HIStalk Interviews Carlos Nunez MD, Chief Medical Officer, CareFusion

Carlos Nunez MD is chief medical officer of CareFusion of San Diego, CA.

What led you take the CMO position at CareFusion?

I was with Picis for almost 11 years. My title there was chief physician executive, which was essentially the CMO of Picis.

My background in medical technology and information technology goes back a little over 20 years, all the way to the time when I was still practicing medicine and even into my training as an anesthesiologist and as an intensivist. I guess being at Picis automatically type-cast me as being an informatics person, but my interest and my background really is more than just healthcare IT, but healthcare technology, of which I think IT is a very important part.

When you look at what’s happening in healthcare right now — I probably don’t have to tell you — healthcare is notorious for embracing fads. More than ten years ago, when the IOM came out with the report, To Err is Human, everybody was all about safety. When Leapfrog said CPOE was necessary, everyone was all about CPOE. A year or two ago, it was RHIOs. Six months ago it, was HIEs and Meaningful Use. Now healthcare reform has got everybody all in an uproar about ACOs.

When you see what’s happening in healthcare beyond the fads, and you look at the themes that have persisted for the last 12 years or so, it’s this focus on quality, safety, cost, and efficiency. Regardless of whether you’re talking about an ACO or an HIE or Meaningful Use, those are the themes that continue to rear their heads in everything that either is a fad or a discussion or the theme of the moment.

I think technology is perfectly positioned to help, specifically with American healthcare, but global healthcare deals with these challenges and attacks these themes. Looking at American healthcare in the context of healthcare reform right now, the challenges are the same. It’s decreasing levels of reimbursement and revenue to hospitals and the individual providers. Healthcare reform is trying to squeeze out $400 to $500 billion in savings from Medicare over the next ten years. The aging population, the decreasing resources — whether you’re talking about the nursing shortage or the shortage of primary care physicians to the consolidation of hospitals and practices — technology is perfectly positioned to help with a lot of these problems and changes.

When I looked at the opportunity at CareFusion, I found a company that I felt was perfectly positioned to address these challenges with a very, very unique set of solutions. What I did in my former company was focused on pure IT. It was software and solutions. But using that as an example, our software worked best when it was connected to an anesthesia machine; when it was communicating to a physiologic monitor; when it was getting information from a balloon pump or an infusion pump or a pharmacy system. There was more than just a pure healthcare IT play going on.

There was what I like to call this hidden kingdom of healthcare IT. That’s the medical technology. Information technology only works when it’s full of information, when it’s full of data. Most of that data comes from the patient. In the high-acuity areas of the hospital or in the areas of the hospital where patients are the most sick or most vulnerable, more often than not, that data is coming from a device. It could be coming from an infusion pump or a PCA pump. It could be from the pharmacy and the dispensing cabinet. It could be from the ICU, where the sickest patients are connected to all sorts of medical technology. 

When I looked at this opportunity, I saw a company that had products and services aligned with those same themes and those same challenges that healthcare faces. Medication safety and medication management, looking at infection prevention from the standpoint of central line or respiratory ventilator-associated pneumonia, supply chain management, portfolio IT assets, and most recently, the announcement that CareFusion is looking at ways to make hospitals a little more eco-friendly in dealing with the problems of hazardous waste disposal. 

Looking at their technology portfolio and their IT portfolio, I saw an opportunity to work for a company perfectly positioned to make a difference in those themes and in those areas where healthcare needs help.

Some would argue that healthcare IT is still enamored with IT basics, like having someone enter data and someone else pull it back out on the other end. On the other hand, companies like CareFusion were engineering-driven and not very good at developing software, where they were happy just to get relays to click and solenoids to move. Do you see those worlds coming together to help take care of patients?

I do. Before I took this position I was reviewing something that most of your readers are probably very familiar with, the KLAS rankings of the different IT solutions in the hospital space. My former employer had various solutions that were ranked in KLAS, so we watched these things very carefully. At the end of the year, KLAS puts out their Best in KLAS overall IT vendor rankings based on multiple products that KLAS ranks.

Probably no surprise, Epic was ranked Number One as Best in KLAS. Do you know who was Number Two? It was CareFusion, behind Epic by only two-tenths of a point. Number Three was more than four points away from CareFusion. I’m looking at this saying, here is a company that everybody thinks of as Pyxis machines and Alaris pumps who’s ranked neck and neck with the IT vendor that has taken the IT world by storm over the last few years. There must be a reason why.

As I learned more about what CareFusion does, I uncovered the reason. It is exactly what you alluded to with your question. The Holy Grail of what CareFusion is trying to accomplish is exactly what you say. When someone is adopting an information technology solution at the point of care, where someone is documenting care or making note of a lab result or entering something about a patient, how is that going to affect a drawer that opens or pump that’s infusing a medication or a fluid into a patient or a ventilator or some of the other things that CareFusion does? 

Here’s a scenario. Imagine you have a person who is on an anticoagulant and they’re getting PTT and INR studies done regularly. There’s an order to administer another dose of heparin or Coumadin. The nurse is going to follow the order. The lab results come back and their INR is therapeutic or maybe it’s even higher than what you would like. The nurse goes through the dispensing cabinet. They haven’t had a chance to go to look at the patient’s lab results. The dispensing cabinet says, “By the way, you’re about to take out that drug for a Mr. Jones, but I’ve just checked and the lab is saying that Mr. Jones’ INR actually is a little higher than you’d like it do be. Maybe you want to hold off on that dose. Call the physician.” That’s how that interplay needs to happen, and it already does. 

That’s what was surprising to me as I investigated what CareFusion was already about. The part of CareFusion that does a lot of their IT and analytics and surveillance was a company called MedMined that they acquired a few years ago. It was traditionally a company that did antibiotics infection surveillance in trying to improve antibiotic stewardship. It is now expanded throughout CareFusion’s different vertical businesses to provide notifications at the point of dispensing drugs or at the point of administration, regarding things beyond just antibiotic and infection surveillance, but looking at lab results, electrolytes, anything that could affect why or why not you’d want to dispense a drug. That’s just one example, but it’s a great example of that convergence between IT and devices. 

I spoke earlier about data coming from devices to the IT system. There’s an example of data living in an IT system like a pharmacy system or a lab system that’s now affecting the way someone interacts with the device that you wouldn’t traditionally consider part of IT. But think about it. I know you’re a fan of the Apple iPad, as am I. As a matter of fact, in your Monday Morning Update for just this past Monday, you had a little one-liner that AirStrip Technologies was shown in the very first iPad 2 TV commercial. The iPad is a device, the magical device that Steve Jobs has sold us all on. Incidentally, there are still lines every morning outside the Apple store in San Diego to get one, which is incredible to me. The magic of the iPad is it’s a beautiful device and the apps, the IT, and the hardware, together working in an ecosystem that’s very disruptive. 

Using the iPad example, look at how the iPad has just taken the medical world by storm. Doctors can’t stop showing up to work without their iPads. It’s caused CIOs even outside of healthcare, in businesses like here at Carefusion … our CIO’s got to figure out, “How do I integrate these iPads and these iPhones into our workflow? We’re a Windows-Exchange shop.”

It’s the same sort of revolution that I think it needs to take place. People need to recognize that all technology, not just pure information technology or software, is part of the information infrastructure of a hospital and a health system. It is that interplay between devices and information systems that will define how things become more efficient and adoption increases.

You’re right, we get really excited when we’re able to do very simple things. The adoption of technology and information technology in healthcare is behind many of industries. When you find the appropriate way to integrate information, data, actionable knowledge at the point of care, wherever that happens to be — whether it’s on the screen of a device or on the screen of a workstation — so that it’s less disruptive and more integrated into the very busy workflow of a nurse or a physician, then you’re going to see the adoption increase, the efficiency increase. Things like safety and quality should follow.

When people think of advances in banking technology, they don’t think of what goes on behind closed doors, they think of ATMs and online banking, the sharp end of the stick. In healthcare, nurses are the most vested at having tools, but nobody’s really doing much for them even though they provide most of the care.

Absolutely, yes. I’ll give you another example, because I had this conversation with someone here at CareFusion yesterday. It was the philosophical argument — where does certain information belong? Does it belong in the traditional IT system, or does it belong within a medical device or on a screen that’s part of a medical device? 

I said I don’t think that you can just make blanket statements like that. I think the information, the actionable knowledge that’s going to make a difference at the point of care — like you said, especially for the nurses who really feel the brunt of a lot of this — is wherever it best fits within the workflow.

I know we were talking about nurses, but I’m going to use a non-nursing example because this is off the top of my head. It’s what we talked about yesterday — the respiratory therapist. My former employer had an ICU information system, which is great. I’m an intensivist, loved it. Part of the feature set was that you could create customized flowsheets and a respiratory therapist could look at information on that customized flowsheet.

But more often than not, a respiratory therapist in the ICU walks right up to the ventilator. They’re used to having a clipboard sitting on top of the ventilator where they’ve got information about that patient and then a screen on the ventilator. They’re not going to want to change their workflow and have to go look into a screen.

Imagine if on that ventilator screen, you can see the blood gas results that you’re most interested in, or any other information that makes a difference. Maybe it does need to be on the information system screen. Maybe it needs to be on the ventilator. For me, it should just be integrated into the workflow that makes sense because the biggest problem is adoption — physician adoption, clinician adoption.

Getting people to adopt technology or IT or otherwise is difficult when you ask them to do more stuff. When it’s integrated into their workflow, then it becomes a pleasure to use this stuff.

I assume that the fact that CareFusion hired you is an indication that they’re interested in backing away from that engineering label and getting more into mainstream IT. How do you see that changing what goes on at CareFusion, especially when it comes to healthcare reform?

I think what CareFusion hiring me signals is that they want to take a balanced approach. Not so much that they want to try and become identified as an IT company versus an engineering company. I think they want to take a balanced approach that reflects some of the things that I have been saying — that there is medical technology and information technology working together can have a tremendous impact on quality, safety, cost and efficiency.

That’s the message that they’re trying to send, not just by hiring me, but by creating the portfolio of products and solutions that they have created over the last few years since they spun off from Cardinal. The way they go to market with these strategies and the integration that they are building between their different vertical platforms to show that there is this place where devices and software can play together and play together nicely, creating real benefits for patients and for providers and for hospitals.

I alluded to a couple of things about healthcare reform earlier. We talked about the fact that this is a plan that’s supposed to cost a trillion dollars. That’s what we were initially told — everyone knows that most government programs go over their initial cost estimates. But if we stick to that figure, a trillion bucks, roughly half of that is supposed to be realized through savings in Medicare and other CMS expenditures, Medicaid, etc. 

The ACO rules and regulations were just published. It’s like a fad. We’ve seen this before. You look at the HHS estimates for the adoptions of ACOs, and they’re saying that in their best estimate, somewhere between 1.5 to 4 million lives will be covered within the ACO model by 2014 with savings of roughly $500 million — with an M — dollars.

So they’re saying, “We’re hoping four years into the ten-year plan for healthcare reform we’re going to have maybe four million people in the ACO model.” That’s not even 10% of the roughly 44 to 45 million Medicare beneficiaries that are covered today. Savings of $500 million? That’s not even a drop in the bucket when you’re looking at half a trillion dollars in Medicare savings. 

It makes me wonder why we do this to ourselves in healthcare. Why we elevate these fads and get crazy over them without looking deeply into the facts and say, “Gosh, yeah, this is an interesting thing. Maybe it will end up leading to real savings and real changes in the way we deal with healthcare.” But in the end, it always goes back to the same things. It’s quality, safety, cost, and efficiency.

For me, healthcare reform represents one really important thing. Whether you agree with the way it was enacted, whether you agree with the provisions, whether you think the costs are right, or ACOs are great — and I’m not saying I have an opinion one way or the other — I’m just curious as to way everyone’s so crazy about an ACO model that we’re not yet sure will create significant savings.

What healthcare reform did is announce to the world in a very public way that the United States is finally acknowledging we can no longer afford the system that we have on the cost curve and trajectory that we’ve got. Not only does it endanger CMS and HHS, it endangers the entire federal budget. It endangers the economy of the United States as a country. It’s a very real problem and it’s a big, big part of the discussion that we now see around the Republicans’ new budget proposal trying to cut over five trillion dollars from the federal budget over ten years. This is a big deal. It could bankrupt our government and really make a huge impact on the American way of life, so we have to do something about this. 

Technology is the way that other industries have found the means to become efficient and look at ways to improve quality and safety while becoming efficient and spending less on the things that don’t matter — redundancy and paperwork and overhead and the things that don’t matter. There’s a way that we can refocus healthcare on taking care of patients. I think technology plays a huge part in that.

The last thing I’ll say on my little political diatribe. You know, we don’t have a healthcare system in the United States — we have a disease intervention system. Most Americans wait until something is broken or bleeding or falling off before they show up in the ED and get very expensive care for a problem they should have taken care of years or months before.

I think all of those themes that continue to merge about quality, safety, cost, and efficiency lead us to a remaking of this system in a way that keeps us healthier and tries to avoid getting to the point of disease intervention until it becomes more inevitable. And again, technology — and maybe not even in the inpatient setting — can play a huge role in all of that.

I think that’s what’s important about the ACO model or about healthcare reform or about Meaningful Use. It’s not the few million dollars in incentive payments here or there, or whether or not it’s going to be a million or four million lives covered in an ACO model. It’s the fact that we need to do something to move our healthcare system towards providing healthcare and using technology to become more efficient, to take better care of patients while not going broke in the process.

From my perspective — obviously I’ve got a very inpatient focus perspective as an anesthesiologist and intensivist — a company like CareFusion, from within their perspective mostly focused in the areas of the hospital where things like supply chain management and medication safety and infection prevention — it’s a really, really interesting place to be with all the stuff that’s swirling around.

If you looked out five to ten years, what should technology vendors in general and CareFusion in particular be working on to start to move the needle on patient outcomes and costs?

Five to ten years? Wow, I’m going say a word that is very overused in our circles, but I’m going to try and define what I mean by that. I think it’s a level of interoperability that makes sense.

It’s not just creating interfaces between different systems because they don’t exist now, and maybe we need to have everything tied together. It’s creating an interoperability between medical technology and information technology that provides actionable information at the point of care so that the providers who are being asked to do more with less can make the right decisions, can keep their patients safe, can deliver the highest quality care in a way that is most efficient and most cost effective.

I gave the example of the respiratory therapist or the nurse who’s trying to dispense a medication and it’s contraindicated because of a lab result. The examples go on and on from there, and maybe some of them are very, very clinical and safety-focused. Maybe some examples are more focused on collecting data for retrospective analysis. A patient who’s admitted for a non-infectious disease-related diagnosis and the Pyxis machine notes that they had a central line kit removed, and then three days later, the Alaris pump sends a signal that they’re getting an infusion of antibiotics and there’s no reason why they should based on their diagnosis. Do we now start to see markers for infection? Do they have a central line infection? Can the infectious disease nurse be prompted to go and check on that patient to see what’s going on?

The examples go on and on how you can start to tie devices and information technology to create an ecosystem that is much more efficient than what we have today. It’s not just creating interfaces using HL7 because we think it would be great to connect this system with that one. It’s really creating a web of connected devices and connected systems that allows us to be very efficient in delivering the safest, highest quality care that we can, and saving money in the process.

Monday Morning Update 4/18/11

From RTLS Battle: “Re: Awarepoint. Word is the company outdueled Merge to buy PCTS, a workflow software vendor in Charlotte, NC, with former Allscripts VP Jay Deady (Awarepoint CEO) beating out another former Allscripts VP Jeff Surges (Merge CEO). Deal to be announced next week. Wonder if they’ll split deep dish pizza in Chicago any time soon?” Unverified. PCTS offers the Amelior product line that includes ED and OR asset and patient tracking, hand hygiene systems, and temperature monitoring. They are a business partner of Awarepoint.  

From The PACS Designer: “Re: net collaboration. InformationWeek has compiled a list of the 15 Top Collaboration Apps that promote working together using the Internet. With all that is going on with Meaningful Use, this compilation of collaboration tools is good for institutions who want to progress to the next level of efficiency, which is meaningful structure.” Most of the apps listed involve some flavor of project management in what would have been called a hosted Intranet a few years ago (I guess that’s not a commonly used word these days). I notice that Cerner is listed as a user of Jive Engage (a social media monitoring tool) for its “social network experience,” since the whole point of social media is to sell stuff, of course.

From Katrina: “Re: Healthcare Informatics Executive Summit. I work for a vendor and registered, but was told I needed to either come up with $7,000 of program sponsorship or bow out, which I did. I’m warning other potential attendees about the small print stipulation.” The keynote speakers that Healthcare Informatics won’t allow you see for your $1,095 registration fee are Farzad Mostashari of ONC and Carolyn Clancy of AHRQ, both paid with your tax dollars, so that’s a bit insulting. Maybe you could just register as yourself at XYZ Consulting, pay with your credit card, and put it on an expense report. That brings up another gripe: the registration form requires entry of your job title and employer. Why should someone paying their own registration fee have to provide that information? If my employer isn’t willing to pay for my attendance, why should they (and the conference organizer) enjoy the benefit of having their name on my badge?

From KS: “Re: Epic. Consultant advertisements are popping up at MSN airport. They, of course, also spell it EPIC. Wonder what they think EPIC stands for?” Maybe they’re just shouting the name because they’re so excited about the money they’ll rake in if they can just find some consultants.

From Tango Charlie: “Re: Epic. Duke will announce next week and Wake Forest is suppose to go Judy, too.” Unverified. Duke is going with at least Epic ambulatory, it seems (and as history has shown, hospitals don’t often stop there). Wake Forest (above) was on the list of hospitals attending Epic training for unnamed modules a couple of weeks ago that a reader sent my way.  

Nearly two-thirds of respondents like the idea of biometrically verifying the identity of those claiming Medicare and Medicaid healthcare benefits. New poll to your right: how is the federal government doing against Medicare / Medicaid fraud?

My Time Capsule editorial from 2006: RHIOS Are Taking Away Resources From Better Projects. A snip: “Do you like insurance companies enough to let them control patient information?”

Three free press release tips for you PR and vendor types: (1) always put out press releases in PDF format rather than .DOC, for about a thousand reasons that I hope I don’t have to explain to people who supposedly are experts at media; (b) never put a press release out on a national wire service but not simultaneously on the company’s own site – isn’t that kind of the point? and (c) if you’re going to mention a hospital, include the city and state it’s in. I could add dozens more, but these came up today.

Above is the latest history (is that an oxymoron?) from Vince Ciotti.

Shares in for-profit hospital operator Community Health Systems drop 14% in after-hours trading Friday after the company announces it has been subpoenaed by HHS in conjunction with an investigation of its Medicare and Medicaid billing. Rival Tenet Healthcare, which in December rejected an acquisition offer by CHS, accused CHS of billing fraud in a lawsuit it filed against CHS. HHS wants to review CHS’s ED practices and the algorithms in its Pro-MED ED physician documentation software, which may test that company’s claim that it “Meets and exceeds all CMS Physician Evaluation and Management Documentation Guidelines, ‘maximizing’ reimbursement” depending on how CHS set it up.

CMS is threatening to stop payments to University of Chicago Medical Center after finding that conditions there pose an immediate threat to patient safety. A prominent patient died after a medical error involving a dialysis catheter-caused embolism. Not to be cynical, but oversight organizations react a lot more forcefully when patient harm involves someone wealthy, famous, or the subject of splashy media stories. I’ve worked in hospitals involved in high-profile medical error cases and it was obvious that organizations such as Joint Commission, state hospital inspectors, and HHS don’t like having the hospitals they oversee embarrass them in the press, so their reaction is sometimes overly hostile and critical. I would question the effectiveness of any watchdog group that pronounces conditions dire only after they read about them in the newspaper.

A Rhode Island physician will be in line Monday morning when CMS opens the virtual doors for Phase 1 of the Medicare ARRA incentives. Douglas Foreman DO, a family practice physician who uses the Ingenix CareTracker EHR and its Meaningful Use dashboard, says he has met the 15 Core requirements and seven of the 10 Menu Set items (of which five are required to qualify for the incentives).

UCSF says it’s turning on Epic outpatient, with a price tag of $160 million vs. the originally estimated $60 million due to an expansion of the project’s scope (there’s more to the story I can’t see since I don’t subscribe to the San Francisco business paper).

My new favorite iPad app: the just-released Bing search (the irony of a Google-competing Microsoft app written exclusively for an Apple device duly noted). Not only is it stunning to look at, you touch the microphone icon and can immediately speak your search terms with good accuracy.

The Florid-based developer of the Electronic Medical Assistant software for dermatologists gets a $4 million investment from the British company that owns the Speedo swimsuit product line. Modernizing Medicine was founded by a dermatologist and the co-founder of the Blackboard online learning system used by colleges. The EMA software costs $6,000 upfront and $650 per month. One of its users says he can create 30 notes in 25 minutes.

The military’s TRICARE system team announces that its Blue Button functionality has been expanded to allow users to download include lab results, patient history, and visit history.

A post on Geek.com nominates this as one of the most inopportune times for a Windows update. It’s a picture of a woman’s hospital monitor during labor taken by the dad-to-be, a computer science professor. Perhaps the hospital’s biomed folks should take a look at the device since enabling automatic Windows updates on an FDA-regulated system doesn’t seem like a good idea.

Michael Kirsch, MD, is a pretty funny writer (he even looks a tiny bit like Jeff Foxworthy). His list of Apps I Want includes: “Medical Coding App. This turns your iPhone into a high voltage device, similar to the Invisible Fences that are used to restrain pets to a given area. Tap the App and then place the iPhone in your front pocket. After seeing a patient, if you code higher than you should on your EMR, you will get a light shock. The intensity will increase until you have expressed remorse, atoned and coded properly. I expect that Medicare will provide incentives for using this technology in the coming years.” 

A $5 million malpractice judgment against a Canadian hospital is thrown out when the hospital’s lawyers notice that 321 of the 368 paragraphs of the Supreme Court justice’s ruling were copied directly from the closing arguments of the plaintiff’s attorney. There appears to be some legal debate as to whether the judge crossed some unspecified line or whether that simply means the plaintiff’s legal team did the job they’re paid to do – create sound, well-referenced arguments that, if they win, must have had significant influence on the verdict.

Bizarre: the Texas patient who received the first US face transplant obtains a restraining order and files suit against a British tabloid that insists he sold them his story rights for $2. The man, who lost his eyes in the accident that necessitated the surgery, admits that he signed a document from the company, which told him they wanted to write a human interest story to be run in a women’s magazine. The tabloid has created TV programs that include “Is This China’s Fattest Kid” and “Legless Dancer TV Hit.” Maybe the biggest question is why a face transplant warrants tabloid coverage. How big of a page-turner could it be, especially when Charlie Sheen is out there spreading his Adonis DNA?

The OR of River Park Hospital (TN) goes live on Shareable Ink after a two-week project (kickoff meeting to go-live). They plan to expand its use.

Former iSoft CEO Gary Cohen files proceedings to delay the $188 million sale of the company to CSC, saying the company is required to give his family investment group four weeks’ notice before selling it. He previously said he was considering making his own offer to buy the company.

NPR runs a fun piece criticizing ACOs that includes four ACO jokes: (a) I don’t know how to define an ACO, but I know it when I see it; (b) We have tried ACOs already — they were called HMOs; (c) The three greatest mythical creatures are the abominable snowman, the Loch Ness monster, and ACOs; and (d) the true meaning of ACO is Awesome Consulting Opportunities.

Rochester RHIO says it’s the first HIE to allow patients to upload their advance directives and healthcare proxies so they can be viewed in an emergency.

Everybody’s fighting to protect their healthcare profits, it seems. Case in point: for-profit ambulance companies are fighting with the powerful firefighter’s union over who gets to provide those ultra-expensive (and often Medicare-paid) ambulance rides when people call 911 for whatever conditions they personally deem worth spending someone else’s money on. It would be interesting to study the outcomes of ambulance-transported patients to determine how often their medical needs justified it.

In the UK, designated early adopter Pennine Care Foundation Trust pulls out of NPfIT after years of delays in adding mental health capabilities to iSoft’s Lorenzo.

E-mail Mr. H.

Time Capsule: RHIOs Are Taking Away Resources From Better Projects

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

I wrote this piece in February 2006.

RHIOs Are Taking Away Resources From Better Projects
By Mr. HIStalk

I’ll confess that I’m paying minimal attention to the RHIO craze. Everybody’s starting one, conferences are showcasing speakers who’ve done nothing more than announce theirs, and tiny grants are getting the whole industry atwitter. It’s like living the dot-com frenzy all over again, irrational exuberance and all.

I’m not against RHIOs, but they’re as annoying as CPOE was awhile back, taking resources away from projects that could provide more benefits to patients without the minefields.

I recently interviewed Denni McColm, an award-winning CIO of a 74-bed rural hospital no different than 80 percent of those out there. Oh, except that they’re 100 percent paperless and 100 percent CPOE, something virtually none of the celebrity CIOs and Taj Mahospitals have been able to accomplish. I’ll listen to her, thanks.

First, Denni believes that organizations should be banned from using the word “interoperability” until they can bring their own electronic information to the table. If your IT house isn’t in order, RHIOs don’t need you. Anything short of everyone contributing information equally will cause the whole concept to collapse like an imploded 1960s Las Vegas hotel, so paper jockeys need not apply.

Work instead on projects that will help your patients more than the begrudging swapping of routine lab reports with your cross-town competitor. Or, integrate all those systems you already have. Your admission ticket should be a checklist of what data elements you can supply electronically right now.

Second, Denni advocates a patient-centric RHIO model instead of the common payor-centric one. Do you like insurance companies enough to let them control patient information?

By patient-centered, I don’t mean personal health records. People are too irresponsible to reliably collect and store data with life and death importance. On the other hand, they could be given control over the trusted information generated by hospitals, physician practices, and other providers.

Suppose information resided in an Al Gore-type lockbox that contains everything from discrete electronic data to scanned documents fed over the Internet. Either the patient controls the key (similar to a password) or only they can initiate data delivery to a provider. If they don’t want you to see it, you won’t.

This model makes most privacy concerns go away. It avoids the largely unsolved problem of how you assign some sort of universally mandated patient identifier (aka “political suicide”) to sort out the throngs of people sharing the same name. The patient simply says, “send my data to Dr. Jones” and it’s done. They keep control and there’s no arbitrary “regional” service area beyond which lies a medical no-man’s land.

Maybe some RHIOs work this way. Like I said, I don’t follow them. And, if I can’t see a quick and obvious patient payoff, I probably won’t start following them any time soon. I’ve got plenty of challenges working on clinical system projects that will hopefully save lives right now.

HIStalk Interviews Ritu Agarwal, Director, Center for Health Information and Decision Systems

Ritu Agarwal, PhD is Professor and Robert H. Smith Dean’s Chair of Information Systems at the Smith School of Business of the University of Maryland, College Park, MD. She is also the founder and director of the Center for Health Information and Decision Systems (CHIDS), a research center within the business school.

Give me some background about yourself and about your organization.

I’m a professor of information systems at the Smith School of Business at the University of Maryland. I’m also the director of the Center for Health Information and Decision Systems. I established the Center in 2005 before health IT became trendy.

The mission of the Center is to investigate how technology can be used to transform healthcare fundamentally. We’ve been involved in doing research for the last six years or so on this topic. We work with a variety of partner organizations from the business sector, the government sector, and not-for-profits.

I saw on your Web site that you are working on a number of projects. What are the top two or three?

In our portfolio, we have a couple of projects around health information exchanges, which I think are extremely exciting and important. One is a project with the District of Columbia Regional Health Information Organization. We spent about a year doing an assessment study, which involved a wide range of data collection from different stakeholders. Based on that, we developed a generalizable model that can be used to assess any health information exchange.

We’re currently still engaged with the DC RHIO in helping them evaluate the usability of the technology and the value that it’s generating for all stakeholders. This is going to be an ongoing effort as more and more people join the collaborative and more hospitals and clinics come online.

The second project, which is just getting kicked off, is part of the Office of the National Coordinator’s Health Information Exchange Challenge Grant. We’re working with the Chesapeake Regional Information Systems for our Patients. That is the Maryland health information exchange. They’re in the process of rolling out an intervention which involves direct integration between acute care in long term facilities for exchange of continuity of care documents as well as advance directives. 

We are responsible for the research around the assessment of this particular intervention. We’re comparing how quickly the information can be transmitted, whether it’s reducing hospital readmissions and a host of other outcomes across the set of intervention hospitals compared with a pilot group of hospitals. I think both of these projects are going to provide some important insight into how health information exchanges can be used to deliver more value into the healthcare system.

We’re also working with the eHealth Initiative. They collect data from health information exchanges every year as part of their annual survey. We’re doing some econometric analysis to understand what the predictors of health information exchange sustainability and operational maturity are. We’re looking at financial break-even and looking at what specific aspects of the business model and the revenue structure help predict whether the exchange will be sustainable or not.

Are people showing interest in your findings? How would you intend those findings to be used?

Yes, absolutely. I think they have a lot of implication for how health information exchanges are going to structure their business models in the future. The grant money is going to run out — it’s not infinite. 

Clearly there are examples of health information exchanges that have managed to attain some level of sustainability. The Delaware case is one example. Vermont is another example. They have specific revenue structures and business models that provide some kind of value to all the participants that motivates them to join the exchange. Certainly this is going to be an important aspect in the future.

In terms interest in our findings, I would certainly think so. We made a presentation at HIMSS last month on the DC RHIO evaluation. There was a lot of interests in that. Several people have requested a copy of the report. We’re just in the process of working with the HIE to put out a policy brief on some of our findings around their data, and I think there will be significant interest in that as well.

Another project listed was AHRQ-funded research on EHR usability. What thoughts do you have about that in terms of EHR adoption?

I have interacted with a lot of doctors in the last five or six years around this whole notion of EHR usability. I’ve also seen so many of the products that are out there in use and my own research in the past in usability and other domains. I’ve done research around Web site usability for the retailing industry, for example.

Suffice it to say that usability is probably one of the most important factors that drives any individual’s adoption, especially when you think about how these products are going to be used. Many of them might be used while the doctor is actually interacting with the patient. The last thing you want is the workflow to be awkward or in any sense disruptive in the doctor-patient relationship or engagement.

The answer to your question, “Is usability important?” is a resounding yes. One of the things that we are doing in this project is developing a very simple usability toolkit that physicians can use in an ambulatory setting in the physician offices to figure out whether their EHR is working for them or not. If it isn’t, what specifically they might be able to do in terms of either changing their workflow or making some modifications to the EHR. 

I think it’s going to have a big impact. ONC has significant interest in looking at the usability of EHR products. That’s going to become an important criteria in their certification processes as well. It’s not just the functionality, because all these products are loaded with lots and lots of functions. They probably have a least 80 or 90% overlap in functions, but there’s a lot of variation in usability.

Usability as a condition of “do you want to buy this product” is one thing, but what about usability in the context of “are patients safe based on sound usability principles?”

Both adoption as well as safety are the two important outcomes. I’d say safety trumps adoption. Clearly if the physician is not able to interpret the information that’s coming out of the EHR, or if the EHR is awkward to use in an emergency situation when it’s absolutely imperative to get to the correct information, then the patient safety compromise is completely unacceptable.

But even if the EHR was being used more in a non-real time fashion, just simply to record data after the interaction with the patient is over — even then, usability becomes a concern. It has an implication for how much time the clinician, whether it’s a physician or nurse assistant, spends in updating and accessing information. It’s supposed to make them more effective as well as more efficient.

Are you studying anything related to using government incentives to encourage providers to adopt technology they didn’t want and how that might impact their chance of success?

One of the studies that we’ve done has been around this whole notion of physician identity and how that’s changing as a result of technological innovations and the ARRA mandates and pressure from the government and other important agencies. It is eventually in the interest of the entire system and all the stakeholders if physicians willingly adopt this technology, rather than believe that it’s being something that’s being imposed on them. There has been lots of prior research documenting misuse, ineffective use, sabotaging of this technology when individuals perceive that it’s not their volition or choice to use it. 

The important thing is in the messaging and marketing around these technologies. There has to be a very clear articulation of value to everybody who’s required to use it.

One of the things that we have not been able to do very compellingly yet, which we’re trying to do, is to be able to walk into a physician’s office and say, “Look, here are some reasons why this technology is going to make your life better. It’s going to improve your effectiveness. It’s going to help you take care of your patients better. It’s going to help you improve patient safety. It’s going to help you improve effectiveness,” 

In other words, there’s not enough evidence yet around the value of electronic health records and such technologies. But one recent study that came out of the Office of National Coordinator which was published last month in Health Affairs seems to suggest that now the evidence base has started growing. I think now we have a better story to tell.

That study had some problems, being a meta analysis written by folks who clearly had a bias. And hospitals, where employed physicians were already mandated to use electronic systems, haven’t seen the kind of numbers they hoped on raising quality or lowering cost. Is an interest of  yours proving the value of these systems?

We have a lot of interest in proving the value of these systems. As with every other research organization, we are limited by data availability. We have started on some specific granular studies around individual systems in hospital as well as physician practice settings.

For example, we did a study at Children’s National Medical Center, early findings from which were also presented at HIMSS, with a group of pediatric physicians looking at the readability of clinical documentation system and how much that improves readability over just regular handwritten notes. So you know, those are more micro-level studies. We have several of those ongoing. 

But we also have some studies at the hospital level, where we’re using some of the HIMSS data and combining that with quality measures to try and establish if there is a relationship between different types of information technology investments that the hospital makes and different measures of quality. But it’s going to take a few years before, as a community, there’s enough understanding and data for these affects to start appearing.

I should also point out very quickly that we had similar issues around information technology in general at the turn of the century. There was a very famous economist who said, “You see computers everywhere except in the productivity numbers.” It took a while before there was enough macro-level data to be able to establish that causal link. I think we’re getting there, but I’m not going to say in the next one year we’ll have the definitive answer on health IT value.

That makes it tough to sell a small physician practice since it involves a leap of faith.

Many of their concerns can be allayed with the appropriate kind of assistance and help. There is a learning curve, but they’re not horrendously difficult. Sometimes you get overwhelmed with the complexity of an EHR system, but I think there’s ways to help doctors assimilate it into their workflow.

Part of it is that there has to be a clear understanding of how both the technology and the workflow need to evolve to fit each other. What ends up happening is that the doc sees the technology and then says, “OK, here’s how I do my business. Here’s how I do my all my clinical work and administrative work.” That’s almost like a square peg in a round hole.

You’ve done some work with personal health records. What’s your feeling on where those are and where they’re going?

My own personal opinion is that this next generation of healthcare consumers that’s going to enter the system in the next decade or so … it’s almost a cliché now, it’s a very highly technologically savvy group.

I think personal health records have a big role to play in how people take the control of their own health and wellness and well-being. I personally believe that personal health records or some equivalent is going to be a significant application in the next five to seven years. The question remains is, how should these applications be designed so that they have the same level of exponential growth in adoption as in something like a Facebook?

Has anybody studied what it would take to motivate consumers to use personal health records? They don’t seem very interested.

One of the ARHQ-funded projects that we’re currently working on is learning best practices and principles from the design of other consumer products that can be applied to health IT. We’ve identified 24 highly successful products in other domains. We’ve been examining their development methods and processes that have been used in their construction, their fee, what are some principles and best practices that could applied to consumer health IT as well.

I’m also currently involved in a project with the Air Force medical system and personal health record to users at one of the major Air Force bases, 40,000 users. What they’re discovering in the early stages of the research is that the consumers love it. They love it, they are delighted with the idea that have access to their personal information, that they can update their medications and allergies and everything else. That product is slowly being extended with different kinds of devices to help them monitor their blood pressure if they are hypertensive and various other services depending on their disease condition. I see a growth in personal health record type of technology — consumer health IT in general.

If you could work on any healthcare IT project that would have wide impact on both cost and outcomes, what work would you undertake?

I think I would love to study the comparative effectiveness of health IT interventions. There are resources and funding for that available, but I think a better understanding of how these health IT interventions are assisting people with managing their disease conditions as compared with traditional therapeutic regimens.

Let me just give you an example. We all know that social networks and social influence plays a major role in how people take care of themselves. The moment you use health information technology — or any information technology, for that matter — to connect up people in social networks, suddenly you have the exponential effect of a lot more influence on the focal person. It would be fascinating to study how those types of interactions, social interactions, coupled with health IT stack up in terms of critical effectiveness and cost of care, as compared with just traditional therapeutic regimens of, “Take this prescription for 20 days.”

A lot of interesting work and has been coming out of Kaiser since they have the captive audience of users. I would think that’s a pretty rich mine of data to look at if you could get at it.

Absolutely, yes, that is an amazing repository they have. We’ve had some conversations with Kaiser in this regard, but we’re not quite there yet in having access to the data.

Do you have any concluding thoughts?

I’m quite a passionate believer in the importance of health information technology interventions. I think they can help healthcare achieve many of the goals that they’re all trying to achieve of being safer and more cost effective. I also think that the system has a major problem with the incentive alignment now. Health information technology can have an impact only when it’s coupled with other complimentary changes at the system level — some alignment of incentives around payment reform, some around insurance reform. That has to take place for health IT also be influential.

News 4/15/11

Top News

Healthcare IT is one big reason that private practice docs are taking down their shingles and going to work for hospitals, according to experts interviewed by The New York Times. Unlike the Hillarycare era, there’s no turning back this time since reimbursement is encouraging that kind of vertical integration. The predicted result: less competition, leading to higher prices (although Kaiser is a mentioned as a disrupter in offering cited higher quality at lower cost). The experts seem pretty sure that quality will improve (like in Mayo or Kaiser, with salaried physicians), but not so sure costs won’t go even higher.

Reader Comments

From Hypocrisy: “Re: Judy Faulkner. She was quoted as saying at an ONCHIT Policy Committee meeting, ‘What is showing up in blogs — I have seen and sometimes been told about this — is that we have to be careful of an apparent conflict of interest. That is if, in fact, the primary spokesperson for PCAST does have products that would benefit tremendously by this, do we get into — and I know we’re not supposed to judge — the uncomfortable position of an appearance of conflict of interests.’ She’s apparently talking about Microsoft’s Craig Mundie, discussed a lot on HIStalk as a PCAST committee member. Presumably she does not see a conflict of interest herself in serving on the committee.” I didn’t see the quote, but it’s interesting if accurate. Just to clarify for those who don’t follow the confusing cast of government players, Judy wasn’t actually on the PCAST committee that made recommendations to the President that pretty much had HealthVault or Google Health written all over them – the only for-profit company employees on it were Craig Mundie from Microsoft and Eric Schmidt from Google. Judy is on the HIT Policy Committee, which has for-profit members from Kindred Healthcare, WellPoint, Gastroenterology Associates (a private doctor), and Epic (Judy). I wouldn’t think she carries the level of influence over that group that some have said Craig Mundie had over the PCAST report.

From Ludacris: “Re: rogue Meaningful Use. A vendor is e-mailing consultants offering a ‘private label’ EHR they can sell under their own name for a split of the revenue.” The company’s address appears to be a mail drop and the principals aren’t listed, although I found the CEO’s name elsewhere. The vendor’s Version 1.0 product is certified as a Complete EHR Ambulatory and the offer claims companies that want to private label it get their own name on the list of certified products. I suppose ONC didn’t address that issue – where the same product could be sold by multiple vendors under multiple names, each rightfully claiming to be offering a certified product. Certification was intended to reduce buyer risk, not buyer confusion, and some would argue that it has accomplished neither.

From Dingin: “Re: Epic. You mentioned Oakwood and Singing River. Both were at a recent class in Verona, along with others you probably already knew about: Nebraska Medical Center, Providence Anchorage, Contra Costa, Norton, MUSC, Wake Forest Baptist, University of Cincinnati, and Driscoll Children’s.” I confirmed with MUSC that they’re going only with the ambulatory products, dropping McKesson Practice Partner since it doesn’t work well with MUSC’s TELUS Oacis Health Data Warehouse, but keeping Horizon Clinicals on the inpatient side.

From Lorenzo: “Re: ICA. What’s going with them? Rumors of problems.” Not so, according to our Informatics Corporation of America contact. “We have just won Wyoming Medicaid HIE through our partnership with ACS, just selected as VOC with Central IL HIE, and we are hiring as fast as we can to keep up with recent wins of Middle TN eHealth Connect and KHIN. We’ve grown by 100% since the beginning of the year and we expect to grow by another 50% by year’s end in employees. Our funding is solid through our primary owners and we are working as hard as ever to meet customer demands. Go-lives of major clients are scheduled over many of our clients in the near future. Nothing could be further from the truth.”

From HISwalk: “Re: magazine. Does anyone else think this slide show paints a ridiculously rosy picture of several vendors given their current situations?” I’m not a fan of online slideshows when a simple list would have been much easier to read, but this one’s OK (the information it contains was provided by Vince Ciotti’s firm, so I’d trust it more than if the usual sideline reporters undertook their own analysis). I would say the list contains some opinion, some analysis that’s not quite current, and focuses on revenue (which was the point) and not necessarily profit or market trends. I don’t link to other HIT sites or rags since I don’t use them as sources, but you can probably Google your way to it if you’re determined to check it out.

From FACA: “Re: ONC Policy Committee. There’s a Webcast meeting on EHR usability and accessibility on April 21 at 9 a.m. It’s a public hearing, so questions are welcome.” The agenda is here. The presenter list is interesting. For some reason, the government, like others, capitalizes Epic (Epic does not spell it EPIC).

HIStalk Announcements and Requests

This week exclusively on HIStalk Practice: PracticeWise, a new  column by practice consultant Julie McGovern (who stirs up some discussion in her first post). Reefdiver weighs in on the value of certification in the EHR selection process (readers are opinionated on that topic, too.) KLAS  extends a free offer for HIStalk Practice provider readers. AMA tells CMS what physicians find most burdensome. Dermatologists ask patients for fashion advice. Americans want their physicians to use EMRs. So far, only six states have issued MU incentive checks. In honor of Leonardo da Vinci’s 558th birthday and because it makes me happy, please sign up for the e-mail updates while you are catching up on the latest HIT ambulatory news.

On the sponsor-only job board: Clinical Project Specialist, Software/Implementation Engineer, Healthcare Implementation Project Manager. On Healthcare IT Jobs: EHR/ePM Implementation Project Administrator, Coordinator Clinical Trials.gov, Project Manager – NextGen, Software Product Development Manager.

Acquisitions, Funding, Business, and Stock

Allscripts CEO Glen Tullman earned nearly $8.5 million between June 1, 2009 and December 31, 2010. That breaks down to $4.1 million for the 12 months ending May 31 and $4.5 million for last seven months of the year.

Streamline Health Solutions reports Q4 earnings: a net loss of $1.8 million compared to a profit of $1.6 million a year ago. Revenue fell from $6.3 million to $4.9 million.

In India, Michael Dell chats with local reporters on a number of topics, including healthcare IT:

We are #1 in healthcare IT globally. We acquired a company called InSite One, the leader in cloud-based archiving of medical images. We have taken that expertise all the way back to our product groups and created new offerings. IT in the healthcare industry is siloed. The CIO can’t make them work together. We have created vendor-neutral archives by speaking to medical equipment makers. We capture all the data and store locally or in our cloud archive.

Add Medicomp Systems to the long list of EMR vendors that have been sued by Prompt Medical Systems over the years. PMS has no Web presence, so I assume its primary output is legal rather than technical. It appears to be the brainchild of Bernard Milstein MD, an ophthalmologist, UTMB professor, and founder of The Eye Clinic of Texas who patented the use of CPT codes in computer systems in 1994 (even though AMA holds the copyright to the CPT codes themselves). He appears to be backed financially in his litigation lottery by an investment banker and securities company founder. None of the previous cases made it to court from what I can tell, so I’m sure PMS is banking (no pun intended) on the EMR vendors paying them to go away rather than risk being tied up endlessly in an expensive legal action.

Sales

The US Military Health System selects Mediware’s blood transfusion management system for 68 military health sites worldwide. MHS will also deploy Mediware’s LifeTrak and InSight to track donor records and product inventories in 28 blood donor facilities.

Palomar Pomerado Health (CA) chooses GSI Health’s HIE solutions to connect PPH hospitals and affiliated physicians.

Cooper University Hospital (NJ) awards a contract to MedQuist for computer-assisted coding technology and outsourced coding services.

Girard Medical Center (KS) signs with Cerner.

Regional Medical Imaging (MI) chooses Merge Healthcare’s radiology information system, expecting to receive $600,000 from Meaningful Use incentives for its 13 radiologists. Merge says 90% of radiologists are eligible for MU money and it will pursue certification for its RIS to help them earn it.

Announcements and Implementations

Kaleida Health (NY) says it is actively adding EMR capabilities across it hospitals and clinics. Its $20 million Cerner implementation should be complete by the end of 2012.

Tift Regional Medical Center (GA) goes live with RTLS temperature monitoring and asset tracking from AeroScout.

athenahealth creates a “burn unit” to handle physician practices that have been burned by old EMR systems and are looking for new solutions. CEO Jonathan Bush says about 35% of his company’s new EMR clients are replacing old EMRs.

ODIN announces EasySpecimen, an RFID-based pathology specimen management system, licensing the technology from Mayo Clinic.

England’s Department if Health announces completion a project to move all prisons to a single electronic medical records system, allowing them to transfer records when inmates are moved. The article takes jabs at NPfIT, saying the prison system has more detailed information than NPfIT’s Summary Care Record.

Government and Politics

CMS’s healthcare fraud enforcer (a pediatrician and lawyer) says he’s going to crack down on criminals, many of them working out of South Florida, who are scamming Medicare and Medicaid for up a quarter trillion dollars per year. Much of his arsenal involves smarter payment software that can detect fraud more quickly, needed since the fraudsters are using electronic billing systems to commit their crimes. Says one expert, “The crooks know now that these computerized payment systems are their best friend. They will study carefully the art of billing correctly, they will produce electronic transactions that are perfect on their face, but it’s just a pack of lies.” An irony: Florida Governor Rick Scott was CEO of the company (Columbia HCA) that admitted to extensive Medicare fraud, costing the company $2 billion to settle.

ONC’s got some job openings for a program manager and three policy analysts.

Innovation and Research

CalPERS claims its integrated healthcare pilot saved $15.5 million between January and October 2010. Pilot participants include Blue Shield of California HMO, Catholic Healthcare West, and Hill Physicians Medical Group. The organizations’ combined efforts led to a 17% reduction in patient readmissions, a half-day reduction in the average LOS, and a 50% drop in stays of 20 days and longer.

West Wireless Health Institute awards its $10,000 developers’ challenge prize to a skin cancer detection app. The physician developer, who is a veteran and a melanoma survivor, created the iPhone app for his own self-examination.

Other

CIOs say their organizations will qualify for Meaningful Use incentives, but not as early as they predicted a few months ago. In an August 2010 CHIME survey, 28% of responding CIOs predicted qualifying for funds by April 1 compared to 7.5% of CIOs participating in a survey last month. About 32% of the CIOs expect to qualify by September 30, 2011 and an additional 58% anticipate Stage 1 qualification by the end of the 2013 fiscal year. Only 26% of community hospital CIOs believe they will qualify for stimulus funds by September 30, 2011.

Strange: a “stunning blonde” in her 20s, bidding over the Internet, buys more than $50,000 worth of items ranging from a stuffed owl to furniture at an auction in England. The auctioneer called her to arrangement payment, only to have the telephone answered by a doctor, not surprising since she’s a hospital inpatient committed under the Mental Health Act. Her credit checked out, but the hospital won’t let her pay, so the auctioneer says he’ll sue the hospital.

Umass Memorial Healthcare pulls 10 employee kiosks out of service when they discover that anyone walking up to the kiosk could view pay stub information from the previous user. The IT people changed the software and removed bank account information, then put the kiosks back out.

Associated Press gets punked: a couple of anti-corporate troublemakers float a phony press release with GE’s name on it, saying the corporation will donate its $3.2 billion tax refund to the US Treasury since the American public is upset at learning that GE paid no taxes on $14 billion in profit. AP ran the story without doing anything more than clicking on the link to the convincing-looking but phony Web site, only to pull their news item down less than an hour later.

A reader sent this in for Inga and her shoe-loving followers.

Sponsor Updates

• Advanced Endoscopy & Surgical Center (NJ) contracts with Wolters Kluwer Health for its ProVation MD procedure documentation and coding software.
• Design Clinicals and the AHA are hosting a Web demo April 21 entitled Electronic Medication Reconciliation: Achieving Stage 1 Meaningful Use and Full Compliance Joint Commission Standards with MedsTracker. 
• Concerro creates a cute video that compares workforce management tools to paper-based systems, à la the Mac versus PC commercials.
• eClinicalWorks announces that 2,000 practices have successfully upgraded to Version 9, eCW’s ONC-ATCB  certified MU version.
• Access announces a new version of its e-Signature solution to help providers create paperless registration and bedsid consent processes.

EPtalk by Dr. Jayne

This week marks the 150th anniversary of the start of the American Civil War. What does that have to do with healthcare IT, you ask? Maybe more than you think.

I was listening to NPR when Adam Goodheart, author of 1861: The Civil War Awakening, was interviewed. Charleston, South Carolina (which I’d love to visit if the right invitation presents itself) was the scene. Miscalculations on both sides about who would flinch first ultimately pushed events past the point of no return.

Towards the end of the interview, Terry Gross asks, “Some states today want the right to basically be able to nullify federal legislation in their state and not obey it. For example, not to follow the new health care policy that Congress passed. Do you see that as like a contemporary expression of similar divisions dating back to the Civil War?”

This was just a tiny part of the interview, but it really struck me about how divisive things are in health care politics right now. I certainly don’t think we’re on the brink of Civil War, but we are a house divided.

Acceptance of recent federal legislation is love/hate. There’s confusion on whether Meaningful Use will be repealed, revamped, or replaced. For the first time, I recently heard physicians (who had previously stalled on implementing an ambulatory EHR because they weren’t sure the Meaningful Use final rule was ever going to be final) state that they were holding off on going paperless because they feel healthcare reform (and the accompanying MU legislation) will be repealed.

I think many people agree that this train has somewhat left the station. There’s no guarantee that it might not stop somewhere along the tracks, but it already has pretty good momentum. (Anyone seen the movie Unstoppable with Denzel Washington? Watched it recently — a good diversion from reading yet another stack of documents about forming an Accountable Care Organization.)

It will be interesting to see how quickly challenges (to not only federal, but various state legislation) make it to the United States Supreme Court. Given the current makeup of the Court, I wouldn’t lay odds on any outcomes just yet.

Most large healthcare organizations that depend on Medicare payments aren’t willing to take chances or play the game of wait and see. They need to implement certified systems now and demonstrate Meaningful Use so that they can not only receive incentive payments, but prevent the stick that will ultimately follow the carrot. Whether incentive legislation will be repealed or only partially implemented, we don’t know, but I’m pretty sure the Centers for Medicare and Medicaid Services won’t forget the idea of cutting reimbursements by using lack of technology as an excuse (at least not any time soon).

A lot of people are excited about the billions of dollars flowing into the health IT industry. I envision industry lobbying that will rival Big Pharma in intensity and scope if the effort to repeal recent legislation gains any serious traction. There are plenty of consultants waiting to deal with the things that happen when physicians and hospitals select and implement hastily, not to mention vendors that will be poised to sell replacement systems as the industry consolidates.

There you have it. If you’re ever confronted with an SAT-style question asking for a modern-day analogy to the Civil War, please feel to plagiarize, no citation needed. And if you can recommend a conference that will give me an excuse to visit South Carolina, let me know.

Contacts

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

Readers Write 4/13/11

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

Thoughts on the Department of Defense/VA
By Arturo

Back in the 1980s, Congress, responding to the clamor for greater productivity and using the private sector should the private sector be more efficient (hence leading to such things as outsourced waste pickup and selling of municipal-owned utilities), mandated a competition for selection of the information system to be used by the VA.  And so there was a competition involving EDS, McDonnell Douglas, SMS, and the VA (if I recall properly). 

At that time, the VA VistA system was, in many respects, kludgy, somewhat proprietary (after all, what OS or application isn’t somewhat proprietary in one way or the other for the general population?), had a user interface not particularly friendly to many end users, and quite disjointed. 

By disjointed, I mean that various modules were written at different locations, sometimes with different standards and feels, and that was simply not a standard or uniform implementation of the system throughout the system. There was no such thing as a general release of the system.

The competition ended up with the selection of the VA system.  Now, I’ll never really know if it was the right decision, but I suspect that it really wasn’t. 

Shift forward a couple more years and we had another competition for the Department of Defense TRIMIS system – CHCS (Composite Health Care System). The selection didn’t compare apples to apples in the beta implementations (a single site installed by each competing vendors). The winner in this one was SAIC, which had used the VA system as its basis.

The SAIC bid for the five-year deployment came out about a half billion dollars lower than its nearest competitor. Interestingly enough, SAIC required another $500KK to complete its implementation and the DoD had a system that really wasn’t ready for the future — a database that wasn’t SQL compliant, a more or less command-driven system (MUMPS at work) that wasn’t ready to meet the demanding needs of clinicians, etc.

Eventually, sometime in the first half of the 1990s, as I recall, there was a DoD RFP for a clinical workstation.  I believe that this ultimately led to the 3M proposal for a clinical workstation and clinical data repository which was to become the foundation for DoD’s computer-based patient record system. (3M continues to support the DoD repository – a good thing, I suspect.)

Then came CHCSII.  Now I guess that it’s AHLTA.

And throughout all of this, we just don’t have a tight linking of DoD and VA EHRs.

Now we could talk about some of the inflexibility of VistA, its inability to provide workflows and screens tightly linked with different disciplines, the need for a more robust database manager, or the fact that VistA (and the VA) just didn’t know how to deal with female veterans. Or why the VA delivery system was perceived as being substandard for so long before emerging as a leader in preventative healthcare (although why did we have the disaster with veterans returning from Iraq not so long ago?)

Is it time to use a commercial product for the DoD and VA? Or should the DoD and the VA have taken the lead long ago in providing a robust EHR for deployment throughout our healthcare delivery system? Or if VistA was so good, why didn’t more provider organizations deploy it sooner? 

Something for thought. And, Epic, despite all of its success — is it really the right product or is it really any better?

Filling in the Holes in Your EMR/EHR
By Tim Elliott

With all the hype about electronic medical/health records (EMRs/EHRs) and pressure from internal folks (everyone from the executive team to various committees), hospitals often rush into their EMR projects without seeing holes between their systems, people, and departments. These typically get filled in later, often with inefficient manual processes. This approach reduces the productivity gains delivered by the EMR and frustrates the IT/IS team, clinicians, and administrative staff members who thought they’d be leaving paper pushing behind.

It’s a good idea to get people from each department that’ll be using the EMR to analyze the potential gaps in their areas well before vendors come on site instead of waiting to find and address these gaps later. Involving experts from outside your organization in the process is often beneficial, because they have the objectivity that it can be difficult to get when you’re running through processes you’re involved in. They’re also not going to be worried about hurting anyone’s feelings, which can be a concern when analyzing your colleagues’ daily tasks.

If you didn’t do this before going live with your EMR, it’s not too late. A good place to start a post-deployment review is to ask yourself and your team the same questions that you posed during project planning. By getting feedback from multiple departments (patient registration, HIM, clinical areas, etc), you’ll figure out how the EMR system is working well in some ways, and how can it can do better in others.

Again, consider why you’re doing what you’re doing. What are your goals for people, processes, and systems? How do these impact your overall initiatives, such as patient safety and disaster planning?

Don’t accept a process that isn’t working just because of a vendor’s limitations. If something’s not working right, call them and tell them exactly what the challenge is and what you need to achieve. Chances are they’ve heard a similar question before and will get right on it. Maybe you need a custom workaround, additional functionality in a newer release you didn’t know about, or a couple of extra training sessions for your staff.

We vendors spend lots of dollars on building products that solve problems. It pains us to see customers not using all of the tools we created to make their facility run smoother. Maybe you don’t want all of it, but if you need additional functionality, please ask. If your vendor is worth their salt, they have it, can build it, or will include it in a future release if several facilities share that same challenge.

We want to help you to cut your costs, enable your staff do their jobs better, and improve your patients’ care and safety. Often, the first step is you picking up the phone.

Tim Elliott is founder and CEO of Access.

News 4/13/11

Top News

  UnitedHealth Group unites its health services businesses under the Optum brand and renames Ingenix to OptumInsight. In addition, Prescription Solutions becomes OptumRx. UnitedHealth says the brand unification makes it easier for the market to understand the company’s full capabilities and helps align market engagements. I say the name change makes it easier for me to be confused and I’ll need awhile to align the name in my head. Mike Mikan will serve as CEO of the Optum group, while the CEOs of each company will remain the same.

HHS launches a $1 billion patient safety initiative aimed at making hospital care safer, more reliable, and less costly. The Partnership for Patients is a public-private collaborative and will work to decrease hospital-acquired infections 40% and reduce hospital readmissions 20% by the end of 2013. If successful, HHS predicts $50 billion in Medicare savings over the next ten years.

Reader Comments

  From P. Cockroft-Gault: “Re: open source biology. Love this guy’s drive and motivation.” Stephen Friend, MD, PhD, a former Merck SVP of cancer research, quits his job to start a non-profit to turn genomic analysis into a “wisdom of the crowds” type project, putting more intellectual horsepower behind unlocking genetic secrets and making the results non-commercial. “Our hallowed academic institutions have become factories for people who are trying to keep their own employment, their tenure … the whole reward structure keeps people from sharing the data that makes that connection …We’ll make it or not depending on whether our community of interest goes viral,” he says. In the TEDx talk above, he says the era of defining a disease by its symptoms is over since much more information is available at the molecular level.

From Veronica: “Re: Epic. Judy’s making noise in Wisconsin.” An article says the Greater Wisconsin Committee PAC is funded by children of George Soros, labor unions, and “Madison liberals who don’t unionize their own companies” (that would be Judy).

From Harold: “Re: John Caswell. I thought it would be nice if you mentioned his passing. He was with Compucare/QuadraMed for more than 28 years and will be missed by many in the industry.” Sorry it took so long to get this up, but I was waiting on confirmation from QuadraMed since I found nothing online. John David Caswell, 53, died on April 1, 2011. Details, guest book, and memorial contribution information can be found on the funeral home’s site. They did a nice job on his tribute video, set to Steppenwolf’s Born to be Wild. Condolences.

From Ling Cod: “Re: Black Swan moment. That book suggests that humans are wired to explain complex, chaotic events with simple theories that make them sound plausible even though they don’t predict anything (like reasons that stock markets crash). I challenge your readers to think about the Black Swan moments that may affect the alleged rapid adoption of EHRs and the possibility that, within a couple of years, providers will find the compliance wasn’t worth the aggravation. Possibilities: (a) some or all of the stimulus could be revoked, or (b) CMS may make EHR adoption mandatory with no further incentives if you want Medicare / Medicaid money.” The gauntlet has been thrown down. Feel free to add your thoughtful comments or submit something to me directly. The Black Swan reference, by the way, is the title of a book taken from the fact that experts had all kinds of convincing reasons that swans are always white (chief one being that they’d never seen a black one), which sounded great until a black swan was found.

HIStalk Announcements and Requests 

Listening: Royal Hunt, a Danish progressive band. Hits the spot in a Dream Theater kind of way.

Bored? Feeling as though the whole world is a tux and you’re a pair of brown shoes? My suggestions: (a) put your e-mail address in the Subscribe to Updates box to your right and feel immediately spiritually connected to the 7,288 folks who get my spam-free e-mail updates the instant I write something new; (b) do all those friendy / likey / connecty things on Facebook and LinkedIn, which will let you ride the vast social network that Inga, Dr. Jayne, and I enjoy (not really since we’re anonymous, but we get some superficial satisfaction as long as we don’t think too much about it); (c) send me news and rumors suitable for mongering; (d) peruse the sponsor ads to your left or their links to your lower right and investigate their offerings while feigning deep interest; and (e) use your considerable interpersonal influence to send new readers my way by telling people how the information you regularly glean from HIStalk has made you wealthy, self-actualized, and simply irresistible. Thanks for reading.

Acquisitions, Funding, Business, and Stock

EMR/PM provider ClearPractice forms a strategic partnership with Prognosis Health Information Systems. The companies are collaborating to offer an integrated SaaS-based EMR solution for rural and community hospitals and their affiliated physicians.

A quote from the CEO of Aetna provides some insight into the company’s $500 million acquisition of Medicity:

We recently bought Medicity, a health information exchange (company). We’re using that as a platform to create a data exchange. We will shift risk (financial responsibility for medical costs) to the provider system. We’ll provide them cover with capital as re-insurers. We will be the Intel-inside, if you will. We have dozens of these conversations going on with major systems. We spend $400 million a year on new developments: We are as much a health information technology company as an insurer.

Sales

The VA selects Authentidate Holding Corp.’s Electronic House Call solution as part of its home telehealth program.

The 49-bed Seymour Hospital (TX) purchases ChartAccess EHR from Prognosis.

Oakwood Healthcare (MI) signs a $60 million Epic deal, at least from what I can tell from the half-sentence teaser that Crain’s Detroit Business allows non-subscribers to read.

Methodist Dallas Medical Center chooses RemedyMD for its joint registry.

People

The Indiana HIE hires James S. Hill as VP of sales, tasked with managing sales operations, including market competitiveness, pricing, and strategy. I have to admit I was surprised the HIE world has matured enough to warrant a VP of sales.

Resurrection Health Care (IL) names Bradley Howard, MD its first-ever CMIO to lead its Epic EMR implementation.

Kent McAllister joins fellow Sage Healthcare alum Lindy Benton at Medical Electronic Attachment / National Electronic Attachment (MEA/NEA). McAllister, a former VP of client solutions for Sage, is MEA/NEA’s new CIO. Benton is Sage’s former COO and now serves as MEA/NEA’s CEO.

Healthcare analytics vendor Sg2 names Steve Lefar as president. He previously founded compliance and risk management software vendor MediRegs (acquired by Wolters Kluwer in 2007) and was an Allscripts SVP before that.

Capella Healthcare (TN) names Alan Smith as VP/CIO. He was formerly with Vanguard Health Systems and Cerner.

Announcements and Implementations

El Centro Regional Medical Center (CA) implements eMix for the secure transmission of radiology images and patient reports.

Dell launches a mobile clinical computing solution for Meditech. The product leverages technology from VMware and Imprivata’s OneSign SSO technology.

Here’s what happens when you let HITECH drive your IT projects instead of common sense. Carthage Area Hospital (NY) replaces its Meditech system with CPSI, saying it had to “move quickly to ensure we would receive the $2.8 million in stimulus funding.” So quickly, in fact, that they didn’t have time to train staff or work out billing kinks, resulting in a flood of complaint calls from patients. They say they’ll get everything fixed within a few months.

Government and Politics

The Foundation for the National Institutes of Health brings in HIMSS to help it run the mHealth Summit conference, the third of which takes place in Washington, DC in December. I have mixed feelings about that. I went to the last one and while it wasn’t nearly as fun as the HIMSS conference, it was refreshingly wonky and geeky, with mostly academics and non-profit developers sharing ideas with barely a break between sessions and a small, low-key exhibit hall. I’m sure the HIMSS involvement will bring the glitz, vendors who will dominate the entire conference, and the booth babes. I may go since I haven’t been to anything this year other than HIMSS and I like to get out of the house on occasion.

A proposed but floundering bill in Florida would require insurance companies to cover telemedicine services.

Innovation and Research

HCA Johnston-Willis Hospital (VA) wins a patient care innovation award for its Cancer Survivorship Program, which includes specialized software developed with Varian Medical Systems to generate care plans, schedule visits, and create a comprehensive summary based on evidence-based care. Above is their quite nicely done Pink Glove Dance.

Technology

 

Nashville Medical News profiles Shareable Ink, which moved its headquarters from Massachusetts to Tennessee a few months ago. Shareable Ink President and CEO Stephen Hau provided this comment on the local tech talent pool:

We’ve built an impressive team in Nashville with top-notch, local talent. On the technology front, there are strong candidates in Nashville, but they are few and far between. While I’m not worried about finding the next five strong engineers, sourcing the next 50 will be a challenge.

Other

In honor of National Volunteer Week, 15,000 McKesson employees will build 28,000 care packages for deployed military in Iraq, Afghanistan, and other regions. The initiative is in affiliation with Operation Gratitude and is part of McKesson’s annual Community Days corporate volunteer program.

Singing River Health System (MS) seeks to borrow $37.5 million to upgrade its EMR. Jackson County supervisors are considering issuing a bond to finance the purchase.

Occasionally readers will forward me photos or links of interest. I enjoy most of the items, especially since I work out of my house and some days those e-mails are my only link with the “real” world. Quite often the submissions have little to do with HIT, but serve to assure me that I am not the only one who reads the stuff I write.  Thus, thank you to the thoughtful HIT traveler who enjoyed this bottle of wine and thought of me. Good to know I am not the only one who believes shoes and wine are two of man’s best creations.

Here’s the latest installment of Vince Ciotti’s HIStory.

Fortune’s list of “ridiculous job interview questions” includes one from Epic: “You have a bouquet of flowers. All but two are roses, all but two are daisies, and all but two are tulips. How many flowers do you have?” Pretty easy, and not as ridiculous as my favorite ones, from Intel (“Explain quantum electrodynamics in two minutes, starting now”) and Capital One (“Using a scale of 1 to 10, rate yourself on how weird you are.”)

Sponsor Updates by DigitalBeanCounter

• Consulting magazine names Aspen Advisors one of “Seven to Watch” in 2011 and beyond. Mr. H interviewed Aspen’s founder and managing principal Dan Herman earlier this year.
• Clairvia adds Care Value Analytics, a new tool that aligns data from individual patient experiences with an organization’s clinical and financial objectives.
• Capario partners with Data Media Associates to offer customers customized patient statements, statement mailing, and a  payment portal.
• Hawaii’s Public Safety Department selects eClinicalWorks for its EMR at its seven correctional facilities.
• Bridgehead Software will provide data backup and protection solutions for The London Clinic.
• MD-IT merges with MDnetwork.
• Brad Swenson, VP and national healthcare leader for Winthrop Resources Corporation, is participating in the American Bar Association’s Spring Meeting this week in Boston. He’ll serve on a health law roundtable.
• PatientKeeper releases a white paper entitled Toward Meaningful Usability: Five Keys to Creating Physician-Centric CPOE.

Contacts

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

Curbside Consult with Dr. Jayne 4/11/11

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail Dr. Jayne.

Monday Morning Update 4/11/11

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail Mr. H.

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

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

I wrote this piece in January 2006.

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

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

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

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

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

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

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

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

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

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

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

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

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

HIStalk Interviews Geoff Brown, CIO, Inova Health System

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Any final thoughts?

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

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

Mostashari Named ONC Head

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

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

News 4/8/11

Top News

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

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

Reader Comments 

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

HIStalk Announcements and Requests

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

Sales

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

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

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

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

People

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

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

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

Government and Politics

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

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

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

Innovation and Research

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

Technology

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

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

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

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

Other

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

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

Sponsor Updates by DigitalBeanCounter

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

EPtalk by Dr. Jayne

Dear Dr. Jayne,

Do your patients know or care about IT?

Curious George

Dear George,

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

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

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

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

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

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

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

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

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

Dr. Jayne

Contacts

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

CIO Unplugged 4/6/11

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

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

The CMIO/CIO relationship: Lennon and McCartney Minus Yoko

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

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

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

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

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

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

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

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

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

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

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

Tips for Building That Foundational Relationship

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

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

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

News 4/6/11

Top News

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

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

Reader Comments

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

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

HIStalk Announcements and Requests

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

Acquisitions, Funding, Business, and Stock

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

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

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

Harris closes on its acquisition of Carefx.

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

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

Sales

Hamlin Memorial Hospital (TX) selects Prognosis ChartAccess EHR.

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

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

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

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

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

People

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

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

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

Announcements and Implementations

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

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

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

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

Government and Politics

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

Innovation and Research

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

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

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

Technology

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

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

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

Other

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

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

The latest installment of Vince Ciotti’s HIStory.

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

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

Sponsor Updates

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

Contacts

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

Curbside Consult with Dr. Jayne 4/4/11

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

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

Dr. Jayne,

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

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

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

Can you offer a solution to this dilemma?

Thanks very much,

Perplexed

Respondent 1

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

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

Respondent 2

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

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

Respondent 3

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

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

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

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

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

Respondent 4

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

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

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

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

Respondent 5

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

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

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

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

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

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

E-mail Dr. Jayne.

Monday Morning Update 4/4/11

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail Mr. H.