by somebody else, respected their non-competes, and are back at it again. This is a world where you can actually do that.

Especially when the acquiring company messes up what you did.

Yes. All those people are free agents. They make their way back or they join a firm like ours, because truthfully, a lot of our key members are former Healthlinkers along the way.

You’re a venture partner with SV Life Sciences and you do your own investing. How would you describe the healthcare IT market from an investment standpoint, and how is it for start-ups in other companies trying to get a foot in?

I think it’s hard for the true startups. Right now, the mindshare of a hospital CIO is all around the big mandates. Even if you have game-changing software or a game-changing technology for healthcare, it’s not going to get any attention right now because there’s so many other big things to do.

As an investor, it’s a mixed blessing. On one hand, you’ve got a lot of entrepreneurs with really great ideas that aren’t able to get funding, so their valuation expectations drop and you can make investments at more reasonable valuations. That’s the good news. The bad news is it’s hard to scale right now because the attention and the energy and the dollars are going elsewhere.

The government keeps touting innovation, but its mandates to implement existing products doesn’t leave much room at the table for new players. Plus nobody will have money left to buy their product.

In the near term, but a smarter investor is looking out over a four- to seven-year horizon. Once the big things are dealt with, hospitals are still going to have to say, “So now what? We have these systems, we’re collecting this data, we have all these investments in pump and infusion technology, and we got to connect it all, and we’re going to have to farm the data and use it.” 

I think enabling technologies around collecting and analysis — true informatics –  will be the next wave. But the dollars and the energy on that will follow. This is what I think will be a double wave in the more macro restructuring of the healthcare IT universe.

For somebody who wanted to start a company like that, would this be a good time to get it going?

I think so. As an entrepreneur, you never want to get investors involved too early. They’ll take too much of your company. That’s just the way it works. On the other hand, you can’t do all you need to do without the mighty cash to do it, so it is a tradeoff.

My advice to entrepreneurs is bootstrap as long as you humanly can, because two things will happen. You’ll prove out your concept if it’s truly a good concept. At the end of the day, if you do raise outside money, you’ll be in a far better position to raise it at a valuation that’s favorable to you the owner.

Is there anything else you want to talk about or any concluding thoughts that you have?

If I could wave a magic wand for our industry, there would be additional investment in training the next generation of healthcare IT professionals. The most obvious source would be current clinicians who are ready to expand beyond direct patient care. The Vitalize experience has been that truly some of the most effective consultants are those who have walked a few miles in the shoes of the user community.

I would love to see some kind of a coordinated effort beyond government lip service to try to increase the pool. Everyone will benefit if they are more skilled people in our sector.

News 3/30/11

Top News

From Quilmes Boy: “Re: Google Health. Just heard a rumor that they are not pursuing development or sales.” Unverified, but strongly suggested by the Wall Street Journal as CEO Eric Schmidt steps aside as CEO to make way for co-founder Larry Page. If they back out of Google Health, that ought to have a major effect on … well, nobody. PHRs are the consumer versions of EHRs — potentially useful technologies that, rightly or wrongly, aren’t all that attractive to their target audience in their current form.

MedQuist (MEDQ) announces that it will voluntarily delist its stock from Nasdaq in April, saying MedQuist Holdings (MEDH, the former Cbay) has bought up 97% of the shares anyway. I suppose it’s just a way to cut the administrative cost involved with keeping two publicly traded entities going.

Reader Comments

From John’s Boy: “Re: Partners HealthCare. Announced today that acting CIO Jim Noga, formerly CIO for Mass General and its physician organization, will be promoted to CIO.”  Unverified, but John’s Boy helpfully included what looks like an internal e-mail announcement to that effect.

From Duke_ACC_Champs: “Re: another champion coming to Duke. Warrior Art Glasgow takes the health system CIO position.” Unverified. He is CTO for Ingenix.

From Siouxsie: “Re: Costco. You can buy everything there, even an EHR." Next time at Costco, I can pick up a set of tires, a five-pound bag of shredded mozzarella, a hot dog, and a copy of Allscripts MyWay (via Etransmedia). In fact, since they already have a pharmacy and a contracted optometrist, I’m surprised they haven’t stuck a doctor back there by the cigarettes and beer.

From GearShifter: “Re: browser. In our IT shop, we’d love to run IE9, we’d settle for IE8, but a couple of HIT application vendors require that we run the older versions of IE for their app to be supported or in some instances run correctly. Don’t always assume it’s IT keeping you down — sometimes it’s that shiny app someone selected.” Good point. I remember fighting those battles over Windows versions – one vendor requires the latest and greatest, while another refuses to certify its application on anything developed in the last five years. Even though the major browsers assume you will always want the newest version, you would think there would be a way to have multiple versions co-exist for situations like these (or to use Citrix or some kind of virtual desktop instead). I can understand requiring IE for official work use since it’s free and ubiquitous. As long as the desktops aren’t locked down, users can always grab their own copy of Firefox or Chrome to steer clear of interfering with the standard browser. And I’ll timidly suggest this: Apple doesn’t have that problem since it controls its entire proprietary hardware and software package. If you want that kind of Apple-like hospital system where there’s only one call to make and one neck to wring, your only choice is Meditech.

From Kid Rock: “Re: Allscripts. There are many things to look at when looking at the value of corporation (and earnings is just one of them – bear in mind that free cash flows and the determination of what should and shouldn’t be discounts are judgment decisions as well). Allscripts had a big investment year. Should the cost of goodwill and capital investment in buying Eclipsys be held against them? I’m not so ready to discount Allscripts.” I said pretty much the same thing. The best time to micro-analyze current financials to predict the future isn’t a few scant months after completing a big acquisition and a skillfully led untangling from a not very competent foreign parent company.

From Alhambra: “Re: your poll on who owns patient information. Unfortunately, that may be one of the major reasons we will have difficulty in attaining true record interoperability. The financial industry has made much more movement in the use of technology without any concern of data ownership.” I was thinking after the poll that people often don’t own all the information that pertains to them. Companies buy and sell e-mail addresses and detailed demographic information from those fake “registration cards” that everybody fills in after buying something that clearly doesn’t need to be registered, like a blender. Nobody complains about companies profiting from selling that information, which isn’t even de-identified. Ample precedent seems to exist that just because information pertains to you doesn’t mean you own it – school transcripts, driver’s license records, criminal history, credit history, etc. I’d be surprised if the lawsuit against Walgreens is successful for that reason. I think they have little to fear as long as there’s something in their Notice of Privacy Practices that covers that situation under the super-broad “treatment, payment and operations” blanket (which technically isn’t even necessary for de-identified data), which doesn’t even require them to give you an accounting of disclosures if you ask. Plus, how can a patient prove their de-identified information was sold?

From All Hat No Cattle: “Re: this paper. Interested whether you think the issues raised will generate much discussion.” Only the abstract is free, but from that, I’d say maybe a little. The “unanswered questions” about EMRs include clinician liability for reviewing a glut of electronic information and overrriding alerts, the lack of a way to report EMR software problems, and the lack of alignment of who pays for EMRs (in both money and time) vs. who benefits from their use. Neither the questions nor the lack of answers are new, but the further the practice of medicine moves up the food chain from small practices to bureaucratic government, insurance companies, and mega-corporations (both for-profit and not-for-profit), the less anybody’s going to worry about the individual clinician who’s on the wrong end of these issues. Unless you’ve gone off the grid with a cash-only practice, your soul has already been sold and resistance of many kinds (EMR among them) is futile. He who provides the tools makes the rules, and let’s face it – patient benefit aside, organizations love EMRs because they allow the executives to monitor and enforce compliance with corporate policies that may or may not be in the best interests of patients and providers. I’d like to be more positive, but medicine seems to be turning into one big 1990s-style HMO where nobody’s happy except big companies and their Wall Street investors romping happily through big profits fueled by delivering as little care as possible. What everybody doesn’t like about EMRs is no more than a symptom of the underlying problem.

From American_Idle: “Re: St. Raphael’s. Due to happen, surprised it took this long. Major Epic consolidation will result in many redundancies. St. Raphael’s HIS is very patchwork.” Yale New Haven Hospital considers buying its neighbor, Hospital of Saint Raphael.

HIStalk Announcements and Requests

My talented offshore programmer/DBA developed an elegant workaround to the bug that was causing some readers to have problems viewing this site using old versions of Internet Explorer, like IE6. Everything should be working correctly now.

Ed Marx has added an updated to his Leadership Equations post from last week.

Acquisitions, Funding, Business, and Stock

Physicians from Cleveland Clinic will provide updates and reviews of medical content for First Consult as part of a strategic relationship between Cleveland Clinic and Elsevier. Elsevier offers First Consult as an evidence-based resource tool for providers at the point of care.

Elsevier also just announced free access to both First Consultant and MD Consult from all IPs originating from Japan. Elsevier wants to make the resources easily accessible to clinicians caring for earthquake and tsunami victims.

Charge capture vendor Ingenious Med gets $3.25 million in funding from Council Ventures, which assigned the resulting board seat to HMS co-founder Tom Givens.

Sales

Amerinet selects 4medica as a healthcare IT supplier. Members of the purchasing organization are eligible for preferred pricing for 4Medica’s inpatient and ambulatory EHR products.

Emerson Hospital (MA) purchases the Pinpoint RX system from Centice, which chemically analyzes prescription drugs and automatically links to the relevant Medi-Span drug information.

University of Michigan Health System’s new C.S. Mott Children’s Hospital and Von Voigtlander Women’s Hospital, opening in November, will implement GetWell Town, the interactive patient care solution for pediatrics from GetWellNetwork. The system has been installed in over 20 pediatric hospitals. Also new from GetWellNetwork: Carroll Hospital Center (MD) chooses its interactive patient care solution, which will integrate with the hospital’s patient management, CPOE, pharmacy, nutritional, and other systems to handle patient education, service requests, and patient-clinician communication.

People

Lake Regional Health System (MO) promotes Scott Poest to CIO.

Announcements and Implementations

Rutland Regional Medical Center (VT) goes live on its $15 million EHR system March 1, which it hopes will qualify it for $5-$6 million in EHR stimulus incentives.

Government and Politics

The government of South Australia is cutting 100 healthcare IT jobs as it consolidates hospital IT functions into a centralized statewide structure.

Poor-performing VA hospitals are shaping up after the Department of Veterans Affairs starts publicly posting outcomes data.

Innovation and Research

Kaiser hoped its contest for ideas of how to build 100-bed hospitals of high quality (“innovative use of technology and facility design to improve access to care and foster collaboration and team care while remaining efficient and affordable.”) would generate 25 solid entries, but they’ve received nearly 400 so far from 21 countries.

Technology

Apple says it sold out its annual developers conference in under 12 hours. Tickets for the June 6-10 conference went for $1,599 each and are now selling as high as $4,599 on eBay and Craigslist. Crazy.

Other

Thomson Reuters names its 100 Top Hospital award winners, based on outcomes. The top four teaching hospitals are in Chicagoland: NorthShore University, Advocate Illinois Masonic, Advocate Lutheran General, and Northwestern Memorial.

Above is the next installment in Vince Ciotti’s look-back series called HIS-tory.

HIMSS Analytics says Meditech owns the largest chunk of the hospital EMR market, with its 25.5% share (1,212 installations) beating Cerner (13%), McKesson (12%), Epic (9%), and Siemens (8%).

Another benefit of EMR: speeding the pace and cost of clinical trials. Medical centers and pharma companies recognize that EMRs provide better tools to quickly and accurately find qualified patients to recruit. With EMR, recruiting the required number of patients for large trials can be reduced from years to weeks.

NextGen Healthcare and its parent company Quality Systems, Inc., recently challenged their employees and clients to raise $20,000 for The St. Baldrick’s Foundation to fund childhood cancer research. They exceeded their goal, raising $28,000. As a result, 15 NextGen/QSI leaders have shaved their heads, including  QSI President Pat Cline. Personally, I think bald is hot.

I got an e-mail blast from LinkedIn celebrating its 100 millionth member and noting that I (as real me, not as Mr. H) was among the first million people to join (in fact, I was around #100,000). I also noted while checking that out that the LinkedIn HIStalk Fan Club that Dann started is up to almost 1,500 very cool members.

Flush with being recognized by LinkedIn as an early adopter, I signed up for Amazon’s just-announced Cloud Drive. You get 5 gigabytes of free cloud storage for files (documents, MP3, video) and unlimited access from any computer, including a Cloud Player. Buy one Amazon MP3 album and they’ll raise your free capacity to 20 GB for the first year.

Sponsor Updates

• PatientKeeper appoints Chris Stakutis , previously with Computer Associates and IBM/Tivoli, as VP of engineering. 
• Wheaton Franciscan Healthcare (WI) picks CareTech Solutions to provide SEO services for its www.mywheaton.org website. CareTech also announces that it has added two new Web Content Management System. CareWorks Fundamentals and CareWorks Fundamentals Amped are lower-cost, standardized packages for hospitals with limited marketing budgets.
• Ozarks Medical Center (MO) picks ProVation Order Sets as its electronic order set solution.
• CynergisTek earns Gold partner status from FairWarning Inc., for its commitment to providing expertise and value to the healthcare community and for its consistent sales success.
• GE Healthcare introduces Centricity Research, a clinical research management solution.
• Wayne Memorial Hospital (NC) is implementing Ingenix’s LifeCode computer-assisted coding solutions, which apply NLP capabilities to identify diagnoses and suggest appropriate medical codes.
• Medical Society of Virginia will offer its members PM/EHR software and services from Sage Healthcare, which will include discounts, certification guarantees, and free upgrades.
• HT Systems signs two new customers for its PatientSecure palm vein scanning system: Altoona Regional Health System (PA) and El Centro Regional Medical Center (CA).

Contacts

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

Readers Write 3/28/11

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!

The Status Quo: Profitability’s Biggest Enemy
By Tom Stampiglia

In just a few short years, the financial situation for healthcare providers has changed drastically. While patients only represented 12% of a provider’s revenue sources in 2007, they now account for almost a third of overall revenue, according to a Celent report. Between the rapid growth of high-deductible, consumer-directed care plans and a burgeoning self-pay population, patients are now responsible for a significant portion of both their medical expenses and a healthcare organization’s bottom line.

Despite these changing dynamics, many healthcare providers still employ the same conventional, long-standing approaches to revenue cycle management that were designed strictly with payers in mind. Even if these strategies are precisely what’s needed to capture quick and accurate reimbursement, they are unable to adequately address the unique challenges that come along with patient collections.

Why? Consider the industry standard for capturing patient fees. More often than not, patients are billed for their portion long after services have been rendered because providers are unable to determine exactly what the insurance company will allow for each procedure — the key variable in calculating a patient’s out-of-pocket obligations.

Unfortunately, this approach not only forces providers to postpone patient collections, but it also puts them at serious risk for payment delays and patient bad debt. In fact, more than half of patients’ healthcare obligations are never collected, adding up to more than $65 billion in lost revenues last year alone, according to McKinsey Quarterly reports.

By instituting practices designed to capture these funds at the time of service, healthcare providers can increase the odds that patients will fulfill their financial responsibilities. With recent technology advances, healthcare providers now have the ability to verify a patient’s eligibility and benefits status in real time and then pair it with the relevant CPT codes to determine insurance allowables.

Once allowables are determined, providers can apply patient responsibilities, including co-insurance and deductibles, to calculate precisely what the patient owes. Certainly this process could have been done before. However, using manual processes to examine each of these items for every patient would be cumbersome and unrealistic.

Beyond helping to accelerate cash flow, this upfront approach to patient collections brings greater transparency to payment processes and establishes a platform to conduct more effective patient financial counseling programs. With these initiatives underway, healthcare providers are well positioned to adopt a number of additional retail-based strategies proven to further enhance collections processes, such as introducing more patient-friendly billing statements, offering flexible payment plan options, and accepting credit or debit payments.

Another emerging trend that’s being met with great success is performing soft credit checks prior to the time of service. This approach, which acts like a form of financial triage, generates a rating of a patient’s likelihood to pay medical bills and gives providers the information needed to evaluate any associated financial risks. Once this information is in hand, providers can customize collection policies based on the unique circumstances of each patient.

Looking ahead, healthcare providers that implement these retail-based strategies and embrace their role as patient financial counselors will be well equipped to thrive in this new, patient-centered world. As consumers shoulder greater financial responsibility for care, it’s clear that change is critical to a healthcare organization’s survival, especially when it comes to capturing patient payments both at the point of service and beyond.

Tom Stampiglia is CEO of MPV of Austin, Texas.

Longitudinal Patient Record Systems – A Necessity for Accountable and Collaborative Care
By Alan Gilbert

In response to Dr. Jayne’s inaugural Curbside Consult regarding the lack of longitudinal care systems and the focus on episodic care, our experience has shown that a longitudinal patient record system is critical to realizing a goal of a more effective and efficient healthcare system that results in improved outcomes for patients. We believe that healthcare needs to be delivered at the point of need and not at the point of care.

One example of a longitudinal patient record is the National Clinical Network for Cleft Lip and Palate Services in Scotland. This project was established in 2000 to deliver interdisciplinary care between health professionals providing care for cleft lip and palate patients between birth and 20 years old. The objective was to provide a single record for a patient, creating a virtual multi-disciplinary care team for that patient including dentists, orthodontists, oral surgeons, speech pathologists, ENTs, audiologists, as well as the patients themselves, who were active participants in their own care. The platform accommodated clinical imaging, generated email,and letter alerts to remind clinicians and patient alike of their particular responsibility at specific times, and supported and facilitated audit and outcome assessments.

Benefits realized included:

• Improved communication – sharing of information across care providers
• Improved standards of care — a single source of patient information to monitor and analyze outcomes
• Improved coordinated care — interdisciplinary treatment planning and care has improved due to use of the platform
• Improved efficiencies — more effective use of clinicians’ time as well as the patients, their parents, and caregivers
• Improved data access — minimized risk of data fragmentation over multiple sites, reduced cost, time and effort incurred by offline data entry and replication
• Better patient satisfaction — through improvement in the organization of clinics and coordination among specialties
• Improved reporting — reports and analysis on a national basis

Another example of a longitudinal patient record is the National Sexual Health System in Scotland (NaSH) that was started in 2005. This strategy set out a framework for improving sexual health by enhancing access to information and services while enabling flexibility for local services to respond to local requirements. It also highlighted the need to be able to review existing data and develop a data collection framework to provide a more accurate picture of sexual health and wellbeing, in terms of both sexual conditions (chlamydia, AIDS, etc) and behaviors and attitudes.

Benefits realized included:

• Ability to produce and aggregate national sexual population and public health data
• Improved clinical care and access to patient clinical information by introducing more patient focused processes and the ability to communicate directly with patients through patient portals, secure email and text
• Streamlining of services enabling improved throughput and availability
• Increased ability to share clinical data across services nationally
• Removal of multiple manual record keeping systems
• Ability to address some clinical governance issues more effectively
• Reduced requirement for duplicate entry of patient data and better quality of data
• More efficient and increased integration of systems

These examples, as well as others in diabetes, cancer care, COPD, and infection control, all focus on the need for a technology platform that can create a consolidated clinical view of the patient, no matter their care setting.

Alan Gilbert is VP of business development for AxSys Health of New York, NY.

Playing the Percentages with EHR Uptime Will Not Pay Off
By Nelson Hsu

Playing with the percentages is risky for the many healthcare organizations on the electronic healthcare record (EHR) adoption curve. The percentages in question are EHR systems’ uptime – how often the applications are available and working at sufficient performance to meet healthcare providers’ needs. Industry standards, vendor claims, and assorted misconceptions about uptime conspire to make this critical area of EHR implementation a footnote where it needs to be near the top of the priority list.

EHR’s success depends as much on application availability as it does on functionality. According to a February 2011 report by AC Group Inc., system speed and availability was critical in physicians’ decisions to use an ambulatory EHR application. That’s a good start. Their perceptions of what constitutes acceptable levels of speed and availability, however, leave open the door to punishing financial and productivity costs.

A panel of physicians surveyed at a recent Medical Group Management Association Conference said if the system was not available a minimum of 99% of the time, then they would not consider the application reliable enough to use in the future. While that may sound reasonable, 99% is unacceptable for healthcare applications. System availability at that level roughly translates into an average of more than 87 hours of downtime annually — almost four days. And 99% isn’t even the minimum industry standard. The same AC Group report that included the physicians’ survey polled 37 EHR vendors and found that they don’t guarantee any better than 96% uptime.

That number of hours of downtime costs time and money. AC Group determined that for every minute an EHR application is down, the average physician practice spends 2.15 minutes to perform the required tasks manually plus the time required to update the computer systems once the system is back up and operating. The average cost of downtime, the survey analysis determined, was $8.13 per minute per provider, which equates to a median across all practice sizes and specialties of almost $488 per hour.

Nevertheless, most EHR software vendors will not even include uptime SLAs in their contracts unless specifically required to do so. When they are, almost every vendor AC Group talked to said that the cost of the system would increase from 5-20% for each 1% increase in uptime guaranteed beyond the standard 96%. With the products available today specifically designed for uptime assurance, there is no justification for levying such price premiums.

To gain the full value of their EHR implementations, physicians and healthcare managers must become their own uptime advocates. Eighty-seven percent of medical practices spend no time evaluating their EHR implementation’s uptime and service levels, instead leaving it to software providers who have little interest in it. Neglecting the amount of system downtime that a practice might experience could cost the average five-physician practice nearly $25,000 if the product is down just 10 hours during the course of a year.

Software providers may or may not recommend or provide a high-availability platform solution (either hardware or software) for their applications. Regardless, practices and clinicians must make this a requirement for the critical applications they depend on to run their practices and care for patients. The medical profession always tells patients to take responsibility for their own health. Now it’s time for the profession to take its own advice on this important issue.

Nelson Hsu is senior director at Stratus Technologies of Maynard, MA.