Time Capsule: Vendors: Develop an "Antivirus" Program to Warn of Your Software’s Bugs

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 June 2007.

Vendors: Develop an "Antivirus" Program to Warn of Your Software’s Bugs
By Mr. HIStalk

CIOs and vendors spend lots of money and time addressing system redundancy. Thank goodness. When clinical systems go down, patient risk goes up (or so you hope, anyway, since that’s the ultimate validation of that system’s influence on patient outcomes.)

We can agree that downtime is bad. What vendors haven’t fully acknowledged, however, is that systems can be up and running, yet still endangering patients because of internal logic or data errors. Known bugs, in other words, that cause errors that are subtler and, for that reason, potentially more dangerous.

I’ve worked in vendor support, so I’ve seen hundreds of examples:

• Medication doses, lab tests, or nursing actions are omitted from their respective printed or online schedules
• Interface problems allow time-critical information to be delayed or ignored
• Lack of sufficient storage space causes transactions to be lost
• Patient merging or discharge cancellation does something undesirable to visit information
• Technical issues cause background processing to fail, delaying reports or updates until a user finally notices.

I could go on, here’s my point. The vendor’s support people knew about these problems. They could get on a client’s system, query the database, and say, "Yep, we’ve seen this problem before." In most cases, a simple utility program could have detected the error condition proactively and warned someone immediately, allowing the problem to be resolved before patients were exposed to data-driven risk.

Vendors don’t like this idea. First, it admits that their software has bugs (which it always does.) Secondly, it also admits that even well-documented bugs can’t always be fixed immediately.

I don’t buy the idea that it’s the customer’s job to find and report problems. It’s never acceptable to endanger a patient with a known software defect, even if a fix is on the way. The obvious solution (temporary or otherwise) is to write a program to detect the problem, let the customer choose how often to automatically run it, and provide the appropriate alert when that problem is found.

Here’s a simple example. Suppose I have CPOE and pharmacy systems that should always be synchronized via complex interfacing or integration. That’s great, but what if something goes wrong? The unacceptable answer: let the clinician find the problem. Oops, the antibiotic order is active in CPOE, but expired in pharmacy. Customer support: "Thanks for telling us, but we already know about that problem, even though we can’t fix it. Continue to be vigilant. Can we close your case?"

This is not necessary. A program could easily have detected the problem. Programs are better than clinicians at comparing List A to List B. So, why are preoccupied clinicians expected to be the safety net for programmers?

None of the applications I’ve used provided these low- level diagnostics. Finding bugs was a user’s problem, even after those problems had been documented, acknowledged as bugs, and scheduled for an eventual fix.

This drives users through the roof. IT is proclaimed as unresponsive and the vendor is branded as incurably stupid.

My message to vendors: It’s your job to tell customers when your software has a problem, not vice versa. Ask your support reps for a list of known problem symptoms. Get your developers to write a diagnostic program that users can run on a predefined schedule, including their preference for alerts.

Think of it like your PC’s antivirus program. It has a core detection engine. Users determine how often it runs and what happens when it finds a problem. Automatic updates to its detection patterns let it find even newly discovered problems immediately.

Developing a problem detection engine isn’t an admission of failure. it’s a reflection of reality. Software always has bugs that leave detectable tracks in the customer’s database. Finding the occurrence of those clinical software bugs is good for everyone involved, most notably the patient.

News 6/8/12

Top News

Microsoft and GE Healthcare complete the formation of Caradigm, their 50-50 joint venture that will be led be CEO Michael Simpson from GE Healthcare. Lauren Salata (Care Innovations) joins as CFO an Michael Willingham (Philips Healthcare) assumes the role of quality assurance and regulatory affairs executive.

Reader Comments

From LesserEvils: “Re: what uninsured un/under-employed do. They have several choices. They can wait until they are really sick and visit an ED, which just makes the cost of care even higher. Or they can become self pay, which in many cases translates to no pay, which we all end up paying for in some way. Or, they file for bankruptcy. Something like 60% of personal bankruptcies are due to the un/underinsured being unable to pay medical expenses.”

From Paul: “Re: Cerner. Featured in Investor’s Business Daily. Feels like an optimistic PR announcement, but I see solid stability with their hosted offering and decent improvements on the ambulatory side.” IBD quotes analysts who like the fact that Cerner shares have done well lately, bucking past experience in which any one HIT vendor that reported bad results (like Allscripts) dragged the whole sector down. They also like Cerner’s chances to offset eventually declining EHR sales with revenue from medication dispensing cabinets, medical devices, and outsourcing services. It says that although Epic wins most of the high-profile hospital deals, Cerner’s win rate has improved in the last couple of years.

From AcuVedder: “Re: patient right to access and correct their health information. The Office for Civil Rights posts a video explaining patient rights.” I don’t know if it will help or hurt hospital foot-dragging (long delays and high per-page costs involved with giving patients copies of their own records), but at least the video sends a signal that the government sides with patients, in theory anyway. If it’s so time-consuming and expensive to give patients a copy of their records, imagine the disarray that must be involved with providers trying to access and use those same records for treating those patients during their stay. Or at least that’s how I would see it as a patient. Imagine a garage that isn’t able to provide estimates, sells services ordered by third-party mechanics over which it has limited control, and expects customers to just pay their bills afterward with no explanation of what was done or how their car should be driven or serviced in the future.

From Izzie: “Re: Accretive Health. Are hospitals more or less likely to hire them as their RCM vendor since their dispute with the Minnesota attorney general?” I would expect that’s the case since nobody wants bad press, but let’s ask their customers and prospects: have the headlines changed your plans involving Accretive? How? Tell me. I’ll keep you anonymous.

From Nurse Informaticist: “Re: help! I work for one of the big vendors that thinks a nurse is a nurse. They have no idea what my specialty certification in informatics is or what it means. How about a shout-out for the fact that nurses specialize and have expert knowledge to contribute to system design? Long time, die hard fan!” I’m not an expert on ANCC certification, but I recall that it requires passing a test and clocking a bunch of hours working in any kind of informatics role. Vendors may see that as more of an indication of interest rather than of specific, value-added skills since anybody can call themselves an informatics nurse and lots of nurses make their living doing informatics-like work  (training, consulting, support, etc.) with no higher education or certification at all, just applied informatics experience (which is often true of other professionals as well.) Then there’s the Epic model, where they’d rather have impressionable, cooperative (read: young) licensed people who have recent frontline care delivery experience and no IT connection. Finally, some vendors have a warped view of the provider food chain in thinking that physicians can intelligently speak for nurses, therapists, pharmacists, etc. and don’t seek other clinical expertise. I’ll poll HIStalk’s readers again: are nurses with informatics education and/or certification adequately involved in system design and implementation by your organization? Why or why not?

From Not Very Innovative: “Re: CMS’s $10 billion Center for Medicare and Medicaid Innovation program. In a WSJ editorial, Steven Greer MD says Congress should dismantle it since it’s a poorly conceived, politically motivated system that is unlikely to deliver innovation or ROI.” He should know – he was chairman of its grant review program, concluding from his experience that it is “nothing but a pork program that diverts untouchable Medicare entitlement funds to political cronies in key states.” The first millions went to a Chicago group run by the President’s golfing buddy and a program that eventually subcontracted the work out to IHI, formerly run by Don Berwick, who was running CMS at the time. He concludes, “The newly created CMMI is nothing but a stealth stimulus plan to help job creation and politicians’ careers, just like the extremely ineffective ARRA ‘stimulus plan’ was in 2009. The ARRA did nothing to reduce unemployment, and neither will the much smaller CMMI.” It probably doesn’t help Dr. Greer’s credibility that he is a UFO contactee who has accused the government of an alien cover-up, not that there’s anything wrong with that.

HIStalk Announcements and Requests

Life got in the way of mentioning HIStalk Practice highlights last week, so here are a few don’t-miss items from the last two weeks: Dr. Gregg discusses intriguing new bedside monitoring technology from Blnk Medical Technologies. David Wellons muses on the next generation of healthcare informatics. Over the last decade, more widespread use of EHRs has contributed to a 17% increase in the use of the two highest-level codes for established office visits. Consumer Reports adds ratings for Massachusetts primary care providers. eClinicalWorks treats employees to ice cream in exchange for donations to the troops. I have resigned myself to the fact that I will never catch Mr. H in terms of the number of LinkedIn connections, Facebook friends, or Twitter followers. The only thing that keeps me from falling into a deep depression is seeing lots of visits to HIStalk Practice and new sign ups for the e-mail updates. Thanks for your support, which is far more effective than therapy.

Acquisitions, Funding, Business, and Stock

Streamline Health reports Q1 results: revenue up 31%. EPS $0.05 vs. –$0.03.

Stanley Healthcare Solutions, a division of Stanley Black & Decker, acquires RTLS provider AeroScout. We reported that rumor on May 18.

Veritas Capital completes its $1.25 billion purchase of the Thomson Reuters Healthcare business, which will be known as Truven Health Analytics. You may recall that Veritas sold government healthcare IT contractor Vangent to General Dynamics for $960 million last August, making a 240% profit on its investment.

Ringadoc receives $750K in an angel-led seed round, with the participation of Practice Fusion CEO Ryan Howard and LA-based technology incubator Curious Minds. The company offers virtual visits from its physicians at a cost of $89.99 per year and $29.99 per call, with three free calls per year. Fast Company just profiled Ringadoc, saying that it’s operating out of Practice Fusion’s San Francisco offices and using its EMR. The company says it has 1,600 registered users and will soon launch a service that will allow physicians to use its technology in their practices.

Allscripts creates an incentive program based on earnings-per-share performance for 10 of its executives, but CEO Glen Tullman was not be included for unstated reasons. The company also amends the employment agreements of Glen Tullman, Lee Shapiro, Diane Adams, and Laurie McGraw to require that they resign within 10 days of a change in company control to earn their cash payment for not being retained.

Discharge planning and readmissions software vendor CareInSync gets $1.6 million in Series A funding from HealthTech Capital. Above is a video of staff from Marin General Hospital talking about their use of the company’s Carebook transitions software.

Athenahealth launches a “More Disruption Please” program that will sponsor hack-a-thons, invest in startups, and open up the athenahealth platform via APIs.

An Israel business publication cites sources claiming that iMDsoft is talking to a private equity fund about an $80 million sale of the company. I didn’t realize that its three founders also founded population management systems vendor CareKey (sold to TriZetto for $60 million in 2005), and two of the three also founded consumer telehealth systems vendor American Well.

People

Consultant Karlene Kerfoot, PhD RN joins API Healthcare as VP of nursing.

Lifespan (RI) names Ian Hyatt (GTECH) VP/CTO.

ZeOmega appoints Christopher Mathews MD (Community Health Network) SVP/CMO and adds Anne Wilkins (Healthways) and Anna Haghgoole (Sandbox Industries) to its board.

Santa Rosa Consulting names Patrik Vagenius (Dell Services) as EVP of sales and marketing.

Larry Stofko, formerly SVP/CIO of St. Joseph Health System (CA), has been promoted to EVP of the system’s Innovation Institute, which will design, develop, and commercialize potential solutions; create and manage a venture fund; and convert delivery opportunities into business units.

CareCloud appoints Joseph P. Sawyer (American Well) as VP of marketing.

MediRevv names Holly Krueger (CureIS Healthcare) as director of sales.

Acuo Technologies hires Barry Gutwillig (Virtual Radiologic) as senior director of business development.

Vocera appoints Steven Soderberg (Force10 Networks) as CIO.

Orange Regional Medical Center (NY) hires Sujatha Ramanathan (Pain Centers of American) as its director of ambulatory EHRs.

Announcements and Implementations

NY eHealth Collaborative announces that three RHIOs and three HIE vendors will participate in the state’s HIE.

RadNet, an operator of 232 outpatient imaging centers, implements eRAD’s RIS, PACS, and report generation solution.

The Advisory Board Company launches its 2012 Patient Engagement Blue Button Challenge to encourage the creation of apps for improving care by sharing health data. The prize is $25,000 and submissions are due August 6.

The EntryPoint module of PatientOrderSets.com earns ONC-ATCB certification.

MyHealthDIRECT wins ONC’s discharge follow-up appointment challenge, earning the company $5,000 and the opportunity to run a pilot project.

A team from IOSTREAM wins another ONC challenge, this one for creating the MedDAERS portal that providers and consumers could use to report adverse events and other problems with medical devices.

EXTENSION announces the release of Version 3.0 of its clinical alerting system.

Anthem Blue Cross and Blue Shield in Colorado announces that providers can access Availity’s Health Information Network to verify eligibility, submit claims, and review clinical histories and care alerts.

Government and Politics

HHS posts recorded streaming video of the Health Datapalooza plenary sessions. For celebrity watchers, Jon Bon Jovi goes on at the 1:43:00 mark of the Tuesday morning video. He muffs some lines when reading the script, but then ditches it and speaks really well. He mentions his “pay what you can afford” JBJ Soul Kitchen restaurant in Red Bank, NJ and his corralling of Aneesh Chopra outside a White House men’s room to talk about apps that can find available shelter beds and medical providers in real time.

The Congressional Budget Office says that if lawmakers do what they usually do to address budget problems (i.e., make them worse), healthcare entitlement spending will in 25 years make up 10% of GDP, pushing the country’s red ink to 200% of GDP.

The House passes a bill that would repeal PPACA’s medical device tax that is intended to subsidize the cost of providing insurance coverage to 30 million new people. The bill isn’t likely to pass a Senate vote and the President says he will probably veto it anyway. Device manufacturers will pay 2.3% of gross sales starting in January, and several of them have already announced layoff plans to offset the new expense.

The Federal Trade Commission files charges against electronic payments and collections vendor Checknet, whose customers include healthcare providers, for leaking consumer data. Checknet’s COO installed file-sharing software on his computer, exposing the health insurance and medical information of 3,800 patients to anyone using the same peer-to-peer software.

A proposed Michigan law would create a Peace of Mind Registry, an online database where patients can record their advance directives for review by providers.

Other

If you are a vendor looking for a cool trade show give-away, here is something better than a tee shirt, stress ball, or even a warm chocolate chip cookie. Pong Research announces a $120 iPad case that not only provides protection, but boosts the iPad’s 4G reception up to 10x, the Wi-Fi reception up to 9x, and range by 2x. Plus, it reduces exposure to electromagnetic radiation. The trinket bar has been raised.

Harvard Professor Latanya Sweeney PhD announces theDataMap, a crowdsourcing project to map the flow of personal data in the US. She says her early attempts to document the ever-increasing flow of patient information into more and more corporate hands elicited gasps every time she showed the graphic.

Two of New York City’s biggest health systems, NYU Langone Medical Center and Continuum Health Partners, announce plans to merge into a super-system that would cover the most affluent Manhattan neighborhoods and flank Mount Sinai Medical Center. The reaction of Princeton health economist Uwe Reinhardt: “Economists have for some time now worried about the ceaseless consolidation on the supply side of the health care market, facing a much more splintered payment side with less market power … So a hospital can literally tell an insurer you either take our prices or you take a walk, and that’s what’s happening. Both sides always justify that, not on the basis of crude market power — we want more market power to get better prices — they always find some kind of high national purpose.”

Rapping 10-year-old twins star in a hand hygiene video for caregivers that was developed by All Children’s Hospital (FL), where one of the twins had been a patient. The video won an award from an infection control group. Now I can’t get “scrub-a-dub-dub” out of my head. 

Mostly unrelated except for a medical clinic mention: the best graduation speech in history, even better than the one Steve Jobs gave at Stanford. The message to rich kid high school graduates: you’re not that special – we all are.

HealthLevel Script Object Notation, an open source HIE standard based on JavaScript Object Notation, seeks board members to steer what it says will be the most widely used HIE standard in the world. Nominations are due June 30.

An Oklahoma doctor asks in The Atlantic, Are Computers Getting Between You and Your Doctor? He says doctors are starting at computers instead of listening to and touching patients, are copying/pasting medical information without adding any value, and are forced to ignore the patient and click screen after screen to justify their payment. He concludes, “On my best days in practice, it seems as though all of my patients are savvy, engaged, and connected: e-patients. On the bad days, I feel like an overcompensated data entry clerk.” Check out the hideous stock photo used to illustrate the article (since nobody reads anything unless there are pictures, even unrelated ones): the monitor looks like it was made in around 1997, there’s a keyboard but no mouse, and the office furnishings look a lot more like a lab in Bulgaria than a US doctor’s office.

A doctor’s former receptionist is arrested in Connecticut for using the practice’s computer system to create narcotics prescriptions for herself.

iPhone/iPad EMR vendor Drchrono adds the ability for practices to process patient payments using the Square credit card reader. Square just announced that its reader will be sold at Walgreens and Staples stores or can be ordered at no cost from its site, with swipe card transactions charged at 2.75%.

A PwC report concludes that patients want mobile health to provide convenience or save them money, while doctors have less interest unless it can improve care, ease patient access, or reduce in administrative time. The report also predicts that change-resistant providers will slow mHealth adoption as everybody tries to protect their own turf, with the best chances for adoption being developing countries, and that the entitlement attitude of patients means that vendors need to appeal to payers.

eHealth Saskatchewan finds a computer problem that prevented diagnostic imaging results for about 100 patients from being faxed to their doctors for several weeks.

A group of high-profile healthcare CEOs and the Institute of Medicine develop a 10-point checklist of actions that can reduce costs and improve care. Among them: program hard stops into the CPOE system for duplicate lab test orders, requiring the prescriber to call the lab to override the block.

An editorial in the local paper by Mark Herzog, president and CEO of Holy Family Hospital (WI), talks up the hospital’s EMR. He goofs in his description of the one specific benefit by saying that in bar code medication verification, nurses “scan prescription bottles.” I would hope isn’t the case because only clueless hospitals dispense medications in bottles instead of unit dose packages, but I figure he dumbed it down for the lay folks.

Weird News Andy says clinicians must have had a flaccid response to this patient. He’s suing a Yale-New Haven Hospital emergency facility, claiming that staff watched a baseball game on TV instead of treating his priapism.

Sponsor Updates

• Black Book Market Research ranks Certify Data Systems third out of 20 private core HIE system vendors.
• HealthMEDX’s Bridgette Leonard offers advice on auditing EHRs to reduce readmissions.
• The California Health Information Partnership and Services Organization awards Family Health Care Network of Visalia (CA) $573,750 to advance its use of MED3OOO’s EHR.
• CTG Health Solutions releases CTGTALK 4.0, which allows users to manage the application via mobile devices or PCs.
• Nuesoft announces that its NueMD Android EMR app will be available this summer.
• RelayHealth launches RelayAnalytics Pulse, a comparative analytics solution for hospitals and health systems.
• Practice Fusion releases a 10,000-record HIPAA-compliant dataset and launches a data challenge to solve public health issues
• Western Kentucky Orthopaedic & Neurosurgical Associates selects SRS EHR for its 11 physicians.

EPtalk  by Dr. Jayne

The HIMSS Virtual Conference & Expo began this week. Keynote speakers included MedVirginia CEO Michael Matthews and political commentator Jonathan Alter.

When I’m teaching students and residents, I often challenge them to use non-medical search engines such as Google in addition to “traditional” platforms for finding medical information. A recent study in the Journal of Medical Internet Research found that identical searches performed using multiple search engines will produce different results. Since two-thirds of physicians and an even greater number of patients use standard Internet search engines to find medical information, the doctrine of caveat emptor becomes increasingly relevant.

In follow up to my piece on goat farming, a reader shared this story about a pediatrician’s frozen yogurt shops along the Jersey Shore. I know a lot of primary care physicians who have left medicine (or who have gone part time) and can’t help but think that if the pay were better the impending primary shortage would look different.

I wrote last month about medical schools compressing coursework for students choosing primary care careers. The American Board of Family Medicine, the Association of Family Medicine Residency Directors, and TransforMED are now working in cahoots to expand family practice residency training to four years. I don’t disagree that it will provide additional educational opportunities to trainees, but extending training (which translates to lost lifetime income for family docs) to an already-depressed specialty isn’t going to help recruit new family docs.

CMS keeps e-mailing me with reminders that Version 5010 Enforcement is almost here. The discretion period ends June 20, 2012 and practices that are still experiencing issues should work with clearinghouses and payers to resolve any problems. I’ve asked my trusted source Bianca Biller to provide a summary of her 5010 experience, but it appears she’s so busy fighting fires that she hasn’t had time to write.

Travis from HIStalk Mobile shared a link on Twitter that discussed whether so-called “sunshine laws” really work. These laws require drug and device manufacturers to disclose payments to physicians. I don’t see drug reps any more, but recently encountered this with a medical device manufacturer rep who wanted my NPI and state license number before buying me a drink. Since I’d already authorized purchase of tens of thousands of dollars in hardware, I didn’t think one Cosmopolitan celebrating the closing of the deal was going to cause an ethical lapse. Although I know my state license number from memory, I was particularly glad that my OCD had led me to store my NPI in the contacts section of my phone.

Speaking of phones, MSN reports that nearly 20% of smart phone users are sexting or otherwise sharing explicit photos or text messages. The most common age groups are men aged 18-34 and women aged 35-44. The report states, “only 3 percent of American adults who are smart phone owners say their biggest concern about losing their phone is that their inappropriate pictures or text messages could be exposed… this number is shockingly low when you consider that 69 percent of smartphone owners have lost their phone.” Grammatical issues aside, I find the quote surprising. If I ever lose my phone, I hope the finder is titillated by the sassy acronyms found within: CCHIT, ONC, HIPAA, EDI, PCMH, and HL7.

Have tantalizing news? Let me know on Twitter @JayneHIStalkMD, on Facebook, or if you’re old-school, e-mail me.

Health Datapalooza from the Eyes of an Entrepreneur
By Dan Wilson

Our company, Moxe Health, was invited by HHS to attend the Health Datapalooza (HDI Forum) because of a product we designed during the Milwaukee BuildHealth Hack-a-thon seven weeks ago. Triage.me was our response to a challenge posed by Aurora Health Care: "Reduce the number of ED visits for non-emergent care in Milwaukee County."

I first learned about the Datapalooza listening to Todd Park’s presentation at the HIMSS conference. We had no idea we were going to be participating until a month ago. Talking with other folks around the event, our experience wasn’t unique. In a sense, Datapalooza is a large-scale agile conference. Hosted by the government. For healthcare. It’s pretty wild.

The last conference I went to was HIMSS. The Datapalooza is definitively not HIMSS.

As an exhibitor, we had the same amount of space as IBM, Aetna, and SAS. Specifically, an 8×8 booth, with nothing allowed to hang overhead and no swag over $10. It was refreshingly low key. Also, startups didn’t pay for their own booth (thanks, HHS!) That’s Mark and me in the Moxe / triage.me booth. We were among the first to set up on Monday. Really nice convention space.

This is the closest you’ll see to the government holding a startup event. They pulled it off, and a lot of respect is due to the folks at HHS and the ONC. Todd Park deservedly gets a lot of the attention, with some folks (HHS Secretary Kathleen Sebelius) even referring to it as the "Todd Park Roadshow." But the event was much bigger than that, and it’s clear there’s a lot of momentum propelling it event forward.

As further evidence of the underlying focus on innovation, one of the most anticipated sessions was held in a side room to make sure the Wednesday afternoon app demos could be simulcast online. While two youngbloods from Wisconsin (and the other code-a-thon winners) were presenting their product on the main stage being simulcast across the nation, Atul Gawande and Farzad Mostashari were facilitating an ACO breakout in a relatively small, overheated room with spotty Internet connectivity. We’re not sure if this was by design or by accident, but the it reinforced the statement that the only thing bigger than the technologists innovating things at the HDI was Bon Jovi (who aside from his noble work for the homeless, also innovated the technological wonder that is "Living on a Prayer.")

Even the ACO event panelists were made up of a number of small, yet terribly innovative companies. One example I learned about was Forward Health Group, a 20-employee company that’s coming up with awesome ways to connect and visualize data. They’re now working with the Guideline Advantage program, which is a collaboration of the American Heart Associate, American Cancer Society, and the American Diabetes Association.

From our standpoint, the event was a huge success. As a young company, we gained incredible insight and valuable contacts from ONC, HHS, and private enterprise leadership. I’m excited to see where the Datapalooza goes next, and I’ll be doing everything I can to stay involved.

Random Musings

@Farzad_ONC Humble apologies, sir! Truly, I did think…no bowtie…aaarghh. But that apron…oh dear.

— Forward Health Group (@ForwardHealthGp) June 6, 2012

• The bow tie is in vogue around the ONC.
• The new Healthdata.gov site launched. I spoke with one of the guys who helped program it. His take is that structurally, the site is a step forward and a good foundation for releasing better data. He also felt that the currently available data/APIs weren’t much changed and there’s still a ton of work required to make sure the data being opened up is both valuable and usable.
• Kathleen Sebelius mentioned that another 150 ACO organizations are slated to start in July.
• VC investment is up 60% in the HIT sector since 2009.
• From Kathleen S.: a recent diabetes study showed patients cared for by a doctor using an EHR had a 600% better chance of receiving the right care.
• I think Bill Frist summed up the focus of the conference well: "The goal is to turn data into discovery."

Dan Wilson is CEO and Mark Olechesky is CTO of MOX eHealth, LLC.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Readers Write 6/6/12

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

Moneyball and the Power of Data Analytics
By Gerard Livaudais

I’m not much of a baseball fan, but I really enjoyed the movie Moneyball. If you haven’t seen it (or read the equally excellent book by Michael Lewis), here’s a ten-second synopsis. Billy Beane, general manager of the Oakland As baseball team, bucks traditional scouting methods by using data analytics to find undervalued players. He is pilloried by baseball purists for his stats-obsessed methods, but he builds a winning team on the league’s lowest payroll.

Moneyball may be a baseball movie, but the real story is about the transformative value of data. And as the final credits roll, what’s clear (at least to this viewer) is that even the most under-funded team in baseball uses data more effectively than most healthcare providers.

The use of data as a business intelligence tool is hardly new. In almost every industry on the planet, companies are leveraging data-driven decision-making to realize productivity gains, achieve competitive advantages and improve overall performance. Even the smallest of SMBs (small and medium-size businesses) are getting in on the act, thanks to the simultaneous rise in computing power and drop in hardware and storage costs.

Businesses like the Oakland As are using data to win baseball games. In a hospital, access to the right data at the right time saves lives. Yet healthcare organizations as a whole are failing to use current, accurate data to support their clinical, financial, and operational decisions.

Healthcare should be setting the standard for data-driven business intelligence. Here are three strategies we can use to get there.

1. Focus on the Data that Matter

Healthcare organizations certainly don’t lack for data. Thanks in part to a constellation of regulatory mandates, we already capture, store, and report phenomenal amounts of data. On the other hand, financial incentives – never the top priority but always a factor — for effective use of data are rising. Meaningful Use Stage 2 includes numerous value-based purchasing elements and aggressive penalties for hospitals and physicians who fail to demonstrate the quality of care they deliver.

One way we can leverage data more effectively is by breaking down the data silos that prevent the right information from getting into the right hands. As an industry, we spend billions of dollars building and maintaining the data warehouses that power analytics across healthcare environments. These internally-hosted systems may be great at assembling data and powering analytics for specific departments or functions. But they also isolate that data, inhibiting its value as a decision support tool.

The right business intelligence technology can break down these data silos much more easily and cost effectively, enabling all decision-makers within an organization to access the most relevant metrics and performance indicators. The implementation and support cost factors for Software-as-a-Service (SaaS) solutions are several orders of magnitude less than internal systems.

2. Leverage Internal and External Data

Once internal data silos are torn down, healthcare organizations have the ability to seamlessly share information across departments and business units. Integrating data from outside your organization is essential to enabling true comparative analysis. Inconsistent data formats are a nightmare to normalize and aggregate manually. But industry data standards such as HL7 are helping enable true interoperability among best-of-breed technology solutions.

3. Influence Positive Patient Behavior

Health outcomes are ultimately dictated by patient behavior. One of the most promising frontiers of clinical business intelligence is the ability to blend data that reflect not just clinical activity, but social factors that can help predict how well certain patients will comply with a treatment plan, particularly for chronic illness.

These factors can range from patient-generated measures – such as how patients prefer to interact with their physicians – to the presence of psycho-social indicators such as depression and exercise level. Their economic impact can be profound. The cost to treat diabetes in patients with depression is more than twice that of diabetes patients without depression. By blending clinical and social indicators, providers are able to “personalize” treatment plans that simultaneously raise the probability of successful health outcomes and reduce the overall cost of treatment.

However, some of these measures of efficiency are not universally appreciated just yet. As Billy Beane discovered, prioritizing on-base percentage over batting average may be a more efficient path to building a successful team. But his Oakland As had to win games first – a lot of them – before his industry appreciated his logic.

The good news for healthcare is that everyone – from physicians and providers to device manufacturers, pharmaceutical companies, insurers and other payers, and even academic and research institutes – benefits from more efficient and successful patient outcomes. All parties also benefit from instant access to accurate healthcare data. The right tools can open up a world of opportunity to improve outcomes and save lives.

Gerard Livaudais is chief medical officer of Quantros.

Care in an Emerging Market
By Arvind B. Deshpande

Recently my father, who is 84, was hospitalized for profuse sweating based on telephonic advice of our family doctor.  I live in a city about 150 km from Bangalore (or Bengaluru). I am describing the care at the hospital.

We arrived on a Saturday around midnight without calling the hospital. As soon as we reached the hospital, staff at the entrance wheeled him to ED. The duty doctor took an ECG and advised moving him to ICCU. By the time I finished the paperwork at billing (where they located his nine-year-old ECG record in less than a minute,) he was in the ICCU on the first floor of the four-floor hospital.

The doc in ICCU immediately connected a vital signs monitor. Noting the low heart rate of 40, he mentioned that an external temporary pacemaker might become necessary. I signed the consent, giving my contact details.

Around 2:30 a.m., I got a call saying they had connected the external pacemaker after his heart rate became irregular and he had been defibrillated. My father stayed in the ICCU until Monday morning, when the interventional cardiologist took a look and advised an angiogram. He mentioned that if there was a heart block, they might have to introduce a stent.

I again signed the consent papers. The whole procedure, including angioplasty, was completed in an hour. My father was moved back to ICCU. Care in ICCU was good, timely, and home-like, to say the least.

The doctor mentioned that he would stay in ICCU for two days, then be shifted to the ward for another 2-3 days. The external pacemaker would still connected as a safety standby. He was moved to the ward after two days and the external pacemaker was disconnected on Day 4. He continued in the ward until Day 6 as a precautionary measure, then was discharged from the hospital.

I had the opportunity to interact with the doctor every morning. The findings were recorded on paper and explained to me daily.  On the last day, all the records were signed off, billing was completed, and we came home,  which is about a 10-minute drive from the hospital.

This 30-bed hospital dedicated to cardiac specialty has its own IT hardware setup and software locally developed to support them. Meaningful Use and EMRAM standards do not exist and are not mandatory. This hospital is ISO 9001 certified ,and one can say they comply with the standard in letter and spirit.

I work for a medical device manufacturer here. I am an avid reader of your blog, from where I have gained some insight into how providers and vendors work towards patient care in the US.

I am not suggesting that the recent measures announced in the US are not necessary. The above incident is only to spread awareness as to how good care is primary and systems are required to support care.

Arvind B. Deshpande is head of quality assurance and regulatory affairs for Larsen & Toubro of Mumbai, India.

Why We Do What We Do
By Dan Herman

I have received a birds-eye view of our healthcare delivery system while tending to my mom over the past couple of months. She had major open heart surgery at a hospital outside of Chicago in late April. She was discharged to rehab and is doing pretty well for a woman who will turn 82 next week.

The hospital that cared for her is part of a large IDN, highly integrated on a single EMR platform for their inpatient and multi-specialty physician group practice.

They are a HIMSS Analytics EMRAM Stage 6 organization. Not only was the care and patient service impressive, but the collaboration and coordination among the care team was practically seamless. Her internist, cardiologist, thoracic surgeon, and anesthesiologist; nursing teams in the med-surg, ICU and SICU units; physical and speech therapists; dietitian; and social worker for discharge planning were all working in synch across her episode of care and had access to her clinical information across the care continuum (including her previous problem list and meds and allergies from her internist that practices at the medical group). Mom also accesses her regular lab results from home (and now the rehab facility) through the health system’s patient portal.

My key observation was the impact of what we do as healthcare IT and operations improvement professionals. The hospital that cared for my mom has long been recognized as a leader in the use of information technology to support care delivery, operational, and financial management processes. They had a paperless business office in the early 80s; standardized the nursing documentation process across their four acute care sites in the 90s; and obtained 90%+ CPOE adoption almost 10 years ago.

During the inpatient stay, I didn’t see any paper. Everything was documented in the system – nursing notes, MD notes, anesthesia and OR record, legal documents, ICU monitoring device results, etc. But more than the IT aspects, I noticed a very streamlined and coordinated care process that was centered on the patient. Patient safety and service was the driver behind the outstanding use of the top-of-the-line technology. Always confirming the patient’s name, medication bar coding that ensured the right meds, doses were delivered to mom at the right time (she really hated being woken up at night or at 7 a.m.)

Mom was transferred there from the hospital down the street (it’s where the ambulance took her). She never felt comfortable and safe at the first hospital. Her doctor didn’t practice there. They didn’t explain what was going on. They didn’t have access to her past clinical history. The caregivers weren’t coordinated. Patient safety was in question (a nurse came in with meds for another patient). The facility wasn’t as nice, and the food was not nearly as good. However, they used the same EMR.

It’s not about systems. It’s about leadership, accountability, and the care delivery process. The contrast between the two hospitals was a case study. This overall experience drove home the significance of what we do. Whatever your specialty is or your role within your organization, it’s essential to never forget our true mission – improving healthcare.

Dan Herman is founder and managing principal of Aspen Advisors.

News 6/6/12

Top News

An article in The Economist covers the programming that powers medical devices such as smart IV pumps and pacemakers, proprietary systems that the FDA has the power to examine but rarely does even though the programming can be sloppy, error-filled, or vulnerable to hacking. Penn researchers are working with the FDA on an open source alternative that would bypass uncooperative manufacturers, hoping to prevent more bugs and turn fixes around more quickly. Similar projects at other universities address open source CT and PET machines and surgical robots. The article also mentions $10 million NIH-funded The Medical Device Plug-and-Play Interoperability Program and the more ambitious Medical Device Co-Ordination Framework of Kansas State University, which is developing a core set of downloadable, open source apps that could be pieced together to create medical devices.

Reader Comments

From Defiant: “Re: the University of Missouri billing fraud story. The dean of the med school is also the former chair of the Department of Radiology. He was the key influencer in having the Cerner RadNet application uninstalled six months after installation some six years ago. The Feds would be wise to plan an extended stay at this place.” Unverified. The health system announced that Dean Robert Churchill MD will retire after news of the federal investigation broke.

From Who CaresFX: “Re: Carefx. Looks like Chairman and CEO Andy Hurd has left for greener pastures. I heard they were doing a RIF, but the CEO? His profile has been removed from the site.” He has indeed been expunged from the site, but that’s because he left to become CEO of Epocrates in March. Harris bought the 250-employee Carefx just over a year ago for $155 million, expressing interest in its interoperability business .

Acquisitions, Funding, Business, and Stock

Awarepoint raises $14 million in funding, including the first investment of the Heritage Healthcare Innovation Fund, which is backed by several health systems and vendors.

Data analytics vendor MedAssurant changes its name to Inovalon.

Sales

Winter Haven Hospital (FL) will implement Amcom Mobile Connect for encrypted smart phone communications.

The VA awards Harris Corporation a two-year, $19 million contract to create a wireless network infrastructure for 26 medical centers.

People

Physician learning network QuantiaMD appoints Beth Israel Deaconess Medical Center CIO John Halamka, MD to its board.

Harry R. Jacobson MD, former vice chancellor for health affairs at Vanderbilt University Medical Center, joins ICA’s board.

M*Modal hires Jonathan A. Handler MD (Microsoft, MedStar Health) as the company’s first CMIO.

WebMD names former Pfizer executive Cavan M. Redmond CEO and a member of the company’s board. He replaces Wayne Gattinella, who resigned in January following a failed attempt to sell the company.

RF Technologies hires Ken Sandifer (GE Healthcare) as SVP of service and operations.

Anthelio Chairman and CEO Richard Garnick resigns in what the company describes as “an amiable and mutually agreed upon process.” Chief strategy and innovation officer Rick Kneipper will serve as interim CEO until a permanent CEO is hired.

Medsphere Systems names Lily S. Chang (Advent Software) as CTO.

Shareable Ink names Keith Slater (Henry Schein Medical) as VP of client services.

Mediware SVP/COO John Damgaard resigns effective September 7, when he will join an unnamed private company as president.

Halfpenny Technologies appoints Brian Muck (Vitera) as EVP of sales and marketing.

Plastic surgeon Howard Krein MD PhD, Organized Wisdom’s CMO, makes non-HIT headlines for his marriage last weekend to Ashley Biden, daughter of VP Joe Biden. I loved his unofficial bio, published in an independent Jewish newsletter:

Dr. Krein, 45, is quite the catch. He is double board certified in otolaryngology and plastic surgery and has a PhD in cell and developmental biology. He is an assistant professor at Thomas Jefferson University as well as maintaining a busy medical practice. Krein, who is a Cherry Hill, N.J. native, also serves as chief medical officer of Organized Wisdom, a company founded by his brother to provide digital solutions to medical professionals. Most importantly, he is a mensch.

A 21-year old Chicago man becomes the youngest student ever awarded an MD (as well as a PhD in molecular genetics and cell biology) by the University of Chicago. Sho Yano began reading at age 2, was writing and composing music at age 3, and earned his undergraduate degree from Loyola at 12. He’ll begin his residency in pediatric neurology. When I was 21, my biggest accomplishment was winning the Quarters tournament in my dorm. 

Announcements and Implementations

The DoD extends Authorization to Operate certification to Mediware, paving the way for the implementation of Mediware’s HCLL Transfusion software to 68 MHS sites worldwide.

PDR Network announces that 18 EHR vendors have signed agreements to deliver its drug and safety information to their users.

Release of information vendor MRO Corp. announces availability of its patient portal solution, ROI Online.

Government and Politics

CMS reports that Medicare and Medicaid EHR programs have paid hospitals and EPs over $5 billion in incentives through the end of April.

ONC extends the public comment period for the Nationwide Health Information Network Condition – Conditions for Trusted Exchange until June 29.

Even CEOs and politicians wish they were rock stars, and you can see why given Jon Bon Jovi’s draw with the ladies at Tuesday’s opening sessions of the sold-out Health Datapalooza in DC (the photo is from the IOM.) The live streaming was of really good quality, so I watched Todd Park speak for a short time before I had to get back to work. HHS Secretary Kathleen Sebelius will speak Wednesday morning, with former Senate Majority Bill Frist later in the morning and other speakers and demos in between.

Innovation and Research

Children’s Healthcare of Atlanta and Georgia Tech form a $20 million research partnership that will develop pediatric technologies, including medical devices and healthcare software.

Technology

Matt Grob, senior director of enterprise IT planning at The Mount Sinai Medical Center (NY), says he was inspired by recent HIStalk and HIStalk Mobile articles on pagers to write this mHIMSS blog posting that works in a mention of Caddyshack’s Dr. Beeper and the drug dealer/doctor pager connection in adjacent paragraphs.  

Other

The Consumer Federation of America says CSC’s Colossus evaluation software, used by insurance companies to classify bodily injuries in auto and homeowner insurance claims, intentionally downgrades injuries and saves the insurers 20% over the evaluation of human adjusters. The group claims the software can be used with other applications that reduce “usual and customary” medical costs. The above description is from CSC’s site.

The company that operates Walmart’s retail medical clinics is piloting in-store telemedicine-based video consultations.

Consumer Reports will publish ratings of Massachusetts physicians  in copies of next month’s issue that are distributed to that state.

In Greece, the diabetes association claims that diabetics are at risk because pharmacists have cut off credit to the country’s largest healthcare fund, which owes them $670 million. The health ministry says it can’t pay its debts without more bailouts, leaving patients without the 75% medication subsidy it provides.

A Norwegian foreign exchange student rushed to a California hospital after a rattlesnake bite is billed $144,000, almost all of that the cost of antivenin. The patient, who notes that the same services would be free in Norway, expects insurance to cover most of the costs. Yesterday I opened a bill for recent medical expenses and nearly cried reading the astronomical amount due in the “patient responsible” column. Not to get political, but what do the uninsured and un/underemployed do?   

Weird News Andy finds this story to be a mash-up of recent HIStalk ones involving heroic Army nurses and surgeons removing explosives from patients. A helicopter crew of four New Mexico National Guardsmen volunteers to medevac 20-year-old Marine Lance Corporal Winder Perez from the site of a Taliban attack in Afghanistan despite the presence of a live, foot-long rocket-propelled grenade lodged in his leg. They work on the patient in flight, exposing themselves not only to the possibility that the RPG would explode in their faces, but also that it might ignite the helicopter’s 300-gallon jet fuel tank just 18 inches away. They bring their patient safely to a field hospital 65 miles away, where a Navy lieutenant commander nurse and an Army staff sergeant, wearing full combat gear and flak jackets, remove the explosive so the medical teams can get to work. The patient is recovering at Walter Reed. As WNA says, “May God bless these brave people.”

Bizarre: a 31-year-old police officer dies during a sex threesome that doesn’t include his wife. His family sues the cardiologist he had seen the week before for chest pain for medical malpractice, claiming the doctor didn’t advise the man to avoid physical activity. His stress test appointment had been scheduled for the day after he died. The jury awards the family $3 million.

Sponsor Updates

• nVoq will exhibit at the 11th International Congress on Nursing Informatics this month in Montreal.
• DIVURGENT employees raise $5,000 for Miami Children’s Hospital Miracle Network.
• EMC presents World Wide Technology with its Velocity National Partner of the Year Award.
• Macadamian Technologies’ Matt Hately, VP of product Strategy and innovation, will participate in a panel discussion on mHealth opportunities during next month’s 9th Annual Healthcare Unbound Conference in San Francisco.
• Billian’s HealthDATA presents EHR saturation by physician specialty based on CMS’ latest attestation reports.
• PROFIT Magazine names NexJ Systems Canada’s fastest-growing company.
• Christi Clinic (IL) selects eClinicalWorks EHR solution suite for its 150 providers.
• The Advisory Board Company highlights best practices and new technology supporting ACOs at this week’s Health Datapalooza in Washington, DC.
• An Allscripts-sponsored study finds that C-level executives have an positive attitude about value-based purchasing and its impending takeover of traditional fee-for-service reimbursement.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Curbside Consult with Dr. Jayne 6/4/12

Being an anonymous blogger, I never know when an idea is going to drop into my virtual lap. When I’m not in the healthcare IT trenches, I like to embrace certain summer pastimes – drinking mint juleps on the porch, gardening, and making the occasional trip to see some minor league baseball.

I was seated behind first base enjoying some Cracker Jack when the conversation turned to healthcare IT. A particularly tech-savvy friend of mine was talking about iPad apps. Knowing I’m a physician, he mentioned that his old college buddy recently showed him an electronic health record app that he’d been working on.

Turns out Joe College works for a major HIT vendor. My curiosity got the best of me. I asked my friend what he thought of the app. This was his response:

Well, he kept trying to show me a bunch of features that weren’t coded yet. It looked like something that was designed by an IT guy who may have talked to a doctor once and really didn’t have any idea how to do a good user interface.

Knowing the vendor in question, I’m not sure if I should be surprised or not. I didn’t have details on whether the app was for hospital or ambulatory scenarios so I don’t have a lot to go on, but it got me thinking about the role of physicians in software design.

Working for a major health system I’ve been exposed to many vendors. There is significant variation in whether they have physicians on staff, let alone physicians who participate in the design process. Some are very open about the docs on their teams and will connect clients with them for doc to doc conversations. I’ve found those valuable, especially when implementing new software and those “what were they thinking” questions arise from end users.

Others rarely mention whether they have physicians on staff. If you push them they may trot out one of a variety of archetypes:

• The physician who hasn’t practiced in decades but is great with software
• The physician who is a highly-trained informaticist but doesn’t understand office practice
• The physician who really knows what he or she is doing, but is far too busy to interact with clients.

After talking to a couple of my CMIO buddies, I think it’s time to have a little industry conversation about the role of physicians in design and usability testing.

Much like when Mr. H poses “state of the industry” questions to the leaders of the vendor space, I’m giving an opportunity for companies to speak up about how they use physicians and other clinical experts in design, implementation, and support. Here’s the hitch though – I’m not going to come begging for information.

This opportunity is for companies with staff that are loyal HIStalk readers. Let me know how your organization leverages licensed providers and at which stages of the game. I’ll feature the responses in an upcoming Curbside Consult. Priority placement will be given to companies with witty submissions. Extra credit will be awarded for photos of your physician team in action.

Got docs? E-mail me.

E-mail Dr. Jayne.

EHR Design Talk with Dr. Rick 6/4/12

Special Edition: The ONC/NIST Workshop on Creating Usable EHRs — Part 1

On May 22, ONC and the National Institute of Standards and Technology (NIST) jointly sponsored a workshop in Gaithersburg, Maryland on Creating Usable EHRs: A User-Centered Design Best Practices Workshop.

If any major vendor CEOs had attended, I think they would have come away with the mission to make EHR usability, defined broadly, a top priority of their organization.

In his opening remarks, Farzad Mostashari, National Coordinator for Health Information Technology, noted that when talking with clinicians across the country, the number one issue he hears is that their EHR is unusable, that "the system is driving me nuts."

Broadly speaking, EHR usability is about suiting EHR design to human requirements and abilities, not the other way around. I’ll start by giving three examples.

Example #1

Pediatric cardiologist David Brick presented an error-prone EHR design that could lead to a catastrophic result in a safety critical environment, a neonatal ICU. In the medication module of the EHR, the column containing the names of the medications is too narrow, presumably to conserve screen space. Consequently, the names of medications are truncated. In the example below, the truncated forms of the medications amiodarone and amlodipine are visually similar.

Administering amlodipine to a neonate when amiodarone was intended is an error with potentially fatal consequences. One can see how a neonatologist might confuse the two, especially in a high-stress clinical setting.

Example #2

As part of his talk, Bentzi Karsh, Professor of Industrial and Systems Engineering at the University of Wisconsin-Madison, conducted an audience-participation experiment by presenting the same data set in two different formats. (The 2 figures that follow are printed with permission from Sue M Bosley, PharmD, CPPS.) Our task was to determine as quickly as possible how many of the lab values were outside the normal range for the patient below. Try it:

In the view above, it took us anywhere between 15 and 45 seconds to determine the number of out-of-range labs and 20% of us came up with the wrong number. Furthermore, we were so focused on the task at hand that not one of the 150 of us noticed that the patient was a dog.

Then the same data was presented in a format better optimized for visual processing:

Using the visual display of the same information, we all identified the out-of-range lab value in less than 3 seconds and there were no errors.

Example #3

The third example comes not from a presentation, but from a conversation over lunch with fellow attendees of the workshop. Jared Sinclair, an R.N. and developer of iOS applications for bedside nursing, was telling us about a widely-used workaround that hospital-based nurses have devised to deal with an EHR design problem.

One of the major tasks of hospital-based nurses is to make sure that each patient assigned to them gets the right medications at the right time of day. The EHR medication screen view that nurses see is called a Medication Administration Record (MAR). It serves both as a schedule for administration and as a tool to document whether and when medications were actually given. Jared was kind enough to create the MAR mock-ups below (shown as an overview and then a zoomed-in view) based on the design of several widely-used EHRs:

What nurses need for each patient, however, is a portable list of medications organized by the time of day those medications should be administered. Because most EHRs don’t provide this alternate view of the data, at the beginning of every shift nurses create their own paper-based lists (see example below):

***

Each of the three examples above represents a disparate aspect of EHR usability. The fact that they are so different helps explain why designing usable EHRs is so difficult.

Further complicating the discussion is the fact that usability can be defined in a number of ways. If usability is narrowly defined, it can focus on the kinds of issues in example #1 to the exclusion of the kinds of issues in examples #2 and #3, which in fact may represent greater risks to patient safety.

The three examples above just scratch the surface of the EHR usability problem. To better understand these issues, I recommend a superb viewpoint paper in JAMIA discussing EHR usability and related issues. The two lead authors, Bentzi Karsh and Matt Weinger,  spoke at the workshop. Their points are easy to follow. In my opinion, their paper should be required reading for vendors, administrators, and clinicians alike.

Broadly speaking, the field of usability can be divided into two parts:

• User-Centered Design (UCD), which deals with the design process, and
• Summative Usability Testing, which evaluates and validates designs toward the end of the design process.

While these two components can be seen as parts of a continuum, in practice it is helpful to separate them.

I was glad to see that the ONC/NIST workshop focused on User-Centered Design – the process of creating usable EHRs – as opposed to focusing narrowly on testing protocols. Of more consequence, in its March 2012 Notice of Proposed Rule Making (pp. 13842-3), ONC states that a significant first step toward improving overall usability is to focus on the process of UCD (as opposed to mandating formal summative testing).

For me, there are two major questions:

1) What exactly is User-Centered Design (UCD)?

2) What role, if any, should ONC play in regard to UCD and EHR usability?

I look forward to sharing my thoughts on these issues in my next post.

Rick Weinhaus MD practices clinical ophthalmology in the Boston area. He trained at Harvard Medical School, The Massachusetts Eye and Ear Infirmary, and the Neuroscience Unit of the Schepens Eye Research Institute. He writes on how to design simple, powerful, elegant user interfaces for electronic health records (EHRs) by applying our understanding of human perception and cognition. He welcomes your comments and thoughts on this post and on EHR usability issues. E-mail Dr. Rick.

Monday Morning Update 6/4/12

From Roger Collins: “Re: JAMIA article on dictating into the EMR. The authors measured ‘quality of care’ by looking at discrete quality measures in the EMR. By definition, clinicians who dictate their documentation aren’t using templates and would not have double-documented by checking off boxes. The study didn’t look at the transcribed dictation notes, so they had no way to know whether those clinicians even met the quality metrics, much less that they provided lower-quality care.” It appeared to me that the study looked only at whether the documentation was complete (tobacco use recorded, blood pressure taken, etc.) rather than patient outcomes, so I was suspicious about its conclusion that “physicians who dictated their notes appeared to have a worse quality of care than physicians who used structured EHR documentation.” But it does raise an interesting question: if we agree that transcribed dictation provides a richer narrative, then in our fanaticism to distill every encounter into a set of predefined checkboxes that will be used to measure quality, determine payment, and drive Meaningful Use payments, how are those checkboxes going to be populated without losing their original context? We’re reaching an electronic decision point: as a clinician, would you rather assess a patient based on the verbatim thoughts of your peers or a bunch of lists and graphs? And if the answer is that we need both, how do we make that happen? Your comments are welcome.

From CT Scan Moneyball: “Re: healthcare price disparities. One way to fix this is a fixed fee schedule like they have in Japan as described in this article, but it probably can’t happen here in our poisonous political climate. A bonus is controlling cost – Japan’s spending on health went from 7.7% to 8.5% of the gross domestic product over eight years, compared to an increase from 13.7% to 16.4% in the US.” 

From SmallTown CIO: “Re: MUSE 2012. The crew from MUSE have done a great job again with a well-organized conference. As a long-time attendee, it is a little strange seeing a younger crowd – some of the usual suspects I haven’t run into. However, at the same time it is great to see the up-and-comers that will keep MUSE and Meditech strong. The vendor exhibits have been good with some new faces. Forward Advantage, Iatric, and Dimensional Insight are among a few that have a bigger presence. Forward Advantage held a great party at House of Blues – definitely an extracurricular event highlight. The thing I appreciate more than anything at MUSE is the vendor exhibits aren’t ostentatious, which fits very well with the customer base of Meditech (we are all driven by cost effectiveness). It is great to see Meditech have a presence at the conference in terms of presentations. My hope is that next year they have a presence in the vendor exhibit area as well, where we can catch up on the latest software changes. All in all, it has been a good conference and I tip my hat to Alan Sherbinin and crew – nice job!" Thanks for the report.

From THB: “Re: Epic. Going down the path toward NHS implementation – they’ve posted a job to help prepare their product for the UK. Anyone know where I can find workflow documents for NHS hospitals?” I found the listing above. People thought Epic was kidding when they talked about world domination. They weren’t.

From Cyber Spy: “Re: hacking. Medical IT is highly vulnerable.” This article covers the development of Zero Day exploits. A former NSA hacker shows how randomly changing file data at the byte level will eventually cause a system to crash, and once that happens, he can often figure out why to discover a previously undocumented exploit. It mentions the secret Stuxnet cyberattack on an Iran (the White House financially admitted last week that it was a US-Israel creation and it got out of control) and that the Pentagon now considers cyberspace to be a theater of war. I seem to remember that at least one UK hospital was hit by a Stuxnet-caused outage, so if so, that means the US government may have caused patient harm in England.

From No Bull: “Re: sex in the road. Doctors could not get to their patients. Thank heavens for mobile medical devices.” A busy highway in Pennsylvania is closed for hours due to a bull-and-cow hookup, or as one state trooper described the scene, “They’re having relations in the road.”

From Wheeler and Dealer: “Re: deals between Congress and pharma. There other others between Congress, HIMSS, and IT vendors.” The House Energy and Commerce Oversight and Investigations Subcommittee (made up of 14 Republicans and nine Democrats by my count) reports on what it calls Closed-Door Obamacare Negotiations. It says the White House struck a PPACA deal with the Pharmaceutical Research and Manufacturers of America, committing to protect the drug companies from price controls, government-run prescription insurance, and new drug importation policies in return for $80 billion in payment cuts. The deal came together quickly when the Obama administration was getting beat up over PPACA the week of June 18, 2009, and was desperate to announce something positive before the Sunday political talk shows. I actually read this as pro-Obama: he told the drug companies that if they didn’t play, he was going to call them out as foot-dragging and hit their profits via mandatory rebates and the elimination of tax-deductible direct-to-consumer advertising. The gist of the findings is that Obama conducted closed-door meetings with drug companies after being critical of such practices as a candidate.

From The PACS Designer: “Re: World IPv6 Day. This coming Wednesday, we’ll see the launch of the next Internet upgrade to IPv6, promoted as World IPv6 Day. The upgrade has become necessary since the supply of available IPv4 addresses has been exhausted. The challenge for IT departments will be testing IPv6 on all browsers and servers for compatibility with existing applications and security issues.” You can follow along on Twitter.

Listening: Fitz and the Tantrums, LA indie kids who sound eerily like a really good 1965 Detroit soul band, right down to the growling organ. They are amazing in this live video, especially the female lead singer, and were the subject of an episode of the excellent Live from Daryl’s House, where they did a better-than-the-original cover of “Sara Smiles.” On tour now, appearing in Houston, Birmingham, Greenville, Manchester, Charleston, and Raleigh this week.

Being blessed as I am with heightened perception of the obvious, I believe I see some agreement (95%) that hospitals should be able to provide a bill that the average patient can understand. New poll to your right: does the average hospital CIO encourage innovation or stifle it?

HMS customers meeting last week at its Nashville office: Millie Schinn (Hamilton General), Diane Sherrill (Medical Arts), Rob Malone (Houston Orthopedic), HMS Chief Medical Officer Frank Newlands, Cindy Jandreau (Northern Maine), and Angie Waller (McDonough).

The weekly employee e-mail from Kaiser Permanente CEO George Halvorson says KP has once again mined its HealthConnect database to discover a new treatment, as reported in the journal Neurology. In reviewing the records of nearly 13,000 ischemic stroke patients spanning seven years, it found that starting cholesterol-reducing statin drugs as soon as possible cuts the death rate by nearly half and raises the chances of the patient going home instead of to a nursing home by 20%. And if the patient was already taking statins at the time of their stroke, simply continuing the drug during their hospitalization dropped the death rate to 5% (if the drug was stopped, deaths jumped to 23%). As George concludes, “We are the only people in healthcare who have done that analysis. Our stroke researchers have done truly great work. This finding has the potential to save many lives. Every stroke treatment program on the planet Earth can and should either start to give or continue to give cholesterol-lowering statins to their stroke patients.” KP has already changed its stroke order sets to start statins on Day 1 as the default.

In less-cheery Kaiser news, its Oakland hospital gets hit with a $75K Department of Health fine for a 2010 incident in which nurses ignored a telemetry patient’s tachycardia alarms, including warnings that the alarm itself was about to shut down due to a low battery. The patient was found unresponsive and was resuscitated, but died afterward. The nurse says he didn’t call the doctor as instructed for the tachycardia because the patient seemed OK, and ignored the low battery warnings because he was too busy.

I curse the name McAfee regularly when Scan32 and MCShield suck the life out of my hospital laptop, especially during the once-weekly antivirus scan that assures a solid several hours of hourglass when I’m trying to work. Now I can humanize that annoyance with this story of founder John McAfee, who at 66 is living on the run in the jungle. Forty-plus police officers in Belize (specifically the Gang Suppression Unit) raid his guarded estate, kill his dog, and rouse him from the bed he is sharing with his 17-year-old girlfriend, charging him with running an illegal antibiotics factory and possessing unregistered weapons. He claims he declined to bribe a local official and the drug companies don’t want competition from the topical antiseptic and female Viagra that he’s developing, so they hired the police as muscle to claim he was operating a meth lab. A fascinating 2010 profile is here – the man’s clearly both a genius and a total wack job. I think we can agree that he looks great for 66, although perving around with a 17-year-old might be a bit much even in a country where it’s legal at 16. 

In the UK, Brighton and Sussex University Hospitals NHS Trust is fined $500,000 when hard drives containing the medical information of patients were sold on eBay. The hospital is upset about the size of the fine, says it can’t afford to pay it, and is appealing. It hired a subcontractor to erase 1,000 hard drives, but he listed 250 of them on eBay without the hospital’s knowledge.

This could be a hint of things to come (or a 1990s flashback). Three fired HCA doctors in Florida publicly criticize the chain for hiring huge waves of physicians to prepare for an ACO environment, then dumping those whose practices were not profitable. They also say the company doesn’t have the infrastructure to support the practices it’s buying. One doctor who left said that HCA was sloppy in controlling costs, paying multiples of what he paid in private practice for everything from business cards to transcription services. My experience is similar: hospitals in general are inefficient, bureaucratic, loaded with VPs of inconsistent talent and motivation, and the worst possible partner for a small business. I’ve sat in those meetings when docs complained and once they were gone, we mostly talked about how to marginalize them. Some physicians are fine with working for a huge corporation under their rules (like academic medical center docs), but the free spirit types hate every minute of it. Like any other business, entrepreneurs enjoy selling their businesses to big companies for a big one-time payday, but don’t usually last long with them as employees afterward.

New Hanover Regional Medical Center (NC) was set to go live Saturday with Epic. Their cost was given as $56 million.

The University of Missouri School of Medicine fires two radiologists and announces that its dean will retire following the announcement that the health system is the subject of a federal Medicare fraud investigation. The school says it believes that the radiologists, one of whom was the chair of the department of radiology at the time, billed for work performed by medical residents without reviewing their work. The MU radiology department says it will modify its software to prevent future occurrences and says it will pay for having the images of any concerned patients re-read, either by the health system or by an outside radiologist of the patient’s choosing.

I’d like to see Vince’s HIS-tory series continue. I know the best way to make that happen: send him fun anecdotes, old articles, or “where are they now” updates that will get him enthused to keep it going. He’s specifically looking for anyone who can facilitate connections to the folks who started companies back in the 1970s and 1980s so he can get their first-person stories, which would be very cool.

A Texas urologist and his practice manager wife are charged with healthcare fraud, with federal prosecutors saying the doctor submitted at least $1.5 million in fraudulent benefit claims since 2003. His claims indicated that he treated as many as 117 patients in a single day, sometimes billed for more hours than exist in a day, and billed for services provided by office personnel while he was traveling in Iran. The couple was indicted in 2010 for funneling $1.8 million to Iran for investments claimed to be charitable contributions, using a charity run by their daughter.

The Lexington, KY newspaper covers a non-profit mental health board whose for-profit subsidiary, run by the board’s retired CEO, sells scheduling, billing, and payroll software to other state-funded regional boards. It also notes that the retired CEO is married to the current CEO and continues to be paid as a consultant, while their son-in-law is the organization’s IT director.

Weird News Andy says the bomb squad and ED “cheated Darwin” again by removing unexploded fireworks from a man’s chest. He was apparently setting off illegal fireworks from a hand-held mortar to celebrate Memorial Day when “a firework intended for the sky penetrated his chest.” The hospital had to call the bomb squad to remove the pyrotechnic before they could operate. The last reports I saw said the patient is in critical condition with massive chest trauma.

E-mail Mr. H.

Time Capsule: Services-Heavy Vendors: The High-Flying Offense Turned Boring Ground Game

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 June 2007.

Services-Heavy Vendors: The High-Flying Offense Turned Boring Ground Game
By Mr. HIStalk

Enterprise software vendors go through three lifecycle stages:

• Stage 1 – We’re going to develop and sell the greatest software application in our market.
• Stage 2 – The software market is fickle and cutthroat now that new entrants are in play. We’ll keep our product competitive but, in the meantime, we’ll ramp up a highly profitable services business like all those consulting companies that are pulling down easy money.
• Stage 3 – Our legacy software applications are getting killed by Stage 1 competitors, so we’ll just milk the services side and maybe someday develop some new applications if that cash cow ever dries up and the market forces us into it.

If you’re a vendor, what stage is your company in? If you’re a provider, where are your vendors?

It’s important, because in all but Stage 1, there’s not much innovation going on. Once the services money starts rolling in, no one wants to risk it by investing in innovation. The big money is made in Stage 3, where the capital investment is paid off and the gravy train is rolling in.

It’s like the Super Bowl. A team often gets there by fearlessly airing the ball out and running reckless blitzes, beating all comers. Once they’re in the big game, they suddenly drag out a conservative ground game and prevent defense that causes spectators to nod off in their $1,000 seats. Often, they lose.

You see that a lot with publicly traded companies that are scared to death of one bad quarter. Instead of playing to win, they’re playing not to lose.

Conservative customers keep encouraging them. They give Stage 3 companies preference, using the same criteria that a grandmotherly investor looks for: solid financials, a long list of customers (even if they’re largely indifferent ones), and well-groomed executives who talk about vision but mostly worry about financial ratios and earnings reports.

In other words, customers claim to want innovation, but when it comes to their own IT capital, they invest in those companies least likely to innovate. Vendors say they want innovation, too, but they usually just take the easy way out and buy the Stage 1 upstart and smother them with their stifling culture.

A Stage 1 company might offer the best chance of creating a truly brilliant product, but getting a critical mass of customers is hard. The company could run out of capital, lose its visionaries, sell out to a big competitor, or otherwise stumble and never realize its potential. If there’s a 60 percent chance of that vs. a 100 percent chance of a boring but serviceable Stage 3 product, most hospitals will take Door Number 2.

According to KLAS surveys and watercooler discussions, few hospitals really like those multi- million dollar systems they keep buying. Certainly the results they obtain from implementing them are largely unimpressive.

That isn’t surprising if you buy the idea that vendors are all striving for Stage 3, having long outgrown their starry-eyed beginnings. Recurring revenue is the Holy Grail. Software only needs to be good enough to keep the service revenue coming. The one-shot capital bump from licensing is small potatoes in comparison.

The market won’t change unless threatening new companies enter at Stage 1. A constantly replenishing supply of them is needed because they, too, want to hit the Stage 3 Promised Land.

You’ll know if we ever get enough Stage 1 vendors nipping at Stage 3 heels. The Stage 3 powerhouses will suddenly get mad enough to start airing the ball out again. That ought to wake up the bored fans.

HIStalk Interviews Jim Hewitt, CEO, Jardogs

Jim Hewitt is CEO of Jardogs and CIO of Springfield Clinic, both of Springfield, IL.

Give me some background about yourself and the company.

I started in healthcare IT back in 1989 with a startup company named Enterprise Systems out of Bannockburn, Illinois. They were focused on hospital-based systems. Their CEO at the time had this vision that PCs and networks were going to be the future, so we needed to migrate everything off of the mainframe into this client-server environment. I started as a developer there and have been focused on healthcare IT pretty well my entire career.

I did a short stint in the financial space for the Options Clearing Corporation, which was a very unique opportunity to do some work for them. But really, my heartstrings were back in healthcare. I left the OCC and joined Allscripts just as they were starting. I spent about six and a half years with Allscripts as their CIO.

I left there for family reasons and moved to Central Illinois. I got a call from one of the Allscripts’ customers, Springfield Clinic, to ask me to come help them implement their EMR. I decided to do a short-term stint with them to help them do their EMR implementation, which was very successful throughout all of their locations.

At that point in time, I was getting the itch to get back into the vendor side of the world. I decided to start a new company, which was Jardogs. I started that a little bit over three years ago. The clinic had come back and asked me to stay on with them as their CIO and have the clinic incubate Jardogs for us. That brings us to current state. I’m still CIO of Springfield Clinic and I’m also CEO of Jardogs.

Jardogs was founded on my vision that as you look at healthcare as a whole, healthcare IT really started in automation of those back-end systems within the hospital. Over the years, we’ve evolved to be ambulatory focused, where the dawn of the EMRs have come about. As I was looking at that trend as well as where we are nationally in a healthcare state, I truly believed that the next big thing and focus was around patient engagement.

That was the basic premise of starting Jardogs three years ago — to look at the evolution of how to engage the patient as part of this whole healthcare system and how we can add value both to the patient as well as those connected organizations.

Tell me about the name. I don’t think I’ve ever heard where it came from.

It’s a closely-kept secret. It is an acronym, but the mystique is much better than what the actual name means.

We went through a very long and tedious process. It’s almost impossible to find a unique name that isn’t already taken from a domain name standpoint, so we had run a contest three years ago. We asked a bunch of people to submit different names and ideas and then we brought that to our board. Jardogs won without anyone knowing what it actually meant. It won because it stuck out in everyone’s mind. After the name was selected, that’s where the logo and the branding and that fun component of the company came into play.

It’s hard for me to get a grasp of exactly what you do. Is it population health? Is it interoperability? Can you characterize all the things that are out there circling around in your ecosystem and where you fit?

It’s a great question. Honestly, we have hard time putting ourselves into a specific niche because we are a very unique offering into the industry.

The primary system is our FollowMyHealth, which we call a Universal Health Record, which is different from a patient portal or a personal health record. It’s a combination of a multitude of different systems. At its core is that it is a national personal health record, but it has all the attributes of a connected patient portal.

When I was sitting back and looking at personal health records and that concept, it’s very important to our nation that we have central repositories for patients to manage their healthcare. But the downside is if you look at HealthVault, or Google Health at the time, those products did not really add any value to the patient. They were very difficult to manage because they weren’t connected to their healthcare providers. You had to go in and manually update all of your information. I go see the doctor, then I have to go home and remember to key in all that information. 

That’s what’s so great about what they call a tethered patient portal. The patient portal is directly connected to the organization or your provider. The downside with that is it’s not national, and it doesn’t share information with everybody else.

The concept was to come up with a national or local community-based portal where all of your information could be aggregated and managed by that patient. To do that was very complex, because it was really building parts of an HIE, building a tethered patient portal with all the integration into a multitude of different EMR vendors, as well as creating a national infrastructure to share that data like a personal health record. It’s a culmination of all of those things together which creates the Universal Heath Record.

That would be different from something like Epic’s MyChart in that you’re not vendor specific. Is it otherwise similar?

That’s exactly right. Epic is trying to do some things with trying to share that record outside of their organization, but they haven’t built the framework to translate all of their data into a common nomenclature and then allow that to easily flow with patient consent to all other healthcare organizations.

There are some differences. The reason that Epic is at that national level is because they are widespread throughout the United States. We do have customers that are on Epic that actually use the FollowMyHealth system to aggregate data and provide that inside their own entity.

Who buys your product and how do they roll it out?

Our customers are clinics and hospitals throughout the US. The providers or those hospitals will buy a license. They get a customized website. They have all the attributes of a tethered portal — their own branding, their own information — but then that entire system is connected into the national FollowMyHealth infrastructure across the board. It’s free to the patient.

If a hospital has its own practices or affiliated practices, they can connect those electronic medical record systems, whatever they are, to integrate with the product?

There are really two different scenarios. The first scenario is that I’m a large IDN, and I have multiple EMR systems within inside my organization. The main problem that they’re trying to solve in that case is how to provide a single portal across their entire entity. How do I aggregate the data inside my own organization and then provide that through a single portal to my patient population?

In that case, our infrastructure allows us to very easily pull that all together and then drive that into a single portal for the patient. On the flip side, when the patient tries to communicate back to that entity, we can then route that information and integrate it into the appropriate hospital system or EMR on the back side. It provides that one fluid portal to this large complex entity.

In another case, you may have a community in a large city where you have multiple hospitals, clinics, multi-specialty groups, and single-specialty groups that all have different portals, but have come to the realization that patients want to manage their health information in a single location. That’s where we’re seeing multiple entities go into those communities and say, “We need a community-based solution. We’re going to all have separate portals and separate entry points, but we’re going to have one central repository for the patient to manage all that data.” There are multiple storefronts on that single repository.

You’re not just showing the patients stuff from different systems — you’re reposing data and doing something with it in addition to presenting it to them.

That’s correct. We have national master patient index, and one of our key components is translation services. When a patient connects to an individual organization and that organization releases the information to the patient or makes that connection, we translate all that data into a single nomenclature and put it up into that patient’s personal health record or repository. When they connect to another organization, we do the same thing, and we translate it into a common nomenclature and bring that in to the repository. The patient has a single view of their data across those multiple systems.

If they want to share back into those individual organizations, the aggregated sum of the data then comes back down. It can be discretely brought into those EMRs for verification by the healthcare provider.

Will there be capabilities on the provider side to do public health or surveillance or anything like that with the data that didn’t necessarily come from their own system?

Sure. We bring it back in to their systems, so then they have the capability if their systems support it. The first phase for us is building that national infrastructure and connecting patients with the physicians. For me, that was Phase I.

But if you look at trying to solve the overall healthcare issues that we have today, we know that we have to engage the patient. We know that we have to be proactive within our healthcare. Once we have this conduit in place, how can we leverage that to actually engage the patient and become proactive? That’s where population management, monitoring compliance, home health and wellness components layer on top of that to provide that true engagement at home.

The three product lines that we’re working on right now that sit on top of that infrastructure are exactly those. We have a population management component, we have a monitoring and compliance component, and then we have a home health and wellness component. Each one can live individually, but the entire suite together is what rounds out our whole patient engagement solution.

HITECH grant money is funding development of HIEs. How does your offering fit into the situation where somebody is already getting HIE money? What are they not doing that they could do if they had your product?

I’m on the board of Lincoln Land HIE here in Central Illinois, so I understand the HIE. I know what they’re trying to do. The way that I break it up is that current HIEs today are more focused on B2B transactions. You’re going to have data moving from organization to organization without the patient being involved.

That’s great. I love the concept of standardized interfacing for orders, results, documents across a large area, even potentially across multiple states. That’s much better for healthcare. The struggle is, how do you use those systems to engage the patient? They do provide value to the physician side, but I don’t see that patient engagement component.

What some of the HIEs are gearing up to do is to try to create a central repository and then do population management on that central repository, but organizations are really struggling with data ownership and competitive issues. If there’s five primary care physician groups all using that same repository trying to do population management, is the patient going to get five notices on some health maintenance reminder from five different people? That’s where the struggle is from an HIE perspective. 

Where we’re a little different is that the data is managed by the patient and released by the patient. The patient decides, “I want this organization to be my primary care manager of that information,” and that’s where it’s going to flow and be managed.

So they’re not specifying data element by data element, saying, “This is OK to release. This isn’t.”

Right. There’s two different levels of release we’re building. The first level is based on request.  The healthcare organization, based on an appointment reminder, will request information. What is being built with these new solutions is that the patient can set up a real-time flow of information back to an individual organization. That’s where that organization is going to get a lot more value, because all that information can flow real time to them.

Other than seeing their own data and controlling who else can see it, what patient engagement tools are possible?

From the Universal Health Record standpoint, all of the standard stuff that you get from a tethered portal. You can pay your bill online, prescription renewals, lab results, health maintenance reminders, online consults, either direct scheduling in or requesting a schedule appointment. I’m sure I’m probably missing something, but all of those basic features that you get from a tethered portal.

Other features you get are forms, but also sharing that information across different organizations. We also have a mobility suite for them, so if they are travelling, they can either fax or e-mail their health information directly from their phone. If I’m in Florida and my kid gets sick or I’m sick, I can provide that information directly to them if they’re not a FollowMyHealth user already. We have proxy support, so I can manage my parents’ health information if they give me access. There’s a lot of features I’m just managing and reviewing my information.

The other big thing that we see within our customer base is that most of them are doing a full release of information. They’re releasing all chart notes and scanned documents. You’re really getting a full release of information as opposed to just problems, allergies, meds, immunizations, and results. Our system is delivering a lot more tangible information to the patient.

A physician can set up a monitoring and compliance program and order that through the EMR system. That will monitor and notify care teams if a patient isn’t being compliant or if a data range became out of range. We can be very proactive in saying that we want you to either go through the patient portal and enter this information, or we want you to take one of these connected devices at home and we want you to take your blood pressure every day or whenever it may be. If you fall out of compliance, the system will automatically notify care team, nurse, physician … however you want that to be configured. Because of that connectivity, we have the ability to do some pretty cool things.

The trend everywhere, but especially on the interoperability side, is to open up the platform and let other folks build apps to sit on top of it and add value.

We’ve already done that. We provide a software development kit. Organizations, either our customers or non-customers, can come in and build applets that snap directly into the FollowMyHealth infrastructure. We provide that for free. There’s no fees for that. We believe in complete open systems and allow the consumer to choose. We are very, very open. We also have a very open standard on all of our interfacing into different systems. We’re trying to be as easy as possible to use.

People have shied away from the term “personal health record” since Google Health left a stench over it. What did you learn from the failure of Google Health?

There were really two issues. One was concern about privacy of data. Number Two was adding value to the end users. The Google Health mindset was to have the consumer or the patient come in, create an account on their own, and then manage it. If their organization someday decided to be a Google Health user, you might get some data to flow.

We’re taking a completely different approach. We are engaging the healthcare organization upfront, having them engage the patients to connect, and then providing real value in that connection. They get their data immediately. They have the ability to request appointments. They can get prescriptions refilled or renewed. They can go through that entire process and have real data right there upfront.

I’m really concerned about HealthVault as well. They take the same approach of, “Let’s have consumers come to us, create that record, and then hopefully connect someday.”

Any concluding thoughts?

We have to figure out ways to engage the patient. Not only sick patients, but healthy patients as well. We need to move to a model where the patient is engaged, the patient cares about their health, and they are being compliant. The focus need to be on how we can do that effectively. How can we create engaging tools that will allow our patient populations to help us manage their health?

That’s the true way we’re going to get cost out of healthcare. Whatever system it may be, we need to figure that out and make sure that we are engaging those populations.

Allscripts Caves to Proxy Fight, Nominates HealthCor’s Board Candidates

Allscripts announced this morning that it will nominate a three-member board slate to settle a lawsuit and proxy fight brought by key shareholder HealthCor Partners. HealthCor previously called publicly for the replacement of Allscripts CEO Glen Tullman, sued the company over its plan to nominate its own candidates to replace four board members who quit in April in a management dispute, and had obtained an expedited review of its arguments in a hearing that was scheduled for June 14, the day before the Allscripts shareholder meeting.

The director nominees are:

• Stuart Bascomb, founder of Express Scripts and chairman and CEO of QualSight, which offers managed care refractive surgery
• David Stevens, former chairman and CEO of specialty pharmacy vendor Accredo Health Group
• Randy Thurman, founder of Viasys Healthcare and former CEO of Corning Life Sciences and Rhone-Poulenc Pharmaceuticals

Tullman said in the announcement, “We welcome the addition of Stuart, David, and Randy and believe they will bring new perspectives and additional industry experience to our board. Taken together with the recent additions of Paul Black and Robert Cindrich, the Company will have added five, high-quality, independent directors in just the past few weeks. We believe this is a positive outcome for Allscripts and its stockholders and we look forward to working collaboratively as we continue to implement our strategic initiatives and make the important and necessary investments to deliver a connected community of health for our clients and build value for all of our stockholders.”

HealthCor co-founder Arthur Cohen said, “We are pleased to have reached this amicable resolution with Allscripts, which we believe will serve the best interests of all stockholders. We continue to believe that Allscripts has great products, strong capabilities and a unique installed base of customers. Furthermore, we are confident that Stuart, David, and Randy will make strong additions to the Board, and will work hard to represent all stockholders and assist the Company in seizing the tremendous market opportunity before it.”

News 6/1/12

Top News

A study finds that physician practices using EMRs did no better (in fact, did a bit worse) in delivering diabetes care. It wasn’t a very large study, it was narrowly focused, it didn’t take into account such important variables as insurance or patient demographics, quality of EMR use wasn’t considered (the survey just asked whether the practice “owned” an EMR), and it used old data (the baseline assessment was from 2004 and the follow-up was in 2006.) I don’t take it to mean much, to be honest, but I’m sure it will be widely (mis)quoted with headlines that don’t reflect the data. The full text article is here.

Reader Comments

From Master of Tweets: “Re: Aneesh Chopra tweet chat sponsored by HIMSS and the magazine they publish. He mentioned HIStalk, but their magazine removed that from their transcript.” Above is the former US CTO’s answer when asked what he reads to stay current on health IT trends, That tweet does indeed not appear in the magazine’s transcript (which means it’s not really a transcript since they edited stuff out.) My favorite question he was asked: "Many ‘experts’ in health IT have never used let alone implemented an EHR – how do we get stories of success out?" I’ve learned to tolerate the writing and tweeting of HIT-naïve reporters, academics, etc. when they stick to repackaging the news, but I don’t recognize their credentials to be armchair quarterbacking to CIOs, doctors, government folks, or vendors. You need street cred like Inga when she threw down by fearlessly by asking Farzad Mostashari, “When was the last time you used an EHR?” with both her question and his answer (after his initial shock) raising their respective levels of professional credibility.

From Maxwell Smarts MD: “Re: Cerner. Their silence is deafening giving their central role in the HealthSMART program, now declared a total failure.” The Victoria, Australia government finally puts HealthSMART out of its misery due to the ubiquitous dynamic duo of cost overruns and implementation delays. I’ve been reporting regularly on HealthSMART, launched in 2006 with an estimated cost of $318 million, but now dead after blowing through $557 million with only 40% of the sites live several years after the expected completion date. Millennium was the key component and Cerner struggled to localize it according to critics there, but the government apparently also contributed its expected share of incompetence. Maybe there’s a shining example out there somewhere of government bureaucrats and politicians hunkering down in the mud with big contractors and Wall Street-driven vendors to deliver a successful IT project on time and on budget, but I can’t think of even one.

From Killjoy: “Re: Harris Corporation. Looks like they are purging many of the CareFx positions after their acquisition last year. I heard 40 or so were let go Wednesday.” Unverified.

From Secretive: “Re: Accretive Health. Its SVP apologizes while being grilled by Sen. Al Franken’s committee.” It was a conditional apology – the SVP says that while some patients may have been offended, the company operated within legal and industry guidelines, also pointing out that it fired the employee whose widely quoted e-mail called patients “deadbeats” and “stupid.” More interesting to me was that according to Minnesota Attorney General Lori Swanson, Accretive customer North Memorial Medical Center turned patient information over to Accretive without having a business associate agreement in place, but created one later and back-dated it. That hospital’s data was exposed when a laptop was stolen from an Accretive employee’s car.

From @Cascadia: “Re: NHS. They are shutting down the PHR, but they are clearly emphasizing patient portals according to their just-released Department of Health strategy.” They are indeed. The PHR, in addition to being a big-time flop, wasn’t really necessary to give patients access to their own information. The story of vendor-offered PHRs is pretty much like that of mullets, Zamfir’s pan flute, and the Big Mouth Billy Bass – they’re an unpleasant memory of an unfortunately popular fad that nobody admits to having embraced.

HIStalk Announcements and Requests

On HIStalk Mobile, Dr. Travis posits a great question: why aren’t we hospitals involving inpatients and their families in their care by giving them their own meds lists? They could not only learn by following along with their copy of the MAR, but would also undoubtedly catch a bunch of medication errors. You would think that despite potential embarrassment, hospitals would appreciate being given a chance to avoid making a medication mistake. Why wait until right before discharge to suddenly start dumping information on the patient for take-home use?

HIStalk stats for May: 116,203 visits (the second-busiest month ever, barely behind the HIMSS month of February 2012) and 219,070 page views (beating the all-time record from last month by 20%). Year over year, visits are up 42% and page views are up 98%. Very nice for a month that’s usually the beginning of the summer doldrums. I don’t really follow the numbers, but some readers e-mail me if I don’t mention them. I work the same whether it’s a bunch of readers or not many. Which reminds me as I’m writing this: HIStalk turns nine years old on Sunday, meaning I can’t even remember what it was like having only one full-time job.

I don’t have any reports from the MUSE meeting. Yours is welcome.

On the Jobs Board: Service Delivery Manager, Cerner and Epic Resources. On Healthcare IT Jobs: Programmer Analyst II, Cerner Go-Live Project Manager, Network Engineer II.

It doesn’t take much to make Inga, Dr. Jayne, and me happy. Just your reading HIStalk pretty much does it. If you’re an overachiever, you can (a) sign up for the spam-proof e-mail updates; (b) check out the searchable, browsable sponsor Resource Center; (c) use the Consulting RFI Blaster to painlessly get proposals for your consulting needs; (d) connect with us on LinkedIn, Facebook, Twitter, and all those trendy sites since we approve all requests to join our fairly large network; (e) support our sponsors by perusing their ads and clicking on those that tickle your fancy; and (f) keep the news, rumors, photos, etc. coming since we are not omniscient – we get a lot of help from readers. Of which you are by definition one, and we appreciate that.

Acquisitions, Funding, Business, and Stock

MED3OOO announces its acquisition of St. Louis-based KASS-MSO, an 80-employee provider of medical practice services.

RTLS vendor Versus Technology announces Q2 results: revenue up 89%, net income $198,000 vs. –$405,000.

SAIC reports Q1 numbers: revenue up 4%, EPS $0.35 vs. $0.36. The company said its Vitalize Consulting Solutions acquisition increased revenue, but its Military Health System revenue was down.

Sales

Greater Houston Healthconnect (TX) selects Medicity’s HIE solutions to connect more than 130 hospitals and 14,000 physicians.

Catholic Health East purchases NetSafe business continuance and downtime protection software for its 15 hospitals.

Covenant Health (TN) selects InfoSystems to provide data center virtualization and optimization infrastructure.

NextGate and CSC announce plans to integrate the NextGate Multi-Language Enterprise MPI with several iSOFT applications.

Caverna Memorial Hospital (KY) selects clinical and financial solutions from Healthcare Management Systems.

People

Robin Settle, former leader of PricewaterhouseCoopers’ HIT leadership team, joins Kurt Salmon’s HIT practice.

CORHIO announces that its policy director Liza Fox-Wylie has been selected to become Colorado’s State HIT director.

RCM provider Medical Business Resources appoints Thomas D. Sidebottom (Oracle) its CTO.

N-of-One, a provider of personalized diagnostic and treatment strategies for oncology patients, names Christine Cournoyer , former president and COO of Picis, as CEO.

Vitera Healthcare Solutions appoints Steven Holmquist (MedPlus/Cerner/HBOC) VP of sales.

Apollo Health Street brings on three sales professionals with healthcare IT experience: Andrew Finck, Greg Williams, and Anil Kumar.

Announcements and Implementations

Maine’s HIE announces the pilot of the nation’s first statewide medical imaging archive, which will include data from 56 radiology imaging centers, require about 200TB of storage, and be hosted by Dell.

UPMC deploys AeroScout’s Healthcare Visibility Solutions to automate temperature monitoring at its St. Margaret Hospital and will roll out temperature monitoring and asset tracking across most of its US hospitals.

DPR, a provider of imaging informatics for the radiology industry, will embed M*Modal Fluency Direct technology into its CaseReader structured reporting software solution.

St. Michael’s Hospital in Toronto implements Amcom Software’s Mobile Connect solution to send encrypted messages to staff on their iPhone, iPad, and BlackBerry devices.

Madison Memorial Hospital (ID) goes live on PatientKeeper CPOE and Medication Reconciliation.

Gateway EDI announces that it has signed its 100,000th client and expanded its client base by 19% over the last year.

Government and Politics

Last chance: nominations are due June 11 for open slots on the HIT Policy and Standards Committees.

Other

An article called That CT Scan Costs How Much? in the new Consumer Reports covers wide variation in healthcare charges, even for patients who are careful to use in-network providers. The price of an in-network colonoscopy in one city ranged from $840 at a freestanding practice to $4,481 in a big academic medical center. In another example, a woman with new Cigna insurance was treated in the ED for back pain and the hospital told her she owned $6,500 of the $14,600 bill that included a $9,000 CT scan. The hospital told her they’d take $3,000 cash if she paid immediately, which she did, only to find afterward that other Cigna providers offered CT scans for $318. Other stories: a woman with high-deductible insurance couldn’t find any lab that could tell her what her two routine tests would cost; a patient went to an out-of-network neurosurgeon for a risky procedure and was charged $592,000 by the surgeon vs. the $112,000 the insurance company would pay as usual and customary; and a woman who carefully chose an in-network surgeon still got stuck with a $10,000 bill from the hospital’s out-of-network anesthesiologist.

Feather River Hospital (CA) will shut down its 12-employee medical transcription department and outsource the work, saying the government’s push for EMR usage will reduce its need for transcription services. Said one of the transcriptionists, “I think they are going to find that they still need us. I don’t think computers are going to cut it.” That’s what stenographers said.

The 3,700-physician Hill Physicians Medical Group (CA) posts its financial results publicly: $481 million in revenue and $11.6 million in profit, even after spending $7 million last year on an EMR. The full report mentions specific applications they use: RelayHealth, Ascender, and NextGen.

A specimen control clerk at Mount Sinai Hospital (FL) is arrested on identity theft charges after police found credit cards and hospital computer printouts that were later traced back to her.

National Coordinator Farzad Mostashari will deliver the opening keynote for the 2nd International Summit on the Future of Health Privacy, held in Washington DC June 6-7. Registration is free to either attend in person or to view via streaming Webcast. The agenda is here.

An Abu Dhabi publication profiles Cerner nurse executive Deirdre Stewart and the state of healthcare IT in the Middle East. It says UAE spending on healthcare IT will rise from $3.1 billion to $4.7 billion this year, with quality (“the latest technology from reputed companies”) rather than price driving product selection.

The government of South Australia provides $186 million to fund three health IT projects: a patient administration system, a pathology information system, and a medical image storage system.

Weird News Andy predicts that June 21 will be a long day for patients in the UK. Unionized doctors there vote to go on strike for a day for the first time since 1975. The docs are mad about government plans to push back their retirement age from 60 to 62 and to make them contribute more towards their pensions. In the example given, a doctor making $185K today could retire at 60 with an annual pension of $74K, with one Member of Parliament (who’s also a doctor) saying, “The public will simply not understand why doctors have called for strike action over pensions that private sector workers and many other frontline NHS workers can only dream of.”

A money-losing hospital in Canada that installed a Tim Horton’s coffee shop expecting to make the same $300K annual profit that similar outlets rake in instead finds itself losing $260K per year. The CEO of the health authority explains: “We charge you a buck-ninety-four for that large coffee, but we insist that the staff who are pouring the coffee are Eastern Health staff, and they get paid $28 an hour.” The health authority says it will turn the location over to a private operator that isn’t saddled with its generous compensation practices.

Sponsor Updates

• Memorial Medical Center of West Michigan selects Wolters Kluwer Health’s ProVation Order Sets as its electronic order sets solution.
• Frost & Sullivan awards Imprivata its 2012 North American Customer Value Enhancement Award for accelerating EMR adoption with its single sign-on solution.
• Hayes Management Consulting announces that its MDaudit software provides an E&M bell curve reporting module to help organizations identify providers who are consistently coding higher than their peers.
• A local newspaper interviews Kareo sales director Jason McDonald, who shares how his experience as a Marine has transferred to his civilian career.
• The Advisory Board Company posts a case study that details how St. Joseph’s Hospital (TX) launched a four-hospital clinical integration network in just six months.
• Premier Bone & Joint Centers (WY) selects SRS EHR for its 12 locations and 10 physicians.
• CTG Health Solutions hosts a Webinar on healthcare security issues.
• Health and Social Care Northern Ireland selects Orion Health to provide a clinical portal-based Electronic Care Record.
• Sentara Healthcare discusses how Capsule Tech’s DataCaptor solution helped it connect more than 1,800 medical devices from over 1,000 patient beds. 
• Healthmark Regional Medical Center (FL), Millford Memorial Hospital (UT), Beaver Valley Hospital (UT), and Kit Carson Memorial Hospital (CO) select Prognosis HIS Enterprise Clinical and Financial systems.

EPtalk by Dr. Jayne

NCQA offers a seminar on Improving Organizational Performance to be held July 11 in Washington, DC. Speakers will discuss overcoming obstacles and barriers as well as implementing effective quality interventions. ONC will be providing faculty support as well. The fee is a bit steep, though – $795 unless you register prior to June 13 for the early bird discount.

George Washington University’s Hirsh Health Law and Policy Program has launched Health Information & the Law as a guide to federal and state laws on the access, use, release, and publication of health information. Information is grouped by topic and an analysis section also features articles and issues briefs by GW authors.

A colleague from residency recently introduced me to Quackwatch, which describes itself as “your guide to quackery, health fraud, and intelligent decisions,” which got my attention. Although some of the articles are older, there were many interesting reads. The kinds of scams described never go out of style, unfortunately.

If you build it they will come. Or not. A recent report shows that less than a third of eligible physicians reported quality data to CMS for 2010. Although 125,000 physicians received a bonus, 50,000 attempted and failed. Physicians who don’t report in 2013 will be assessed a noncompliance penalty starting in 2015, although it’s relatively small at 1.5%. I don’t blame paper-based physicians who have small Medicare panels for concluding that reporting may be more trouble than it is worth. On the other side, for most providers with reasonable EHR technology, you’re just throwing away money if you’re not reporting.

CMS will host a National Provider call on June 7 for Eligible Professionals to learn about registration and attestation for the Medicare/Medicaid incentive programs. There are quite a few providers out there who still have only minimal knowledge of the programs. Since this is the last year that providers can start and still earn the full incentive, it’s a good starting point for providers who need to catch up. If you’re a provider who didn’t report, why not? Do you plan to report in 2013?

A thoughtful reader sent an article to Mr. H “for Inga and Dr. Jayne on their never-ending quest.” It was a review of Rachelle Bergstein’s book, Women From the Ankle Down: The Story of Shoes and How They Define Us. It’s been added to my Amazon wish list (ahem, to certain men in my life who may be shopping for a soon-to-be arriving birthday) and I’ll be sure to read it prior to the next HIStalkapalooza so I can provide more informed commentary on the shoe competition. In the mean time, I learned a great factoid from the review: Salvatore Ferragamo invented the cork-soled wedge after taking human anatomy classes at USC. Who would have guessed?

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

CIO Unplugged 5/30/12

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

Memorial Day: What is Your Legacy?

April 2007. While in Washington DC on business, I spent some time sightseeing with fellow/former Army officers. One gentleman was the recently retired commanding officer of the 3D US Infantry Regiment (Old Guard) charged with guarding Arlington Cemetery, including the Tomb of the Unknown Soldier.

He gave us the most unexpected honor. He prearranged for a couple of us to lay the flowered wreath at the Tomb during the evening changing of the guard.

I still get the chills as I reminisce that moment: escorted between sober, armed soldiers; laying a measly garland of flowers before a solemn tomb; silently saying “thank you” for the millionth time to men of sacrifice with no identity, lost but never forgotten. The sight of our flag coupled with the singing of our national anthem generally brings tears to my eyes, so this honor was as good as it gets.

A sacrifice… never forgotten. Despite language, religious, and geographical differences, humanity shares a universal desire: to make life meaningful. Whether it means having an impact on a family, a village, or a nation, we all want our lives to count for something.

The Memorial Day Service my wife and I attended this weekend reminded me of the brevity and sanctity of life. Every song sung, every speech read, and each poem recited proved life was meant to be lived with relevance and significance. Am I living in such a way that beneficiaries will take time to reflect on my contributions?

For some, contribution means laying down life in battle to defend freedoms. For another, service and sacrifice will have a different flavor. Whatever we are called to do, let us impact people positively and serve the forthcoming generations.

I began to personalize these thoughts in terms of my career. “There’s no limit to the amount of good you can do if you don’t care who gets the credit.” I don’t know who said that, but it’s a truism that helps me keep a healthy perspective. The world isn’t about me, but it does either gain or suffer based on my involvement, how much I give and take.

My new philosophy goes like this:

Let my employer be a better place for teaching, healing, and discovering as a result of my leadership. Let the decisions I preside over have lasting beneficial effect. May I treat others in such a way that their children and their children’s children will benefit. May I always keep the long term in mind to avoid compromise and complacency. Let me leave my employer a better place than when I arrived. May those who I serve have accomplished more than otherwise possible, furthering their careers and thus their impact. May clinical and business outcomes have been positively impacted and lives improved.

Though no one else might see it, my epitaph will read, “My service in healthcare mattered.” In the end, even if no one remembers our names, maybe they’ll still place a metaphoric wreath at a tomb in honor of all of us who served to make healthcare better.

What about you? What legacy will you leave behind?

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

News 5/30/12

Top News

In the UK, NHS says it will shut down its HealthSpace personal health record by March 2013. The Department of Health director says the system attracted few users, which he says is because, “It is too difficult to make an account. It is too difficult to log on. It is just too difficult.” A 2010 report commissioned by the government said it was failing for the reasons that government-run software projects usually fail: poor project oversight, lack of ability to define standard datasets, poorly defined consent practices, and contractors looking out for their own interests. I found this comment fascinating and relevant to other clinical IT system deployments:

The fortunes of the SCR and HealthSpace programmes appeared to turn partly on the philosophical question “Where is the wisdom we have lost in knowledge?”. Many though not all senior stakeholders in CFH, the professions and the IT industry viewed knowledge as stable and discrete data items which could be extracted from their context, placed on the SCR and transmitted to new people and contexts while retaining meaning. An alternative perspective holds that much knowledge is tied to particular people, organisations, experiences and practices and is difficult if not impossible to extract from its context or the people who know it.

Reader Comments

From Period Piece: “Re: hospital pricing article. Cash is king.” The LA Times covers the seldom-discussed topic of hospitals offering lower prices to cash-paying patients. Its lead example is a hairdresser who pays $700 per month for medical insurance and who was charged $6,707 for a CT scan, of which her share after insurance was $2,336, but had she just written the hospital a check, she would have paid only $1,054. Another hospital lists the same test at $4,423, the Blue Cross Blue Shield negotiated price is $2,400, and the cash price is $250. Says the patient, “I was really upset that I got charged so much and Blue Shield allowed that. You expect them to work harder for you and negotiate a better deal … it kills me that I’m paying that much in premiums and it’s better to pay cash out of my own pocket.” In yet another example, a doctor ordering blood work for his patient found that the hospital charges $782, the insurance company billed the patient for $415, but the patient’s cash price would have been $95. Like everything related to hospital charges, there’s even a catch to paying cash: you have to lie upfront in saying that you don’t have insurance since hospitals won’t give the cash discount otherwise since they don’t allow price cherry-picking, although they may offer a cash discount on the insurance company’s negotiated price. The hospital’s Robin Hood-like explanation: insured patients have to pay more to cover the underpayment of Medicare and charity care. The hairdresser is suing Blue Shield and seeking class action status, but the insurance company says it doesn’t guarantee that providers won’t undercut its negotiated prices for cash-paying patients (in other words, they’re making a fortune on administrative skim and premium-raising and thus have no incentive to worry about what their customers are paying providers.) Here’s the thing about medical insurance: both patients and providers would be better off without it other than for its coverage of catastrophic events, which of course is what it was supposed to be in the first place until it morphed into the borderline socialist “health insurance” that used to pay for everything, but now pays less and less even as medical costs increase and patient rebel at the idea of being responsible for their own healthcare expenses.

From Pico D’Gallo: “Re: Duke. Their cost for implementing Epic was announced at $700 million over seven  years, surely a record.” Verified, at least the $700 million part — I found a link here.

HIStalk Announcements and Requests

Based on the success of the HIStalk Advisory Panel, we want to add a separate HIStalk Practice Advisory Panel for practicing physicians and others working in the ambulatory space. Every month or so we’ll e-mail 3-4 questions pertaining to product issues or needs, cool technology that you might be using in your practice, and other issues affecting physician offices. If you have a few minutes every so often to participate, please drop me an e-mail. Many thanks!

Thanks to HealthCare Anytime, joining HIStalk as a Platinum Sponsor. The San Diego-based company offers a cloud-based patient self-service portal (online bill pay, recurring payments, once-time payments by telephone, appointments, pre-registration, secure messaging, refills, and PHR) that gets providers paid faster and makes their operation more efficient. Of course, patients like it too – who wouldn’t, compared to playing time-wasting telephone tag and jotting down indecipherable notes about balances and appointments? The portal helps providers meet two key Meaningful Use Stage 2 requirements: allowing patients to view/download their information and actually exchanging secure messages with at least 10% of them. The company has been around since 2000 and is run by Steve Click (founder and former CEO of Dairyland, now Healthland) and Brady Click (CEO of Intelligent Health Systems and founder of HealthCare Anytime.) The company is at MUSE in Orlando this week if you’d care to drop by Booth 207 to say hello. Tell them you saw them mentioned on HIStalk – sponsors love that tangible manifestation of their support. Thanks to HealthCare Anytime for supporting HIStalk.

I trolled YouTube to see if there were any videos about HealthCare Anytime and, what do you know, here’s a just-posted two-minute overview of their patient portal. I’m usually not that lucky, mostly because not all companies have caught on to the marketing value of posting videos on YouTube or Vimeo.

I can’t believe I’m saying this, but I’m getting kind of excited about Windows 8. I’m hoping it’s an easy and cheap upgrade, but the “cheap” part is negotiable with me – I don’t mind paying for an OS that’s more stable and functional (but I wouldn’t use Internet Explorer even if you paid me.) History has shown a predictable “every other Windows release sucks” pattern going back to Windows for Workgroups, so I’ll believe Microsoft has regained its long-lost relevancy and reputation for innovation if they can break that pattern. If not, Steve Ballmer needs to be fired immediately and I may go with a Mac since the Win 8 team appears to have stolen liberally from the Mac OS anyway. I’m interested in the announcements from WWDC (Apple’s developer conference, probably the most-watched conference in the world) in a couple of weeks, the first without Steve Jobs.

Acquisitions, Funding, Business, and Stock

In the UK, McKesson hires a lobbying company to help it earn IT business following the demise of the government’s NPfIT project. McKesson, which wasn’t a successful bidder in that project, can now sell directly to individual hospital trusts.

Sales

The National Institutes of Health awards Evolvent Technologies a 10-year contract to provide IT services and solutions for the NIH IT Acquisition and Assessment Center. The contract’s ceiling value is $20 billion.

Australia’s Austin Health and the Center for Ambulatory Surgery (NY) select ProVation by Wolters Kluwer Health for GI coding and documentation.

In the UK, Surrey and Sussex Healthcare NHS Trust votes to not only stick with the NPfIT-provider Cerner Millennium, but to extend its contract and add on the RadNet radiology information system. The trust is also seeking a PACS.

David Miller, vice chancellor and CIO of University of Arkansas for Medical Sciences, tells me that the organization has approved an $87 million Epic implementation. They expect to save $10 million per year in clinical improvements and $2 million in reduced software maintenance costs. Upgrading existing systems to meet Meaningful Use requirements would have cost $24-30 million.

LongView International Technology solutions wins a $300 million Military Health System contract to develop proof-of-concept applications that may have something to do with the joint DoD-VA EMR (the announcement doesn’t really say). The company also recently won part of another $20 billion contract. The five-year-old company was started by a retired Navy officer with an MS in hospital administration who had been assigned to the Secretary of Defense to manage a $20 billion appropriation (hopefully not the same one his company won.)

People

Imprivata names Mark Clark (Hitachi Data Systems) as VP of international sales, based in London.

Andrew Terry is named VP of software engineering at electrophysiology lab software vendor Perminova. He was previously with Sotera Wireless.

Announcements and Implementations

Krames StayWell makes its library of discharge instructions available to Meditech customers.

The HealthBridge HIE (OH) announces the go-live of its ED Admit Alert System, which lets physicians know when their patient visits the ED or is admitted.

MediServe announces that its MediLink for Outpatients solution will support recent changes to therapy caps for hospital-based outpatient therapy services.

The White House invites Iatric Systems to participate in the June 4 Patient Access Summit, where it will be one of 25 invited participants. Facilitating the event will be US CTO Todd Park, National Coordinator Farzad Mostashari, and VA CTO Peter Levin.

Image sharing network vendor lifeIMAGE anounces release of programming APIs that will allow software developers to enable image sharing directly from their applications. The announcement cites an unnamed academic medical center’s use of the API to send images from access management systems to Epic and to allow its employees to populate WebMD’s PHR with their images. I interviewed President and CEO Hamid Tabatabaie awhile back and learned a lot about the state of image sharing.

Government and Politics

Former US CIO Vivek Kundra, now with Salesforce.com, takes a shot at the IT establishment, which he says is stifling innovation. “There are these evil CIOs that everyone hates because they’re the ones that tell you ‘you can’t bring technology to your workplace.’ They represent the greatest threat not just to innovation, but also to citizens getting the services they want.”

Under fire: the Affordable Care Act’s 2.3% excise tax on the gross sales of medical devices, set to kick in next year but facing increasing Congressional resistance. At least if you believe the WSJ article, which seems to be partisan in the Republican direction (read the article comments for fun).

Innovation and Research

The CareFusion Foundation awards a $329K grant to the Healthcare Technology Safety Institute to study smart IV pump errors. Brigham and Women’s will coordinate the efforts of 10 hospitals in observing smart pump use to find problems, then identify possible solutions. The institute is part of the biomed-intensive, non-profit Association for the Advancement of Medical Instrumentation, which has worked with FDA on issues related to IV pump safety.

Technology

Epic authorizes implementations of its EHR on Intel x86 servers running open-source Linux, virtualized to VMware. Previously Epic ran exclusively on AIX and UNIX servers. This should make Epic a bit less expensive and perhaps more attractive to smaller facilities, though hardware is a minor part of the Epic implementation budget. Awhile back we ran a rumor that Epic was looking at the open source equivalent to Cache, so this might be a signal that they are looking for less proprietary and less expensive ways to run their systems.

Cisco kills off its Cius tablet for businesses less than two years after it was launched, born back when the original iPad wasn’t all that robust and businesses were expected to buy enterprise-grade tablets instead of succumbing to pressure from their employees to be allowed to  bring in their own far cooler tablets. It’s bad enough to be trying to move non-Apple tablets, but you are toast if yours is more expensive besides (the Cius was $700).

Other

South Shore Hospital (MA) will pay $750,000 to settle charges related to a 2010 data breach that compromised the personal data of 800,000 people. The hospital contracted with Archive Data Solutions to erase and resell 473 data tapes, but failed to encrypt the data and didn’t tell the vendor that the tapes contained PHI. The vendor shipped the tapes to a subcontractor to do the work and two of the three boxes were lost.

A UK doctor accused of killing two elderly patients by ordering tenfold overdoses of morphine is acquitted of manslaughter. He admitted that he made a mistake in prescribing the drugs while he was reading e-mail and checking online cricket scores.

Also in the UK, a hospital launches an urgent investigation after a patient complains that an exam light wasn’t working when the doctor was trying to stop her post-delivery bleeding, leading him to order the nurse to hold up his iPhone so he could work from its light. Says the patient, “Then the doctor and nurse had a bit of an altercation when the light went off, as she didn’t know how to do the finger swish thing to keep turning it on, and he… felt she wasn’t listening to his instructions.”

Weird News Andy says this took guts, but he urges police to add practicing surgery without a license to the charges. Police responding to the home of a New Jersey man who was threatening to harm himself with a 12-inch kitchen knife find him barricaded in his room, and when they kick the door down, the man stabs himself repeatedly in the abdomen and throws skin and parts of his intestines at the officers. The man, who has a history of psychiatric problems, is hospitalized in critical condition.

Sponsor Updates

• AT&T Health sponsors a June 5 Webinar discussing the creation of an enterprise image management strategy in the cloud. 
• Bloomberg Businessweek profiles Digital Prospectors Corp.
• Capsule will showcase its device integration solution a this week’s International MUSE 2012 Conference.
• Newfoundland and Labrador Centre for Health Information selects Orion Health to provide framework for its providence-wide interoperable EHR.
• SCI opens registration for its Client Innovation Summit 2012, to be held October 21-24 at Chateau Élan in Braselton, GA.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Curbside Consult with Dr. Jayne 5/28/12

Just when you thought it was safe to go back to the office, Big Pharma is at it again. I’ve never been a fan of direct-to-consumer advertising. I’d rather spend the few minutes I have with each patient in careful discussion of health promotion and disease prevention rather than discussing those “ask your doctor if Brand X is right for you” drug ads. My primary care patients learned over time that I’m a big fan of generics. If I recommend a drug, we’ll have a pro/con discussion of all the alternatives, not just the ones with great TV commercials.

Takeda Pharmaceuticals dropped this little number in my inbox – an app called Tummy Trends that allows patients to track their bowel symptoms, chart and graph them, and e-mail reports. The e-mail encourages me to let my patients know “that tracking symptoms can be convenient and discreet.”

I tried to get more information on the app, but found that the top five sites that my search engine served up were actually outlets for maternity clothing. Kudos to the marketing team for their excellent research of the name. Additionally, I’m not sure how many adults really refer to their digestive system as their tummy. I did finally track it down and ultimately downloaded it to my iPad to check it out.

I was disappointed. It wasn’t optimized for iPad, running in the tiny iPhone-shaped window instead. Data collection was minimal. I’d expect that if a pharmaceutical company was going to slap their name on it, they’d give it lots of bells and whistles.

I decided to see what other apps were out there for the same patient group  and found Bowel Mover Lite. It not only seemed to have more features, but even more important in my book, was pharma-free and the kicky logo was an added bonus. Really – don’t patronize patients with names like Tummy Trends (which is a little too close to the tummy time we recommend for infants anyway.) Bowel Mover displayed nicely on the iPad and also introduced me to Habits Pro and a couple of other apps. One was quite interesting – not appropriate for mentioning in mixed company, but check out Track & Share Apps, LLC and you might find it.

I haven’t had too many patients bring in smart phone diaries other than calorie trackers and exercise apps. When you’re in the primary care trenches, however, every day is a new adventure. I’ll keep you posted if I see anything sassy, humorous, or awesome. If you see one that fits any of those categories, e-mail me.

E-mail Dr. Jayne.

HIStalk Advisory Panel: Wrap-Up 5/28/12

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

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

I previously ran the panel’s recommendations to Allscripts and a list of the innovative companies they’re working with. These are their remaining comments.

General Comments

”The coming wave of BI use that will be required for any healthcare organization to be profitable, especially if they get involved in ACO or population health management. There was such a void of these companies at HIMSS it was shocking.”

”CMS and AHIMA are pushing ICD-10, a 30-year-old coding system. Like forcing us all to buy Betamaxes.”

”We have an internal debate ongoing within our parent organization whether EHRs will become a commodity purchase in the next few years. The implication is that you would be able to buy the EHR in pieces from best-of-breed vendors and then meld them together. I would be interested in what HIStalk readers, and of course yourself, feel about this prediction. Big organizations with lots of R&D dollars haven’t been able to pull it off even with just to products to integrate. I don’t think we have the standards to pull this off for at least a decade.”

”I think the platforms being developed by Allscripts and Greenway are an important harbinger of where the industry is going — the idea of the EMR as a platform and companies building apps to sit on top of them to help fill gaps and expand functionality. Other companies talk about it, but are not ready technically. Epic says they won’t do it, but I think they all eventually will.”

Cerner

”We are getting excellent results with Cerner PowerChart on both the ambulatory and acute sides. The newer mPage technology has let us develop specific apps within PowerChart that address Meaningful Use and quality goals while also improving physician experience and adoption with the EMR. Examples include a physician-designed ED CPOE template (that only an ED doc could love) and an app for admission med rec that better ties in nursing, physician, and pharmacy workflow (for example, the physician hands off therapeutic substitution task to the pharmacy). Cerner’s tools let us optimize workflow.”

Entrada

“Entrada is an interesting little dictation and transcription service that is partnering to bring voice to data services along. They are making some noise in the ortho markets.”

”Epic is good and not great. The install methodology is good, but they rely too much on their UserWeb to send customers for information. They also do a poor job of preparing CIOs for what life will be like after the install. We don’t have time to figure out which classes we should attend so we can get an idea of how the suite works and what it takes to support it. I have asked repeatedly for guidance and am still waiting.”

GE Healthcare

”What’s up with the GE Healthcare product suite? I haven’t heard much. I fear that their ambulatory PM/billing system formerly known as IDX has seen better days. They have been historically strong products.”

”I haven’t heard much lately about what GE is doing with their ‘new product’ or how the new joint venture is going with Microsoft.”

Hyland Software

”Hyland is doing a great job for us. On time, on budget. Can’t ask for more than that.”

InterSystems

”We’re vendor shopping and you get to see many products and talk to a lot of sales reps. InterSystems gave us their sales pitch, but didn’t even pitch us their correct product. We had met with them at HIMSS and clearly they didn’t take any of that conversation into account.”

McKesson

”It was painful that McKesson announced in December that they are going to sunset Horizon Clinicals. Having stopped developing their emergency and ambulatory solutions (HEC and HAC) puts lots of things into question. We don’t use HAC, but we do have HEC in all our facilities. Moving to Paragon – really?!?!? They have been unable to execute over the last five years on what they said they would deliver on. Who would believe they could do it with this neophyte product?” 

“It might be interesting to ask of those healthcare organizations using Horizon Clinicals as their primary EHR solution how many are currently considering moving on from McKesson and not waiting on transitioning to Paragon.This question would also be interesting for those organizations utilizing Meditech 5.6 and whether they are going to move to Meditech 6.x or will be selecting another vendor.”

Oberd

”Oberd is an outcomes research company targeting ortho.”

Prognosis

”We’re opening a new hospital. An interesting EHR vendor they liked is Prognosis of Houston, TX. I haven’t seen the product, but the selection team has raved about it.”

SYSTOC

”We installed SYSTOC (now part of PureSafety), the market leader in occupational medicine. It was a very expensive mistake that destroyed productivity. They told us they supported voice recognition several years ago, and are now promising that it will come out in the fall. They have promised improvements with every upgrade and the system just deteriorates more with every release.”

Vocera

”I have worked a lot with Vocera. Great company, very focused, recent IPO is doing well. Smart guys running it. It’s a good product that works and happy customers.”

Monday Morning Update 5/28/12

Memorial Day is not just a three-day weekend — it’s the one day set aside each year to honor those who have died in military service. Go to the beach, picnic, or have a cookout, but please take a moment to honor the memory of those who gave up all of those things to die thousands miles from home while serving their country (and are dying still today.) Most of us will never experience or even understand their sacrifice, but the least we can do is take a few minutes from our year-round comfortable existence to honor it.

E-mail Mr. H.

Time Capsule: Surprise! Below-Average Doctors Use EMRs, Too

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 June 2007.

Surprise! Below-Average Doctors Use EMRs, Too
By Mr. HIStalk

A just-published journal article seems to rip the use of electronic medical records in physician practices. Its conclusion: paper-based doctors hit diabetes quality standards more often than their EMR-wielding colleagues.

From that, you might logically conclude that EMRs don’t provide the outcomes benefits claimed by their vendors. And that, my friends, is why a little bit of information can do a lot of damage.

Observational studies often leave questions unanswered. A researcher observes that Factor A and Factor B co-exist. In a journalistic leap of faith, the conclusion (stated or not) is that one of those must cause the other.

I wish it worked that way. I’d find myself a young, intellectually impotent young lady as a companion. Why? Because you see those women on the arms of rich old guys. Ergo, eye candy makes poor men wealthy. See the fallacy?

Back to the EMR article. I assume the following:

• Caring, competent physicians will find a way to practice good, evidence-based medicine no matter what gadgets they do or don’t have at their disposal.
• Uncaring dolts won’t really get much better just because they have promising toys.
• Those doctors who will get the biggest benefit from information technology are in neither group, that undecided 60 percent who can be pushed either way.

What the article doesn’t tell us is how individual physicians changed after implementing EMRs. Isn’t that what we really want to know? If EMRs improved individual physicians, the rest wouldn’t matter.

Which leads me to these conclusions:

• EMRs can make it easier for physicians in the first category to do the right thing more conveniently. Compliance may go up a shade, as may efficiency.
• EMRs may make less-competent physicians more or less efficient without necessarily improving their adherence to clinical standards.
• Those docs in the middle might be steered and swayed by the path of least resistance to improve their practice, given both EMR technology and the motivation to change (that’s another whole discussion.)

The EMR payback comes from those doctors in the last category. Such systems won’t change the votes of party loyalists, but they can sway the masses of the undecideds.

It’s also not just what you have, but how you use it. Doctor A effectively uses a crappy EMR. Doctor B has the really hot, expensive application, but doesn’t use most of it. Doctor A’s bad EMR may greatly enhance good practice, while Doctor B’s great one may offer no improvement.

Personally, I don’t care whether my doctor uses electronic medical records, pen and paper, or a stone tablet and chisel. His tools are his business. I judge him on my personal outcomes. I expect him to invest in whatever it takes to deliver those outcomes, no different expectations than I would have for a mechanic, masseuse, or chef.

The article will likely cause interesting debate (if for no other reason, it’s a slow news time.) Still, it shouldn’t be a surprise that EMR-wielding doctors don’t necessarily deliver better care.

In fact, it’s actually surprising that anyone finds the study’s conclusions to be inflammatory. Apparently we’ve been sufficiently brainwashed to believe that brushes make the artist. We ought to know better by now.