News 5/18/12

Top News

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

Reader Comments

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

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

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

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

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

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

HIStalk Announcements and Requests

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

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

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

Sales

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

People

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

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

iSirona promotes Philip Sawa to VP of sales.

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

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

Announcements and Implementations

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

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

Government and Politics

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

Other

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

Sponsor Updates

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

EPtalk by Dr. Jayne

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

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

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

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

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

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

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

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

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

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

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

CIO Unplugged 5/16/12

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

The Good Boss

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

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

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

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

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

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

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

Ensures Appreciation and Value

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

Mentoring

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

Fairness

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

Performance

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

Team

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

Transparency

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

Vision

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

Positive

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

Individuality

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

Style

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

Miscellaneous

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

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

Be the boss! The good boss.

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

Quality Systems Acquires The Poseidon Group

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

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

The acquisition closed May 1. Terms were not disclosed.

News 5/16/12

Top News

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

Reader Comments

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

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

HIStalk Announcements and Requests

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

Acquisitions, Funding, Business, and Stock

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

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

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

Sales

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

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

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

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

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

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

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

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

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

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

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

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

People

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

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

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

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

Announcements and Implementations

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

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

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

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

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

Other

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

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

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

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

Sponsor Updates

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

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Curbside Consult with Dr. Jayne 5/14/12

Over the last several months, there have been quite a few articles and studies about the growing phenomenon of mobile device distraction. Smart phones, tablets, and other devices have become ubiquitous. It’s almost unusual to see a group dining in a restaurant without devices littering the table. I don’t need to mention the danger of distraction while driving or otherwise being on the street and using a mobile device.

I wasn’t surprised then to see four Tweets in the last 24 hours that addressed the issue. There’s quite a buzz around psychologist Larry Rosen’s book iDisorder: Understanding Our Obsession with Technology and Overcoming Its Hold On Us. Some of his ideas are pretty common sense, such as the recommendation that families should have dinners where technology is not allowed at the table. I do agree with his point that technology might be making us dumber – the “Google effect” may make us less able to remember facts when we know that they are at our fingertips through search engines. His acronym for wireless mobile device (WMD) is accurate when you consider its other meaning: weapon of mass destruction.

Maybe having been required to be accessible 24×7 during my medical school and residency years jaded me, but until the last year or two, I had never been one of those people to compulsively carry my cell phone. Even now I don’t always answer it. Definitely not during a meal or a social event unless I’m on call or waiting for a specific return call.

The advent of the smart phone has made it easier to be in touch, though. I find texting or e-mailing to be less disruptive than taking a phone call as long as it’s self limited. However, when you open your e-mail to send a quick note to your staff or a colleague, it’s awfully tempting to troll through your account(s) to see what else is in there, and down the rabbit hole you go.

Like any other dependency, some have an easier time returning to real-time socialization than others. Some also have a hard time switching from texting-based communication to the traditional written word. This becomes apparent when I work with young people who can barely write grammatically correct sentences, but can text like crazy. In addition, despite having vast social networks, many are isolated when it comes to the skill of face-to-face communication.

An opinion piece in The Wall Street Journal proposes that, “We ought to group these machines with alcohol and adult movies.” I’m not sure I disagree. I’ve had to conduct interventions with parents who can’t seem to understand that their 11-year-old children shouldn’t be playing with an iPhone while I’m trying to take the child’s history and perform a physical exam.

Often, the phone belongs to the child, not the parents. That still baffles me given the cost of a data plan. I’ve had to explain more than once that when parents complain that children are spending too much time on the phone or with video games, it’s the parents’ job to put limits on those items.

What do you do, though, when the offenders are adults? It doesn’t seem like we have collectively developed the skills to police ourselves. I can’t imagine using a Bluetooth phone to make personal calls while performing surgery or surfing the Internet while administering anesthesia. We know it happens, however. I’ve had physicians complain that the EHR makes it to difficult to complete their documentation, one of them as she sat doing holiday shopping on her phone.

Do we need to put device behavior clauses in our medical staff bylaws along with rules about documentation deadlines and appropriate interpersonal behavior? Should facilities create WMD-Free Zones to allow us to decompress? Or do we just throw up our hands in defeat?

Have a suggestion on the wide-open field of WMD etiquette? E-mail me. I’ll try to read it in between surfing the net for animal-print crystal phone cases and signing charts.

E-mail Dr. Jayne.

EHR Design Talk with Dr. Rick 5/14/12

Pane Management — Part 1

The quantity of detail is an issue completely separate from the difficulty of reading. Clutter and confusion are failures of design, not attributes of information.

— Edward Tufte, Envisioning Information

We’ve been considering a high-level EHR user interface design that employs multiple panes within a single screen to display all the categories of data in a patient encounter.

In my last post, I discussed how mouse hovers or clicks can be used to expand and contract panes as needed. Excellent reader comments by Dr. Gregg and Dr. Robert Lafsky have made it clear it would be helpful to explore the limits of how much EHR data can be effectively displayed within an unexpanded pane.

In other words, can a relatively small pane present information at a high data density without creating clutter and confusion? Can multiple panes on a single screen be used to display most of the relevant data for a patient encounter, even before expanding or moving panes?

In my T-Sheet post, we explored one advantage of a single page or single screen view of the data. Each category of data is assigned to a fixed location on the page, allowing us to organize abstract data using our highly-evolved capacity to remember things by their spatial location.

A second advantage of a single page or single screen view is that we can rapidly access information by simply redirecting our gaze toward any part of the display. These rapid eye movements, lasting about a tenth of a second, are so integral to the way we take in and process information that most of the time we are not even aware of them.

Because data anywhere on a single page or screen is immediately available by using these ‘saccadic’ eye movements, we can simply retrieve it rather than remember it. Thus, the single screen design largely eliminates both the working memory problem and the cognitive costs of navigation. It also reduces complexity by reducing the total number of EHR screens needed.

For a single screen design to work, however, the individual panes need to be thoughtfully designed. Each pane needs to present a high density of data without clutter. We have already seen one problematic pane design, based on scrolling, that does neither.

Let’s return to the medication data set we’ve been working with. Here is the first part of the medication screen:

This design has lots of problems:

• It uses hard-to-read, all upper-case lettering for the drug names and dosages.
• The numeric values in the dosage column are not right aligned.
• The instructions are written in a form more appropriate for the patient than the clinician.
• The instructions present different classes of data (number, route, frequency, and notations) as text rather than in separate columns.
• The horizontal lines separating the rows of data are distracting.
• There is no way to re-order the medications in the list by importance, class or physician preference.
• Other than using all upper-case letters, the names of the medications are not emphasized.
• Abbreviations are underutilized.
• No effort has been made to eliminate redundant or self-explanatory information.

Many of these problems are improved with the redesign below:

Surprisingly, this small pane display contains almost as much information as the larger display above. Not only is this redesigned pane easier to read, it requires only 30% of the screen area needed for the first design. The redesign also uses the same number of pixels as the problematic pane with scrollbars design. Here are all three designs shown at the same scale:

Many computers now support monitor resolutions of 2.1 megapixels (full HD) or higher. The redesigned pane, at 57K pixels, takes up less than 3% of a full HD display:

By taking advantage of the greater display resolution now available and by using multiple well-designed small panes, the amount of EHR information available in a single screen view can be significantly increased.

Well-designed small panes can present detailed EHR information accurately, efficiently and simply. Multiple high data density panes displayed on a single screen, with each pane assigned to a fixed location, is an extremely powerful design. It allows us to use two highly-developed components of our visual system — our capacity to organize data spatially and our ability to access that data using rapid eye movements — to make sense of complex EHR information.

The take-home lesson is that no matter how good a user interface is, less is better. Eye movements are by far the easiest and most efficient way for humans to access or retrieve visual information. They beat using a mouse or other device to navigate, scroll, or expand panes hands down.

There will still be times, however, when expanded panes are needed. I look forward to discussing this issue in my next post.

Next Post:

Pane Management — Part 2

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

Monday Morning Update 5/14/12

From McPACS: “Re: McKesson. Pulling out of the UK PACS market.” Unverified.

From The PACS Designer: “Re: iPad at Sears. TPD decided to look for a new dishwasher at Sears and was surprised that the sales consultant used an iPad to show the features. Not only are the sales consultants using them, but so are customers as they travel through the various departments. Hopefully healthcare institutions will put iPads in patients’ hands so they can understand what diagnostic tools and procedures are being used to treat their ills.”

HIStalk readers are evenly split in which political party their beliefs most closely match, as unlikely as that might sound. New poll to your right: is it OK for hospitals to ask ED patients to pay before treating them for non-emergency problems?

Listening: reader-recommended The Hellacopters, 70s-style defiant, no-nonsense hard rock from a Swedish punk band that not only sounds like MC5, but does an even more frenetic cover of Kick Out the Jams than the Detroit original. Disbanded in 2008.

My Time Capsule editorial this week from May 2007: All Government Agencies Agree – You’re Free to Buy EMRs for Physicians, Even When it Doesn’t Make Sense. A test dose:

Being a bureaucratic IDN, we were known for high overhead and low performance, especially compared to the doctor’s A+ certified, college dropout nephew who was willing to design networks and develop software for $15 an hour after his grocery bagging shift was over. He was cheaper, so that made us thieves, our doctor customers assumed (doctors always assume that hospitals are getting rich, underestimating the profit-sapping effects of inefficiency and inertia.)

Researchers from Penn’s medical school develop an EMR “accountability tool” that asks ED physicians who are ordering a CT scan for abdominal pain to justify the need. Its use reduced the likelihood of having a CT scan ordered by 10%, reducing cost and patient radiation exposure.

Weird News Andy wants this Mayo Clinic Jacksonville radiology tech charged with Murder 1: he pleads guilty to stealing fentanyl that was ordered for interventional procedure patients by replacing it with saline contaminated with hepatitis C. One of the patients had just received a liver transplant and later died of hepatitis C without knowing how he contracted it. The tech faces life in prison.

Another big health system struggles with the bottom line following its Epic implementation. The bond rating agency of Norton Healthcare (KY) gives it an A-, but notes that its finances are “weak for its rating level” given its expected $37 million in operating losses for FY2012 due to “full implementation of the electronic medical record, strategic spending to expand women’s service at the St. Matthews campus, strategic spending on pediatrics in cooperation with the University of Louisville in addition to Medicaid reductions.”

Encore Health Resources names Clair Detraz as partner for corporate planning. She was previously with CTG Health Solutions.

The Government Accountability Office needs to fill an open patient/consumer advocate position on the HIT Policy Committee, which is kind of a big deal given that group’s influence. Nominations are due May 25.

Boston-based web and mobile healthcare developer Medullan moves into new office space to make room for the 35 new employees it needs.

In the UK, a physical therapist designs neck testing software, hoping to reduce the huge number of phony of whiplash claims that require only the patient convince a doctor of their choosing that they’re in pain.

Prosecutors claim a doctor was drunk, texting, and speeding when he ran into the highway’s bike lane and killed an 18-year-old skateboarder, later cleaning the blood from his BMW’s bumper, deleting the text messages, and refusing to give a blood sample. His two employees also deleted the text messages he sent them, claiming they did so before finding out that he had been arrested.

St. Joseph’s Children’s Hospital (FL) holds a prom for 100 current and former peds patients, giving seriously ill patients a chance to experience something they either missed in the past or may not survive to enjoy in the future. Employees donated many of the gowns and tuxedoes.

Kaiser Foundation Hospitals and Health Plan took in $12.7 billion in revenue in Q1 and earned profits of $770 million.

In the UK, a study finds that the cash-strapped NHS is paying “extortionate” prices of up to double or triple those listed on Amazon for flash memory and cables. It also finds that a plan that allowed private companies to fund new construction in return for long-term maintenance contracts has resulted in hospitals being charged over $500 to have a light bulb changed.

In Pittsburgh, newly filed tax records show that the former CEO of West Penn Allegheny Health System was paid $7.4 million in 2010, some of that from severance. UPMC’s president and CEO was paid $6 million.

Shares in Greenway Medical Technologies jumped 26% Friday after the company reported increased revenue, making GWAY the biggest percentage gainer on the NYSE for the day. Shares are up 20% since the February IPO.

E-mail Mr. H.

Time Capsule: All Government Agencies Agree – You’re Free to Buy EMRs for Physicians, Even When it Doesn’t Make Sense

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

I wrote this piece in May 2007.

All Government Agencies Agree – You’re Free to Buy EMRs for Physicians, Even When it Doesn’t Make Sense
By Mr. HIStalk

The Internal Revenue Service clarified its position this week on hospitals donating technology and related services to physicians. The bottom line is that non- profits can do so without fear of losing their non-profit status.

Lots of folks (most of them vendors) were excited about loosened up Stark laws, so this announcement removed what appears to be the last barrier before the EMR spending orgy gets officially underway.

Vendors love it. Docs weren’t buying their wares when their own money was involved, so creating a misaligned incentive is the best possible outcome. If someone else is paying for dinner, I’m having both the steak and the lobster, even if I’m not likely to finish them.

I’m not sure that getting the green light to give away expensive products is great news, but I’ll try not to rain on the parade of those who do.

I’ve worked for big IDNs that provided practice management systems to affiliated physician groups. Our doctors were fairly willing to use the software we chose on their behalf because it got them paid. Even then, we heard plenty of gripes about product design, reliability, and most of all, cost (this was a simple, character-based scheduling and billing system that only the office staff used anyway.)

As little of a picnic as that was, I don’t envy bright-eyed hospital IT types who think they want to be in the physician EMR business.

One problem we had was allocating ongoing costs. Being a bureaucratic IDN, we were known for high overhead and low performance, especially compared to the doctor’s A+ certified, college dropout nephew who was willing to design networks and develop software for $15 an hour after his grocery bagging shift was over. He was cheaper, so that made us thieves, our doctor customers assumed (doctors always assume that hospitals are getting rich, underestimating the profit-sapping effects of inefficiency and inertia.)

We thought we could cover our relatively fixed cost with the number of physicians who signed on. A few bailed out, though, because of cost (or maybe value.) That forced the pie slices of those remaining to get larger, which caused a few more to reconsider — well, you get the idea. Allocation is hard, especially when the user base is shrinking.

If you’ll be charging ongoing fees, you’ll be competing solely on cost and willingness to rush over to the office (or even the doctor’s house) any time something’s not working. It’s your fault, even when the doctor’s wife/office manager brings down the network by unplugging your router to make a space for her curling iron.

The worst scenario is if the stuff you’re paying for isn’t used. Remember, your doctors weren’t buying when it was their money. Try to structure a vendor deal where they get paid only if the system gets used, otherwise, it’s just you trying to strong-arm doctors and we know how well that works (cough*CPOE*cough.)

CCHIT has certified 81 ambulatory EMR products, so cast a wider net than that handful of old-line, CIO- friendly vendors with correspondingly high price tags and old technologies. That was the whole point of certification, after all. While you can’t trust a doctor who swears he or she will use a product, you can definitely trust one who swears they won’t.

Don’t whip out the checkbook until you’ve developed an integration strategy. If you just want to give away free software, that’s fine, but otherwise, what information do you want to send and receive from your new doctor buddies? Doctors don’t want a portal, they want your information dropped into their EMR – can you do that?

Lastly, don’t be swayed by what seems to be an unstoppable trend of hospitals paying for physician systems. Magazines, consultants, vendors, and member organizations love to encourage the bandwagon effect, detaching your wallet from your brain to their benefit. If return on investment is shaky, surely you have other IT projects you can fund instead.

News 5/11/12

Top News

Government investigators applying statistical tools to sift through HHS data find $5.6 billion in questionable Medicare billings from 2,600 pharmacies, many of them in the Medicare fraud hotbed of Miami. Some beneficiaries received hundreds of prescriptions each year (two patients received more than 1,000 prescriptions per year), while pharmacies in Baltimore, Detroit, and Tampa had unusually high narcotics dispensing. CMS administrator Marilyn Tavenner said she agrees that oversight should be improved, but doesn’t want CMS to be flooded with false leads, especially since the report does not provide examples of proven fraud.

Reader Comments

From Not a Smurf: “Re: insourcing in healthcare. What do you think about this book’s premise that American workers are being left unemployed because of the importation of RNs and MDs to work at American hospitals & other healthcare settings?” I assume we do import a lot of doctors and nurses. I’ve worked in rural hospitals where we had basically no American-born physicians, creating odd communities of extended families of doctors from mostly India, the Philippines, and Colombia taking care of people who had never been more than 50 miles from home and who often couldn’t understand a word their doctors said. Those docs were smart enough (or maybe just more ambitious) to have chosen procedure-based specialties like surgery, radiology, and cardiology instead of the lower-paying general medicine and pediatrics. And, to open their own practices instead of working for someone else. We had some horrible ones that were certainly harming patients with their obvious incompetence, but I don’t know that the numbers were disproportionate to some equally bad good old boy docs who didn’t pay much attention in their med school classes. I agree with the premise that we have more foreign healthcare workers than you might expect, but I don’t see that as necessarily bad. Foreigners usually take jobs that Americans either aren’t smart enough to do (engineering, computer science) or are too lazy to do (farming, restaurant work). I don’t buy the idea that foreign docs and nurses are stealing desirable jobs from equally qualified and willing American candidates. In the backwater places I worked, you couldn’t pay enough money to get American docs to move there from the more desirable cities — it was foreign-born docs or none at all. The supply of doctors and nurses is artificially limited by schools and licensing boards to keep incomes high anyway, so I like the idea of breaking that monopoly. We’re going to need a lot of healthcare people to care for entitled baby boomers. All the docs I know are keeping plenty busy no matter where they were born. But as I gaze down from high on my soapbox, I’ll ask: what do you think?

From ORISpilot: “Re: Andrew Brearton, CIO of St. Joseph’s Health Center in Toronto, Ontario. Resigned today due to ‘health reasons’ and will be replaced by an interim CIO until a full-time replacement is found.” Unverified.

From Pickle_Juice: “Re: heard two rumors. Partners is dumping their Soarian install in favor of Epic. Lifespan in Providence, RI is switching from Siemens (I think they were Invision, tried Soarian, but pulled back to Invision) to Epic.” Rumor #1: true. Partners has indeed chosen Epic as vendor of choice, but I haven’t seen a definitive list of what they’ll be replacing (knowing Epic, probably everything possible, but the business apps weren’t mentioned in the e-mail from the Partners CEO that was forwarded to me). Rumor #2: not true yet. I asked Lifespan SVP/CIO Carole Cotter (above) and she says Lifespan is considering five vendors, with the incumbent Siemens being one of them. The selection will take several months.

From Joey: “Re: Partners. This is a dream sale for Epic. The private offices are latched onto Partners as part of their IPA, so Epic’s sale goes far beyond the hospital itself. Partners will tell them that to stay in the IPA, they will have to get on Epic, and they will.”

From Eagle Driver: “Re: St. Luke’s in Kansas City. Just heard a wild rumor that they’re going Epic. I think they’re McKesson inpatient, Allscripts outpatient. No real information, but maybe you can check with your sources.” VP/CIO Debe Gash says they’re evaluating products, but haven’t made a decision yet. The fact that they’re evaluating products says a lot (are any Horizon customers not actively looking?)

From Blue Dog: “Re: [hospital system name omitted]. Re-evaluating their EHR strategy for owned practices in over 100 cities. [product name omitted] was picked in 2010, but has been an epic (no pun intended) failure, with no successful implementations and three botched ones. They are moving to athenaclinicals for at least a quarter of future installs. Hospital and vendor staff can’t get along and hospital leadership is so frustrated with the IT department that it’s beyond reality. Huge internal struggle. Many of the EHR issues are actually related to IT issues.” Unverified, with names removed for now. The CIO didn’t respond to my inquiry, but I’ll allow a bit more time.

HIStalk Announcements and Requests

This week on HIStalk Practice: ONC launches an Health IT Dashboard. Sermo says its iConsult app is a hit with physicians. ONC publishes a guide to privacy and security for physician offices. A Tennessee practice agrees to pay $4.36 million to settle a fraudulent claim lawsuit. ChartLogic makes a big EHR sale to a 25-provider group in Arizona. Dr. Gregg shares a juicy (and unconfirmed) rumor about his EHR vendor. It’s all good stuff, but I think Dr. Gregg’s piece is particularly thought provoking. Sign up for e-mail updates when you stop by. And thanks for reading.

We are always looking for interesting and fun content for HIStalk Practice, including contributions from providers, consultants, road warriors, or other ambulatory HIT enthusiasts. We can’t promise fame and fortune, but our other regular contributors will likely tell you that Mr. H and I are highly appreciative, occasionally offer constructive feedback, and every now and then send amusing off-the-record information. Drop me an e-mail if you are interested.

Thank you very much to those 45 generous readers who have contributed to the hat-passing I’m doing to support the four young daughters of Tim Dodson, a long-time HIStalk reader who passed away suddenly last week at 34. He was an Epic analyst with Children’s Medical Center (TX). I’ll leave the Donate button in the right column of this page for a couple of days, also mentioning that two readers (Ed Marx of Texas Health Resources and Dave Shaver of Corepoint Health) have offered to do as I did and match $250 in contributions dollar for dollar, just in case you need to be convinced to slide off the fence. I’ll be sending the money to the fund that’s been set up for the girls shortly and will give you the total. I’m sure I speak on the family’s behalf in saying that they appreciate any and all support, both emotional and financial.

Acquisitions, Funding, Business, and Stock

MEDSEEK announces that private equity firms Silver Lake Sumeru and  Essex Woodlands will finance a management buyout of the company. CEO Peter Kuhn says the change will allow the company to accelerate the expansion of its platform.

e-MDs reports a 20% increase in revenue and a 10% increase in employee count over the last year, also saying the company was profitable in 2011 and that it invested 40% of its annual revenue in R&D.

Enterprise data management vendor CommVault announces Q4 numbers: revenue up 27%, adjusted EPS $0.29 vs. $0.25. The $2.4 billion market cap company has never done an acquisition.

Vocera turns in its first quarterly report after its April 2 IPO. Its Q1 results: revenue up 26%, adjusted EPS $0.06 vs $0.07. Full-year 2012 was given as $100-102 million in revenue and non-GAAP earnings of $2.5-$3.0 million. Shares that were IPO priced at $16 are now at $23.35, including a 7% jump after the earnings announcement.

Ireland-based startup Cara Health is profiled in an Irish publication for its Patient Journey Record readmission avoidance software that will be aimed at the US market. Recently discharged patients are called by telephone and their responses to specific questions are linguistically analyzed and compared to a database of key phrases that may predict a need for readmission, allowing earlier intervention. Clinical trials of the software found that 30-day readmissions were reduced by 51%.

UK-based hospital patient care software vendor Ascribe engages William Blair & Company to explore its strategic alternatives, with speculation being that the investment banker might find a US buyer.  

Nuance announces Q2 numbers: revenue up 22%, adjusted EPS $0.43 vs. $0.32, beating expectations. Healthcare revenue was up 24%.

Greenway reports Q3 results: revenue up 52%, adjusted EPS $0.08, beating revenue expectations and with year-ago quarterly EPS not stated due to tax changes.

Sales

Banner Health Network and Aetna expand their ACO relationship to include HIE technology from Medicity for population health management and patient services.
Lutheran Healthcare (NY) selects Merge Healthcare’s iConnect solutions as its enterprise imaging platform.

Dossia (NY) selects NexJ Connected Wellness platform as part of a NYC Health Department pilot program to give patients PHR access.

People

Cognosante appoints John Calabro (OK HIE Trust) as leader of the company’s HIE practice.

EHR provider Spring Medical Systems promotes Mark Benvegnu to president and CEO. He will continue as chairman of the board.

iSALUS Healthcare, developers of OfficeEMR, names Chuck Dietzen MD (Timmy Global Health – above) chief medical officer, Randy Kidd (Stratice Healthcare) EVP/CIO, and John Brady (Stratice Healthcare) EVP/chief marketing officer.

The National Council for Prescription Drug Programs elects First Databank VP Thomas R. Bizzaro to its board of trustees.

Scott West (STC/SeeBeyond/Sun Microsystems) joins NextGate as SVP of global sales.

Announcements and Implementations

Michigan Department of Community Health, Michigan Health Connect, and Michigan Health Information Network activate real-time electronic reporting of public health information to the State of Michigan’s Care Improvement Registry using Medicity’s platform.

Baptist Health South Florida deploys Centrify Suite for access management and centralized user management.

BCBS of North Carolina and SAS announce their collaboration, with BCBSNC using SAS database analytical tools to identify patients who could benefit from specific interventions and to allow the insurance company to target its offerings and communications.

PDR Network and the iHealth Alliance announce a drug safety certification program for EHRs and e-prescribing platforms. Products earning a PDR Certified seal must contain full FDA drug labeling for prescribers, drug alerts and warnings (safety alerts, boxed warnings, recalls, and REMS Communications), adverse drug event reporting, and patient education content, all updated at least weekly. 

Veriphyr donates its patient privacy breach protection service to Gillette Children’s Specialty Healthcare (MN).

M*Modal launches its cloud-based speech understanding platform and M*Modal Fluency Direct for enabling speech in EHRs.

Government and Politics

In compliance with the HITECH Act requirement, CMS publishes the names, NPI numbers, business phone numbers, and addresses of Medicare EPs and hospitals that have successfully demonstrated MU as of March 2012. If you happen to need a free list of 44,000 providers or almost 1,000 hospitals, the lists can be downloaded in either CVS or PDF file formats.

HHS issues final rules to streamline reporting requirements for hospitals and to retire older versions of e-prescribing transactions for Medicare Part D. The regulation changes are expected to yield over $1.1 billion in savings the first year.

The Utah Division of Occupational and Professional Licensing puts its upgraded disciplinary action database online, including records of physicians, nurses, pharmacists, and other licensed healthcare professionals.

I’m impressed with The Health Datapalooza taking place in Washington, DC on June 5-6, put on by the Health Data Initiative. Speakers include some VC guys, the CEO of Aetna, Matt Miller of NPR, the executive editor of Wired magazine, former Senate Majority Leader Bill Frist, Todd Park (US CTO), Kathleen Sebelius (HHS Secretary), Atul Gawande (physician author), Dominique Dawes (former Olympian), and Farzad Mostashari (ONC). Sessions look interesting. Hospital guys like me find it hard to get time off to run around to conferences, so if you’re going and want to be my on-the-ground reporter there, let me know.

Speaking of government conferences, I’m excited that EHR design guru and HIStalk contributor Dr. Rick saw my mention of the May 22 ONC/NIST EHR usability conference and has decided to attend (and to provide a post-conference report, I assume.)

ONC announces its Health IT Dashboard, with geographic maps covering its various grant programs and HIT adoption.

Other

Imprivata announces the results of its Fifth Annual IT Trends Survey, including findings that single sign-on, virtual desktops, and remote access are the top three enablers for engaging physicians to adopt CPOE.

Speaking of Imprivata, here’s their latest cartoon (insert your own orthopedist joke here). If you’re a Scott Adams wannabe, submit your cartoon ideas here.

Finding it hard to keep track of which vendors have acquired which other vendors over the years? Check out this acquisitions family tree, graciously offered to HIStalk readers by Constantine Davides, senior analyst with Boston-based JMP Securities. It could be turned into a fun HIT trivia game, with questions such as, “ What was the coding solution vendor that Cerner bought a few years ago?” or, “What vendor bought Intelus?” I bet it will jog some good stories out of Vince for future HIS-tory presentations.

Here’s another video in honor of Nurses Week, this one recommended by a reader since it makes her think of her sister, a pediatric oncology nurse, and her patients.

University of Miami’s medical school will lay off up to 800 employees because of state budget cuts and reduced payments from struggling Jackson Health System, which itself laid off more than 900 employees earlier this year.

An employee of Waukesha Memorial Hospital (WI) is charged with embezzling $1.5 million from the hospital by submitting invoices from his wife’s painting company. Management got suspicious five years later at the large number of invoices paid to a single company, then determined that nobody had seen anyone doing any painting other than hospital employees. The employee told investigators that he wanted to make restitution, saying he estimated he owed the hospital $100K. When shown the deposited checks for $1.5 million, he said, “So I guess I probably owe them more.”

Sponsor Updates

• A group from the University of North Carolina Hospitals wins a prize for their abstract on LVAD at the UNOS Transplant Management Forum. Their work was sponsored by OTTR Chronic Care Solutions. Above are Paul Kenyon of OTTR, Randy Watkins of UNC Hospitals, and Tim Stevens of Providence Sacred Heart Medical Center & Children’s Hospital (WA) and chair of the OPTN/UNOS Transplant Administrator’s Committee.
• Bloomberg Businessweek profiles Digital Prospectors Corp.
• At this week’s Healthcare IT Institute Conference, Aventura SVP Brian Stern discusses comprehensive solutions to change the way clinicians work with HIT.
• Passport Health reports that more than 50% of the facilities listed on Thomson Reuters Top 100 Hospitals for 2012 use Passport’s eCare solution for RCM.
• Orion Health announces the release of Rhapsody Integration Engine V5.
• Medicomp Systems offers a free webinar May 24 and 30 on navigating future demands in healthcare.
• Practice Fusion profiles Andrew Bronstein,MD, an orthopedic surgeon who uses its EMR.
• Emerson Hospital (MA) goes live on the Intelligent Forms Suite from Access, launching its forms on demand functionality from Meditech.

EPtalk by Dr. Jayne

An article published in the Journal of the American Medical Informatics Association demonstrates that linking a personal health record medication review tool to the provider’s electronic health record can reduce potentially harmful medication discrepancies. The trial was cluster-randomized and included 11 primary care practices using the same personal health record. Over the 18-month study period, some practices received an intervention that provided access to a medication module capable of prompting patients to review their medications and identify potential discrepancies.

Now that the comment period for Meaningful Use Stage 2 is over, there seems to be a preponderance of medical associations commenting against it. Nearly 100 groups joined the American Medical Association in sending a 37-page letter to CMS Administrator Marilyn Tavenner. Highlights:

• Non-participants in Stage 1 should be surveyed to identify barriers to participation prior to finalizing Stage 2 requirements.
• New core measures (or Stage 1 menu measures moved to core in Stage 2) should be evaluated for “evidence of efficacy, administrative burden, costs to physicians, and technological standards.”
• Measures assessing elements outside a physician’s control (such as patient use of technology) should be avoided.
• Providers should not have to meet all 20 core measures plus clinical quality measures. Allowing providers to opt-out of a few would allow them to achieve MU with a good faith effort.
• MU rules should only apply to Medicare/Medicaid patients.
• Disparate health IT programs need to be synchronized so that providers are not penalized for participating in one over the other.

Interesting note: state medical societies not signing include California, Montana, and New York. Major organizations not signing include the American Academy of Family Physicians and the American College of Physicians.

The American Medical Association Journal of Ethics (online at virtualmentor.org) publishes an editorial discussing the need for physicians to counsel patients on material they obtain from the Internet.

HIMSS13 calls for both proposals and reviewers are still open. If you have a great story to tell, now’s the time to ensure your boss has to fund your trip to the Big Easy.

For my friends in clinical engineering, Fluke introduces a new device for simulating vital signs during patient monitor testing and calibration. I noticed the website says it’s 17 pounds lighter than its predecessor, which apparently also had the ability to simulate the new onset of a hernia.

We’re wrapping up National Nurses Week, so if you haven’t taken the time to thank a nurse (or several), you still have a couple of days to do so. On further thought, how about making it part of your everyday routine?

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

HIStalk Interviews Jonathan Teich MD, CMIO, Elsevier

Jonathan Teich MD is chief medical informatics officer of Elsevier.

Tell me about yourself and about Elsevier.

Elsevier is the world’s biggest producer of scientific and medical information. Traditionally that has come in the form of journals and books, and then ever increasingly over the past 20 years, more about electronic information. First as just electronic representations of those same things, but now more and more as specific electronic delivery of information for a particular need. It’s been very interesting to watch this evolution about how to turn information from these huge amounts that you have to go find into something that’s delivering what there is to you. 

I am an emergency doc in one life, still practice at Brigham and Women’s, and an informaticist for the past 20-something years. I helped with a lot of the design and led the clinical systems charge at the Brigham, working for John Glaser over about 12 years, and then went into the industrial side to try and see if I could make an even broader impact.

I spend my time between working with Elsevier in an R&D capacity and a strategic capacity, as well as representing them and the field in government and industry conversations. I’ve also spent a lot of time working with ONC over the past three years as their CDS gopher, and a lot of interesting things have come out of that. It’s a broadly motley career that seems to be working out pretty well.

There’s a lot of information out there in the form of literature and reference material, but clinical decision support never seems to quite realize the promise of actually applying that knowledge in a manner that measurably improves measurably frontline patient care. What are we doing right and what do we need to do better?

I think you’ve really hit the problem. There are places that are doing it very well, places that haven’t quite been able to do it very well, and places that have given it up altogether.

You’re right about information. A company like Elsevier … I’ve been told that we produce seven million distinct pages every year of medical content. Books, journals, whatever else. As I’m going through it, I’m an emergency doctor and I’m seeing a new patient and I have a question — the answer’s in there somewhere. One of those seven million pages has what I want to know.

Clinical decision support has a lot to do with saying, “Where is that information? Can you get me that spot without me doing a lot of work? Can I get that information and then can I make use of that information?” Typically, that’s a wide range of things. People know about alerts, order sets, care plans, and pharmacy information. More and more, how do I deliver the intelligence that I need at a particular point? 

It really has been an up and down situation. There were a number of leading institutions through the ‘90s and early part of the last decade that showed that you could do a great deal of change with preventing adverse events, reducing costs. Work we had done at the Brigham with Dave Bates and myself and others showed that we could knock off about 55% of the significant adverse drug events and the corresponding cost savings. We could show we could save a couple of million dollars a year on certain kinds of drug overuse costs and so on. Z

There’s certainly the potential for it, and certainly under some circumstances it works very well. But then as you’ve seen, when it comes to bringing it out into the open and having 6,000 hospitals and all the ambulatory practices use it, many places have been able to use it very well, other places have not.

I think that a lot of this has to do with two things: culture and information delivery. I think the culture, in terms of places where I’ve gone to see what hasn’t been working, have often led to problems with communication, problems with not involving people in the clinical decisions before the decision support goes live, problems with not getting everybody to see what’s about to happen before it happens. I think that’s been probably one of the biggest issues on that side.

On the information delivery side, some of this information is just not in its most usable form. If you try and build this 6,000 times at 6,000 hospitals, sometimes it works well and sometimes it doesn’t. There should be a way to pool everybody together to get the best delivery systems and the best information to be used by everybody.

It’s interesting the Brigham’s BICS rules that Eclipsys bought were very sound, but not widely used. Is the challenge that the underlying data just isn’t there in a way that can connect the rules to the real world? Is there a gap between what rules could do vs. what information is available to allow them work?

I haven’t had anybody ask me a question directly about BICS in a while. That’s good to hear.

The BICS rules were using data that was unique in its time, but I think it’s not unique anymore. I don’t think the problem is that we have insufficient data to get these things done. I’m sure I could construct rules that are making use of obscure data, but a great deal of what I need to know to handle basic quality measures, to handle Meaningful Use, to handle accountable care, and to handle just good practice are things that are are generally available. Most of this comes from medications and laboratory and problems and so on.

I don’t think it’s a matter of data. I do think that there hasn’t really been a good systematic way of showing somebody else at the next hospital what I’ve done at this hospital. I think that maybe some of the things that we did at the Brigham have been ported to other places that use the same IT team. But, it’s very hard to convey this in, say, a research paper and have that go along. I think that if I was going to put a technical finger on it, it’s that it’s been hard to share the techniques very well.

It’s hard to measure success or failure because when a clinician accepts the guidance, they may not enter the order and you don’t have anything documented as to why. On the other hand, then they override 95% of the warnings, you have a record of that and the implication is that warnings in general weren’t really very useful. Can decision support work without allowing clinicians to tailor their desired levels of messaging and without using more patient-specific information, making it less about interruptive warnings and more about guidance?

I think that’s a lot of it. If clinical decision support in a given institution relies on alert after alert after alert, then it’s simply not going to be something that’s accepted. Quality of care is important, but getting your work done in a timely fashion is also important. If you start getting hit with 50 alerts that are taking time out of what you’re supposed to be doing, you’re going to find a way pretty quickly to game that system and get around those.

You need to have a couple of things. There need to be ways to measure what these things are doing. I think you need to be able to understand upfront that this month, this year, we are going to make diabetes care better in our primary care population. You need to be able to be a cheerleader and do the personal side, and tell people, OK, it’s three months later — we’re getting a little better. It’s six months later, we’ve kind of planed out. Nine months later, we’re getting a lot better. I think people respond to knowing that what they’re doing is having an impact.

I also think that you need to get away from kind of doing alerts for everything. In the newer edition of Improving Outcomes with Clinical Decision Support: An Implementer’s Guide that we just published through HIMSS, we’ve said that there are 10 different types of clinical decision support. They include data displays, order sets, analytics, and they also include providing information. A lot of the things that people use that should be clinical decision support is simple information to say, how do I figure out what to do next? How do I figure out where I’m going?

I see a patient in the department. They’ve got a problem I’m not familiar with. What happens? I go off to the computer and I go look up things. I go look them up in MD Consult, or Clinical Key, the new version. I go look it up in other references. You see that all around our department, people are looking up things. But it takes time, and it’s hard to get exactly what you want. A lot of what decision support ought to be doing is giving you the knowledge that I need to get through the next task. I say that clinical decision support is all about telling me what should I do next.

At Elsevier, that’s a lot of what we’ve been doing with the development of two things. One is Clinical Key, which is the complete overhaul of the MD Consult framework. It is designed to try and filter down your questions. It’s based more on the kinds of questions that we know people to have asked in the past and tries to do as best it can in terms of funneling down the information to match up with your question.

We do that, and that’s been lying on top of the framework that we call Smart Content now. Smart Content is our effort to put semantic tagging under almost everything we do. Books are tagged. Journals are tagged to the paragraph level. The order sets are tagged. Care plans are tagged. The idea of that is that I need to be able to jump from one thing to the other, because my first task is going to be, what am I supposed to know? That may lead me to, OK, I’d better order that. That may lead me to, OK, I’d better do a procedure on that. I want to have some way of connecting these things together. 

You need to use a variety of different types of decision support for different situations. They need to be really focused and task based.

There’s a philosophic underpinning to how people view decision support. On the one hand, people think, “All those other doctors need to get these warnings, but I don’t, because I’m smarter than they are and I don’t have to worry about it.” But on the other hand, the guy who’s getting the warnings says, “I don’t need them either.” Everybody seems to want the other guy to have constant oversight via clinical decision support. Should we trust clinicians to know when they need help instead of constantly trying to find reasons to warn them?

There’s a balance. You need to have something that’s usable and friendly and acceptable to gain acceptance. Physicians and others are smarter than the baseline, but not quite as smart as we think we are.

The history of something like order sets is that whenever someone implements order sets in a hospital, everyone has this big clamor for personalized order sets. So it’s, “I’m going to do these things differently, so I want mine to look different.” People  go along with that at first because that’s what you need to do to build acceptance. Very often, about two years, later the Pharmacy and Therapeutics Committee comes around and says, “We’ve got all these things that were invented two, three years ago and they haven’t been touched and they haven’t been reviewed and they’re using things that are now considered dangerous.” They eventually decide to abandon personalized order sets. That’s one example.

In the area of alerts, should I say that I shouldn’t get a certain alert? I think that it depends on the criticality. I think I should be able to put away certain less-important things or things that I’ve seen repeatedly. I think there should be systems that do smart things like, if I’ve already heard something once on a patient, I probably don’t need to hear it again on that patient during that same admission. I would stop short of saying that I should have a switch that says, “Don’t tell me about this.” But I might have a switch that says, “Don’t tell me about this too frequently.”

The perfect decision support system is order sets. You’re repetitively using things that have been vetted and that keep you from doing anything too crazy. Somebody with enough of those could get rid of a lot of the standardized warnings about doses and drug interactions because everybody is following the same guidelines. Do you think there will be a point where order sets become so prevalent that we can move to the next level of decision support, where instead of saying, “What you did was wrong,” we say, “Here’s what you should be doing that maybe you didn’t think of?”

Order sets are excellent. One reason that order sets are so capable is, well, two reasons really. One is that they are helping you become more efficient at a task you have to do anyway. You have to write orders anyway. CPOE sometimes takes longer than the old way of handwriting. Order sets tend to make it much faster and bring that equation back even or even better. People like order sets because they’re efficient.

The other nice thing about order sets and why they are so acceptable is that you’re usually using them to support a decision and to help you with things before you do them, as opposed to changing a plan. Where decision support tends to be more onerous is where I’ve already made a plan and something comes up and says, “No, you’ve got to change your whole plan” Order sets are timed nicely.

Same thing with nursing care plans, which we don’t hear so much about. Those are timed nicely. They can help you as you’re making the decision. It’s the right timing. 

Order sets are strong and I think they can be a lot stronger. Most order sets are giving you the standard ways of doing things. We’ve been looking at order sets and how you can do them better. I think a lot of that resolves around, “Can I fine tune it in certain ways? Can I help you get down to certain nuances, certain situational aspects that take you away from the standard of care?” Because the problem with order sets sometimes that they’re too big in their quest to support everything.

I think that you’re right. Order sets are a great form of CDS, and again care plans on the nursing side. They have all the right user aspects. I think they will become more common. Probably every hospital has some anyway, but I think that they will become more common. The next step is to say, “Can we make these a little bit more data sensitive? Can we make these a little bit more flexible? Can I share them from one place to another?”

Some people would say that what clinicians want is the same tool they would use to make other decisions – a smart search engine to help them find and sift through all this wealth of material that’s out there. If you had a single body of literature like what Elsevier publishes, you could just search the whole thing and have it somehow graded or weighted or personalized in such a way that it would return meaningful data without having to actually do any thinking.

In a sense, that’s exactly what we’re trying to do, and we are. 

You’re right on target. People need information. They want to get it with as little effort as possible, which is perfectly human and perfectly reasonable. You need different information when you’re first assessing a patient than when you’re on rounds and when you’re preparing someone for discharge and so on. You want to be able to have smart filters that can give you information that is geared to a problem, geared to a set of circumstances, and geared to where you are in the workflow. Then you need to be able to get smart enough to deliver just that. 

Among Elsevier’s book catalog, there’s certainly all the things you’d want in books and among the journals. It’s a combination of things that we publish and things that are published elsewhere, of course. But, really, there’s a hierarchy of what people want to know for different tasks. We are really attempting to do exactly that, which is to focus down on a given task process, a given problem, and try and deliver it, ideally down to the paragraph level, down to the table level. Whatever we can do that’s more focused, that’s quick, the better.

I’ve said in lectures that nowadays, given a choice between good information and quick information, people will take quick information every time. We have to make something that’s both good and quick, because that’s the competition.

It’s like imaging. Everybody says, “It’s not a diagnostic quality imaging,” but they are diagnosing from it anyway. In reality, people will settle for whatever they have available, especially in your field. In the emergency department, you can’t wait for perfection. Maybe asking a system to be perfect is not only not realistic, it isn’t even necessary.

I think that’s true. You obviously want to be correct. What you don’t want to do is put out incorrect or inconsistent information. But you don’t have to put out exhaustive information. Maybe this is the mindset of the emergency physician, where I want to do something that’s good, but something that I can do in the next 15 minutes to an hour.

There is a focused amount of information that I need for anything. I don’t need to know the entire pathophysiology of a given disease to treat it when my question is, “Do I need to do a CT or an MR, or do I need to include angiography?” What I really need is the answer and a reasonable amount of information that can help me justify the answer for the clinical purpose. But when I want to read about exactly the full history of it, let me make a bookmark and let the same system hang it up for me and I can read it when I go home.

Some folks say it just needs to work as well as Amazon, which gives me what everybody else is reading and things I might want to order with a particular product. You’re not reading every factoid in a 20-year-old medical journal. Maybe you say, “Most of what’s in that journal is not important. You just need 2% of it, and we’ll make you smart about that 2%, but then you can go find the rest when you need it.”

We have to explore what new technologies are doing, particularly new social technologies. I don’t necessarily want to have everybody in the country writing into a medical textbook because that has to be carefully curated, has to be carefully checked and triple checked. But there is the possibility, for example, that you could use a social media tool to let people say to each other, “This is by far the best article on diagnosing a pulmonary embolism.” 

Imagine residents in particular, who talk all the time and who rely on each other for their training and their information. Imagine if you could put up your catalog of literature, and people wouldn’t necessarily add to it, but they could say, “This is the place to go. This is the place that I like.” Eventually if 4,000 people say that, maybe there’s something to it. That’s the concept we’re looking at. It’s got its ups and downs.

I do a lecture on social media in medicine. Certainly there’s a lot of space on the curve between reliable information and well-shared information. But I think that you can use certain kinds of crowd techniques and social techniques to great advantage in this world, especially when sifting through all the millions of pages.

People are used to the idea of grading evidence, but maybe not grading each piece of literature. It seems that another alternative would be to  ask each time that that warning, recommendation, guidance is presented whether that information was useful. If not, then downgrade it so it doesn’t come up as high.

Potentially. I think that you have to look carefully at, is there a difference between what someone wants to see and what someone should see? Usually those things line up, but you have to be careful about being so faithful to that that you miss something important because it’s inconvenient.

There’s also the challenge of how vendors implement the hooks into that information. The clinicians might say, “I’m a nephrologist. I’m tired of seeing serum creatinine warnings,” whereas the data vendor says, “Look, it’s not our fault. We’ve got the data. Talk to your systems vendor who doesn’t use it correctly and tell them to fine tune it in a way that makes sense to you.”

Very much so. As I’ve said a couple of times, the ability to share effective CDS across sites is really important. One of the reasons why we haven’t seen universal acceptance is that there’s too much rework going on, and the rework is inconsistent.

I’ve been working with ONC. I’ve been working with the Advancing CDS project that RAND and Partners did, and on how to make a practical way of taking the various types of CDS interventions and putting them into a form that can be easily shared, and that therefore can be easily integrated. 

If I’m Epic and Siemens and Cerner, I may say, “Gee, I really can’t do this right now because I don’t what’s going to win, what going to be the national standard.” But if we can get enough agreement on how these things should look, enough to make a reasonable XML schema that corresponds to certain CDS interventions, then I can get the big vendors to say, “Now we’re confident enough that this is what’s going to happen that we can go and bring this in.”

I think that it’s really important. I think that integration of knowledge and CDS into data and EHRs should be more advanced, and needs to be more advanced if we’re going to fulfill our mission of best care for all the best people.

I had lunch today with a fellow ED doc who’s doing a small project. He’s a child abuse specialist. He’s doing a small project on building a system that allows you to document certain kinds of aspects of a child’s exam and then be able to come back to you with best practices, recommendations, referrals, and so on. He asked me, “Can I get this to work inside all the different vendor systems?” I said, “You know, today that’s a little hard to do because each one’s going to be different and even different implementations of the same system is going to be different.” I suggested that he probably needs to put this out as a service that his practitioners can call on independently. That‘s going to be a way to do things smoothly and a way to do things consistently, but I think if I was an EHR vendor, I’d want to be able to incorporate those.

Any concluding thoughts?

The reason we’re doing electronic health records, in my mind, is that they facilitate the efficiency and the quality of care and the safety of care. CDS has always been an obvious choice of something that can help facilitate that. If you just use the EHRs as data sources, that’s good, but if you can do it and also get recommendations on the right thing to do, that’s even better.

A lot of us, like myself, struggle to know what the right answer is in a given time. Anything we can do to make this more universal, more implementable, more valuable, is going to be utterly good. We really need this. I think we need to see this incorporated more deeply into systems.

News 5/9/12

Top News

Merge Healthcare announces Q1 results: revenue up 16%, EPS -$0.02 vs. –$0.04 GAAP, $0.13 vs. $0.15 non-GAAP. Both revenue and earnings fell short of expectations, sending shares reeling to a 36% drop on Tuesday and trimming the company’s market cap to $229 million. The company also announced that it will divide itself into two operating divisions, with CEO Jeff Surges continuing to lead the Merge Healthcare group (85% of revenue) and Justin Dearborn leading Merge DNA, which will focus on consumer health stations and clinical trials software (the former eTrials Worldwide, which Merge acquired in 2009). Both groups are moving to subscription-based pricing, with the resulting revenue recognition changes causing the Q1 numbers miss, according to Merge.

Reader Comments

 

From Smith: “Re: Accretive Health. Pulling out all the stops, having Chicago Mayor Rahm Emmanuel ask the Attorney General to back off.” There’s never a shortage of political scumbaggery in Chicago, but in this case it’s hard to decide which is more unsavory: Accretive presumably calling in favors or Emmanuel granting them. The mayor provides his unsolicited counsel, saying he doesn’t want the Minnesota AG talking to Accretive customers about its alleged strong-arm hospital collections tactics until she first talks to Accretive CEO Mary Tolan. AG Lori Swanson was unimpressed, saying Tolan has declined to meet with her, also declaring, “This is a law enforcement matter. Unfortunately, Accretive appears to address it as a political one. It has retained or contacted numerous heavyweights in the national Democratic Party.” That’s Emmanuel hanging out with Tolan in the photo above from the Chicago Tribune and Swanson on the right. Being an Obama coattail-rider doesn’t seem to carry the clout it once did given that fellow Democrat Swanson is happy to tell Emmanuel to take a hike.

From Gino: “Re: HIStalk from Epic. It’s a sign of a healthy atmosphere when a number of employees can’t access an industry blog so they bring it up to their supervisors, who bring it up to the COO, who contacts the blog.” I agree. Carl gets extra points for not only taking ownership of the problem reported to him by employees, but also for slyly slipping in my grammar pet peeve in closing his e-mail to me with, “Any way (not anyway) you could help me out?”

From Reality TV Watcher: “Re: The Amazing Race. The finale reminded me of an EHR implementation – no shortcuts to completing an install. Also typical that the Epic team made it work, regardless.” Dave and Rachel Brown of Madison, WI were revealed Sunday night as the million-dollar winners of CBS’s The Amazing Race. She’s a project manager for Epic. If she stays at Epic, you’ll know it’s a pretty good place to work, just like that billionaire lady who hasn’t given up her day job there either.

From Not Very Innovative: “Re: CMS’s first round of innovation grants. Winners announced this morning from thousands of submissions. I’m probably being a sore loser, but I really do think we would see more mileage out of this taxpayer money if awards were given to younger, smaller organizations (maybe some private companies, too). If these huge hospital systems and research universities were going to be doing the kind of innovation that CMS is looking for, one might think they would have already done it out of the hundreds of millions CMS pays most of them each year. Total grant funding may eventually get to $1 billion.” The only project I’d heard of (and was impressed by) was telemedicine-based Project ECHO, and that was because I interviewed its director, Sanjeev Arora MD, in 2009. Otherwise, I have no idea if any of the projects will amount to a hill of beans, and for those large organizations you mentioned, I’m just as skeptical as you are. If those highly profitable non-profits had it in their power to improve outcomes and reduce costs but didn’t bother to do so until Uncle Sam made it rain, shame on them.

From Kathy: “Re: Nurses Week. We have a talented HCA Communications Group who wrote, sang, and starred in this video.” Nice and catchy.

From Charles Rivers: “Re: Partners HealthCare. Rumor is they’ve started to notify physicians of their decision to implement Epic. Any truth to that? I’m curious if how they’ll switch PCHI practices from GE Centricity or LMR.” Unverified, but several folks have told me that Partners has chosen Epic, which is hardly surprising news if true other than that former Partners CIO John Glaser runs Siemens, which I’ve heard was the other vendor being considered.

HIStalk Announcements and Requests

I mentioned previously that long-time HIStalk reader Tim Dodson, senior analyst with Children’s Medical Center in Texas, died unexpectedly this past Friday, May 4 at 34 years of age. Here’s what Ed Marx had to say about him:

Tim Dodson’s death is tragic on many levels. He will be missed by his beautiful family, community, and those who ever had the opportunity to work with him. Tim was a reverse mentor of mine and I learned so much from him. One quick fun memory to share. Tim revered Epic and especially CEO Judy. The bulk of Tim’s career was working for health systems that used Epic and he had just about every Epic certification known to man. One day Judy was in our HQ to meet with our C-Suite and was making her way up to our Board Room. I called Tim to our Board Room and the timing worked out that we were in our foyer as Judy walked in. So Tim was able to meet one of the people he most admired in life. He was beside himself and ironically had worn an Epic polo shirt that day. Judy was gracious with her time and completely engaged. I will never forget the glow on his face. The only times I saw Tim with a brighter glow was when he was with his family. Tim, you are missed already. You will not be forgotten.

The memorial service will be Saturday at 1:00 PM at Park Springs Bible Church in Arlington, TX.

Tim leaves his wife Wendy and four daughters. I’ll hazard a guess that a 34-year-old hospital analyst isn’t leaving a million-dollar trust fund, so if you’d like to help his family out, click the Donate button in the right column below the poll and give whatever amount you like. I’ll match the first $250 in donations dollar for dollar. Our collective donation, which I’ll flag as being from Tim’s fellow HIStalk readers, will go to a fund that has been set up to help raise the little girls. Thanks.

Note: this is a PayPal donation function, which I’ve used before for other charitable endeavors. You don’t need a PayPal account – instructions will be displayed on the left side of the page for making a straight credit card payment and printing a receipt. If you have trouble with it, let me know how much you’d like to donate and I will e-mail you a money request from Google Checkout.

Acquisitions, Funding, Business, and Stock

The board of directors of Allscripts approves a Stockholder Rights Plan that would allow stockholders to buy Allscripts shares at a 50% discount in the event of a hostile takeover attempt. Allscripts says the move was not done in response to any current  attempts, but says the stock price does not adequately reflect the company’s long-term potential. The plan effectively means management has to approve any takeover, even one that would represent a financial windfall to its shareholders.

Mediware reports Q3 numbers: revenue up 22%, EPS $0.22 vs. $0.17. The company attributes the improved numbers to its blood bank and blood center systems and its Department of Defense projects.

Emdeon acquires TC3 Health, a provider of cost containment solutions for healthcare payers.

Israel-based RTLS vendor AeroScout will be sold to an unnamed “international infrastructure and services company” for $240 million.

Sales

Stilwell Memorial Hospital (OK) selects Medsphere’s OpenVista.

Beaumont Health System (MI) contracts for the HealthShare platform from InterSystems to share patient information and analytics across internal and external systems.

The VA awards Harris Corporation a one-year, $1.2 million contract to design and develop a rules-based eligibility system.

University of Louisville Physicians (MO) contracts with Peak 10 to provide IT infrastructure and disaster recovery services.

UC Irvine Medical Center (CA) selects iSirona’s device connectivity solution to connect its medical devices to Allscripts EMR and to export data to a research database.

People

Mission Health (NC) appoints Marc B. Westle DO as SVP of innovation. He was formerly president and CEO of Mission Medical Associates.

Press Ganey hires Greg Ericson (Maxim Healthcare) as corporate SVP and CIO.

Ernst and Young names MedSynergies CEO J. R. Thomas a finalist in its Entrepreneur of the Year 2012 program for the Southwest Area North.

Jocelyn DeWitt PhD is named VP/CIO of University of Wisconsin Health. She was previously with University of Michigan Hospitals and Health Centers.

Pamela Banchy RN is named CIO of Summa Western Reserve Hospital (OH). She was previously with Summa Health System.

Prognosis HIS names Dustin R. Whisenhunt (TransUnion) as EVP of client solutions.

Death

Cathy Mueller, VP of client experience at Cerner, died Sunday, May 6 after a long battle with cancer. She was 65.

Announcements and Implementations

The Indiana HIE launches SeeMyRadiology.com’s cloud-based imaging platform, giving physicians and hospitals access to shared radiology images.

Columbus Regional Health (IN) will go live on its $15 million Cerner system on June 24.

Sonoma Valley Hospital (CA) will go live on McKesson Paragon on May 22.

M*Modal will interface its computer-assisted coding solution with 3M’s coding and reimbursement system.

McKesson releases a 2012 update to its InterQual clinical criteria tool, adding condition-specific capabilities for managing admissions and length of stay.

Craneware announces GA of enhancements to Insight Medical Necessity, including customize keyword pick lists, commercial payor prior authorization, and expanded reporting capabilities.

Government and Politics

NIST and ONC will host an EHR usability workshop, Creating Usable EHRs: A User-Centered Design Best Practices Workshop, on Tuesday, May 22 in Gaithersburg, MD. Farzad Mostashari MD (ONC) and Jacob Reider MD (ONC) will provide a welcome and overview. Beyond the usability workshops, technical guidance on NIST’s guide for EHR usability will be offered. It’s not a budget-buster: registration is $35 and hotel rooms are $125, provided you get signed up before the 60-attendee registration cutoff is reached. CORRECTION: the afternoon session has two tracks. One is a hands-on session by IDEO, a highly notable design and innovation consultancy whose presence indicates a strong government interest in truly user-centered, out-of-the-box thinking EHR design, which is impressive. That’s the session with the 60-participant limit. The other afternoon track of presentations has no limit on the number of participants, and there’s no registration cutoff.

Innovation and Research

Researchers at University of Arkansas develop the e-bra, wired with sensors that transmit blood pressure, body temperature, respiratory rate, oxygen consumption, and a full EKG via Bluetooth or WiFi. The bra, intended for female athletes, can be programmed to send alerts if it detects abnormalities. The team plans to create a vest version for men.

Other

athenahealth earns the #4 spot on Forbes annual Fast Tech 25 list of “growth kings.” Quality Systems, the parent company of NextGen, was ranked 19th.

KLAS reviews Microsoft Amalga, which it says has limited sales and a 14-point drop in performance scores over the past two years. Half of the interviewed customers said its implementation and maintenance costs were higher than they expected. Others noted that the product is flexible, but complicated.

The Kansas City newspaper profiles Cerner’s Neal Patterson and reveals a few lesser-known facts about his background and personal life, including:

• He and his brothers shared chores growing up on the outhouse-equipped family farm in Oklahoma
• To put himself through college, Patterson and his brothers raised hogs
• He visits a certain “dive bar” a few times a year with friends to discuss politics, business, and family
• Patterson’s wife Jean is battling cancer.

The 2nd International Summit on the Future of Health Privacy will be held June 6-7 at the Georgetown Law Center in Washington, DC. Speakers include Farzad Mostashari MD of ONC, Ross Anderson PhD of the University of Cambridge Computer Laboratory, and Latanya Sweeney PhD of Carnegie Mellon University. It’s sponsored by Patient Privacy Rights.

The wife of Army Chief Nurse Captain Bruce Clark, deployed in Afghanistan, watches her husband die 7,500 miles away during their Skype video chat. She tried frantically for two hours to contact someone in the military to check on him as the video feed continued. The army is investigating, but say they do not suspect foul play.

Memorial Hermann Hospital (TX) will run a Twittercast of a live brain surgery on Wednesday, May 9, with live tweeting and delayed photos and video.

A UK hospital nurse apologizes for the care she gave to a newly admitted 91-year-old patient who later died. Abnormal results from labs drawn immediately after his arrival were posted on the computer and called in by the lab, but the agency nurse did not alert doctors. In addition, the patient was never given the antibiotics that had been ordered. The hospital says it has has increased training, now requires senior employees to sign off on the assessment, has moved patient details from the white board to an electronic system, and has issued a mobile phone to the charge nurse so the lab could make direct contact. The hospital also banned the agency nurse.

In Canada, Hospital for Sick Children rolls out Pain Squad, an iPhone game app it developed that helps children communicate the pain symptoms they’re experiencing. Several TV crime show stars appear on it. I noticed Toronto-born Enrico Colantoni — who I know only as Keith Mars from the excellent Veronica Mars — at the 2:19 mark. The video suggests that the app will be made available (sold, I assume) throughout Canada and the US.

UnitedHealth Group reaches $100 billion in annual sales, buoyed by 71 acquisitions in 12 years.

Sponsor Updates

• Medicomp CEO David Lareau discusses HIEs and the data tsunami they are creating in a guest article.
• OTTR Chronic Care Solutions will participate in next month’s American Transplant Congress convention in Boston.
• PatientKeeper hosts its user group conference this week in Cambridge, MA.
• Shareable Ink partners with Medical Web Technologies to integrate preoperative information collected through Medical Web’s One Medical Passport system with Shareable Ink’s intraoperative solution.
• The County of Fairfax Virginia, a MED3OOO customer, earns recognition from CMS for its 100% accuracy rate in billing of emergency medical services.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Readers Write – National Nurses Week 5/7/12

In Honor of One Very Special Nurse
By Lisa Reichard, RN

Our Heroes

Captain Donna Rowe and fellow servicemen

As nurses, we are called to work in emergency rooms, school-based clinics, homeless shelters, and even war zones. I recently had the distinct honor and privilege to meet and interview Army Captain Donna Rowe, RN, for Nurse’s Week. Donna entered the US Army in 1964 through the Student Nurse Corps Program (ROTC). She was assigned to Vietnam: 3rd Field Hospital-Saigon as the head nurse in the emergency room/triage area from 1968-1969.

“At times, Vietnam War veterans have been portrayed as dropouts or drug addicts,” said Rowe. “This is far from the truth. They were the best our country had to offer.“ She said, “I have to tell you about the men and women I went to war with before I can tell you my story.“

“My generation instilled in us courage, compassion, and patriotism. When we entered the army, we were taught duty, honor, and love of our country. This is what our parents had already taught us – how to be good Americans. Halfway was not acceptable. Contrary to popular belief, most who served in Vietnam –74%, actually – were volunteers, not draftees. I was an ‘old woman’ when I was there at 25 years old. The average age of those who served in Vietnam was 21. The average age of the men there was 18,” said Rowe.

In Washington, DC, there are 58,267 names on the Vietnam Veteran’s Memorial Wall.  Of these, 33,000 belong to service members who were 18 years old.

“Today, the average age of those serving is 26,” Rowe explained. “We were very young men and women sent to war by a country that, when we came home, hated us. This is why not many vets told their stories.”

Donna then began to pull out photos to share from her scrapbook.

“There were 11,000 women who served in Vietnam, 98% of whom were Army nurses,” said Rowe. “We were ER nurses cross-trained in OR and we worked to cover trauma seven days a week, 365 days a year. Nurses saw the worst. Eight were killed in action. For those who served, families suffered, the sacrifice was great, and the transition was tough coming home. We came home one by one to ridicule. Many were not welcomed back as heroes. They called us baby killers.”

Baby Kathleen

Specialist Darrell Warren, Baby Kathleen, Richard Hock, and Captain Donna Rowe

This is the true story about brave American men and a nurse who saved a baby’s life in the middle of a war.

It was May 15, 1969. Rowe had only 30 days left on her tour of duty. The ER area at her hospital was capable of handling 225 casualties at a time, and averaged 700-900 per day during the height of the Tet Offensive.

In a Viet Cong attack on a village that day, everyone was killed except a baby girl who had been found severely wounded in her dead mother’s arms. The mother had died trying to protect her child.

Rowe received a radio message that eight medevac helicopters were on their way to the hospital, each with at least 10 casualties aboard. ER triage priority status went to US servicemen, then US civilians, allied forces, South Vietnamese troops, and then Vietnamese civilians. (Rowe explained they were not allowed to treat civilians because they had their own hospitals.)

“We were in the offensive mode and supplies were short,” said Rowe. “We worked at a school turned into a hospital in the heart of Saigon. I got a radio call from a pilot saying he needed immediate permission to land because he had a critically wounded infant on board. The chopper had already been turned down by other hospitals and ours was its last hope.”

“I knew right from wrong,” she recalled. “I remembered what my mother said to me as I was leaving my hometown of Sterling, MA, to go to war: ‘Always do the right thing, Donna.’ So I turned to my sergeant with the radio and said, ‘Tell him that the Third Field Hospital will receive them.’” She accepted the baby against standing military policy.

“My sergeant then said, ‘You’re going to take some hell for this, Captain.’ I said, ‘What can they do to us? Send us to the front lines of Vietnam? We are already in hell.’”

”Our ambulance met the Dustoff at the helipad. Her dead mother’s arms had to be broken to release the baby from her tightly wrapped, protective arms. The medic rushed the baby into the ER and told me, ‘Dear God, Captain, this baby is dying on us and they killed everybody in her village.’ The North Vietnamese had wiped out the village.”

Rowe continued, “Specialist Richard Hock, one of my best combat-trained medics, took the baby from the ambulance drivers. He immediately realized the baby was in respiratory distress due to bleeding and fragmentation wounds in her chest and abdomen. We got a breathing tube into her with the smallest tube we had in triage, put a manual breathing bag on it, and Richard took over breathing for this little one until we turned her over to the operating room staff several distressing minutes later.”

“The Triage doctor ordered a full-body screen on her, so we rushed the baby to the X-ray room to locate shrapnel to be removed in surgery. On the way from X-ray to the operating room, I saw Father Luke Sullivan, our Catholic Chaplain, and pulled him into the crowd that was half-running down the hospital corridor. Fearing the baby might die at any moment and knowing that if baptized she would have a place to stay, if she recovered, at the Saint Elizabeth Catholic orphanage, I told him ‘Father, come with us. You have to baptize this baby.’”

“Father Sullivan used water from the sink to sprinkle on her tiny forehead and said, ‘I baptize thee …” he looked at me for a name. A name, a name …. I remembered the Irish song my father sang to me while dancing me across the floor as a child, ‘I’ll Take You Home Again, Kathleen,’ so I blurted out quickly, “Name her Kathleen Fields!’ Kathleen from the Irish ballad and Fields because we were at the 3rd Field Hospital.”

“Father Sullivan stated the baptismal rights then looked around the gurney moving by fast, and said, ‘And your Godparents are Specialist Medic Darrel Warren, Specialist Richard Hock, and Captain Donna Rowe.’ The three of us became Godparents that day, joining with a Catholic priest to help with a tiny bit of God’s work while rushing this baby to life-saving surgery.”

“A few days after Kathleen arrived, three soldiers in combat gear came into the hospital. They asked if the hospital had treated a wounded baby and if it had survived. Rowe directed them to Kathleen’s room, where they visited briefly, then headed out. As they passed me, one of the men said, ‘Thank you.’ Those combat troops did something exceptional and wonderful because they could have kept right on walking. They were compassionate and caring. They were Americans."

“After about two weeks,” Rowe explained, “Kathleen was healthy enough to be transferred to St. Elizabeth’s orphanage.” Rowe told the men to scrounge extra food from the hospital mess to take with the baby to the orphanage. An American Naval officer and his wife then adopted Kathleen.

The Need For Technology

“We had no Internet or electronic health records,” Rowe explained. “I truly wish that each soldier would have had a flash drive on them with all of their medical history and information instead of a dog tag. The reality is that a lot of times, the boys did not want to wear the dog tags around their necks. They did not want them clanking when they were walking by in the brush. We would receive the injured with no ID, medical history, or any information. Hand-held devices to enter patient data from multiple locations would have been very helpful in the battlefield environment.”

Today, the Department of Defense and the Department of Veterans Affairs operate the two largest health systems in the United States. They now use integrated, comprehensive clinical application suites that work together to create a longitudinal view of the veteran’s electronic health record. Deployed medical professionals use these on the front lines to streamline medical logistics and enhance situational awareness for tactical forces, as well as promote continuity of care.

Reunion and Update

Specialist Richard Hock, Kathleen Epps (" Baby Kathleen"), and Captain Donna Rowe

After 34 years, Rowe and her colleagues got to hold their "baby" again. Rowe, Hock, and Kathleen were re-united in April 2003 in Fort Sam Houston, TX. Kathleen had been Googling names on her baptismal certificate hoping to find answers. She finally got to meet Rowe and Hock. It was a truly special and emotional reunion for all. “Baby Kathleen” is now Kathleen Epps. She lives in California with her husband and their four beautiful daughters.

Hock, who was a paramedic in Georgia at the time of his reunion with Rowe and Kathleen, remembered the baby as, “A bright spot in a very bad time. She made all the rest of it bearable. She became a beautiful woman with a beautiful family. It is the great American dream all over again."

Kathleen and Specialist Hock, who passed away a year after their reunion, are featured in “The Kathleen Story” segment of the World Film Festival’s award-winning Vietnam War documentary film, In the Shadow of the Blade. Darrell Warren, formerly of Tucson, Arizona, is still living out west. 

Never Forget

Donna received the Vietnam Service Ribbon and Army Commendation Medal. Forty years later, she now travels the country, unpaid, to tell her story. Today, Donna lives with her husband, Colonel (Ret.) Al Rowe, former four-term president of the Georgia Vietnam Veteran’s Alliance. They have two sons. She is a real estate broker in Georgia.

Donna said she would like all to remember that we still have women and men serving in harm’s way – the sons and daughters of the Vietnam vets. “Let’s make sure that these men and women do not come home to a country that hates them or treats them with disrespect of disdain like we had to deal with,” she adds.

Finally, I asked Donna, How we can we show our appreciation for veterans who have served?”

“When you are out and you see a serviceman or service woman in uniform,” she replied, “offer to buy them their meal. Look them in the eye and give them a big thank you for their sacrifice and service to our country.”

Lisa Reichard, RN, BSN is director of business development at Billian’s HealthDATA.

Curbside Consult with Dr. Jayne 5/7/12

Have You Been Meaningfully Used?

I recently attended a continuing medical education seminar. On breaks, people normally stand around tables of stale baked goods and institutional coffee, complaining about the twin threats of Medicare and Medicaid. Sometimes we gripe about the venue (in this case, a hotel which had smooth jazz versions of “Like a Virgin” and “Personal Jesus” playing in the lobby – the horror, the horror.) This time, every conversation seemed to revolve around Meaningful Use.

I felt like I was back in medical school again, with everyone standing around the Dean’s office wanting to look at the posted exam scores in hopes of determining who was the smartest in the class. Instead of comparing microbiology vs. pathophysiology it was:

• Have you attested yet?
• When did you attest?
• How much money did you get?

Surprisingly some attendees were still in the process of transitioning from paper to EHR. Almost half of those that I chatted with still planned to attest this year in hopes of assuring their full MU payouts. At least two-thirds of those people were completely oblivious to what it actually takes to be successful when implementing an electronic health record.

Having been in the CMIO trenches for some time, I’m fully aware that the risk takers and early adopters are long gone. What we are left with are large numbers of physicians who are only going to EHR because (a) they want the MU money; (b) their health system or employer is forcing them to change; or (c) they’re afraid of future penalties.

In my experience, the early adopters really wanted to transform patient care. Their goals were to improve quality and patient outcomes and the EHR was a tool to that end. These users are now reaping rewards with quality recognition and have the ability to demand higher levels of reimbursement from third party payers.

Many of the users we now see implementing EHR are merely trying to meet the MU requirements. It’s the healthcare IT equivalent of sitting in class and only taking notes when the teacher specifically says something will be on the test.

Most disturbing were the physicians I spoke with that were acutely aware of the fact that other than a few things, they didn’t even have to use the EHR to meet Meaningful Use. Their staff members would do pretty much everything other than the CPOE requirement. While meeting the letter of the Rule, they certainly aren’t meeting the spirit or doing any great service to their patients.

Interestingly, I was not only an attendee at the conference, but also a speaker. My nametag, though, didn’t give that fact away, allowing me to gather lots of interesting anecdotes before speaking on Day Three of the conference. My topic was practice transformation through EHR adoption. It was great to see some of the looks on the faces of those who had previously admitted they didn’t care about anything other than achieving MU.

True meaningful use (the non-capitalized variety) involves transforming the practice of medicine to better serve our patients rather than doing the bare minimum. It’s not about a federal program or a software package. Until we reach that understanding, we just feel used and not in a particularly meaningful way.

E-mail Dr. Jayne.

Monday Morning Update 5/7/12

From Artie: “Re: Allscripts. The big event is the end of this quarter. If the company doesn’t show large improvement, it will be all she wrote.”

From The PACS Designer: “Re: better heart health. TPD is all for improving one’s heart health, and a tool that can help others do so is THUMPr. It’s an interactive tool to help you learn how to take better care of your heart by using Aspirin, Blood pressure control, Cholesterol management, and Smoking cessation (ABCS).”

Listening: Hospitality, happy, jangling, female-led 60s-feeling pop from Brooklyn. Their first video stars the actress who played Maeby Fünke in Arrested Development.

Respondents to my last poll chose CERN for their imaginary $100K investment even after the recent inadvertent discounting of Allscripts shares. New poll to your right, as requested by a reader: which political party’s beliefs most closely match your own? (“most closely” being the key word since it’s not much of a poll if everybody writes a lengthy position statement).

Thanks to the following sponsors, new and renewing, that supported HIStalk, HIStalk Practice, and HIStalk Mobile in April.

Epic EVP Carl Dvorak send me a nice e-mail asking if I could figure out why HIStalk wasn’t accessible from Epic’s campus. Lots of employees were asking, apparently. It wasn’t Epic’s fault: last Friday’s Allscripts news and my mention of two Epic wins in the UK caused a flood of Epic readers to visit HIStalk. So many, in fact, that my hosting company’s firewall suspected a denial-of-service attack and blocking incoming traffic from Epic’s IP addresses. That’s been fixed. Now I’m wondering if the report that Allscripts had blocked HIStalk access from the Raleigh office was the same issue, since certainly their employees would have been equally curious about that day’s news.

The bond rating agency of Dartmouth-Hitchcock (NH), noting the health system’s weak operating performance, blames two factors: reduced state funding and the cost of implementing Epic.

HIMSS Analytics names 17 of the 23 hospitals owned by Banner Health (AZ) as EMRAM Stage 7. They use Cerner, I believe.

Long-time HIStalk reader Tim Dodson, senior analyst with Children’s Medical Center (TX), died last week.

The Nashville Medical Trade Center names six new tenants, including software vendors Informatics Corporation of America and The SSI Group. They’ll be next door to big tenant HIMSS on the top floor.

Vince’s HIS-tory this week deals with  big drops in a company’s stock price..

Document management system vendor BlueWare will move its corporate headquarters and 190 jobs from Cadillac, MI to Melbourne, FL.

Imprivata is assigned a patent for a rules-based method of authenticating a computer via biometrics without using the security functions of the underlying operating system.

E-mail Mr. H.

Time Capsule: Perk-less IT Peons: It’s Good to Be King (Or At Least Prince)

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

I wrote this piece in April 2007.

Perk-less IT Peons: It’s Good to Be King (Or At Least Prince)
By Mr. HIStalk

If you’re a non-management hospital IT employee, I’ll let you in on a little secret: your bosses are benefiting greatly from your labors.

I’m qualified to say that because I’ve been on both sides of the fence: management and peon. I’m happiest not being in management, but there’s no question that it comes with secretive perks that mere software analysts, network engineers, and help desk analysts will never see.

Here are some management-only benefits I’ve seen nonprofit hospitals offer:

• Higher salaries. Duh, right? But you have to love that 50% or 100% premium for sitting in meetings instead of doing real work. IT employees are usually self directed, so remembering their names and smiling benevolently when you pass them in the hall is most of what’s expected.
• Bonuses. I’ve seen a roomful of people go deathly silent in a department meeting as my clueless boss went off-script in a moment of exuberant IT camaraderie and let fly with a chuckling, "We’ll do it because my bonus depends on it." Uh, boss, keep in mind that these folks get a magnanimous $200 or so of gain-sharing in those rare years where we make budget and move our ED satisfaction scores from "awful" to just "bad," so we don’t talk about management bonuses (the funny thing is that I’ve seen this happen at least five times, all with different people at the podium who should have known better.) Ordering employees to work harder so managers can pocket a $15,000 windfall isn’t much of a motivator.
• Reserved parking. I always said I’d never work someplace where bigwigs are too good to find a parking place like everyone else. Unfortunately, that eliminates about 80% of potential employers. Hospitals whose lack of money, brains, or real estate forces caregivers to schlep in on an offsite parking bus still manage to find reserved, close-in spots for the suits.
• On-call. Only employees whose roles are vital take it. Unless a Code Yellow signals an immediate need for a performance appraisal or offsite planning session, managers get a pass.
• Offices. Managers get private offices because they’re supposedly constantly supporting and coaching their valued team members, all of whom sit in ugly, Soviet-looking windowless cubicles and gripe about cube mates listening to voice mail on speakerphone. Managers can shut the door and check their stocks, make personal calls, or run an eBay business, especially since no one really knows what they’re supposed to be doing in the first place.
• Vendor goodies. Executives need never pay for their own lunches, fall short on sports tickets, or wonder if their Christmas stocking will be empty. Sure, it’s the position, not the person, that triggers the fawning and phony friendship, but it’s still fun.

There are many more: special retirement plans, memberships, unlimited travel and education budgets, sweetened medical insurance, car allowances, and many more. All pretty generous for an allegedly cash-strapped, nonprofit hospital that begrudgingly gives $10 an hour employees a 20% discount on bad, 40% overpriced cafeteria food.

The only thing I disliked about our benefits package is that it was a secret. Employees weren’t supposed to know (although the analysts running the payroll system certainly did.) Apparently our managerial excellence was so subtle that worker bees couldn’t be trusted to discern it. In other words, the people being managed would probably think their managers weren’t worth it.

Off the record, while sprawling back in my private office and musing about my peers and bosses, I’d usually agree.

News 5/4/12

Top News

The US Congress asks Accretive Health CEO Mary Tolan to provide the company’s hospital customer list, employee policies, and past complaints, citing its concerns about violations of HIPAA, EMTALA, and the Fair Debt Collection Practices Act. Above is a snip from the letter. AH shares dropped 3% Thursday and another 2% in extended trading, having given up 58% in the past four weeks.

Reader Comments

From Calorie Counter:  “Re: Cinnabon and nurses. Cinnabon is giving nurses free rolls (730 calories, 24 grams of fat) in honor National Nurses Week. Maybe hospitals should ban Cinnabon consumption.” Yeah, well, I wish hospitals good luck with enforcing that. Here’s another brilliant marketing idea: maybe CVS should consider honoring nurses by giving them a free pack of cigarettes.

From HIPAA Police: “Re: passwords. A nurse in IMCU was complaining to me about having to remember too many passwords. She then showed me the back of the badge to illustrate just how bad it is and let me take this photo.” In case you can’t make it out, her badge notes the passwords for several different systems, including Pyxis, pharmacy, and e-mail. I am sure that HIPAA Police does not work at the only hospital that can’t afford an SSO solution, so how do others manage multiple passwords? Bigger badges?

From Sweet Tea: “Re: size of the healthcare IT market. One commercial company’s estimate is $40 billion per year, close to your estimate of three times Vince’s $12 billion revenue number for the largest companies.”

From Stock Analyst: “Re: size of the healthcare IT market. Our company thinks it’s around $32 billion in size, of which $9 billion is hospitals.” Thanks for that information.

From J-Lo: “Re: Stage 2 comments. I seem to recall that with the Stage 1 NPRM, you could see the comments everybody else submitted. Is that not the case with Stage 2?”

From Nasty Parts: “Re: Allscripts. If things to continue to go bad for Glen Tullman, he can always focus on his other company. How many people know that Glenn is the CEO of another company?” At least 20,000+, assuming HIStalk’s readers paid attention when I mentioned it a couple of times in the past. People are always sending me stuff that I’ve already run, though, so maybe they’re trained by newspapers to assume that small stories aren’t important and are skimming HIStalk posts just a bit too fast. Here, I could describe World War III in one paragraph while using twice that space to rave about some weird band I like.

From Moe: “Re: Trinity Health. The group of hospitals in Columbus, OH (Mt. Carmel) brings 10,000 users live on Cerner big bang , including revenue cycle, clinicals, lab, and more.” Nice. If you have any pictures, send them over. Who doesn’t love command center pics?

HIStalk Announcements and Requests

This week’s highlights from HIStalk Practice: electronic medication reminders may improve adherence in the short term, but long term effectiveness remains unclear. More than 40% of all primary care providers are enrolled in RECs, including 50,000 in practices with fewer than 10 physicians. CareCloud CEO Albert Santalo wins Miami’s Technology Entrepenueur of the Year award. Dr. Gregg muses on odds and ends, inluding a shift in HIT discussions beyond Meaningful Use and the end of service for a few clinical informatics professionals. If you’re not a regular HIStalk Practice reader, what are you waiting for? And if you are one of the thousands of readers stopping by each month, many thanks!

A few folks always seem to be getting Inga and me confused, sending her information intended for me. Just to clarify: we don’t tag straight news items with who wrote them – we both do. If Inga adds her opinion, answers a question directly, or otherwise writes something in a way that might not be clear who’s talking, I put the little red icon in front of that item (as above). Otherwise, it’s me (Mr. H) you’re reading. I was tagging my items with a blue icon, but that was a bunch of unnecessary blue icons given that it’s just the two of us (other than Dr. Jayne, who has her own clearly marked section).

A pet peeve: confusing one-word adjectives with two-word nouns and adverbs. Example: Walmart may have everyday low prices, but you will see them in the story every day (not everyday.) You may have a backyard swimming pool, but it’s not in your backyard.

Acquisitions, Funding, Business, and Stock

MedAssets reports Q1 numbers: revenue up 15%, EPS $0.00 vs. -$0.28, with the company pointing to costs involved in its Broadlane acquisition in November 2010, but still beating estimates on both revenue and earnings. Non-GAAP earnings were $0.24 vs. $0.17.

The Advisory Board Company announces a 2-for-1 stock split following the release of its Q4 numbers: revenue up 33%, EPS $0.46 vs. $0.30.

Amcom Software acquires the IMCO-STAT CTRM product from IMCO Technologies that will allow traceable delivery of critical lab test results to the ordering physician by paging, PCs, tablets, and smart phones.

Facebook’s upcoming IPO will raise about $11 billion based on Thursday’s announced price range, valuing the former dorm room project at up to $100 billion.

Two law firms file class action lawsuits against Allscripts, charging the company and its officers with intentionally hiding failed integration efforts, missing its revenue and earnings guidance, and misrepresenting its post-merger prospects after it acquired Eclipsys. All routine and rarely meaningful, of course, guaranteed to happen when any company’s stock drops unexpectedly.

Sales

HHS contracts with Archimedes, Inc. to develop a modeling and simulation software platform for clinical scenarios, health interventions, and disease conditions.

Samaritan Regional Health System (OH) enters into a multi-year contract with CareTech Solutions for comprehensive IT services.

Radiology Associates of Fox Valley (WI) selects McKesson Revenue Management Solutions for its 33-physician practice.

Shands HealthCare will use the Rothman Index to monitor patient status and to conduct research at its Gainesville and Jacksonville campuses. I interviewed co-founder Michael Rothman 18 months ago for insight into how the software works.

People

Medecision names Katherine Schneider MD (AtlantiCare) as chief medical officer.

Former Eclipsys CFO Bob Colletti joins academic credentials exchange vendor Parchment as CFO.

MIT Sloan CIO Symposium chooses four finalists for its CIO innovation award based on four criteria: trusted advisor, business leader, strong communicator, and proven manager. Among the finalists is Catherine Bruno, VP/CIO of Eastern Maine Healthcare. Healthcare CIOs on the speaker list for the May 22 event include James Noga (Partners HealthCare), Chuck Podesta (Fletcher Allen Health Care), and Sue Schade (Brigham and Women’s Hospital.)

DuPage Medical Group (IL) names Krishna Ramachandran as chief information and transformation officer, where he will lead the 330-physician group’s Value Driven Health Care initiative. I note that he’s a member of the HIStalk Fan Club on LinkedIn, so special congratulations to him (it’s fun to read down the list of 2,408 members – since most folks have photos, it’s like an HIT yearbook.)

Announcements and Implementations

Mercy Health System (PA)  activates its Meditech EHR across its four hospitals and 44 physician offices.

Phoebe Putney Memorial Hospital (GA) goes live on McKesson CPOE on May 15.

Newark-Wayne Hospital (NY) goes live on Epic as part of Rochester General Health System’s $65 million EHR initiative.

JPS Healthcare (TX) will go live on its $110 million Epic system this Saturday, the seventh Metroplex-based health system to do so.

Practice Fusion launches an API that allows any laboratory to connect directly to its EMR and send lab results using standard HL7 data files.

Gartner names Kony Solutions a Visionary in its report on mobile application development platforms. The company also announces that it supports the BlackBerry 10 platform.

CE Broker announces the EverCheck paperless system for automatically verifying professional licenses for credentialing, including sending alerts about licensure status changes and maintaining an archive of all licensure changes for Joint Commission review. The price is $0.45 per employee per month.

Vassar Brothers Medical Center (NY) credits technology it had just installed with saving the life of a firefighter who had a heart attack during a fire. His EKG, taken immediately in the ambulance, was sent to cardiologists at the hospital, allowing them to hit a door-to-balloon time of 18 minutes, a third of the standard. The technology they use is AirStrip Cardiology (remote EKG viewing), GE Healthcare’s MUSE Cardiology (EKG storage), and Physio-Control’s LIFENET (EKG sharing between emergency medical services and hospitals).

The Johns Hopkins Hospital opens its new Sheikh Zayed Tower and The Charlotte R. Bloomberg Children’s Center using the Versus Advantages RTLS to support asset tracking, fleet management, nurse call automation, and food cart tracking. New York Mayor Mike Bloomberg donated $120 million of the $1.1 billion construction cost of the two towers.

MediServe announces a Web-based solution for private practice therapy providers. The Attigo system includes billing, documentation, scheduling, and practice management.

Government and Politics

During this week’s HIT Policy Committee meeting, members discussed whether licensed professionals and scribes should be allowed to enter data into EHRs on behalf of physicians under the Stage 2 MU program. The proposed rule would require physicians to use their own user IDs when accessing the system, also holding them responsible for approving information entered on their behalf by anyone else. Several committee members raised concerns that the doctor won’t benefit from clinical decision support otherwise since most systems provide their guidance during order entry.

Also from the HIT Policy Committee meeting: CMS reports that more than $5 billion in Medicare and Medicaid MU incentive payments have been made to 93,650 EPs and hospitals through the end of April.

Representative Renee Ellmers (R-NC), chair of a House subcommittee on health technology (also a nurse and the wife of a surgeon), asks CMS to exempt from MU requirements those physicians in small practices and those close to retirement.

Other

The US again outspends other industrialized countries on healthcare with mixed results. At $8,000 per person, well above the next-highest Norway and Switzerland at $5,000, survival rates for breast and colorectal cancer were the highest, but death rates for asthma and diabetes-related amputations were also the highest. The report blames US costs on expensive drugs, medical services, and technology such as MRIs and CT scans, with a high obesity rate also adding to the total.

In Canada, the Hospital Employees’ Union publicly criticizes the outsourcing of 130 hospital medical transcriptionist jobs, saying the result will be less secure, of lower quality, and increasingly expensive. The hospital executive in charge of HIM says they’re already outsourcing half their transcription to the same group without problems, no information is stored on transcriptionist PCs, and per-minute rates are the same as they were in 2006 and will save $3 million of the $14 million annual transcription budget. Part of the appeal was the chance to move to a system that has better speech recognition capabilities.

Also in Canada, Nova Scotia’s Department of Health and Wellness and Canada Health Infoway announce an expansion of their peer support program for users of the Nightingale ambulatory EMR.

McKesson Automation’s building in Cranberry Township, PA was evacuated Tuesday evening after a female employee reported hearing a bomb. Police gave the OK to return when they concluded that the woman was hallucinating after experiencing an adverse reaction to an unnamed medication.

Bloomberg BusinessWeek profiles eClinical Works CEO Girish Kumar Navani and the company’s involvement with health projects in New York City. The company’s annual revenue was reported as $250 million.

Sunday night’s finale of The Amazing Race pits Epic employee Rachel Brown and her husband, Major Dave Brown, against three other couples. The winners will get $1 million.

In Ireland, three NUI Maynooth students win the Irish finals of the Microsoft’s Imagine cup for developing docTek, which allows patients with chronic illnesses to record symptoms for online review by their doctors. They will compete in the global finals this July in Sydney, Australia.

A UK doctor is investigated after sending an 18-day-old baby home with what was later determined to be myocarditis, which killed the baby the next day. The parents say that during the examination, the doctor looked up the baby’s meds on the computer and suggested giving him Tylenol, but he never left his chair to actually look at his patient.

Sponsor Updates

• Benefis Health System (MT) signs an agreement with MedAssets to use its Spend and Clinical Resource Management Solutions and initiate use of MedAssets GPO and other cost containment services.
• Angleton Danbury Medical Center (TX) creates a paperless registration system for its Meditech system using forms software from Access.
• DrFirst announces that 6,000 pharmacies can now accept electronically transmitted prescriptions for controlled substances using EPCS Gold.
• GetWellNetwork recognizes ten hospitals for Excellence in Interactive Patient Care during its GetConnected 2012 conference.
• The Advisory Board honors Virginia Hospital Center (VA), Alegent Health (NE), and Monmouth Medical Center (NJ) with 2012 Crimson Physician Partnership Awards for improving the quality of care they provide while documenting more than $13.2 million in aggregate savings.
• MEDecision introduces its new brand and highlights the evolving healthcare market during this week’s 2012 Client Forum.
• A Detroit business publication profiles the growth and focus of JEMS Technology, which has seen one-year growth of 100% for its encrypted remote video solutions for healthcare.
• Culbert Healthcare Solutions promotes Tina Sarantos to manager of consulting services for the company’s GE and Allscripts practices.

EPtalk by Dr. Jayne

CMS keeps sending me e-mails about ICD-10. For whatever reason, I thought this header was really funny given the recent delay. I’m personally worried that the 60-day comment period for the Stage 2 Meaningful Use NPRM is almost over and I haven’t gotten my personal comments finished yet. You can submit yours via the MU specific comments page. Although my organization has submitted its own official comments, I’m encouraging every physician, provider, and patient I know to comment as well.

CMS also issues a final rule on the use of the National Provider Identifier (NPI) on Medicaid and Medicare enrollment and claims documents. I can’t imagine that anyone out there practicing doesn’t have an NPI after all this time, but if you don’t, you have 60 days until the rule takes effect.

A Circulation article documents improvements in blood pressure control among US veterans. Over 10 years of data from the VA Health Data Repository was analyzed. Authors credit performance measurements in the EHR as contributing to the improvements.

Medical Economics advises providers how to respond to negative reviews on physician rating sites. Common complaints from a patient group profiled in the article include long wait times, lack of communication about delays, not being informed about test results, and failure to return phone calls promptly. Among the tips:

• Don’t respond to negative reviews. Ask the site to remove unfair information.
• As your patients to review you since most give positive reviews.
• Conduct your own surveys to let patients feel heard.
• Start a blog or practice website to help control your online presence

For women physicians tethered to their practices via smart phone, JoeyBra provides a solution that lets you avoid those pesky purses, totes, and satchels. Right now, it’s only available in leopard print. Personally I think an iPhone is a little bulky to be storing in my bra, but to each his (or her) own. Even with the leopard print, I don’t see Inga lining up to purchase one either.

Remembering an Industry Leader and Friend
By Daniel S. Herman

John Cornelius Wade, former CIO at Saint Luke’s in Kansas City, former chair of the HIMSS Board of Directors, colleague, and a close friend of mine, passed away on Saturday.

He was ill for the past several months. I spoke with his wife Cheri Thursday evening, and to John on his birthday a couple of weeks ago. He was in great spirits and was talking shop.

I first met John in Chicago in 1987 when we served on the First Illinois HFMA chapter IS Committee when I was with KPMG/Peat Marwick and he was CIO at Northwestern Memorial.  We were reacquainted by a colleague at FCG in the spring of 1993 shortly after he took the CIO position at Saint Luke’s.

John was a loyal person who was tenacious in everything he pursued. He would drive from Kansas City to Boston all night to see family. He did home repair himself, refusing to call a handyman despite his wife’s objections (until he fell off a ladder and dislocated his shoulder).

His loyalty was expressed in many ways across business and personal situations. He was an authoritarian leader when it came to running the IS shop, and was often opinionated when interacting with his customers throughout the health system.

In 1993, John took over a data processing (DP) shop from an interim management team from Andersen Consulting. He was swift to make leadership changes inside the IS organization, also changing how the department served its customers. He redefined the IT strategy; enhanced governance, project prioritization and executive ownership of technology-enabled IT initiatives; and established service level metrics by which he measured and demonstrated accountability. Saint Luke’s went on to become one of the first healthcare organizations to win the coveted Malcolm Baldrige Quality Award and the Missouri Quality Award almost 10 years ago.

When John retired from Saint Luke’s in 2008, the health system’s IT group was (and still is) considered one of the most effective and well-run healthcare provider IT functions in the country. It has been recognized for its outstanding IT governance structure.

John accomplished much in his 71 years and touched many people. I’ve learned a lot from him personally and professionally during our 25-year friendship. His memory will be in my heart for eternity.

Information about John, including photos and information about funeral and memorial services, is available here. Please take a moment to read the many memories and tributes from his friends and industry colleagues and add your own.

Daniel S. Herman is founder and managing principal of Aspen Advisors.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

CIO Unplugged 5/2/12

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

Get Off of My Cloud!

1960s entertainment nailed the future. Star Trek tricorders are here. Lapel communicators are ubiquitous. And who can forget the Rolling Stones singing about the Cloud?

Most agree that mobility and agility are the future. The cloud is the infrastructure which enables them. The cloud is the delivery of computing as a service, not a product — akin to a utility. The cloud enables technology to propel the speed of business.

Friends recently returned from a trip abroad. The advanced wireless infrastructures found in third-world countries both astounded and pleased them. By unintentionally leapfrogging the technological revolution, these regions had bypassed the incremental advancements of the last 30 years and gone straight from laggard to leader. Societies that have not had a telephony infrastructure, for example, are suddenly delivering the highest per capita cellular subscribers.

Leapfrog advancement. Can we do it in healthcare IT? Maybe a better question to ask is: do we need to?

YES! Mobility, enabled by the cloud, is the path to the future.

Healthcare organizations viewed as laggards now have the potential to leapfrog peers. The cloud will empower them to bypass heavy capital investment and kludgy hardware and render single-organization data centers obsolete. You can shrink implementation timelines from months to weeks. Focus your institution on implementation and optimization rather than worry over floor space or cooling requirements.

If we don’t transform our organizations by routing capital away from brick and mortar to cloud-based mobile applications and services, the third world will pass us up.

As legacy hardware and software contracts expire, look for cloud alternatives. Basic requirements for any new application should include cloud capabilities. If the vendor has no cloud offering, be concerned. Ask deep questions. You don’t want the clock turn to 2015 and you still have data centers bursting at the seams with legacy applications residing on heavy iron.

The cloud has been around for several years in one form or another. Non-healthcare industries have embraced the cloud successfully. Some worry about security, yet the number of incidents are no different in the cloud versus in-house. Breaches occur in both. Security is not the barrier.

As a leader, show courage. Move your organization forward. Become relevant by leveraging mobility. Embrace the cloud!

Hey you, get onto my cloud!

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.