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.

News 5/25/12

Top News

The FCC votes 5-0 to approve allow wireless patient monitoring systems such as those being developed by GE Healthcare and Philips to share a frequency spectrum that was previously used exclusively for aircraft testing. Hospitals using the new systems will be able to monitor patients anywhere in their buildings without connecting them to hard-wired instruments and limiting them to specific areas such as ICUs. In-home patient monitoring via Medical Body Area Network devices will also be supported, so that body-worn sensors can communicate wirelessly with an in-home station that will send data to a hospital or other provider.

Reader Comments

From Raydonia: “Re: downtime of Transcend Systems/Nuance on 5/21. They are paying full-time transcriptionists the princely sum of $60 for the day of downtime. As of this writing Tuesday, we are down again. It’s a big deal. At-home workers don’t have the rights that on-site workers have. Any questions and you’re told, ‘Be glad you have a job.’” Unverified. I’m probably the last person you’d want to have soothing you since I’m not usually too sympathetic to career-related gripes. If you don’t like the job and have better prospects, you should take the better job. If you don’t have better prospects, then I agree with the company – the market is telling you something and you should be glad you’re working since lots of people aren’t. In this economy, knowledge workers and those with skills that are in high demand but limited supply are going to be treated very well, but the rest will be have to reset their expectations since the threat of automation or offshoring is always there (hello, HP layoffs). I don’t mean to be a downer, but our parents and schools are feeding us the “dream big and do whatever makes you happy and you’ll be rich and famous” story that doesn’t usually match reality unless you’re freakishly smart, cunning, connected, hard working, or lucky. I think that’s one reason the unemployment rate isn’t going down much – people are holding out for yesterday’s comfortable, high-paying jobs that are gone for good for many of them. In your case, I concur that being paid a “salary” based on piecework seems odd, but if that’s the work arrangement you signed up for, then I guess being paid just the base amount for days you can’t work is consistent, even though it sucks when it’s not your fault that there’s no work to do (kind of like minimum wage restaurant servers who would starve without tips). Hopefully they’ve got their systems back to normal since I’m sure your hospital customers are as anxious as you are to reconnect. 

From Pop Top: “Re: HL7. They are encouraging vendors to put the ‘Care Connected by HL7’ logo on their splash screens. Do you think any vendors will do this?” I don’t know why they would. Users are the ones who see the splash screen and they don’t care about HL7. Other than giving HL7 free advertising, I don’t see the benefit. And not to be overly critical since I’m probably the worst at aesthetic design (as readers who are always complaining about the HIStalk format can attest), but the logo looks kind of cheesy to me – harsh and badly proportioned wth an unpleasant 3D chiseled effect. Not to mention that the HL7 part of it, even though it’s their regular logo, is hard on the eyes. White on black looks like a DOS screen.

From Annie: “Re: Cerner. Consulting SVP David Sides resigned last week.” Unverified. His bio is still up and his LinkedIn profile says he’s still there.

HIStalk Announcements and Requests

Some nuggets you might have missed this week from HIStalk Practice: former Medic and A4 CEO John McConnell shares insights on HIT startups, Meaningful Use, Allscripts, and more. Dr. Gregg discusses the data-drenched world of HIT and the need for tools to keep things simple. A glitch leads to the rejection of 450,000 Humana claims sent through the Availity clearinghouse. Is the direct primary care model just a new name for concierge medicine? My take on banning smart phone pics in doctors’ offices (hint: good luck with enforcement.) A physician seeks opinions on drchrono. ONC promotes device integration for ophthalmologists. What do these news bits, interview, and opinion pieces have in common? None can be found on HIStalk, meaning you best pop over to HIStalk Practice to ensure you remain in the know. While there, click on a sponsor ad or three and educate yourself on some cool offerings. And don’t forget to sign up for the e-mail updates. As always, thanks for reading.  

Listening: brand new from Slash, excellent guitar-heavy rip-it-up rock that’s loaded with licks reminiscent of the best of the 1970s and early 1980s: Deep Purple, AC/DC, Whitesnake, and of course Guns N’ Roses. Nobody’s making straight-ahead hard rock these days, especially the kind that sounds like a real band instead of one guy and a laptop. It doesn’t exactly break new ground, but it’s going to be killer at summer gigs like Rocklahoma this weekend. And I can’t help cheering for Black Sabbath, together on stage again (minus drummer Bill Ward over money issues) after a seven-year hiatus and Tony Iommi’s lymphoma, opening their Birmingham, UK show last week with 1971’s amazing Into the Void.

Dr. Rick is back from the NIST-ONC EMR usability meeting. I asked if anybody recognized him since I work in an anonymous vacuum and always wonder what that’s like. He said a few folks did, including Farzad Mostashari. Rick will be providing a meeting recap after he gets caught up on his ophthalmology work.

On Healthcare IT Jobs: Application Analyst II, Assistant Director IT-Medicine, Hospital Software Analyst II, System Architect, Cerner Testing Project Manager.

Welcome to new HIStalk Platinum Sponsor Clinithink. Healthcare solution vendors use the company’s cloud-based CLiX natural language processing engine to turn free text medical notes into fully coded structured data (ICD-9, ICD-10, SNOMED CT) that payers, providers, and analytics companies can use to improve quality, increase revenue, and meet reporting and regulatory requirements. Structured data entry via check boxes and drop-downs makes like easier for the computer, but the richness of the patient encounter is often locked away in the detailed narrative of those providing the care. CLiX converts that data to information for everything from capturing Meaningful Use measurements to providing doctors with smart search capability for research that understands “bronchial hyperreactivity” as being related to “asthma.” Thanks to Clinithink for supporting HIStalk.

Here’s an overview I found of Clinithink’s CLiX on YouTube. It shows the user’s narrative popping up SNOMED CT codes.

Acquisitions, Funding, Business, and Stock

Kony Solutions closes on a $15 million third round of funding, led by Insight Venture Partners.

Healthcare payment network InstaMed secures $14 million in new capital.

Shares of Scotland-based charge master systems vendor Craneware drop by 15% after analysts speculate that its US customers might be chasing Meaningful Use money rather than buying its financial software, at least until next year. The company indicated in January that the situation was exactly that, but predicted a quick reversal of the trend. Other analysts agree with that earlier assessment, saying demand is already recovering.

Compuware reports Q4 numbers: revenue up 21%, EPS $0.12 vs. $0.16. Its Covisint subsidiary, which offers HIE and cloud-based services for healthcare, had annual revenue of $74 million, up 34%.

Nashville Medical Trade Center signs its biggest tenant so far, the RFID in Healthcare Consortium trade group. It will use part of its 80,000 square feet for The Intelligent Hospital, the hospital replica you saw in the downstairs exhibit hall at HIMSS in Las Vegas earlier this year (it was doing big business each time I checked). HIMSS will have 25,000 square feet in the building, which has 1.5 million square feet.

University of Maryland spins off Analytical Informatics, Inc., which will offer radiology dashboards and eventually expand into BI and quality tools that cross systems. 

Philips shares drop after its CEO warns that the European debt crisis may hurt imaging sales there.

Sales

Kosair Children’s Hospital (KY) selects Amcom Software’s clinical alerting middleware and smart phone communication solutions, planning to integrate it with their GE Healthcare Telligence nurse call system, GetWellNetwork interactive patient care system, and Cisco wireless IP phones and smart phones.

Omnicell closes on its previously announced acquisition of MTS Medication Technologies, a provider of medication adherence packaging systems.

Tri-State Gastroenterology Associates (KY) selects eMerge | ENDOTM for procedure documentation and workflow for its endoscopy center.

Lakeland Healthcare Group (IL) selects Merge Healthcare’s complete radiology cloud solution.

Indiana Orthopaedic Hospital selects the anesthesia information management system from Surgical Information Systems.

People

Former WellPoint VP Ryan Miller joins Availity as SVP of strategy and corporate development.

Todd Helmink (Allscripts) has joined The LDM Group as VP of strategic partnerships.

Greater Houston Healthconnect, a regional health information network, names Philip Beckett PhD (Baylor College of Medicine, RosettaMed) as CTO.

Announcements and Implementations

The US Olympic Committee announces that GE’s continued sponsorship will include the use of Centricity to manage the care of the 700 athletes participating in the London 2012 Olympic Games.

Iatric Systems and Order Optimizer announce the availability of an evidenced-based order set platform for Meditech Magic using Iatric Systems’ OrderEase solution.

MED3OOO announces the general availability of InteGreat EHR V6.5, which includes Quippe technology from Medicomp Systems.

RelayHealth and Greenway Medical complete a development agreement to exchange data between hospitals and ambulatory clinics.

Healthwise wins a Center for Plain Language award for its course on coronary artery disease. The non-profit company’s course combines easily understood content that is personalized by user type (recent coronary event, someone whose symptoms have subsided, etc.) Healthwise has previously won similar awards for its arthritis and low back pain materials.

Government and Politics

Representatives Michael Burgess MD (R-TX) and Gene Green (D-TX) introduce legislation that would require states to require hospitals to disclose information on charges for certain inpatient and outpatient services and to require insurance companies to provide enrollees a statement of estimated out-of-pocket costs for healthcare services.

US CTO Todd Park, writing on The White House Blog, announces the Presidential Innovation Fellows program. He’s looking for 15 innovators to spend 6-12 months in DC starting in July to work on one of five projects:

• Open Data Initiatives (entrepreneurial use of government data for societal benefit, including but not limited to healthcare)
• Blue Button for America (consumer downloading of their own health information)
• MyGov (access to government information)
• RFP-EZ (development of a platform to make it easier for the government to buy technology from startups)
• The 20% Campaign (move US aid payments from cash to electronic payments)

Innovation and Research

Three students at a Ugandan university win a prize for their smart phone-powered fetal monitoring system, which analyzes fetal sounds and produces a plain-English description that midwives and birth attendants can understand. The device costs at least 80% less than an ultrasound machine.

A study finds that OptumRX’s text message prescription reminder program improved medication adherence, with 85% of patients taking their at-home oral meds correctly vs. 77% without the reminders.

Technology

Cerner is looking pretty smart for buying up 65,000 IP addresses from bankrupt Borders for $12 each. The IPv6 kickoff is in a couple of weeks, but the transition is expected to take up to 10 years, meaning Cerner hedged its bets in being able to run in dual stack mode with the additional old addresses.

Other

The main Delaware newspaper covers the Delaware Health Information Network, which it says has enrolled 92% of the state’s providers. The front page story’s key figure is Christiana Care Health System CIO and DHIN Chair Randy Gaboriault, who had a recent positive experience with the value of shared medical information during a heart attack scare. He says his mother was not as fortunate – she died a couple of months ago after being treated by an unconnected hospital that did not have her history available, which he is convinced led to her unfortunate outcome.

Fairview Health Services (MN) fires CEO Mark Eustis, presumably after being embarrassed by never-ending press caused by the heavy-handed patient debt collection tactics allegedly employed by Accretive Health, which he brought in. Of course he also could have been fired had Fairview lost a ton of money by not collecting aggressively enough, so there’s that fine line thing.

As already reported here thanks to a tip from reader Gran Cru, Partners HealthCare (MA) takes a $110 million write-down on its soon-to-be dumped Siemens financial system, dropping its Q2 net income to $5 million vs. last year’s $71 million. As also reported here, bringing in Epic will cost another $600-700 million.

A scrub nurse at a Washington urology practice sues Robert Weissman MD, claiming that he threw an intra-operative tantrum that included cursing at her, throwing instruments, and finally intentionally stabbing her in the finger with a needle that he had just withdrawn from a patient’s scrotum.

Weird News Andy finds this story to be weird and wonderful. A Baltimore area high school freshman develops a 3-cent paper sensor that can detect cancer by indicating high levels of a particular protein, making it cheap enough to use in routine screening. Over 200 researchers he asked to help him test his invention turned him down, but now he’s working with a Johns Hopkins researcher, he has won $75,000 in the Intel International Science Fair (above), he has patented his device, and a San Diego biotech firm has offered to help him perform the FDA-required clinical trials.

WNA also likes this spooky security camera video from the ED of St. John’s Mercy Hospital in Joplin, MO as it was being hit by a tornado a year ago.

Dr. Jayne wants to play Weird News Andy in finding this obituary of a “crazy woman” characterized by her family as “De Facto empress of the hell she lived in.” I almost ran out of fingers trying to tally her former / present, living/dead husbands, not to mention her “friends at the Lakeside Trailer Park.” The family also noted that among the folks who will miss her most are Anheuser-Busch, Philip Morris, and the Ohio State Lottery. Her loved ones concluded with some sound advice: “Everyone dies, but not everyone lives. Mom lived. She lived hard, but she lived full. So, ‘Don’t cry because it’s over….. Smile because it happened!’ Light your smoke and raise your glass and remember the last thing she said to you that made you laugh so hard you thought you were going to wet yourself; but this time don’t hold back. Because she never did. “

I was startled to see this pop up on my LinkedIn page.

The executor of the estate of a 102-year-old heiress says everybody robbed her blind before she died, convincing her to give them extravagant gifts. Her daytime nurse got $31 million, the night nurse was given $1.1 million, her two doctors got $3.1 million, and Beth Israel Medical Center got a $6 million Manet painting for allowing her to live in the hospital for years even though she was healthy. Her attorney says she gave the gifts because she was generous (and he got only $60,000).

Sponsor Updates

• Practice Fusion announces the availability of customizable endocrinology templates.
• Cooper Green Mercy Hospital (AL) goes live on Stockell’s InsightCS Revenue Cycle Inofrmation Management system, including patient access and patient accounting.
• TELUS Health Solutions and Orange partner to develop remote monitoring solutions for chronic disease patients.
• Allscripts releases a white paper by CMOs Doug Gentile MD and Toby Samos MD that explores insights from ACO pioneers.
• Lifepoint Informatics is sponsoring G2 Intelligence’s Laboratory Outreach Conference June 6-8 in Las Vegas.
• The Advisory Board Company’s Crimson team will lead two breakout sessions at the 3rd Annual Health Datapalooza June 5-6 in Washington, DC.
• CareTech Solutions announces that its clients Barnes-Jewish Hospital (MO), Touro Infirmary (LA), and Wheaton Franciscan Healthcare (WI) have won 2012 Aster Awards for their websites.

Dr. Sam 5/23/12

On the Other Side of the Quality Chasm

The acceleration of the movement toward electronic health record (EHR) implementation and adoption begun by the Institute of Medicine reports of the late 1990s and fueled by the American Reinvestment and Recovery Act of 2009 has propelled us away from the paper environment at a rate that would undoubtedly not have been present in their absence. It is now possible to conceive of a time when the majority of our healthcare institutions and professionals function entirely in an electronic environment.

Now that the other side of the quality chasm is in sight, it is worthwhile to consider what it may be like when we land there, and prepare for a vastly different environment.

A significant body of evidence has been building over the last decade reflecting medical errors that may occur because of electronic medical records. Examples include default acceptance of all orders in an order set when some may not be applicable to a specific patient, or an inaccurate weight entered manually for a newborn but used to automatically calculate medication doses. Any implementation should include attention to proactively averting such errors by responsible quality control processes.

The practice of medicine in real time and enhanced capabilities for granular auditing bring the considerable exposure to medical liability to the forefront. Standards of expectation should be established for reasonable response times to alerts, e-mails and data generated and delivered in real time. Clear policies, consistent with state law, should be established to define exactly what compromises a legal electronic medical record, what information must be produced in the event of litigation, and consideration of consistency in patient care considerations in implementing new features and functions. (Is a different level of care being delivered to a subsection of patients within a hospital if a new feature or function goes live on one service and not another?)

It will be very long time before most hospitals and practices cease to work in a part paper, part electronic environment, but the common goal is to eliminate as much paper as possible. It is therefore highly probable, if not certain, that a generation of clinicians will eventually evolve who have never worked on paper.

It is also certain that hospitals and practices will experience both planned and unplanned system down time. Downtime policies specify circumstances where documentation and order entry must revert to paper, but do not generally address the possibility that clinicians may not know how to work on paper. As part of disaster planning and down time policy determination, policies should be in place for clinicians to be trained at regular intervals in the use of order forms, progress notes, history and physical notes, medical administration forms, etc. that may be called to use in a disaster environment or system down time. After a few years using fully implemented EHRs, they may simply not know how to use paper.

Similarly, ward clerks, pharmacists, lab technicians, and other support personnel must know how to carry out their responsibilities on paper, and must periodically be retrained.

Paradoxically, we may have to be certifying people to work on paper in the future.

Several years ago, I began to consider the vulnerability of our massively growing medical databases. Even though security measures, redundancy, and backup processes are in place, much of the firewall technology is "off the shelf," which simply means to me that someone sitting in a distant country can find a way through it. Most hospital security and background checks on IT personnel consist of credit reports and other forms of superficial investigation, but are rarely in-depth security evaluations.

In spite of painful mass casualty attacks and natural disasters that we have experienced (the Oklahoma bombing, September 11, Hurricane Katrina), our emergency rooms remain woefully unprepared to handle a massive number of injured people or able to sustain care for a large population of injured individuals for anything other than a very short time. If one considers the potential chaos that could ensue from a combined mass casualty episode combined with an intentional attack on the same regions’ medical databases, the importance of this consideration becomes obvious. Organizations such as HITRUST are bringing the importance of protecting our databases to light. As we move further toward the universal use of EHRs, hospitals and database specialists will need to devote more time, energy and money to protecting our healthcare databases.

I have recently been an active participant in the debate over physician-patient communication by e-mail. The greater issue goes far beyond this particular debate. While the mechanics of physician-patient interactions may be brought into the 21st century by reduction to the 1s and 0s of the binary world, the art of medicine cannot be.

If one has ever engaged in online dating, cyber political debate, or an e-mail argument, they will appreciate that much is lost in the absence of face-to-face interaction. Things are said that would never be said when an immediate reaction can be anticipated with someone who is physically present in real time and not in an untouchable, invisible virtual space. In an electronic environment, as much attention needs to be paid to taking care of the emotions and reactions of patients as is paid to the convenience of the communication vehicle in use. This lesson must not be lost for the upcoming generation of texting / Facebooking / Twittering clinicians. Those of us with grey hair have a teaching responsibility in this arena

Let’s not cross a quality chasm and create an empathy chasm.

Samuel R. Bierstock, MD, BSEE is the founder and president of Champions in Healthcare, LLC, a strategic consulting firm specializing in clinical information system implementation and healthcare IT business strategies.

HIStalk Advisory Panel: Innovative Companies 5/23/12

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.

For this report, I asked panel members what small and/or innovative companies they’ve worked with recently that readers should check out.

AirStrip Technologies. “We are implementing our second solution, Cardiology, and they are doing a great job of meeting our expectations.”

Anypresence. “They have developed a platform so that organizations can create mobile apps.”

AutomateMD. “They call themselves an EMR company with an interesting suite of products, which I like to call more peripheral additions to an EMR solution. The company is looking for investors and claims to have some big-name partners. Marketing rollout for Northern California is supposed to start June 2. The company offers PM/EMR, e-prescribing, EDI, claims, medical transcription, scheduling, billing, document imaging and management, and collections.  They have offices in California and the Philippines.”

Aventura. “You’ve profiled them. We have implemented their clinician access solution.”

CenterX. “Not working with them, but stumbled on an interesting company which is creating competition for Surescripts. This is good, as they are acting like a monopoly – high prices, low innovation. The CEO is an ex-Epic guy.”

Design Clinicals. “They have a standalone medication reconciliation product, MedsTracker, that works very well. I believe they also have a CPOE product for smaller hospitals.”

EGIS Systems. “We’ve used them for HIPAA assessments and vulnerability monitoring. So far, I think we get a lot of value for the cost. They’ve negotiated some great deals to resale other security products (e.g., vulnerability monitoring, e-mail encryption, etc.) for greatly reduced prices. Could be a great offering for small to mid-size organizations. “

Emmi Solutions. “Tracks delivery and consumption of targeted information.“

Ingenious Med. Excellent results for inpatient physician charge capture. Cerner is not quite there yet. Good tool and easily adopted by physicians, replacing either spreadsheets and manual tracking or an older tool that hasn’t kept up with mobile technology.”

Interfaceware. “Its product, Iguana, has a shorter learning curve than HL7 integration and testing. The small, bootstrapped firm is out of Toronto and has an impressive client list of hospitals and vendors. Eliot Muir is founder and CEO.”

Voalte and InterMedHx. “Awesome. Customer service is over the top and products deliver.”

MobileMD. “We’ve been talking with multiple HIE vendors and have great experience with MobileMD. They were recently acquired by Siemens, but still act like the small company they started as. Hopefully they keep it up!”

Nordic Consulting. “We’ve been very pleased with them and their consultants we have engaged.”

Strategic Healthcare Programs. “A solution of choice for real-time decision support and data analytics in the subacute segment. SHP has a dominant position and its partners page reads like a directory of subacute software vendors. Barbara Rosenblum, founder and CEO, is a great lady.”

Tableau. “Fantastic visualization software. Allows presentation of complicated information in a ‘simplified’ graphical format.”

Voalte and InterMedHx. “Awesome. Customer service is over the top and products deliver. “

White Stone Group. “On the rev cycle side. Very cool product and technology that helps hospitals and md offices deal with the nasty payors who don’t want to pay on time or want to create ‘stories as to why they can’t pay. Product is called Trace.”

News 5/23/12

Top News

HealthCor, which owns 5% of Allscripts, launches a proxy fight for control of the company by suing Allscripts over its nomination process for board members. HealthCor says the resignation of three of the company’s nine directors last month, all of whom had ties to Eclipsys before Allscripts acquired that company, left the Eclipsys product lines unprotected “from the continuing failures of execution of [Glen] Tullman,” whose ouster it had previously demanded. HealthCor wants the June 15 Allscripts annual meeting postponed to give it time to nominate its own candidates for the three open board seats, saying Allscripts should not have put forth its own slate of prospective new board members without giving shareholders the same opportunity. HealthCor is also criticizing Tullman’s $7.2 million compensation in 2011, saying he makes more than the CEOs of competitors whose stock is going up instead of down.

Reader Comments

From BoltUpright: “Re: Shantanu Paul. Interesting that he left Allscripts to head up product development at Vitera. He was a major player in the overall integration strategy at Allscripts. Not sure if his departure is motivated by a desire to jump ship because they weren’t listening to him, or if he’s being pushed out as a scapegoat for the integration problems they are having.” Vitera announced Paul’s appointment as SVP of product development here.

From White Lightning: “Re: Dan Michelson, chief marketing officer of Allscripts. Leaving the company.” Unverified, but a purported internal company e-mail sent my way says he’s leaving to become CEO of a private software company after 12 years with Allscripts. He won’t be replaced, according to the e-mail.

From Reverse Transcriptionase: “Re: Transcend. The servers of the former Transcend Systems transcription company that Nuance acquired have been down for days.” E-mails forwarded to me refer to a major system issue that was caused by failed storage devices. The last e-mail I saw, from Monday, said that they were still down and were typing and faxing stat reports, preop H&P, and radiology reports. I tried the Transcend Services Web site on Monday evening and it was down, but it’s working now, so I assume the problem has been resolved. Anybody can have systems fail and I give them credit for communicating thoroughly, although I’d be interested to hear what customers did in the interim.

From Casual Hospital Administrator: “Re: famous highly wired hospital. Patients appear to have been harmed.” The family of a former post-bypass ICU patient of UPMC Shadyside (PA) sues the hospital, claiming the 68-year-old man was somehow not attached to monitors when he died. Documents apparently verify that the patient was not being monitored for a 16-minute period, saying only that “mistakes were made.”

From Don Diego: “Re: HIStalk Advisory Panel. I’m an avid reader and also impressed with the insight, but the post on what Allscripts should do to fix things is absolutely amazing. Way to go, HIStalk.” I appreciate the involvement of the 79 panel members (now 94) who have volunteered to offer their opinions on topics I’ll e-mail them every few weeks. Most of them are CIOs, CMIOs, and practicing doctors, with a few vendor executives added to the mix. They can provide their honest thoughts knowing that even though I won’t identify them in any way, they’re still not potentially untrustworthy anonymous commenters (like Allscripts competitors, for example) since I know who they are. I’ll take suggestions on what I should ask them in the next round of crowdsourcing. In the mean time, I’ll be listing a few companies they mentioned in response to my question about any cool, small companies they’re working with – stay tuned later in the week.

From CDiff: “Re: Chicago CEO pay. The Chicago Tribune set up a Web page so you can do your own sleuthing on any aspect of compensation. Allscripts and Accretive did not bubble up, the the Trib’s lead story was about Debra Cafaro of healthcare real estate investment trust Ventas, who made $18.5 million. As you know, we have no method to compensate you for all you do; you remain the very definition of priceless.” Healthcare well represented on the list: drug maker Abbott ($24 million), supplies vendor Baxter ($14 million), supplies vendor Hospira ($12 million), and drug store operator Walgreen ($12 million) on the first page alone. Glen is on the list at $7.2 million and Mary Tolan of Accretive lags the well-enriched executive pack at $1.6 million.

From Carriage Bolt: “Re: Cerner single revenue cycle product. I’ve heard Adventist Health West is helping them develop a clinic and physician revenue cycle module.” Unverified.

HIStalk Announcements and Requests

Here’s a tip for companies who go to the trouble to issue press releases about their new hires. Include a link to a hi-res photo and insist that the person create a LinkedIn profile that includes a head shot (and not a thumbnail-sized one – a professionally made full-size headshot since LinkedIn automatically creates the thumbnail). You would be surprised at how many press releases I get about folks who have no apparent photographic presence on the Web, or who use a blurry, small, or amateurish snapshot as their LinkedIn photo. I’m less likely to run those announcements. Another gripe is PR companies that e-mail me a press release that hasn’t been posted anywhere else (including the company’s own site), so I don’t have anything to link to. Or, that send Word documents instead of pasting the text into the body of the e-mail or attaching a PDF – I practice safe text, meaning I’m not opening your Word doc unless I know where it’s been.

Acquisitions, Funding, Business, and Stock

Apple’s iPad in Business page features HCA’s use of AirStrip, Epocrates, PatientKeeper, Heart Pro, and other apps I didn’t recognize.

Here are iPad screen shots of Nova’s $17.99 Heart Pro, developed with Stanford University School of Medicine as a patient teaching tool. Very cool.

Sales

Iowa Primary Care Association selects Ignis Systems to integrate lab orders and results for 15 community health centers running Centricity EMR.

San Jacinto Methodist Hospital (TX) chooses PerfectServe for clinical communications.

People

Former Optum/Axolotl VP Anand Shroff joins Health Fidelity, Inc. as chief technology and product officer.

Nate Ungerott joins Health Care DataWorks as VP of sales. He was previously with Accuvant.

Investor Sue Siegel is named CEO of GE’s healthyimagination, which is spending billions on healthcare innovation and bringing healthcare IT to rural and underserved areas. She replaces Mike Barber, who has moved to VP/GM of molecular imaging at GE Healthcare.

Teresa Jamison is named VP of customer operations of SciQuest. She was previously with Allscripts.

Announcements and Implementations

Oregon’s statewide HIE implements Harris Corporation’s CareAccord platform and Direct Secure Messaging system.

Anthem Healthcare Intelligence, a provider of healthcare BI solutions and services,  rebrands as Agilum Healthcare Intelligence.

The 319-bed Cooper Green Mercy Hospital (AL) implements Medsphere’s OpenVista EHR and Stockell Healthcare’s Insight CS financial and accounting solution, replacing Meditech. The hospital says it will receive considerably more HITECH money than its five-year costs.

CBORD will offer Horizon Software International’s point-of-sale system that allows cafeterias to handle meal plans, payroll deduction, and gift cards to provide “the best total return on investment for healthcare food service operations.” Pretty cool, but I wish hospitals cared enough about their cafeterias to stop outsourcing them to companies like Aramark or Sodexo, who are given free rein to coldly enforce margin-preserving policies that would drive a real restaurant out of business within days: pre-portioned freezer-to-grease prisoner food from Sysco (the potato peeler has left the building), wildly overpriced drinks with no free refills, and weighing plates so that a modest portion of waterlogged spaghetti with canned sauce ends up costing $8. Nobody cooks, everybody scowls defiantly (especially the cashiers), and they all clear out by mid-evening, leaving the captive audience of off-hours employees and visitors with only the vending machines as a shining example of wellness. The best, cheapest, and most nutritional food that’s anywhere close is usually the hot dog cart out front or the caterers who bring in real food for the executive meetings.

Government and Politics

The VA refines its VistA strategy at the Open Source Think Tank, planning to spend up to $5 billion to tap the open source community and the private sector to advance VistA. Among its significant challenges is the Military Health System, which likes the fat cat contractor approach that turned its own AHLTA EMR into a $10 billion flop. The generals claim they’re leading the military-industrial complex charge, trying hard to win some EMR hearts and minds. In the mean time, the VA and DoD announce that they won’t roll out their integrated EHR until 2017. The excellent NextGov got a copy of the presentation outlining the problems. The only sure thing is that it will be late, over budget, and politicized.

Innovation and Research

A Brigham and Women’s study finds that doctors who dictate their notes instead of using templates or typing free text have lower quality of care, as evidenced by standard quality measures. The authors postulate that doctors who use a keyboard instead of a microphone pay more attention to on-screen discrete data elements and clinical decision support messages.

Technology

Bloomberg profiles Jintronix, a company I’ve mentioned that’s building technology around Microsoft Kinect that helps home rehab patients do their exercises correctly.

Mentioned in the above article is potential Kinect competitor Leap, a $70 iPod-size Minority Report-type pre-order USB peripheral that the company says will be 200 times more accurate than “a game system that roughly maps your hand movements,” able to distinguish individual fingers and track movements down to 1/100th of a millimeter. Assuming it’s not bogus, which seems to be a topic of discussion.

Other

In the UK, NHS announces an initiative to provide patients with online access to their medical records by 2015.

Bond ratings firm Fitch Ratings surveys its client hospitals about capital spending and finds that they consider IT investments to be the most important, ranking much higher than capital spending to increase capacity and align with physicians. The company was surprised to find that hospitals don’t expect the Patient Protection and Affordable Care Act to have significant influence on their capital spending plans regardless of the Supreme Court’s ruling.

Boston Children’s Hospital announces that an employee at a conference in Buenos Aires, Argentina lost an unencrypted laptop containing information on over 2,000 patients as an e-mail attachment. Somehow until trying to track this down I didn’t realize that Boston Children’s Hospital is one facility of Children’s Hospital Boston (if I’m correctly deciphering the seemingly contradictory logos and names on their site).

One of those lame problem-solver type news crews investigates a woman’s 10-hour ED wait, quoting the ED doc’s two mitigating issues: a new EMR system (Cerner from Trinity Health, I believe) and the need to treat sicker patients first.

HIStalk reader Alexander Scarlat MD’s book, Electronic Health Record: A Systems Analysis of the Medications Domain, is now available on Amazon. This is not one of those easy-to-skim books that seem to get published without any real purpose – it is hardcore into the medication domain (prescribing, drug concepts, dispensing, MAR, user interface, etc.) Alex was kind enough to send me an autographed copy since I reviewed a pre-press chapter and provided a quote for the back cover:

… encompasses high-value, high-volume therapeutic transactions of indescribable complexity that touch nearly every licensed professional in a hospital, enrobing drug ordering, dispensing, and administration in sophisticated layers of clinical decision support, caregiver work lists, and back-end charging and continuum of care functions. I am pleased that the topic merits its own formal review and analysis in Dr. Scarlat’s book. I found the user interface chapter immediately useful – in fact, I’m hoping the vendors of my own hospital’s systems take its recommendations to heart.

Weird News Andy is all up in our grill with , which he subtitles, “A Brush with Death.” Doctors investigating a man’s suspected appendicitis instead find that his intestine is pierced by a nail-like object later identified to be a bristle from his metal grill cleaning brush, which had become embedded in the steak he ate.

Sponsor Updates

• Greenway Medical and NextGen will participate in a patient data exchange demonstration during the ONC’s 2012 Direct Demonstration Showcase in Washington, DC May 31.
• Healthcare Informatics releases its annual list of top 100 vendors based on revenues from HIT products and services. HIStalk sponsors earning a spot of the list include: 3M Health Information Systems, API Healthcare, Allscripts, Beacon Partners, Capario, CareTech Solutions, Cumberland Consulting Group, eClinicalWorks, GE Healthcare, Greenway Medical, Health Data Specialists, HealthStream, Iatric Systems, Impact Advisors, Lawson Software, maxIT Healthcare, MED3OOO, MEDSEEK, McKesson, MedAssets, Merge Healthcare, NTT Data (formerly Keane), NextGen, Nuance, Optum, Orion Health, Passport Health Communications, SCI Solutions, Sunquest Information Systems, Surgical Information Systems, T-System, TELUS Health Solutions, TeleTracking Technologies, The Advisory Board Company, Vitera Healthcare Solutions, Vocera Communications, and ZirMed.
• ICA and AlliedHIE launch a national health information exchange to identify technology and communications issues within healthcare organizations.
• Michael O’Neil, founder and CEO of GetWellNetwork, gave a patient engagement presentation at Cleveland Clinic’s Patient Experience Summit on Tuesday.
• Hayes Management Consulting reports that eight of the top ten US hospitals listed on US News and World Report’s Honor Roll use MDaudit.
• The hospital authority for Memorial Hospital and Manor (GA) approves a consulting engagement with Vitalize Consulting for the implementation and training of hospital’s eMAR/BMV project.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Curbside Consult with Dr. Jayne 5/21/12

Mr. H posted the results of a recent poll asking whether it’s OK to ask emergency department patients to pay before treating them for non-emergent problems. The vast majority of HIStalk readers responding thought it would be OK.

Since I’ve spent the better part of the last week working the ED, I have to say I agree. Normally I don’t work this many shifts, but the combined stresses of recent changes in our nursing ratios that resulted in some “blue flu” among the nursing staff seems to have inspired an unusual number of call-ins among the medical staff as well. (Either that, or my partners just want to get a jump on their summer vacations.)

Most of my shifts were on the lower acuity side of the ED, which suits me just fine. The full-time docs can handle all the gunshots, “fit for confinement” exams, strokes, heart attacks, and major trauma, thank you very much. I’m perfectly happy to handle fractures, asthma exacerbations, lacerations, and minor trauma. This week, however, we had a boom in patients who simply should not have been in the ED.

This was a bit of a bummer from an electronic documentation standpoint. Our recent upgrade brought us the ability to have condition-specific defaults, and I had spent a fair amount of time building out my personal templates for the conditions I typically see. I did not, however, spend any time building templates for problems that might be best handled at home with a wet paper towel and a nap. The highlight reel:

• A teenager with an insect bite. His mother wrote a note giving permission for a neighbor to bring him in. He noticed the bite in the morning before school when it wasn’t bothering him at all, but mom decided at 10 p.m. that she wanted to know what kind of insect it was that bit him. Unfortunately, I am not an entomologist.
• A high school senior with mild sunburn who wanted to know what she could put on it to make it go away before graduation (which was the next day.)
• An adult male with a 0.5 cm lump on his arm that had been there for six months. That prompted him to arrive at 1 a.m. “just to get checked out,” although he couldn’t say why he was coming in NOW.

I’m pretty sure that if someone in the waiting room would have told them it would be a minimum of a two and a half hour wait and a $200 charge, these three musketeers (and the dozens like them) would probably have chosen to go home. I wish we could have a seasoned registered nurse stationed in the waiting room, administering simple first aid and counseling patients to follow up with a primary physician or a walk-in clinic in a day or two rather than using scarce ED resources. While I was dealing with them, we had an elderly woman with a complex fracture of her upper arm, several patients with lacerations, and a chap with a knee the size of a grapefruit that needed my attention.

Unfortunately, fallout from the Emergency Medical Treatment and Active Labor Act (EMTALA) makes it difficult for us to employ creative strategies to reserve the ED for appropriate use. Becoming law in 1986 as part of the COBRA legislation, EMTALA seemed like a good idea at the time. Although EMTALA was intended to ensure that patients presenting with emergent conditions were not turned away for inability to pay or other discriminatory reasons, the unintended consequence is a generalized fear of saying “no” to anyone who walks in the door.

The Code specifically defines an “emergency medical condition.” More than half of my patients this week failed to meet that standard, yet they had full visits anyway. We had to document each visit in detail, including a full review of systems, counseling on advance directives, nutritional screening, and more. (We also had to arrange transportation home for the mom who brought her daughter by ambulance for a splinter, but that’s another story entirely.)

I wasn’t in practice prior to 1986 so I can’t say what it was like, but I can’t imagine it was as chaotic and soul-sucking as it is now. I was, however, in the trenches when E&M Coding appeared on the scene, and I experienced first-hand the ridiculous make-work that ensued.

Looking at the track record for federal meddling in health care, it’s hard for me to think that the changes occurring as a result of Meaningful Use will turn out well in the long run. I may have Certified EHR Technology and full command of the Meaningful Use program. I can cite all the measures verbatim even after a couple of glasses of wine. I have more timely access to old charts (which are now actually legible) and better drug interaction checking, but other than that, the benefits still seem elusive.

How do you think we’ll feel in 25 years when we look back at Meaningful Use? E-mail me.

E-mail Dr. Jayne.

Readers Write 5/21/12

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!

The Art of Medicine: Unlocking the Power of Patient Data
By Nick van Terheyden, MD

We are awash with information and choices in every aspect of our lives, from the selection of our morning coffee to the choice of painkiller in our local pharmacy. Worth noting, Starbucks currently offers 30 variations of espresso beverages, and each comes in three sizes with four types of milk. That’s 360 choices — enough to potentially make you want to not get out of bed in the morning.

This problem is magnified in medicine with a deluge of new information, studies, treatments, and the explosion of genome understanding and its impact on patient care. Based on current estimates, medical information is doubling at least every five years. Cyril Chanter encapsulated today’s medical information challenges best when he said, “Medicine used to be simple, ineffective, and relatively safe. Now it is complex, effective, and potentially dangerous.”

There is general agreement in the medical profession that the delivery of quality medical care is no longer possible based on recall and applying what individuals can remember at the point of care. In fact, according to the Kaiser Permanente Institute for Health Policy, “Current medical practice relies heavily on the unaided mind to recall a great amount of detailed knowledge – a process which, to the detriment of all stakeholders, has repeatedly been shown unreliable.”

The digitization of medical records, accompanied by the requirement imposed on the care team to capture discrete data, is setting the healthcare system up for failure. We’re promoting the incomplete capture of the patient note. Discrete data is much like a black-and-white drawing — it contains some of the data, but much of the critical information and nuances are missing. In order to ensure the complete capture of the patient note, discrete data and the clinical narrative must coexist.

The key transport mechanism for medical intelligence is the clinical narrative, which provides the detail that is essential for the execution of intelligent, high-quality medical care. From there, language understanding offers a legend for these pieces of information – the narrative and discrete data – which allows us to view the complete work of art, also known as the patient note.

We are a long way down the path to enabling clinicians to capture complete patient information using the latest advances in voice recognition, which converts spoken word into text. Still, it is with language understanding that we unlock the true meaning of this information, offering a “Rosetta Stone” to tap into the insights of this information and allowing us to connect the dots in our expanding picture of patient care in a digital world.

It is this unlocked data that will link the subtle details of the patient record to vast mountains of medical intelligence; allowing for a guided, evidence-based approach to medicine alongside integrated decision support. This in turn will offer care takers a more complete picture from which they can guide individual care, while enabling possibilities surrounding large health population analysis and insight.

As we unlock the capabilities of clinical data in healthcare, we open the door to new discoveries, associations, and yet-unimagined treatments that will directly affect the care of those we love and look after now and into the future.

Nick van Terheyden MD is chief medical information officer of Nuance of Burlington, MA.

I once heard it said that successful device connectivity in a hospital is like implementing a universal remote on your TV. The consolidation of controls allows for easier training of new users, fewer steps to execute a command, and less room for error. But in today’s age of accountable care and new care delivery models, the health systems that are still operating in the “universal remote” mindset will be left behind as the industry progresses.

It’s great that my DVD player can talk to my TV. But what about when I want to watch the same movie on my laptop in the other room? And while this entertainment glitch is a little frustrating, it’s actually criminal when we think of a similar scenario in the healthcare world. We don’t need to just connect one point solution to another. We need to be able to effectively care for patients, regardless of where they are within the hospital; what systems the hospital has in place; or how many physicians, nurses or other staff are involved in the patient’s care. The sooner hospitals begin to think beyond individual technologies and develop an overarching strategy to connect people and processes, the faster we’ll start to see a real change in patient care.

Historically, hospitals and health systems have approached medical device connectivity tactically, focusing on how to connect a nurse call device to a smart phone, a monitoring device to an iPad, or data from a smart bed to an EMR. Often purchased by IT departments as middleware, a range of IT solutions have been viewed as a solution to one or two key problems, and have typically been implemented one department or one facility at a time.

Because many of these technology investments were made to solve only singular, point-in-time problems, providers still struggle to deliver care that focuses on the patient across the entire care continuum. They need to get smart about implementing solutions that cater to the unique workflow of their personnel – not their hardware – if they want to drive efficiency and improved patient care.

It’s not really the provider’s fault, though. The vast majority of vendors have played into this universal remote mindset by building point solutions that connect a small subset of devices or departmental systems to one another, rather than focusing on the entire system. Providers need solutions that both cater to a department’s unique workflow and enable collaboration from one department to the next, making it possible to efficiently serve patients as they move between these diverse care settings. They need to come to the table with customizable solutions, and with services that help hospitals implement these solutions as part of a broader workflow strategy. It’s not enough to drop off a box and wish them well. Providers need partners to help them learn and improve for years to come.

We need a new movement in healthcare, one that takes a system-wide view to clinical workflow design and leverages clinical technology solutions to both connect devices and foster collaboration across the entire system. This includes everyone from patients to clinical teams to ancillary groups (biomedical engineering, dietary, environmental services, IT, and pharmacy). Clinical workflow is about more than hardware and software. It’s about the clinicians who use these solutions and need them to promote — not hinder – high-quality patient care. Vendors need to offer their customers something better than stale point solutions. 

As an industry, we need to map to the bigger picture, driving teamwork and collaboration among every individual and across the entire care continuum in order to drive dramatic performance improvements for healthcare organizations.

Mary Baum is chief healthcare officer of Connexall USA of Boulder, CO.

The Long Road Ahead: Choose your Traveling Companions Wisely
By Chad Morrill

When hospitals choose a healthcare IT provider, they too often just focus on the same questions many of us consider when buying a car: “How fast does it go?” and “How much does it cost?” But for a successful project, these are just two of the many factors to consider. Another key decision point should be a vendor’s suitability as a long-term partner.

We’re not just talking the equivalent of a 100,000-mile power train warranty, whereby the vendor will fix your system if it breaks, though of course responsive support is important. But beyond that, you’ll be better off working with a company that not only understands its products and services, but also your processes, your staff, and your goals, and will do its best to unite these elements to give you maximum performance and value.

The first thing to consider before getting on the road is your hospital’s needs, both now and for the next few years. What are the pain points you’re trying to overcome, what new compliance mandate are you struggling to satisfy, or which facet of your EMR/EHR project are you finding most troublesome? This then defines the focus of your solution search, which will in turn narrow your list of prospective vendors.

Next, ask for references from facilities like yours and see how they’re solving the very issues you want to solve. Then ask them what else they’ve been able to do with the product. A hospital sometimes picks a solution because it fits neatly into whatever box they’re trying to fill, but yet leaves the full potential of that solution untapped. One of the reasons is that an IT team is typically tasked with solving a very narrow problem, and once they’ve done it, they must move on to putting out the next fire lit by clinicians or the CIO. They then go out and look for other vendors to meet the very needs that could be met by the product they’re already using – a waste of time, effort, and money for everyone involved.

Executives tend to chase the next “shiny object” or respond to the newest tech trend, and this leads to the misconception that something ‘new and improved’ is required. Just like we all want the next iPhone or iPad, many hospital users hanker after the latest IT toys on the market, following the hype rather than putting in the effort to explore the full capability of the applications already deployed.

Despite the need for hospital project managers to be proactive in working with vendors to get the most from their systems, the burden cannot fall solely on the facility. A responsible vendor that cares about its customers and the staff and patients they serve should dedicate time and resources to helping hospitals get the most out of its solutions. A regular onsite “checkup” with both a customer advocate and a member of the vendor’s executive team can provide the hospital with a view of what its products can do now, and what the roadmap is for upcoming functionality. The vendor can explain and even demonstrate how other customers are using its offerings in new ways, and can then help the IT staff put this knowledge into action. Executive buy-in is also crucial on the hospital side, as the CIO and IT director will be key in both understanding the full potential of vendors’ products and services, and then in driving widespread user education and adoption.

The challenge to such leaders: push your IT analysts/project managers to explore each product’s entire feature set and get involved in engaging your vendors to see what else you could or should be doing. Yes, it requires accountability and an upfront time investment. But it will yield the benefits of doing more with existing tools, moving further toward achieving your facility’s goals, and, most importantly, of improving care and service to your patients. Time to start your engine!

Chad Morrill is an account manager at Access of Sulphur Springs, TX.

HIStalk Advisory Panel: Allscripts 5/21/12

The 79-member 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.

For this report, I asked panel members what advice they would provide to Allscripts after the company’s recent earnings disappointment and board shakeup. Their responses have been edited for brevity and to ensure their anonymity. Your comments are welcome.

Vision and Strategy

• The anti-takeover defense made them look weak in my eyes. They need to communicate their go-forward strategy with large clients as soon as possible. People here are worried that our vendor is going out of business.
• Phil Pead was all about the stock price and less about the product, integration, and ease of use. Allscripts tried to tell the integrated story with several different legacy flavors of PM/EMR – too many products, too many moving parts. The Eclipsys purchase was 2-3 years too late since Epic and Cerner have already beaten them and Epic is the only one with a real story of true integration. On the low end, they are most likely getting hurt bad by eClinicalWorks, athenahealth, Greenway, and similar companies. My advice: sell Eclipsys and use the money to pick a lane with one or two flavors of product and just kill it in that space. They cannot be all things to all people.
• They need to re-examine their market and whether this Eclipsys thing is really going to work. Seems like Glen did not learn anything from McKesson and GE.
• Post-acquisition is difficult and companies sometimes make all the parties feel good by including all the legacy resources – people and products – in the path forward. That leads to lack of vision, resource mismanagement, and excessive costs. I think Allscripts got caught in that vortex. They need to clarify what they want to be, then clean up the operation despite painful changes and bruised egos. A change at the top may be necessary to keep the institutional shareholders and analysts at bay while they right the ship.
• Put a plan in front of your most important customers and enlist them to create a public statement of support. Customers trump boards of directors every day.
• Come clean to everyone with what the problem is. Replace the corporate audit firm. Either replace the management team or give them a 12-month notice to clean up their own mess and then get out, assuming there is a belief they can clean it up. Appoint an external firm to work with the board to identify the issues and to decide which board members should stay. Make sure key intellectual capital employees are willing to stay and reinforce your need for their services.
• Allscripts is a finalist in our inpatient EHR selection. The recent news has raised concerns about the company’s viability. Show the market you can recover and succeed since partnering with Allscripts at this point represents significant risk. The failure to integrate Eclipsys products is a key issue since companies like GE and McKesson promised it after an acquisition and failed miserably, leaving customers in a lurch.
• A trick of publicly traded companies is to reveal all your bad news at once, let the market kill you, then build back up. I assume this is the case and future revenues will come with a clean slate. I think they will have some good upcoming quarters.
• They have had a pretty successful ambulatory product offering. They need to leverage that business model to tackle new accounts. With the internal politics hopefully behind them, they can concentrate on integration. They have a good product – I hope they understand that. It’s their execution that’s hurting them.
• Senior management, led by the CEO, need to be transparent if they’re going to put this turmoil behind them. They need to communicate clearly, thoughtfully, and comprehensively what the plan is, with no BS and PR. Humbly admit past mistakes, acknowledge vulnerabilities, reiterate its strengths and lay out the plan to recover. Spend 30-60 days to do a thorough, honest self-assessment – including consideration of the complaints of its critics – and play out best- and worst-case scenarios. If past decisions (i.e. integration) are criticized, those can’t be changed, but they should be acknowledged and addressed. The market is still large and I don’t believe it’s too late for Allscripts to get its share. It may not achieve a #1 or #2 market position, but it can still emerge as one of the winners. It has good products, a sizable customer base, and many talented employees. The message should be positive and encouraging, but above all, credible. In the absence of an ability or willingness to do this, Allscripts should fire Glen Tullman and hire a CEO with the determination and commitment to turn the company around, like fresh leadership did at IBM with Lou Gerstner.

Sales

• The sales team needs better access to technical resources. When they do a dog and pony show for our executives, our technical team is always invited and the sales team can’t answer their questions. I want to be sold, but they can’t bring it.
• Closing deals is the way to show viability. We’ve evaluated their products for our clinics and they didn’t stack up well. One group we’re associated with uses Allscripts and they have not been happy with the product for some time, but I don’t see them moving away from it.

Products

• They need to focus on clean integration of products they are selling as integrated. The last few times we purchased ‘integrated’ solutions from Allscripts, we had to take over the integration because we were getting nowhere with the company.
• Articulate the vision of the combine Allscripts-Eclipsys platform and provide a well thought out plan on how they will get there.
• They may want to take the approach McKesson used for Horizon Clinicals – sunset Eclipsys and focus on ambulatory. They carved out a nice space in the ambulatory area and the R&D dollars going into Eclipsys integration could have been used to further the ambulatory product line. Ambulatory clients are confused. This plays right into the hands of Epic.
• Allscripts needs to stop talking about an integrated record as though they can compete with Epic. They need to find a way to leapfrog Epic. Take what Sunrise customers are developing using Objects Plus/Helios (some of which knocks the socks off Epic) and incorporate it into the product.
• We were a long-time Misys client who left after Allscripts dropped the ball. They couldn’t deliver on support. They decimated their personal relationships by replacing dedicated professionals by a different nameless person every time we made a support call. Their salespeople couldn’t even present a proposal for community integration without innumerable failures in the demo. The ‘free upgrade’ from Misys EMR to Allscripts Professional turned into a morass of fees for training that would have cost more than  buying a competitor’s product. Not surprisingly, small practices in our area have turned to eClinicalWorks and Greenway and never looked back. Simply merging individual products repeatedly without true integration and delivering on promises is not sufficient for success.

Services

• The India-based support we were getting from Eclipsys and then Allscripts was horrible, but they have really taken the bull by the horns and cleaned it up. Recent responses to our problems were clean and focused and I have been pleasantly surprised.
• Outsourcing support to India was a bad idea. Docs like me call and we get people who don’t know the product. The same is true of their patient portal – it is a Babel Tower.
• We have seen deteriorating support and turnover amongst the sales/support team that crosses product lines. Physicians are losing confidence in the product.
• We’re a large Allscripts Professional client and it’s been frustrating to watch them struggle to grow and try to compete with Cerner and Epic. Their overall support and quality has suffered, especially with new releases.
• Please care about me and provide support. I know life isn’t the best for you right now, but I still have to work and I need you to fix the support structure. Keep current customers from being so put out with you and fewer of use will become someone else’s customer.
• Hire more qualified staff. They are hiring high school graduates for implementation consultant positions and giving them only basic training before sending them out to clients at $205 per hour.

Monday Morning Update 5/21/12

From Determinant: “Re: Cerner. Have you heard of them trying to sell ProFit patient accounting for both hospitals and practices? Looks like Cerner wants to complete head to head with Epic by offering one combined solution set for hospital, professional, and physician clinic billing.” I haven’t heard that. Anyone?

From The PACS Designer: “Re: Samsung Slate. One of the drawbacks of the iPad when it comes to viewing healthcare legacy apps is its small size. This hampers the effort to move these apps to a tablet display. Samsung has released a tablet called Slate with a 11.6 inch form factor, which should make the legacy app transition effort easier.” Samsung seems to be leading the “bigger than Apple is better since we can’t beat them otherwise” charge with its 3×6” Galaxy smart phone (or “smablet”) and now the 11.6” Slate. You’re going to look like a tool yapping into the bigger-than-your-hand Galaxy that covers the whole side of your head like Gordon Gekko’s 1987-era cell phone in Wall Street (which in turn looked like a Vietnam War walkie talkie), so I suggest budgeting for a headset and to arrange tailoring services for pocket expansion. The Slate will basically be the size of the entry level MacBook Air screen without the keyboard, meaning you’re back to a laptop size again other than the touch screen and a lot more money. Wasn’t portability the whole point of these devices? All of this makes me think that Windows 8 could be a really big deal since it seems that everybody wants some features of iOS (apps, touch, crisp display) but doesn’t care too much otherwise, and Win 8 will of course run on cheaper commodity hardware.

From Real Doll: “Re: former Cerner COO Paul Black on the board of Allscripts. The other new board member is from UPMC, which has close Cerner ties. Could be a merger in the works.” Unverified. I suppose anything is possible and Cerner isn’t all that strong on the ambulatory side, but that would be an ugly marriage.

Listening: Material Issue, a Chicago-based guitar-heavy power pop trio from the mid-80s. The frontman-founder killed himself in 1996, but the band left behind some great music. I also looked back to my February 13 post as Van Halen started their tour, when I said, “Check out their tour, but I’d be cautious about buying tickets for anything after the Boston show since tours seem to bring out the squabbling between the Van Halen brothers and whoever their lead singer is at the moment (Roth, Hagar, Cherone, lather, rinse, repeat) and the whole thing could go down in flames (think The Eagles without the concert-dollar greed that makes them pretend to get along.)” Sure enough, the band has postponed the remainder of their tour, although I missed the date — the Boston show was March 11 and it lasted a few weeks longer than that.

It’s OK to ask ED patients with non-emergent problems to pay before treating them, say 82% of respondents. New poll to your right, from the next story down: will Cerner and Epic be the only hospital information system survivors?

Cerner CEO Neal Patterson says at Cerner’s shareholder meeting that the company could be pulling in $10 billion per year in revenue by 2020, almost five times today’s total. He also says he’ll probably retire before then. When asked about the complexity of meeting provider technology needs, he said Cerner and Epic might be the only companies left standing. The “and Epic” part is not very Neal-like, so maybe he’s already mellowing on his way to the rocking chair.

Long-term care provider Deseret Health Group chooses HealthMEDX Vision to manage patient records across its 20 locations.

On HIStalk Practice, Inga interviews John McConnell, who sold more than $1 billion worth of companies that weren’t Eclipsys (Medic and A4) to what is now Allscripts.

Eight physician groups in the Kingsport, TN area start the OnePartner HIE, which will use the Siemens MobileMD platform.

The Twin Cities paper profiles the use of SafetyPad by Hennepin County paramedics. The tablet app, developed by Open Inc., receives 911 information, records vital signs, provides checklists, and notifies the ED that the patient is inbound. The hospital’s server receives a copy of the chart, looks for trends that may signal an epidemic, and bills insurance companies quicker than on paper (10 days vs. 90).

Here’s your weekly dose of HIS-tory, in which Vince talks about product names.

The FCC will vote this week on allocating a chunk of the wireless spectrum to Medical Body Area Networks, in which wearable patient sensors would communicate wirelessly to a local base station to send information back to physicians. FCC Chairman Julius Genachowski lauded the technology, citing examples such as remote EKGs, smart pill boxes, and diabetes management devices, also pointing out that half of hospital inpatients aren’t monitored and could potentially be with MBANs. If the rules are approved to reallocate the spectrum formerly used by commercial test pilots, the US would be the first country in the world with a dedicated spectrum for MBANs. He specifically mentioned that GE and Philips are working on the technology.

The results of Dr. Oz’s 15-minute physical on 1,000 Philadelphians using Practice Fusion’s free EMR: 43% were obese, another 29% were overweight (meaning a total of 72% weighed more than they should), 43% had high blood pressure, and 40% had pre-diabetes. Two patients were found to have significant problems (blood chemistry, hypertension) and were admitted to the hospital. Practice Fusion compared the data from its records on 40 million patients to conclude that more of those 1,000 patients were hypertensive than in several other large cities. The article says the Dr. Oz show chose Practice Fusion over several other EMRs that were considered, including Epic and drchrono.

Reading Hospital (PA) reports that a now-fired employee exposed the medical information of 12 patients by printing their billing information and using it in a training class.

A Department of Homeland Security bulletin warns that connecting medical devices to wireless networks is risky, and organizations that do it need to implement a really good security program. They mention the VA’s use of virtual LANs with access control lists as one way to keep unauthorized users out. A problem is that more devices are using commercial operating systems rather than custom-developed embedded ones, meaning they are more susceptible to malware.

A team of electrical engineering students from Portland State University wins Cornell Cup USA Presented by Intel for its prescription drug identification device, which provides near-instantaneous identification of tablets and capsules from their image. The students came to the university through the Intel Vietnam Scholars Program, in which interns from the Intel’s Ho Chi Minh City factory study engineering at Portland State.

In Australia, the government of Victoria finally kills off the HealthSMART project that was to have provided hospitals with software from Cerner, iSoft (now CSC), and InterSystems. The initial $318 million budget had run up a $557 million tab before funding was ended. Only four health services are live today of the 10 the government had promised would be running by 2007. Most folks blame mismanagement and poor planning rather than the vendors.

The Chicago business paper reports that Merge Healthcare Chairman Michael Ferro and companies he’s invested in have earned $9.3 million in side deals from Merge. Only four of the 11 related-party transactions were reviewed by independent directors. Shares have dropped 61% in the last couple of months.

The former assistant dean of Temple University’s medical school, along with the university, will pay more than $1 million to settle Medicare fraud charges in which $4.5 million in plastic surgery work was billed to Medicare but performed by unsupervised medical residents. The doctor is serving a seven-year term in federal prison for 150 counts of fraud.

The Tucson newspaper recognizes Sunquest Information Systems interface programmer Kenny Wickert, who throws annual  cookouts at work to collect co-worker donations for a Tucson child protection organization. Each event raises around $5,000. Says Kenny, who has worked for Sunquest for 21 years, “I see people dropping 20 and 30 bucks in the jar for a burger … We grew up just dirt-poor, and she always made it work with what we had. It’s kind of fair that I give back now that I can.” The award was given by Ben’s Bells, a kindness recognition program started by the mother of two-year-old Ben, who died when a respiratory infection caused his airway to swell shut while he was playing.

I lauded HealthNovation President and CEO Mike Mosquito at HIMSS in Las Vegas after observing his sartorial splendor, explaining as I asked to take his photo that Inga would be impressed with his truly sharp-looking outfit. Here’s a shot of him taken by Jennifer Dennard at last week’s Georgia HIMSS golf tournament, pulling off a great look despite what might appear to a highly questionable choice of trousers even in the “go to hell pants” world of golf clothing (I’m thinking Rodney Dangerfield’s Al Czervik in Caddyshack). I found by searching that I ran a photo of Mike from the same tournament last year, in which he was equally resplendent. I should get him to take a pic of his closet contents.

The event funded $2,000 scholarships for Ana Alston (Georgia Health Sciences University), Tiffany Formby (Georgia Tech), Laura Griggs (College of CoastalGeorgia), Lars Moen (Georgia State), and Laura Sims (Georgia Tech).

E-mail Mr. H.

Time Capsule: Incompetence by Committee: How Customers Dumb Down Vendor Software

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 May 2007.

Incompetence by Committee: How Customers Dumb Down Vendor Software
By Mr. HIStalk

We software customers often complain that our vendors lack vision. Maybe so, but what goes unsaid is that we ourselves are largely responsible.

Many or most vendors do their best work before their second customer comes on board. Their bright and dedicated employees, along with perhaps a development site’s subject matter experts, work from a blank slate and do some really innovative work.

Once customers sign up, however, the once-fresh product is dumbed down. Every new customer has their list of must-have enhancements, almost entirely (a) a smorgasbord of unrelated bells and whistles they saw in some other vendor’s demo; or (b) a feature of questionable necessity that exists only in the product they’re replacing. Consider the irony in either case.

That’s why software turns into a crazy quilt of unrelated and immature ideas. Too many customers come up with lame ideas that vendors are scared to ignore.

Customers, you see, are terrible visionaries. They always have a punch list of minor productivity tweaks and site-specific changes that move the product sideways at best. Vendors who ignore these suggestions, often with good reason, are considered unresponsive.

No wonder quality assurance, product documentation, and integration are so bad in healthcare software. Applications aren’t an integrated software platform with a clear focus – they’re a collection of unrelated product features and emergency tweaks held loosely together with the unreliable glue of a common user interface, customization switches, and a single database, all voted on by committees of self-interest.

Too many cooks in the kitchen indeed. We blame customers or poor training when only 20% of software capabilities are used. Maybe it’s because only 20% of a scattershot of functionality applies to a given site.

The enhancement process encourages this. A bunch of customers – heavily overweighted by those from big hospitals with travel money – sit in a room and vote on enhancement ideas. What’s wrong with that democratic approach?

• The larger the committee, the less likely anything bold or innovative will result.
• The voting process ensures that only safe, universally acceptable enhancements will be chosen. Products that were created through risk-taking and creativity get watered down by dull, uninspired changes that neither enrage nor delight anyone.
• Small, obviously beneficial changes never get done. Why waste your user vote on something less than a sweeping change that no one else wants?
• Customers have no idea what they want or need. They’re also unwilling to expend any more effort than to toss out off-the-wall suggestions.
• Customers will provide crudely drawn screen mockups (users think only in terms of screens). They don’t employee critical thinking skills until the enhancement arrives on their doorsteps, at which time they suddenly get engaged and loudly proclaim its imperfection and refuse to use it.

Ample evidence exists that hospitals have few original thoughts and little ability to think strategically. Putting hospital staff in charge of product design and strategic direction is a bad idea.

Once a product has evolved into a Frankenstein-like set of unrelated product appendages, testing and integration get geometrically more difficult. A great niche product with a fanatically loyal customer base becomes an unwieldy fibrillation of disjointed ideas with an indifferent audience and mediocre KLAS scores (sound like anybody you know?)

Vendors don’t help. Is the intended product audience a 50-bed rural hospital, a 1000-bed academic medical center, or an IDN with a big ambulatory business? "Yes!! We want a product that is universally cherished and appreciated." Fat chance.

I see nothing to challenge the basic premise that innovation will come only from small, cheeky vendors willing to break the rules and provide leadership, not contract programming to customer specs. At the other end of the product life cycle is the elephant graveyard, those publicly traded vendors and multi-industry conglomerates where once-interesting products go to die slowly and painfully.

What happens in between is up to us customers.

News 5/18/12

Top News

Big Meaningful Use news: 3M, as part of its deal with the VA and DoD to help create a shared electronic medical records system, makes its Healthcare Data Dictionary available to all providers, payors, and vendors anywhere in the world for free. The dictionary translates to and from standard terminologies such as LOINC, RxNorm, ICD-9, ICD-10, and SNOMED CT, allowing disparate systems to communicate via concepts that support semantic interoperability. Check out the company’s white paper on the dictionary. You may recall that the feds licensed SNOMED for the entire country a few years back, making it free. This announcement may be even more important for interoperability, although I don’t see much buzz about it for some reason.

Reader Comments

From HIT Cynic: “Re: Cal eConnect. Looks like another state HIE bites the dust.” Not exactly. California’s HHS announces that it will move oversight of the state’s ONC-supported HIE program from Cal eConnect to the Institute for Population Health Improvement, which is part of UC Davis Health System. IPHI’s director is Ken Kizer MD, renowned for whipping the VA into shape in the mid-1990s.

From Wise Guy: “Re: new Allscripts board member Judge Cindrich. He’s a major consigliere to UPMC CEO Romoff, whose former right-hand man Phil Green is also on the Allscripts board.” I assume their UPMC connection is a coincidence. It’s a sure bet that they are Glen-friendly, though. I’ll be interested to see this quarter’s announcements and results since it’s pretty much go-time, one way or the other.

From Grand Cru: “Re: Partners HealthCare. They are all in with Epic. A catalyst was the Siemens rev cycle project, which needed a significant cash infusion over and above the existing budget. They were supposed to have all hospitals live by now and only one is (barely). This got the board’s attention since they were already looking for a clinical solution. I heard the write-off will be around $100 million on top of the cost of moving to Epic. Yikes! Siemens had an entire floor of one of the Partners office buildings, with employees who had moved their families and been there for years. Within two hours of Siemens getting the Epic decision, the floor was empty – they were told to move out ASAP.” Unverified. But in the mean time, Partners goes public with its plan to spend $600 million on Epic, which I’ve heard from several folks is a soup to nuts implementation, not just clinicals. I either didn’t know or forgot that former National Coordinator David Blumenthal MD has a Partners position – chief health information and innovation officer, according to the article.

From Dr. Gregg: “Re: health literacy. I was on a focus group call for the AHRQ-sponsored Center for the Advancement of Health IT concerning health literacy, which you mentioned on April 6. We were asked how to best get the word out about their health literacy guide and someone suggested popular HIT blog sites. Someone said, ‘Great idea, like HIStalk’ and it sounded as though everyone the call enthusiastically agreed. The moderator concurred with gusto that many of their focus group participants had come by via HIStalk.” I’ll try not to get all soapboxy, but I’ve been an obnoxious advocate of readability for many years. Everybody’s talking about software usability, but we medical people are even more deficient in content usability – the words we speak and write for patients are poorly thought out, full of jargon, and way beyond their level of comprehension. It’s hard – I once researched and wrote 100 or so patient education handouts (conditions, meds, treatments) and got the readability down to around 6th grade level, but it took a lot of careful wordsmithing and translating. This AHRQ publication contains most of my secrets, including a super-handy checklist at the end. I wish someone could convince the medical journals to break the self-sustaining cycle by eliminating their snotty, third-person dry recounts of studies in their articles – providers learn absolutely everything wrong about how write, resulting in articles that no human being can possibly understand even with the fivefold increase in time it takes to try to pry apart the dense, lifeless, code-worded verbiage to extract the tiny bit of useful information. I guarantee I could summarize a stack of medical journals in a couple of easily-read pages and you wouldn’t miss anything important. Anyway, the AHRQ pub is good whether you’re a readability beginner or just need a refresher. It’s a free download and, as you might expect, it’s easy to read.

From Radar Love: “Re: InfoLogix. It’s hard to believe the company, which largely failed in the RTLS market, is owned by Stanley Black and Decker and is acquiring AeroScout. They have maybe two installs that I can recall.” A rumor posted by a business publication in Israel (where AeroScout was founded) says Stanley Black and Decker will acquire AeroScout for $200-250 million via its healthcare division (meaning InfoLogix). InfoLogix lists quite a few customer testimonials on their site (Baylor, Tucson Medical Center, Albert Einstein, Swedish, etc.) so either your two installs number is incorrect or there’s something going on with the testimonials.

From Dennis “Doc” Gross: “Re: Captain Donna Rowe and National Nurses Week. I will always be grateful to Capt. Donna Rowe. She was the triage nurse the night our Dustoff helicopter went down bringing in a scout dog injured by shrapnel. We flew out of Dong Tam in the Mekong Delta  and were bringing  the dog to the Army’s veterinary hospital in Saigon. Our tail rotor blew out and all I remember was a big bang and then the helicopter did six 360s and we dropped into the trees from about 400 feet. I woke up the next day in the 3rd Field. A few years back, I was in contact with Capt. Rowe by e-mail. She and all of the nurses that served in Vietnam will always have my respect. They are special people and did a thankless job with compassion and professionalism. Many of my buddies and other soldiers owe their lives to these wonderful nurses. May God bless them.”

HIStalk Announcements and Requests

Highlights from this week’s HIStalk Practice: MGA-ACMPE asks HHS for a six-month deadline extension for submitting e-prescribing exemption requests. Vitera CEO Matthew Hawkins says his company will add up to 100 employees and spend $25 million on new technology. The AMA asks CMS to push the ICD-10 deadline to October 1, 2015. CureMD, Practice Fusion, and athenahealth take the top spots in KLAS’s review of SaaS ambulatory EMRs. Aaron Berdofe explores the definition of health informatics. Julie McGovern of Practice Wise offers advice for providers investing in IT hardware and services. Thanks for reading!

Constantine Davides felt pangs of responsibility to update his healthcare IT vendor family tree with your suggestions, so here’s the new version he did. I was thinking about it today. With consumer application software, companies buy each other and usually just keep selling the same software with no new claims. Purchasers continue to be happy since they have no new expectations and already got what they thought they would get. In healthcare, companies try to convince prospects that the mess of thrown-together unrelated products have become seamlessly integrated and synergistically improved just because the marketing people said so, happy to take the customer’s money even though they are sure to be disappointed in the futures they bought but may not receive. If you are industrious, you could plot number of acquisitions against KLAS scores and see if there’s a relationship.

On the Jobs Board: Business Development Executive, Director Solution Sales EPSi, Clinical Pharmacist.

Inga, Dr. Jayne, and I aren’t as smart as that $20 billion brat Zuckerberg. Instead of inventing Facebook (aka the OS for Farmville), we toil anonymously on HIStalk, trying to inform our healthcare IT audience while we actually work in healthcare IT (a novel concept). We’re on the non-profit side of the house, which means that a few muckety-mucks at the top of our org charts make millions, but down at our pagers-and-cubicles level, the perks are few and far between. You can, however, provide us with an emotional payday without spending a cent. Sign up for the spam-free e-mail updates by clicking the Subscribe to Updates link at the top of the right column (or by clicking here). Bond with us on all of the social not-working sites, or join Dann’s “no dues, no benefits” HIStalk Fan Club on LinkedIn as 2,460 cool people have done (check the list … impressive.) Choose a color and click each sponsor ad to your left that uses it, possibly finding an interesting offering purely by chance. Play with the searchable Resource Guide and give the Consulting RFI Blaster a try if you need consulting help. Send me news and rumors. I’m sure you can think of other ways to stroke our fragile egos, but I’ll leave that up to you. Reading HIStalk is the best way, of course, as is using your beguiling charm to get others to do the same. Thanks for hanging out with us.

Acquisitions, Funding, Business, and Stock

DICOM Grid, which offers a SaaS platform for medical imaging applications, closes a $5 million financing round. The company also announces sales to Frederick Memorial Hospital (MD), Ella Health (PA), and Texas Medical Center.

Emdeon reports Q1 results: revenue up 5.4%; net loss of $17.3 million versus a profit of $7.3 million a year ago. The company attributes the loss to the cost of taking the company private last year when PE firm Blackstone Group purchased the company for $3 billion.

Measurement technology vendor Agilent will acquire Denmark-based cancer diagnostic company Dako for $2.2 billion.

Sales

Catholic Health Initiatives signs a 10-year agreement with Tenet Healthcare subsidiary Conifer Health Solutions to manage revenue cycle services at CHI’s 56 hospitals. The agreement calls for CHI’s revenue cycle employees to transition to CHI and for CHI to receive a minority position in Conifer.

People

Healthcare RCM provider Adreima names Bob Wilhelm (TriZetto, Cerner) CEO. Former CEO Connie Perez is moved to the position of president.

Paul Black (Genstar Capital and former Cerner COO) is appointed to the board of Allscripts. Also named is Robert Cindrich (UPMC). All directors will stand for re-election at the June 15 shareholder meeting.

iSirona promotes Philip Sawa to VP of sales.

Medicomp Systems promotes Dan Gainer from senior software engineer to CTO.

CynergisTek hires Neil Buckley (Partners Healthcare) as VP of technology solutions, Eric Nelson (Secure Privacy Solutions) as a contributing principal, and Arnold “Van” Zimmerman as a contributing principal.

Announcements and Implementations

Bon Secours Charity Health System (NY) chooses MediRevv to provide A/R management for its three hospitals.

Wolters Kluwer Health will integrate its ProVation Order Sets with Meditech Client/Server and Magic version 5.64.

Government and Politics

Here’s a dynamic Farzad Mostashari from ONC, effectively explaining Meaningful Use in five minutes to an oddly boisterous audience.

Other

The body refrigerator at the Oklahoma Medical Examiner’s Office breaks down, requiring 28 bodies to be moved to refrigerated trucks just as the state legislature debates funding of a new building for the office. Coincidence or leverage?

Sponsor Updates

• GetWellNetwork will offer CBORD’s room service offering in its interactive patient care solution.
• The Ontario Ministry of Health and Long-Term Care signs a two-year contract extension with TELUS Health Solutions for its Health Network System.
• MEDecision hosts more than 150 customers at its client forum.
• T-System is selected as a finalist for Red Herring’s Top 100 Americas Award, which honors the most promising private technology ventures.
• DrFirst recognizes 10 of its client hospitals for being named to the Thomson Reuters list of Top 100 Hospitals.
• New York eHealth Collaborative will honor Jeffrey Immelt, chairman and CEO of GE, and Samual Palmisano, chairman of IBM, at its 2012 gala in October.
• Allscripts and dbMotion will host a June 12 seminar discussing the connecting of healthcare communities.
• Beacon Partners offers new Webinars on MU Stage 2, project management, and Epic Community Connect.
• A Billian-sponsored Webinar presents results of a post-implementation EMR perception study.

EPtalk by Dr. Jayne

Inga already mentioned this on HIStalk Practice, but I have to put my two cents in. The AMA recently sent a letter to HHS Acting Administrator Marilyn Tavenner, requesting an additional delay of ICD-10 until at least  October 1, 2015 citing “inadequately aligned” federal programs. Although I don’t disagree about the number of competing initiatives, this sort of feels like a child trying to renegotiate bedtime. They already extended it once, and since we’ve known about this for years, many of us just want to be done with it.

Speaking of HIStalk Practice, I really enjoyed the Practice Wise piece that Inga published earlier this week. Topics like proactive network support and asset management are often overlooked by small practices (and frankly some large ones) who later are surprised by their importance when something goes wrong.

Many physicians are worried about the loss of privacy (for both physicians and patients) resulting from the boom in social media. Cyberstalking is certainly easier when someone has an online presence, but I didn’t realize how many physicians have been impacted by old-fashioned stalking. A recent report presented at the American Psychiatric Association annual meeting notes that more than 20% of surveyed physicians said they have been stalked by a current or former patient at some point. Having been on the receiving end of stalking a few times, this is worrisome.

Recently I’ve seen an uptick in the number of spam e-mails I receive. One today asked me if I’m the person responsible for adding content to a particular HIStalk page from 2008. This was clearly not from an HIStalk reader based on other things in the e-mail, so off to the trash can it went. Of course I couldn’t avoid going to see what the topics of the day were and I wasn’t disappointed: bad decisions at Allscripts led the news.

I’ve heard the phrase Goat Rodeo used to describe various IT projects, but I’m wondering if we’re going to have to retire it from the lexicon? Apparently it’s also the title of a recent album by acclaimed cellist Yo-Yo Ma. Speaking of goats, I enjoyed reading a recent blurb about a New York emergency doc who found happiness on a goat farm. In the midst of a go-live right now, I agree that career alternative is starting to sound awfully appealing.

Speaking of go-lives, I wanted to share a hilarious email I received last week in response to my piece on EHR upgrade training. I was lamenting the difficulty of finding the training room. This reader earns the coveted “Laugh of the Day” award:

Don’t blame IT for lack of signage to your training room. I’ve gone around and around with facilities on this. They won’t put up permanent signs because not that many people need to know this information on a regular basis. TJC and the fire marshal prohibit 8 1/2 x 11 paper signs. I’m not sure how many people are killed annually by these things spontaneously combusting.

In the same spirit, some top pieces of advice from this go-live:

• When your implementation team recommends you reduce your schedule, they’re not kidding.
• When they asked you six months ago to start cleaning up your illegible paper problem lists and medication histories to make go-live easier, they weren’t kidding then either.
• Don’t be afraid to ask questions – we won’t laugh at you (at least not to your face – at happy hour, however, it’s another story.)
• Please, for the love of all things, let your support staff support you.
• If you’re going to drink from the secret bottle of bourbon you keep in your desk, the least you can do is share.

Have a favorite piece of go-live advice? E-mail me.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

CIO Unplugged 5/16/12

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

The Good Boss

One of my assignments as a young captain was serving as the convoy commander for our combat engineer battalion. We were moving over 250 vehicles across the state of Colorado. Given the size and type of vehicles (Hummers, dump trucks, semi-tractors carrying bulldozers), we covered a good 15 miles of highway end to end.

I missed a turn and inadvertently split my convoy in two. Applying a few off-road techniques, I’d put the pieces back together within a couple of hours. But not before catching the attention of the battalion commander.

At our next stop, I steeled myself for one of the famous ass-chewings our commander was known for. We both stepped out of our Hummers. He looked at me and said, “Carry on, Marx!” He spun back around and climbed into his vehicle.

That was it. And you know what? For me, that’s all it took and he knew it. He purposefully chose a different form of discipline for that situation. Later, he told me that he could tell by the look on my face that I had learned the lesson and understood the gravity. He did not have to say anything more. And he didn’t.

Earlier this year, I posted the Bad Boss. It is always easier to point out the negative over the positive. So what is the Good Boss?

I don’t believe there is a magical checklist of Good Boss attributes. There are too many variables and permutations. Put simply, the Good Boss first and foremost does not follow a checklist. She understands every person is unique and should be treated as such. Just like my commander following my convoy fiasco.

I crowdsourced for input. Here is a compilation of attributes of a Good Boss. This is not research or academia or consultant or stats based on one person’s experience. It is not a checklist. These are ideas, and I imagine they reflect the thinking of your staff as well. Ponder the following and adopt as your situation dictates.

Ensures Appreciation and Value

• Thanks subordinates regularly
• Demonstrates gratitude in words and action
• Rewards success
• Personalizes awards and recognition
• Listens often
• Gives the subordinate glory for success

Mentoring

• Takes active interest in the subordinate’s career and guides growth in the job
• Teaches the subordinate how to best interact with customers
• Encourages professional development and provides educational opportunities
• Willing to learn from the subordinate
• Hopes one day the subordinate will step into his position
• Guides the subordinate to their ultimate goal, even if it means losing them

Fairness

• Never steals ideas from subordinates
• Always honest and ethical to the core
• Does not undermine anyone
• Possesses a strong work ethic
• Treats everyone without bias (race, religion, ethnicity, gender, age)

Performance

• Sets high but reasonable standards and removes non-performers
• Gets more out of subordinates than they can get from themselves
• Sustains the continuity of the organization by hiring only “A” players
• Provides insightful and regular feedback
• Elevates performance without the subordinate even noticing
• Provides appropriate tools and training for the job

Team

• Holds individuals accountable to performance standards so the team does not suffer
• Represents team and department with passion and confidence
• Makes the subordinate feel proud to be on the team
• Takes public responsibility for the action of the team when failures occur

Transparency

• Makes themselves transparent and vulnerable
• Admits errors and apologizes without excuse
• Gets to know subordinate as a person (family, hobbies)
• Is in tune with their emotions and not afraid to show it (smile, laugh, cry)
• Shares their wisdom in decision making and is open to other possibilities

Vision

• Encourages vision
• Articulates and lives the mission and values of the organization
• Tells the subordinate when to be practical and when to dream

Positive

• Remains positive when things don’t go as planned
• Always finds the good in bad situations

Individuality

• Does not micromanage and allows for creativity and self-expression
• Welcomes and supports innovation and creativity
• Recognizes individuals strengths and positions people accordingly
• Knows when to be the boss, friend, or mentor
• Knows when to lighten difficult moments

Style

• Leads by influence and not by position
• Jumps In the trenches as needed
• Walks the talk and shows flexibility
• Trusts, respects, and gives benefit of the doubt
• Possesses high emotional and social intelligence

Miscellaneous

• Promotes work-life balance
• Allows for downtime
• Able to charm Joint Commission surveyors!

Is this how your employees describe you? Which of these attributes will strengthen your leadership? Remember, one size does not fit all. Treat everyone in the style that works best for that individual and circumstance.

Be the boss! The good boss.

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.

Quality Systems Acquires The Poseidon Group

Quality Systems, Inc. announced this morning that it has acquired The Poseidon Group, an Atlanta-based emergency department information systems vendor. Quality Systems will integrate the Navigator PC and NavigatorWeb EDIS modules into its NextGen Inpatient Solutions small hospital product line.

NextGen Healthcare Inpatient Solutions EVP Steve Puckett was quoted as saying, “This acquisition provides our clients additional value by extending our hospital suite portfolio of advanced solutions to the Emergency Department. This product along with our surgical services suite will help support our rapid growth upward into the community hospital market.”

The acquisition closed May 1. Terms were not disclosed.

News 5/16/12

Top News

Accretive Health sends a detailed response to Senator Al Franken, who is investigating the company’s hospital collection practices. The company says its primary purpose is to help patients by making sure they use the benefits to which they are entitled, also adding that the company follows HFMA guidelines, including making it clear that services won’t be withheld for financial reasons. Accretive says it complies with all federal laws, including HIPAA, and that all but one of its missing laptops was encrypted and that one was because a now-fired employee messed up. The company also hires a boatload of influential guns-for-hire former politicians to polish its tarnished reputation: former HHS Secretaries Mike Leavitt and Donna Shalala, former Senate majority leaders Tom Daschle and Bill Frist, and former CMS administrator Mark McClellan. Newt Gingrich on Line 1?

Reader Comments

From MT Hammer: “Re: Transcend Services (now Nuance). Medical transcriptionists file a class action lawsuit against the company for labor law violations.” The 13 named transcriptionists claim that Transcend violated federal labor laws by paying them per line of text transcribed or edited but not for related activities such as looking up information, thereby dropping their compensation below the $7.25 federal minimum wage. I’m surprised that Transcend hired them as work-from-home employees instead of independent contractors, but maybe the company provides more direction than would be expected for a contractor.

From David Stock-Man: “Re: Quality Systems/NextGen. Anyone have thoughts on the company missing its numbers and shares getting crushed?” QSII announced preliminary Q4 results last Thursday, with expected revenue for the quarter of $107-111 million and EPS $0.24-0.27, blaming revenue recognition delays for missing expectations and issuing guidance down for the fiscal year. FY2013 guidance calls for revenue and earnings growth of up to 25%. Some folks on the stock message boards are crying foul, saying that pro traders were taking huge put positions in the shares right before the announcement, suggesting the possibility that word leaked out (without having any proof, of course.) Shares that were trading in the $45 range just a handful of weeks ago are down to $30. Above is a one-year graph of QSII (blue) and the Nasdaq (red). Shares have a long track record of steady growth, are now priced relatively cheaply, and the company’s margins are good, so if you’re feeling confident that this is just a bump in the road, you get to buy shares at a discount (and if you’re wrong, you get to lose even more money). All I know is that quite a few of the old-school EMR vendors seem to be failing to meet lofty expectations lately despite billions of taxpayer dollars being spent to help them sell product, so if not now, when?

HIStalk Announcements and Requests

Thanks very much to the 68 readers who donated to support the four young daughters of Epic analyst and long-time HIStalk reader Tim Dodson of Children’s Medical Center (TX), who passed away recently at 34. Including the three of us who matched $250 in contributions dollar for dollar, our total contribution was $5,495, which I’ve deposited to the fund set up by Tim’s wife Wendy for the girls, flagging it with a note saying it came from Tim’s fellow HIStalk readers. I covered the credit card fees, so every dollar you donated went directly to support the children. Those of us who chipped in know that it could have been us who died young and unexpectedly, leaving a family deprived of not only their loved one, but of their primary breadwinner as well. You did good.

Acquisitions, Funding, Business, and Stock

The Trizetto Group announces that its subsidiary Gateway EDI has acquired NHXS, a provider of contract compliance and point-of-service adjudication workflow automation. Gateway will incorporate NHXS’s capabilities into its EDI and RCM offerings.

Wolters Kluwer sells its prescription data business to PE firm Symphony Technology Group.

Simplee, which offers free online medical expense management tools for consumers, raises $6 million in a Series A funding round.

Sales

Unity Health System (NY) selects Phytel’s Atmosphere platform as part of its infrastructure for population health management.

Cape Cod Healthcare (MA) chooses Courion Suite for user access management for its Siemens Soarian system, scheduled for a December go-live.

Stewart Webster Hospital (GA), a 25-bed critical access hospital, selects the ONE EHR from RazorInsights.

The State of Arizona contracts with Mosaica Partners for consulting help in updating strategic and operations plans for the state’s HIE.

Orange Coast Memorial Medical Center (CA) selects PerfectServe’s clinical communication platform.

Hartford Hospital (CT) will deploy OTTR’s transplant system, including the recently announced OTTRvad module for ventricular assist device patients.

Norton Sound Health Corporation (AK) will deploy ambulatory and inpatient solutions from NextGen.

Chesapeake Regional Medical Center (VA) contracts with ICA Informatics to develop an HIE for its integrated delivery network.

Boston Medical Center (MA) signs a five-year license agreement with Streamline Health for use of its business intelligence and analytics solutions in 19 physician group practices, while Bronx-Lebanon Hospital Center (NY) extends its licensing agreement with Streamline Health for five years.

North Texas Accountable Healthcare Partnership (TX) selects Orion Health’s HIE solution to connect its 12,000 physicians.

Advocate Health Care (IL) selects Merge Healthcare’s cardiac imaging and informatics solution. Merge also announces that 12 radiology and orthopaedic practices have selected its EHR products.

Aetna selects Kony Solutions’ KonyOne Platform for its mobile health app.

People

The Massachusetts eHealth Institute names Laurance Stuntz (NaviNet, CSC Healthcare) as director.

e-MDs hires former CO-REC director Robyn Leone as director of public policy and government initiatives.

M*Modal brings on Kathryn Twiddy (Quintiles, Misys) as chief legal officer.

Blair Butterfield (GE Healthcare IT) joins VitalHealth Software as president of its North American division.

Announcements and Implementations

Rockford Memorial Hospital (IL) goes live next spring on the health system’s $40 million Epic system. Rockford’s physician group has been live since last year.

SoutheastHEALTH and Missouri Delta Medical Center join forces to build and manage a $3.5 million networking and data storage center for their organizations and other medical providers. Both hospitals will also install a $12 million Siemens Soarian system over the next year.

Austin Diagnostic Clinic (TX) goes lives on PatientKeeper Charge Capture for its 120 physicians.

Aetna Pharmacy Management offers its members new services based on their prescription claims data: (a) switching to once-per-day meds when appropriate; (b) recommending trying a less expensive single component of a combination drug; (c) flagging prescription that have been taken longer than recommended; (d) sending prescribers a letter for daily doses that exceed that listed in product labeling; and (e) identifying cases where a new prescription may indicate that a previous one caused side effects.

Medical billing and financial management vendor Fi-Med Management says it will expand its services and add 145 new jobs in the Milwaukee area. It says its new software can help hospitals identify over- and under-charging and avoid audits.

Other

Allscripts will train and hire 40 City College of Chicago graduates, whose salaries will be paid by the City of Chicago for their first six months.

Cerner customer The Hospital de Denia achieves HIMSS Analytics Europe Stage 7, the first Spanish hospital and the second in Europe to do so.

A Northwestern Memorial Hospital (IL) employee is charged with identity theft after a police search of her home, triggered by her use of several credit cards to pay her water bill, uncovers the credit card numbers, birth dates, and Social Security numbers of more than 50 patients.

Last weekend I had the chance to snuggle with a relative’s new baby, which reminded me of this recent article. Laptop magazine compiled a list of 15 current technologies that newborns will never see, including wired home Internet, Windowed operating systems, hard drives, the mouse, desktop computers, and fax machines. If I had written the article, I would have put an asterisk by a few of them (desktops, fax machines) and added, “Not applicable to healthcare because providers are resistant to change.”

Sponsor Updates

• Surgical Information Systems recognizes five hospital systems with 2012 SIS Perioperative Leadership Awards, among them Holy Spirit Hospital (PA – above.)
• Certify Data Systems ranks as a tier one enterprise HIE vendor in the Chilmark 2012 HIE Market Report.
• CynergisTek expands its portfolio of offerings to include the HIPAA Surveyor Solution Series and the HIPAA Audit Readiness Solution Portfolio.
• AHA Solutions and GetWellNetwork host a Webinar featuring Texas Children’s Hospital and its interactive patient care RFP process.
• PatientKeeper awards Ashe Memorial Hospital (NC) its customer innovation award.
• EHRConsultant’s AIMSConsultant division provides advice on choosing the right anesthesia information management system.
• Informatica releases its Informatica 9.5 platform, designed to maximize customers’ return on big data.
• BridgeHead Software will sponsor The Big Event social gathering at the 2012 MUSE International Conference May 29-June 1.
• Computerworld honors Lehigh Valley Network (PA) with its 2012 Laureate award and NASCAR Teamwork award for its innovative use of DigitalShare, T-System’s ED patient documentation system that’s based on Shareable Ink technology.
• Barrington Orthopedic Specialists (IL) selects NextGen’s EHR, PM, portal, and other solutions for its 15-physician practice.
• College Park Family Care Center (KS) selects eClinicalWorks EHR for its 91 providers.
• Emerson Hospital (MA) integrates Access Intelligent Forms Suite with its Meditech Magic system.
• Kareo upgrades its billing system clients to a new release, which includes enhanced claim scrubbing capabilities.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.