CIO Unplugged 10/13/10

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

Healthcare Passion Refueled

My passion for healthcare began in high school while working in environmental services at an outpatient facility (they called us “janitors” back in the 80s). From that point forward, different encounters have renewed that passion. The most dramatic experience was personal.

A Journey Home

Four years ago this month, my mom traded her earthly rags for a robe of righteousness. After a courageous four-year fight against the ravages of ovarian cancer, Ida Wilhelmine Marx bid us farewell. The entire experience had a profound impact on me not only as a son, but also in my profession.

My mom and I were tight. As I blindly plodded my way through adolescence, she represented mercy and grace. When I shoplifted, got arrested for joy riding (at 14 years old), set the house on fire, partied excessively, and flunked junior high, she was there. I’m convinced that if it weren’t for my father’s discipline balanced by my mother’s care, I would not enjoy the successes of today in my education, career, and family.

Radiance

Mom suffered much from illness her entire life. She took the cancer in stride: eight rounds of chemo, two rounds of radiation, and a couple of surgeries. Her sole desire before transitioning from this life to the next was to celebrate her 50th wedding anniversary. When we transferred her to hospice, it became apparent that she would be a few weeks shy of reaching her goal. With my parents’ permission, my brothers and sisters planned an early 50th anniversary party and vow renewal — the final celebration of Mom’s life. Knowing our world would change the following day, that night we put on a heck of a celebration.

Hollywood could not have written a better script. Hospice physicians agreed to give my mom life-sustaining nutrients and fluids through the big day (normally not allowed). They arranged for a “Sentimental Journey” pass: a limousine (ambulance) service for my mom and dad to the picturesque Cheyenne Mountain Resort in Colorado. Two paramedics waited in the background just in case their services were needed (they weren’t). They quipped how special my mom was because the only other person who ever received two paramedics as an escort was Dick Cheney when he came to town.

All seven of us children attended, plus all 15 grandchildren. My parents invited their closest friends. With the backdrop of the Rockies and all the majesty of a traditional wedding ceremony, I had the privilege of walking my father to the front. My oldest brother Mike had the honor of escorting my mom in her wheelchair to join my dad at the altar. She looked ravishing. My sisters had dressed her to the “nines.” Her dream was unfolding in real time.

Each of her children had a part in the ceremony, as did each grandchild. Assigned to deliver the sermon, I decided not to use notes, but instead prayed that God would intervene and deliver a message that would bless my parents and set vision for successive generations. The primary message: my parents had created a legacy of marriage that would impact not only the first generation (my siblings and me), but the grandchildren, and their grandchildren, and so forth. The fact that my parents stuck it out and endured a lifetime full of sickness and health is a testimony to the world: “Yes, it can be done.”

The ceremony ended with the exchanging of vows. A co-worker of mine had arranged for a Papal blessing of the 50th milestone as well, which touched my parents deeply. We printed the blessing in the renewal program. Unity candles, songs, prayers, and standing ovations lent to the evening’s incredibleness. But this was only the beginning.

One Heck of a Show

We then entered the adjoining room for a superb five-course meal. Taking advantage of the live music and dance floor, Dad rolled Mom out in her wheelchair to dance. My parents are fantastic dancers, and seeing my dad wheel my mom around was moving. Throughout dinner and beyond, we danced to our hearts’ desires. All four sons danced with my mom, who was clearly delighted. Even my son Brandon danced with her, to which she commented, “You’re not dancing. You’re just shaking your ass!”

Next came toasts, the garter ceremony, and all the similar accruements of a fine celebration. At that point, Mom addressed the room with loving words. Dad tried but fell apart. As a finale, guests and family formed a tunnel by joining hands. Dad wheeled Mom through as we hugged, kissed, cried, and spoke blessings.

Returning to her limousine, she was still beaming. My dad shared that as he laid Mom in her bed that evening, she said, “We sure gave them one hell of a show tonight, didn’t we?”

Timing

During her illness, I flew out often to visit her. I wanted to be at her side when she transitioned, just as she had been at my side so many times. I missed by eight hours, but that was OK. Over the years, I’d left no doubt in my mother’s heart of my care, admiration, appreciation, and love for her. Arriving shortly after her passing, I supported my brokenhearted father and assisted siblings with the funeral arrangements.

Kiss

My mom had taken her last breath shortly after midnight. Two of my siblings and my father were at her bedside and described that, while painless, her body struggled for every last breath. As a result, her mouth was stuck wide open. The hospice nurse explained that, given the timing, the mortician would be the only one able to close Mom’s mouth. My sister-in-law, an ICU nurse manager, validated this.

Meanwhile, my dad knelt at Mom’s bedside and held her frail body, the first time in months where he could hold her without causing her pain. He kissed her lips. Wept over her. Sometime in the next two hours, while they awaited the mortician’s arrival, Mom’s mouth closed…and she smiled. Comfort permeated the room and reinforced our belief that she had indeed transitioned to a happier place.

Passion Fueled

My mom’s battle allowed me to spend considerable time in various care settings. I observed the processes, evaluated technology, and pondered how things could be improved to benefit caregiver, family, and patient. The clinicians treating my mom lacked the communications and clinical decision support needed to deliver the highest quality of care. I was shocked by the lack of access to critical and timely clinical data. The wasteful amount of paper utilized and manual processing disappointed me.

I ended up creating medication reconciliation lists and pulling together charts. I swore it would never be this way in my work environment. As I took mental notes from the perspective of patient and family, my passion to leverage technology and transform the clinician and patient experience was renewed.

It’s this passion that drives me in my daily work. This is why I’m tenacious in advocating technology, why I continually innovate and collaborate with clinicians, and why I blog. This is why I advocate for stronger IT leadership. It’s the heartbeat behind why I spend more time with my people on leadership, customer service, process, and passion than I do on virtualization or cloud computing.

Until my people have a heart for patients and are in a position to empathize with their plight, the technology platforms, while critical, will be limited. The full potential of technology in the delivery of high quality healthcare comes with a transformed heart.

Thanks, Mom, for refueling my passion as a leader of healthcare technology.

What fuels your passion? What stokes your fire? Leave a comment below.

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 sitesLinkedIn and Facebook, and you can follow him via Twitter – User Name “marxists

Readers Write 10/6/10

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

EMR: One Size Does Not Fit All
By Evan Steele

A recent comment on HIStalk, by a hospital CIO about what he identified as the best EMRs for enterprise systems and their physicians, highlights a problematic and all-too-prevalent misconception. The fact is, it is impossible to satisfy both hospitals and community ambulatory physicians with the same EMR product.  Furthermore, even the ambulatory market cannot be looked at as a whole. EMRs designed for primary-care physicians respond to a set of needs that are very different from those of specialists.

Enterprise EMRs simply do not work in high-volume ambulatory practices. This is particularly true for specialists’ practices. Many hospitals have had some success with Epic and other hospital-focused EMRs, but success has been limited when these same hospitals ask physicians — again, particularly the specialists — to implement these systems in their practices. A monolithic enterprise product cannot possibly support equally well such different workflows, patient care scenarios, and providers’ needs.

Within the ambulatory market itself, it is time to bifurcate the EMR discussion into two groups: EMRs for primary care physicians and those for specialists.

Industry analysts typically lump all EMRs into one category, which does not adequately differentiate the market segments or their distinct needs. The major EMR vendors have massive footprints in the marketplace, yet a small company like SRSsoft has the lion’s share of referenceable high-volume, prominent specialty practices in areas like orthopaedics and ophthalmology. Why? Because one size does not fit all, and it is impossible to satisfy the needs of both groups without compromising the needs of one.

The American Academy of Orthopaedic Surgeons (AAOS) acknowledged this issue in its recently released EMR Position Statement, pointing out that “Many systems are geared toward primary care medical practice, which can limit the utility of EHRs for specialty surgical practice.” It correctly suggests that “the different needs and uses of EHR by disparate medical specialties should be recognized.”

Specialists represent approximately 50% of the physician market, a sizeable segment that is largely being ignored. How are specialists to determine which EMRs are designed for their needs?

KLAS, the closest our industry has to a JD Powers–type of rating source, does not break out its ratings by specialty. This means that if an EMR vendor does well in the ambulatory primary care market and has high KLAS ratings, an unsuspecting specialty practice might purchase their product based on those ratings, only to find out that the product does not fit their unique needs. 

Exacerbating the situation is the fact that KLAS only surveys practices that have actually installed the EMRs. It does not survey practices with failed implementations. Since specialists represent a disproportionate number of the failures, the information is even further biased.

The result is that there are thousands of specialists who purchase EMRs from highly rated and/or household name vendors, but who end up with failed implementations and significant financial loss.

One size does not fit all. There are good EMR solutions available for every type of physician. It is incumbent upon the individual physician to research and identify the product that best suits his/her practice’s needs.

Evan Steele is CEO of SRSsoft of Montvale, NJ.

ClickFreeMD Comment Response
By Bob Gordon

Note: Mr. H here. I’m breaking my “no commercial pitch” rule this one time because Inga had questioned the business model of ClickFreeMD, which offers practice systems including billing for a flat monthly fee rather than the traditional model of a percentage of collections. Inga’s point was that the percentage model encourages the billing company to collect. CEO Bob Gordon was nice enough to e-mail Inga an explanation and we thought his response might interest some readers even though it is hardly unbiased. I’m not endorsing their product and I have no connection to ClickFreeMD.

ClickFreeMD leapfrogs the percentage-based provider business model. Consider the following:

• No start-up, implementation or training charges.
• The flat fee is lower on an equivalent percentage basis than most practices would pay for outsource medical billing alone and far less than in-source options.
• If the practice improves its revenue or we boost it (which we often can do), the equivalent percentage drops through the floor.
• The breadth, quality, and integrated end-to-end nature of our software, services, and support are unrivaled. Physicians are paying twice as much elsewhere for much less elegant solutions today.
• The flat fee sticks. If encounter or charge values increase, the flat fee stays the same and the practice captures cost free revenue. If it drops outside ordinary seasonality range, the rate is adjusted down pro-rata so our physicians’ earning power is fully protected.
• Importantly, the flat fee is backed by a performance guarantee that makes sure we work every claim or we rebate half of the flat fee. There is no equivalent protection in a percentage-based model. In fact, any claim that takes more than 15 minutes to resolve in a percentage system is probably costing them more than they are making, and hence billing company profitability is at some point in the collection continuum inversely correlated to increasing practice collections.
• Our contracts all have 90-day outs and low price match guarantees for comparable services.

You may ask how we do this. We have deep domain expertise from running billing companies, back offices, and technology companies for decades and have organized a Southwest Air-like discount fee, high-result business model that is very scalable. We expect that ongoing volume will feed a virtuous cycle for all, continuing to allow us to offer more for less while achieving top results.

One of the most striking things we are doing is the least recognized — giving the practice their flat-fee price, online and instantly, as well as their included services, without asking them to give us any information. Try this anywhere else like Athena and what we do in 30 seconds becomes a multi-day process that involves e-mail / telephone / online discussions and/or meetings and requires the practice undressing for the vendor. We are completely ONE-WAY transparent. That’s because we want the practice to decide if they want to contact us — after they are satisfied that this is a superior value for them and only then. We aren’t interested in lead nurturing them to death. 

This is about "more dollars for doctors" and great news in the group practice fight to sustain their independence. We are doing our part to create a reversal of fortune in the group practice community with a unique business model that raises revenues faster than costs, delivers immediate and ongoing savings, and provides the tools and support that allow them to be ready for tomorrow.  

Like the boiled frogs of lore, physicians have been nickel and dimed by payers, billing companies, and others, overpaying to under-produce for so long, they find themselves working much, much harder for less and less. We’re changing that and we’re passionate about it! Thank you for your consideration.

Bob Gordon is CEO of Click4Free of Chevy Chase, MD.

It’s Official: The Rush for Talent Has Begun
By Tiffany Crenshaw

In recent weeks, a number of existing and prospective clients have called me for a pulse on the healthcare IT recruitment marketplace and thoughts on how to attract quality resources. After a number of such calls, I decided to put my thoughts in writing and share.

Let’s start with the good news. Industry hiring is definitely picking up and employed candidates are now less afraid to make a career change then they were three to six months ago.

As for hot products, it’s no secret that Epic is hot, hot, hot. Hospitals are purchasing Epic left and right. Honestly, there are simply not enough Epic resources, especially Epic-certified resources, to go around, so the talent war is raging. Cerner recruitment remains modest but steady, while McKesson needs are starting to rebound after quite a lull.

In the ambulatory market, we are seeing more and more requests for eClinicalWorks and Allscripts. New names like Sage and Greenway are coming to light. And occasional needs for Meditech, Siemens, IDX/GE and Eclipsys are surfacing.

On the integration side, Cloverleaf and e-Gate skills are still in demand, but we are seeing more requests for Web-based and lesser known products like Ensemble, Symphony, and Rhapsody.

The hiring demand is highest by far for hands-on resources to design, build, and install EMR applications. However, there is a fair amount of activity for sales, project management, and training professionals, including go-live support.

CPOE, clin doc, pharmacy, oncology, and HIM are generating the most recruitment activity within the applications. Based on new client requests, we foresee growing needs for business intelligence, security, and report-writing resources.

In addition to employers’ desire for one or more of the skill sets mentioned above, most are adding clinical designation to the requirements. Over 50% of our job requisitions right now require clinicians. Pharmacists, nurses, and physicians with healthcare IT experience are in great demand.

However, post-recession hiring is creating challenges previously unheard of in my 12-year history recruiting in this industry. The process is now wrought with excruciatingly slow interview scheduling, shrinking employee benefits packages, little to no relocation assistance, and financially conservative offers resulting in more and more frustrated candidates.

Things have changed drastically since the lowest points of the recession. After the release of Meaningful Use requirements, recruiting mania has taken off. Everyone seems to have hiring needs. Candidates are getting called left and right by internal and external recruiters. Just check out a few of the job boards if you don’t believe me — you’ll see countless job postings. Furthermore, check out all of the recruiting firms with no previous healthcare IT experience trying to break into this market as experts claim abundant need for resources.

If your organization is currently or will be in the market soon for these in-demand resources, you may want to evaluate your hiring process, recognize that your competition is fierce, and take note of a few trends our candidates and clients have shared with us quite candidly over recent months.

• New car syndrome. Candidates are migrating to new implementations. Who can blame them? It’s more exciting to be on the ground level and see a project through from A to Z.
• Red carpet treatment. Employers who roll out the red carpet win. When weighing decisions between job offers, candidates almost always choose the employer who provided quickest response time and showed sincere interest in them. (Both response time and sincerity are simple and no-cost ways to roll out that red carpet.)
• Relocation blues. Relocation is a HUGE issue right now. Even if candidates want to move, they can’t do so because of the housing market. Kudos to all of the organizations willing to work around this by providing remote work, commuting, or coverage of interim living expenses.
• Communicate. Many, many candidates are feeling jerked around by potential employers because of lack of communication in the interview process. Here’s what they are thinking: “If I don’t feel valued as a candidate, how are they going to treat me as an employee?” On the flip side, these candidates are communicating with plenty of their peers. Too many hospitals and consulting firms are getting bad reputations as being lousy places to interview and to work.
• Too much is not always a good thing. In the quest for resources, too many organizations are panicking and calling in all of the troops — internal recruiters, employee recruiting bonuses, dozens of external recruiters and advertisements. Candidates get called multiple times by different sources all looking to fill the same positions. Not only do they end up confused, but all the activity makes candidates suspicious. They wonder what’s wrong with an organization that has such a hard time attracting and retaining talent?
• Get on board. We are hearing more and more horror stories about candidates showing up on the first day only to find their new employer is not ready for them. This gets them off to a bad start from the get-go. Employees stay longer and perform better when they feel welcomed and the transition process is smooth. The period of time between offer acceptance and start date can also be a black hole, when candidates are most vulnerable. Employers are losing candidates this far into the game because they aren’t communicating with them. If you don’t have a formal on-boarding program, now is probably a good time to look into it.
• Disconnect between human resources and hiring managers. As an outside firm, we work with both HR representatives and hiring managers. We hear complaints on both sides about the other on a regular basis — namely due to lack of response. The hiring managers want candidates fast. And HR wants answers fast. Throw candidates in the mix who get frustrated as well and it’s a nasty situation. However, we find that employers who really engage the final decision-maker in the process from beginning to end and set response expectations up front have the least amount of frustrations and the most successful outcomes.

In summary, you can safely say that the industry is quickly changing to a candidate-driven market and that the market is impacted heavily by post-recession recovery and Meaningful Use. It is official. The rush for talent really has begun.

Tiffany Crenshaw is president and CEO of Intellect Resources of Greensboro, NC.

The Coming Speed Bump in the EMR Market
By Jon Shoemaker

It’s no secret that there is currently a mad rush occurring, not unlike The Oklahoma Land Rush of the 1800s, where hundreds of companies both new and old are getting into the business of healthcare information technology. Some come with industry expertise. Others come to take advantage of the financial opportunity. Consider Best Buy, the consumer electronics giant, that will install your EMR using their Geek Squad. So much for needing clinical expertise!

I believe this climate of frenetic activity will cause the EMR market to encounter a large, steep speed bump in the next 10 years. It won’t be from all of the EMR installations or supporting all of these systems, as this will create thousands of jobs and supporting infrastructure that currently does not exist. The bump in the road will come when all of these new digital silos must talk to each other as required in Phase II of Meaningful Use (MU). It is the very selling point of these systems — simple communication and usability — which become the Achilles heel of these EMRs.

EMR’s to date are not installed with a common code structure for identifying exams, studies, or services, all of which will need to be exchanged outside of the office in Phase II of MU. The reason for this lack of standardization has nothing to do with EMR functionality or capability — it is that everyone is still thinking locally not globally.

To ensure true interoperability and exchange of patient health information, EMRs must be installed to satisfy the local requirements, but also with the forethought that they will integrate to larger systems. This requires standards and standardization. The absence of a standard will require the use of translation services so that HIE repositories use the same codes for exams performed across the region.

Translation services, while a viable alternative to standardization, require one-off knowledge for the database structure and logic for each customized local EMR as well as that of the destination repository. This level of granularity creates layers of complexity for maintenance and mapping. Any changes to local system will mandate updates to the translation engine. The support nightmare of constant mapping modifications to assure the proper codes are sent outbound or received inbound will be effectively unsustainable.

Once all of the paper silos are replaced by digital silos, there will be enlightenment of EMRs that were installed incorrectly, don’t address the clinical workflows of the office, and don’t communicate outside of the office with a standard communication protocol using standard coding methods. This will lead to a second phase of the EMR revolution will include translation services and reinstallation of EMRs to address workflow and data gaps. This will have to be resolved before integration to a larger HIE repository can take place.

If we begin now with standardization of workflow and codes and ensure they are addressed with current EMR installations, we will be in a better place in five years and users will see the true benefits of these systems. With our current strategy of “every man for himself,” we risk losing users’ confidence once these systems are installed and address workflow and physician concerns. Once we lose the users’ confidence, they will stop using the system and re-adoption efforts will prove Herculean.

As you begin planning your EMR implementation, there are hundreds of questions to ask. When it comes to meeting the long-term requirements of MU as well as realization of the true benefits of an EMR, here are a few to begin with:

1. Have we reviewed and documented our office workflow?
2. Are we using the new SNOMED codes?
3. Are we following standardized codes for services rendered?
4. Does the installation team understand clinical workflow or do they look glassy-eyed when we discuss medical terms?
5. Is our vendor of choice an IT company trying to cash in on the HIT initiative without clinical experience and knowledge which could place our business at risk?
6. How will this EMR connect us in the future to larger integrated systems?

Jon Shoemaker is senior consultant with Ascendian Healthcare Consulting of Sacramento, CA.

News 10/6/10

From StateHIECoordinator: “Re: Iowa. The state has issued a Notice of Intent to Award to ACS for the Iowa Statewide Health Information Exchange.” SHIEC sent over the award letter that went out to the eight bidders. It includes technical scoring and prices, but I’m not sure if I should run that since it may not be public information. The selection went down to frontrunners ACS and Medicity in the “best and final offer” round, with ACS winning on price.

From Maladroit: “Re: book. You mentioned a book on healthcare IT and the future sometime in the last ear. I don’t remember much about it except it seemed like a great book to help me understand a CIO’s perspective as he/she thinks about maturing their tech org. Do you remember the book?” Hmm. I’ve mentioned a few books, but I don’t remember this one particular. It might have been Ed Marx, too, since he’s well read. Readers, if you know the book or have others to recommend on that topic, let me know and I’ll run a list.

From Wax On: “Re: medical transcription acquisitions. The big buzz among the MT community at the recent AHIMA convention in Orlando was about Nuance acquiring both OSi and Encompass Medical Transcription. And in another deal, Keystrokes acquired Chartnet.” I’m appreciating the irony that the hottest technologies in healthcare IT appear to involve transcription. Voice and paper are hard to kill for good reason.

From Ex-Employee: “Re: CareTech Web Division. All sales staff let go last week. Management plans to eliminate the Web division and focus solely on outsourcing.” Inga contacted the company for a response:

On the heels of significant growth in its Web products and services segment, CareTech made the decision to adjust its go-to market approach for the Web business with an emphasis on balancing its growth with providing the best delivery service. The decision involved a shift in resources, including a reduction in the area of Sales, and an increase in technical resources for the Web Development and Account Management areas. The company remains committed to its Web products and services business, and is especially looking forward to the opportunity to see current customers and meet new ones at the 14th Annual Healthcare Internet Conference where CareTech will have an exhibit and speaking engagement.

From Long Time Reader, First Time Writer: “Re: MU. Several CIOs I work with are gnashing their teeth because their vendors are telling them they’ll only apply to have their latest software version certified. Clients on the now-current version will have to pay the vendor for an upgrade and service fee to get on a ‘certified EHR’. Some have said they are being quoted months to get the upgrade because customers that signed lucrative contracts with the vendor’s service arm are moving to the head of the line. Love the blog BTW.” I guess I’m seeing it through the vendor’s eyes – ONC made them jump through hoops to get their products certified and to get them implemented by a firm date, so somebody has to pay and not every customer can be the first to go live. I’d blame the government for trying to tie something as complex as EHR adoption to something as desperately made up on the fly as economic stimulus. But if you have a particularly egregious vendor example, tell me since I’m sure some are milking it hard.

Ingham Regional Medical Center (MI) helped start and fund the Capital Area RHIO, but won’t participate in it. The hospital and its parent company will instead join Michigan Health Connect, explaining that, “A lot of the larger systems decided to go that route so they wouldn’t have to participate in different RHIOs and repeat the investment over and over again.”

Inga trumped Weird News Andy on this article, although she kept it at arms’ length when she sent it my way, saying it’s “a bit icky for my taste.” It’s a little raw for me too, but if you’re fascinated to know the “Strangest Foreign Bodies Removed From Patients”, many of which seem to involve unusual sexual practices, feel free to check it out. I did, but I think I regret it now.

ONCHIT puts up a Certified Health IT Product List page. It doesn’t include the CCHIT-certified products yet.

The Government of Queensland will implement (warning: PDF) the MetaVision Clinical Information System from iMDsoft in the ICUs of 14 hospitals.

Blessing Health System (IL) will implement Patient Condition Tracker from Rothman Healthcare Corporation within Allscripts Sunrise Clinical Manager. Their nursing school will also participate in research studies involving the system, which turns 26 measurements and observations from the EMR into a single number called The Rothman Index that allows early detection of patients going bad. I’ll have an interview with the co-founder up shortly.

Jack Kowitt, SVP/CIO of Parkland Health & Hospital System, e-mailed to say he was happy that I was puzzled by an ARRA comment attributed to him by the Dallas business paper since he was misquoted. The article said the hospital “won’t seek federal stimulus funds because its electronic records upgrades started before the stimulus bill was passed,” which I thought was odd since HITECH payments aren’t linked to spending. I indicated probable reporter error, which was the case according to Jack: “The question was whether we were using any stimulus funds to implement the EMR. The response was, since we have already implemented, we would not. It wasn’t about MU money, which we are aggressively pursuing.”

It appears that CCHIT’s initial press release that listed certified products was incorrect. ChartAccess from Prognosis Health Information Systems was listed under EHR Modules in the hospital domain, but the current product list shows it as a certified complete EHR in the hospital domain, the only one other than EpicCare.

I got an e-mail blast from a seemingly desperate free HIT magazine today, urging me to post five comments to their online articles to be eligible for a giveaway (so much for highfalutin’ journalistic integrity – what’s The New York Times paying for sending in letters to the editor these days?) Since it mentioned their expert bloggers, I thought I’d check out the competition for the first time. All the blog entries I saw except one seemed to come from other sites – they’re just reprinting them on their own site like they were written for the dead tree people. Maybe I’m an amateur purist, but both the comment bribe and the reposted blogs strike me the wrong way.

Inga contacted the folks at Infogard to get pricing information for their ONC-ATCB certification services. Drummond and CCHIT are pretty transparent about what they charge and were very nice to give Inga the information so she could put a comparison together for readers. Infogard sent her a curt reply: “Unfortunately, we will not be able to provide our price list.” We’ll make sure to help keep their secrets when their press releases come out by not mentioning them.

A Forbes blog riffs on a New York Times article about EMR vendor ClearPractice, which I didn’t realize was run by big-time VC guy John Doerr (Google, Amazon) and his brother. They also oversee a Medicare Advantage insurance plan. The Forbes writer isn’t impressed with ClearPractice or its iPad version called Nimble, although he’s focusing on the business success and not the innovation or potential:

While electronic medical records are a promising tool, the piece lacks context. For a company like Dr. Doerr’s to have been around for a decade and only have 500 doctors using the software basically means it’s failed. Check out this list of EMR vendors by market share based on physician usage. In a rapidly consolidating market there are at least 10 and probably 50 different vendors with more than 500 licenses. The idea that the Apple iPad will somehow, with an assist from stimulus funds, revive the fortunes on an individual EMR company is optimistic to say the least … The other thing that struck me is that the piece made no mention of the history of hubris when Silicon Valley tries to cure health care’s ills. Remember when Netscape founder Jim Clark devised Healtheon on a piece of paper? Or AOL founder Steve Case’s mostly expired Revolution Health?

Meditech got specific about its expansion plans Monday, announcing its intent to purchase 135 acres in a Freetown, MA business park and to build a 180,000 square foot office building for 800 new employees. A local politician estimates the company’s investment there at up to $100 million.

The University of Louisville School of Nursing gets a $792K HHS grant to develop nursing informatics education. They’ll buy simulation lab equipment that includes a patient simulator, iPads, and EHR simulators.

Interesting: a company uses Salesforce.com to deliver and analyze patient EEGs, looking for similarities in a database of known EEG irregularities to suggest psychotropic medications to doctors treating mental illness.

MedAssets is holding its Business & Technology Forum this week in Orlando.

Weird News Andy’s contribution this time around: “1/3 off healthcare ‘reform’ … I wish.” A report (warning: PDF) finds that HHS has already missed a third of the deadlines mandated by the Patient Protection and Affordable Care Act, with another 29 coming due in the next three months.

And speaking of government efficiency, health insurance premiums for 8 million federal workers will go up 7.2% in 2011, which the government spins by saying that’s less than increases in the private sector because of savvy negotiating.

A company brings social networking to crutches, allowing Facebook friends of the injured to create custom “skins” for their crutches. The company will offer advertising materials in the ED and expects to co-brand with healthcare systems.

The Institute for Healthcare Improvement releases a white paper to help hospitals manage serious clinical adverse events.

An interesting analysis: hospitals are buying up primary care practices to prepare themselves to become Accountable Care Organizations, which could be the end of the line for small, independent practices. Hospitals are looking at increasing PCP salaries like a Wall Street analyst looks at price-to-earnings ratios, knowing that internists and family practitioners generate hospital revenues at nine times their average salaries, while expensive specialists generate a multiple of only five times their salary. For industry noobs, it’s time for hospitals to get taken to those 1990s cleaners all over again, because:

1. Docs sell out precisely because they don’t want to work  as hard for their new hospital employer as they did for themselves (duh).
2. Hospitals are notoriously bureaucratic and inefficient managers, making them particularly unsuited for running a low-overhead medical practice in every way from EMRs to personnel policies to regulatory compliance.
3. Private practice docs hate and distrust everything about hospitals except the money they have and don’t usually change their opinions or behaviors just because they sell them their practices.
4. Doctors resent taking orders and being told how to practice medicine, especially from suit-wearing hospital MBA-types who fancy themselves business experts despite always having worked for a paycheck instead of themselves, making it likely all these deals will fall apart in 4-5 years like they did last time around, with the docs scrambling to start up new practices without the benefit of a location, an EMR, or patients that they sold away to the local hospital in a frenzy of co-opetition.
5. Patients aren’t much more enthused about hospitals than doctors are, so they aren’t exactly thrilled to see the big sign go up over their friendly little doctor’s office knowing it’s the same folks with ED waits, bad cafeteria food, and terrible parking.

E-mail me.

HERtalk by Inga

From RDU Dude: “Word on the street is that Vern Davenport has left Allscripts.” Portly Gentleman sent us a note on October 1 suggesting Allscripts would soon announce some executive changes. He named names (Vern’s being one of two), but we didn’t run them since it didn’t seem right until it actually happened. The company confirms that the former Misys president and Allscripts exec has indeed moved on.

Over 50 practices in Tenet Healthcare markets select MED3OOO’s InteGreat PM and EHR as part of a Tenet/MED3OOO community-based EHR partnership.

Hearst Corporation appoints Gregory H. Dorn MD, MPH president of drug database provider First DataBank. He most recently served as EVP at another Hearst company, Zynx Health, and replaces Donald M. Nielsen, MD, who becomes chairman of the First DataBank Advisory Board.

Omnicell acquires Pandora Data Systems, a provider of analytical software for medication management. The Pandora solution is used by several HIT companies, including CareFusion, McKesson, Cerner, and will continue to be operate as a stand-alone product. Omnicell’s comparable product is about twice as expensive, so there goes your cheaper alternative, most likely.

Epic wins a five-year,  $14 million EHR contract from the US Coast Guard, replacing a version of the Department of Defense system. That could be a notable Epic foothold in government down the road.

Penn State Hershey claims its use of CareAware technology has contributed to a 90% decrease in manual charting during surgical procedures. Providers now average one minute of charting during surgery, compared to 10 minutes before the CareAware implementation.

I love and appreciate all our sponsors, but this is funny. I received a note from one today (someone in accounting who has probably never heard of HIStalk) asking us to re-issue an invoice. The reason: they had asked to pay their sponsorship over several invoices, so dividing the total led to a per-invoice amount of xxx.1666 (infinite decimal). We invoiced xxx.17. They’re asking to correct the remaining invoices to xxx.16 so that the yearly total hits the amount exactly instead of being four cents over. Who else wonders how that accounting department handles client issues?

The Institute for Health Technology Transformation publishes a new report that examines the current EHR landscape. I can’t say I gleaned much new information, but was struck by the authors’ comment that the EHR “landscape” is still in its “infancy.” Given that I was selling EHRs (or EMRs as we called them in the old days) years ago, I’m thinking there must be some inverse relationship between EHR-years and dog-years.

North Kansas City Hospital deploys Cerner’s P2Sentinel auditing solution to address the hospital’s Meaningful Use Stage 1 access requirement.

Miami Children’s Hospital will spend $67 million to implement Cerner Millennium. The hospital will also extend a 50% discount to community physicians who wish to implement PowerWorks EHR in their offices. The hospital expects the government to provide $7-$8 million in stimulus funds once Millennium is fully operational.

Here is some not-so-pleasant news: at the current rate, 2010 could be one of the worst years ever recorded for mass hospital layoffs. Blame the increased demand for charity cases, the decline in reimbursements, and a reduction in elective procedures. As of August, 8,233 employees lost jobs in 102 separate layoffs, according to the Bureau of Labor Statistics. At the current rate, 12,349 jobs would be cut by December 31st, compared to 11,757 last year.

Six Texas pharmacies file a lawsuit alleging CVS Caremark of violating patient privacy laws and unfairly competing with its rivals. The complaint highlights Caremark’s plans to establish a data warehouse that includes the names, demographics, and drug histories of patients, plus Caremark’s Rx Review program that is designed to use patient data for direct marketing to patients and physicians.

Sponsor Updates:

• Allscripts introduces Mobile Homecare, a smart phone application for physical therapists, nurse assistants, and other clinicians caring for patients in their homes.
• API Healthcare signs up Halton Healthcare Services as its first Canadian client.
• Quest Diagnostic partners with HP to offer a preconfigured solution that includes Quest’s Care360 EHR and HP hardware, services, and financing.
• Wahiawa General becomes the first facility in Hawaii to implement Voalte’s iPhone solution.
• Detroit Medical Center selects the iDoc document imaging system from CareTech Solutions for its eight facilities.
• The Nashville Chamber of Commerce names Informatics Corporation of America to its Future 50 Award list for the third consecutive year. The award is presented to the 50 fastest growing companies in Tennessee.
• Catholic Health Initiatives expands its partnership with Allscripts to include Allscripts EHR and PM for all of its 1,200 employed physicians and 7,000 affiliated physicians. CHI is also adding Sunrise EPSi Performance Management solution for its 73 hospitals and will develop its own HIE with the Allscripts Community Exchange solution.
• PatientKeeper deploys its new physician documentation product, PatientKeeper NoteWriter, to Mercy Medical Center (IA) and Alegent Health (NE).

E-mail Inga.

HIStalk Interviews Paul Hensler, CEO, Kern Medical Center

Paul Hensler, FACHE is CEO of Kern Medical Center of Bakersfield, CA.

Tell me about Kern Medical Center.

KMC is a 222-bed academic medical center. We have eight residency programs with the UCLA School of Medicine. We’re the only trauma center between Los Angeles and Fresno. It’s a county-owned facility.

You’re going to be going live soon on Medsphere OpenVista. You’re still on for November, right?

No, we’ve delayed it. We had a rather serious virus.

I heard about that.

It took our IT staff off of everything but getting the virus fixed for about three weeks. As we looked at moving back, we started getting into the holidays and so on, and really felt we needed five weeks of uninterrupted training. We decided to go live February 8th.

What would you say are the good and the bad things about the project?

I’ve been very happy with both sides. Plus, our employees have really stepped up and have done a great job with the builds and have not taken the shortcuts. For just what they were offered, the staff’s just put a tremendous amount of good work into it.

The Medsphere staff has been great to worth with. We started this off with the idea of it being a partnership, and I think it really has been.

How large is your IT staff and what capabilities do you have in-house?

The reason I’m hesitating is we’re moving to a model of the county IT staff taking care of the infrastructure that would move all of our servers downtown. Then we have a small staff left out here to deal with applications. I think out here we have about eight FTEs, but then we’re also supported by people who work at the downtown location. I think probably another six or so are totally devoted to us, as well as some other county IT staff that helps out on specialty things.

It’s difficult for a small- to medium-sized hospital to be looking at a $40 million expenditure for an EMR system. Do you feel that you had to give up something to go with OpenVista or do you have any regrets?

Not yet. We started integrated testing this morning. As of midday, it’s going very well. It looks like it’s a system that will work for us.

I was familiar with VistA from the VA. I wasn’t at the VA, but a lot of our physicians in San Diego worked at both our place and the VA. Physicians generally like the system. I think some of the things we’re giving up on bells and whistles are things that are distractions anyway. So far I really haven’t had any regrets.

The VA model’s a little different since they have somewhat of a captive audience of physicians and nurses who don’t really get to choose whether to use it. How do you plan to get, specifically, physicians to interact with the system?

Our physicians are employed.

All of your physicians are employed?

Yes. We won’t really run into a lot of the issues of Meaningful Use that community hospitals will. Basically, the physicians have really embraced it. They’ve done a lot of the work on the builds. I think they’re excited to see it come.

Are you replacing anything with OpenVista or is this all new?

The CPOE and the electronic medical record are all new.

Up until you go live, you’re purely paper?

Right.

You mentioned Meaningful Use. When you look at what dollars are on the table and your timelines, how are you feeling about the Meaningful Use possibilities?

Even with the delay it looks good. As you probably know, you really have to be up to speed on July 1 to get 90 days in before October 1. We’ll be live in early February, so that will give us several months of experience to see if we’re falling down in any areas before we do that last 90 days. I think that should go very well.

Would you have done it without the possibility of HITECH payment or was that the deciding factor?

I think that really pushed it a lot. It turns out, in looking at cost savings by having an electronic medical record, that will pay for itself even without the stimulus funds. But the stimulus funds really, I think, are what moved it to the front burner and it’s kept us on a tight timeframe.

You mentioned the cost savings. What kind of outcomes do you hope to achieve when you are fully electronic?

We’ll save about a million dollars a year in forms and paper and the storage of the forms and paper. Probably another million a year when it’s fully implemented on costs to the medical records department. That’s really just a little low-hanging fruit. We’re expecting a lot of operational savings, but they’re just a whole lot more hard to quantify.

On your team that’s implementing, I assume you have representation from physicians and nurses that are involved?

Oh yes, and everybody who will touch it is represented in the steering committee.

Did you do a lot of work with standardizing order sets or evidence-based medicine when you were building the system?

That’s really a lot of the work that’s going on. Our clinical people got much more involved in that than we originally thought we would, and they’ve done a lot of good work.

Are these physicians that are practicing physicians? Do you have a physician in charge of the project or is it just a collaboration?

There’s a physician in charge of the project. She’s one of our thoracic surgeons who’s also practicing. All of the physicians who are involved in the project are all practicing.

Do you have any that are naysayers? Are you hearing from those yet or are they just taking a wait and see attitude?

Really no one is naysaying the project. There’s little things here, little things there that they don’t like and there’s some compromises we need to make with some of the other systems that will have to interface to it that we’ll probably eventually replace. But no serious “let’s just pull the plug and forget about it” type of naysayers.

How do mobile devices fit into your strategy?

Actually, the whole input device is one of the things I was most concerned about because we don’t have experience with it and everybody has different ideas of what they should use.

The mobile devices just seem their screens are just too small. We had a device fair here and had all the various vendors bring in various devices from hand-helds to iPad-like devices, to regular PC screens and laptops and so on. I think most of the users pretty quickly realized they needed a much larger screen than an iPhone or something would accommodate. We ended up selecting laptops in some areas and PCs on carts for other areas.

Will you have remote access?

Yes, it will be Internet available.

When you look around the community, what’s the status of EMR adoption among the physician practices? Will this change anything?

I don’t see a lot of physician practice adoption yet. There are a couple of large groups or specialty groups that have electronic medical records, but the community has a lot of still-solo practitioners and small groups of two and three physicians that don’t seem to have done a whole lot yet.

I don’t know if they’re waiting to see what their respective hospitals do, or waiting for the ARRA funding or exactly what’s happening. Since we have an employed group, I don’t really focus a whole lot on the community physicians.

What about interoperability? Are you looking at that at all?

In terms of being able to share information with…?

Yes, among other facilities or regionally.

There are two very large federally qualified health clinics in our area. One of them is actually holding off on their electronic record. They may go with OpenVista as well after they see how we do. But we plan to, as soon as possible, have two-way communication with those clinics. We do some psych patients with Kaiser.

Probably insurance companies will be the next large thing, and then as the other hospitals come up with their own electronic records, we’ll expect to have interoperability with them.

Are you considering anything related to patients or consumers as far as a patient portal or any kind of functionality that patients would use?

You know, we’ve had discussions about it and that’s more of a long-term goal we’d like to do, but that won’t be available at startup.

As a hospital CEO, what elements of your overall strategies involve information technology?

I think that two of the differentiating factors for successful hospitals: one is imaging, which is fairly heavily IT related; and the other is IT and the ability to store and use information.

This obviously is the most important initiative we’re taking on this year, and I think, will be the framework for a lot of the quality, patient safety, and even financial things we do into the future.

When you look beyond Meaningful Use and ARRA and HITECH, how important will information technology be for hospitals that are trying to succeed under healthcare reform?

I think it will be very important for healthcare reform. It will connect the patient-home and the outpatient setting with the inpatient setting and with the ED so that there’s one record that caregivers in each of those settings can access. It will avoid a lot of duplication of testing. I think it brings together more, the medical group — even if it’s a virtual medical group — by the sharing of that information.

It also will give us a lot of information we can mine on how we’re doing with utilization, with quality, with patient safety. I think those elements will be very important under reform.

Do you think the OpenVista product is going to give you the technologies that you need to be ready?

Yes.

What are your biggest fears or biggest opportunities that you see coming from healthcare reform?

I think there’s just a lot of confusion left in exactly how the 3,000 or so pages of the bill are going to be translated into many thousand pages of regulation and what all that’s going to mean for us. As a county hospital, one of our issues is going to be will the indigent patients who we now see who suddenly have coverage. Will they continue to use us?

Is your fear that they will or that they won’t?

That they won’t.

Some are saying they’re never going to get their EDs cleared with all these folks who suddenly have an insurance card.

Well, they’re already using the emergency department, so it’ll just be that they’ll have a payer source all of a sudden.

The real big issue that concerns me though is having insurance coverage doesn’t necessarily give you access. Dumping another 20 million people with coverage onto the system that’s already pretty undermanned, I think, is going to create a lot of waiting issues and appointment issues. A lot of people who may not be able to find a primary care provider.

There’s a concern that just because you have insurance doesn’t mean you can get an appointment. Do you see there being new roles for extenders of primary care physicians, or will doctors move back into primary care?

We’re in a medically underserved area, so we already have a physician shortage. We are talking to our clinics about how can we use mid-levels — how can we be more efficient with the patients we see?

You don’t want to push patients through too quickly or have too much mid-level intervention because part of the spirit of it is that they have a Medical Home and a primary care physician who spends time with them and properly directs them, properly oversees disease entities, properly refers to specialists. If we get into a “let’s just hurry everybody through the system,” we’re going to go right back to high ED utilization, high inappropriate referrals to specialists, and patients with chronic conditions not getting their meds on time, and not getting seen on time and not having intervention done on time. It’s going to be a balancing act.

Do you think that healthcare reform is going to save money or improve quality or both?

I think there’s going to be several years of very turbulent years while it settles in. I do believe the country already spends more than enough money to cover everybody, but it’s going to be those transitional years where we go from reducing payment from people who are currently insured — since, in theory, those plans won’t have to cover uninsured — to a more even system where almost everybody has coverage. But I think it’s going to reduce the coverage for all of us and it’s going to increase the access problem for all of us.

Certainly there’s already some polarity of the haves and the have-nots when it comes to medical care. Not just insurance, but the quality and quantity of care available. Do you see that gap widening between the haves and the have-nots?

No. If anything I think it’ll probably shrink. You mean in terms of disparity among patients?

Yes.

No, I think that will probably shrink, and that’s probably going to be the problem for people who are used to having a full indemnity insurance card. As those plans drift down to looking more like Medicaid and more and more of the uninsured are covered, I think it’s going to be a leveling of the system. People who have lived at the high end of the system probably aren’t going to like it a whole lot.

Do you think it will create another class of patient and provider that go off the grid and use cash?

That’s what happened in England. There’s a National Health Service, and then there’s the private. Actually, private insurance service is down as well as private hospitals and private physicians. There could be some of that.

When you look out five to ten years, what are the hospital’s biggest opportunities and threats?

Health reform is both our biggest threat and our biggest opportunity. It’s the best of times or worst of times. We just don’t know which it is.

I think that there’ll be the turbulent years while we try to get used to regulation and people taking on different roles and our revenue streams coming from different areas. But I think ultimately, if we have good strategies and execute them well, it will be a real opportunity for us.

With our academic connections, we offer some of the advanced care in the community as well as the broader care, so it should be an opportunity for us in the long term. But I think it will be some difficult years getting there.

Equifax Acquires Anakam

Equifax announced after the market close Monday that it has acquired authentication management vendor Anakam. The San Diego-based Anakam has a significant healthcare presence, with products addressing online identify verification, credentialing, two-factor authentication, inoperability authentication, and secure collaboration. Former HHS privacy and security advisor Bill Braithwaite MD PhD is the company’s chief medical officer.

Equifax had chosen Anakam this past January to provide authentication for its I-Card product. Anakam’s solution was chosen last month by Buffalo-based HEALTHeLINK as part of HHS Beacon Community demonstration project.

The Atlanta-based Equifax says it will market Anakam’s Identity Suite with its IDverifier service as a single, integrated two-factor authentication solution. Rajib Roy, President, Equifax Technology and Analytical Services was quoted in the announcement as saying, “With Anakam, Equifax will become a premier provider of cloud-based authentication solutions.”

Monday Morning Update 10/4/10

From D.B. Platypus: “Re: ACO. The NorCal HIMSS chapter sponsored a CIO forum on October 1. A speaker showed this video. It had everyone rolling on the floor in a fit of hysteria.” I like it, although someone sent Inga a similar video that we posted on HIStalkTV that I like even better. My newest oft-repeated monotonic mantra from that one involving orthopods: “There is a fracture. I need to fix it.”

From CPAhole: “Re: Allscripts/KLAS. I’ve worked with numerous Allscripts/A4 reps and they did as they were instructed, sitting next to their clients as they completed the survey. KLAS outed the company. Of course Allscripts will take the high road and say they have a better system, but what else would they say?” Unverified.

From Lemmy: “Re: another stolen unencrypted laptop. Here’s the CIO’s internal e-mail from Harvard Vanguard Medical Associates.” I don’t recall seeing this previously, but the purported e-mail says that a vendor-owned laptop containing urodynamic testing data was stolen on August 3. It contained minimal information (name, date of birth, physician, MRN, and testing data). Massachusetts law required encryption starting March 1, 2010 as I understand it, so that might be a problem.

From Elaine: “Re: HIEs. I’m a new HIE manager within our health system and am interested in any data sources regarding interoperability discussions or lessons learned.” I’m sure people are reading who know a lot more than me, so add a comment to the bottom of this post if you can help Elaine.

From The PACS Designer: “Re: iPad’s little sister. Apple is working on a smaller 7" iPad for release early next year. This little sister iPad weighs only 1.1 pounds and will have front- and back-facing cameras. This smaller sized iPad may be of interest to our heathcare colleagues if they can produce it with a case that can be disinfected.”

Listening: Delain, female-led Dutch symphonic metal. Also, reader-recommended Pretty Lights, Boulder-based electronica (two guys doing something between DJing and playing) with some impressive live performances that mix several genres, mostly hip-hop and and synthesizer. Not something I usually like, but it sounds good (probably even better as a soundtrack to romance, I’m thinking without much credibility).  

Meditech says it will expand again, adding hundreds of new jobs to be housed in newly built Fall River buildings. Sales in 2009 were $234 million, up 38% from the year before.

This week’s internal e-mail blast from Kaiser chairman and CEO George Halvorson says the company has donated its internally developed clinical terminology translation engine to the US government, accepted by HHS Secretary Sebelius, CTO Chopra, and National Coordinator Blumenthal. From the example he gave,the Convergent Medical Terminology utility can convert 75,000 terms back and forth, for example between ICD-9, ICD-10, and SNOMED. It will be distributed as open source by the National Library of Medicine. 

Drummond Group issued the first ONC-ATCB EHR certifications, but CCHIT trumps them on quantity, announcing Friday that it has certified 33 EHR products (19 complete systems, 14 modules) in the 10 days since its program started. I’m not sure that will instill confidence in folks who have always questioned the rigor involved since they can apparently crank out three per day including weekends, but there you go. HIStalk sponsors that have newly certified products are Allscripts, NextGen, eClinicalWorks, T-System, and Wellsoft.

Transcription service outsourcer iMedX acquires FORE Transcriptions. And transcription software and services vendor MedQuist gets $310 million in financing, mostly from GE Capital, with the resulting announced dividend causing shares to hit a three-year high (strictly by investors looking to get the dividend – otherwise, borrowing money to pay a dividend isn’t exactly a robust growth engine). What’s with all the sudden interest in transcription companies?

Nearly two-thirds of respondents say KLAS reviews aren’t useful to providers, although I’m sure many of those respondents work for vendors ranked by KLAS as lower than #1. New poll to your right, requested by a reader: providers, which department will conduct and submit your Meaningful Use self-attestations?

Longmont United Hospital (CO) says VHA’s PriceLYNX vendor price comparison tool paid for itself immediately when a vendor was caught overcharging the hospital by $120K and returned the money. The materials manager says the software will allow him to negotiate price reductions of 8-20%, saving the hospital up to $4 million over the life of the contract.

This BBC article on real-time computing is interesting and scary. It says 50 to 70% of banks use it to perform algorithm-based trading of stocks and complex financial instruments. The example given is in trading stocks of two oil companies whose share prices usually follow each other closely. The software can check prices every 10 seconds and blindly buy Stock A shares if Stock B moves up even a tenth of a point. SAP says that kind of situational analysis may be useful in medicine, such as in monitoring the blood glucose of diabetics. Let’s hope the medical application is dissimilar from that of the money changers, whose computer-assisted self-destruction may yet take us all down with them.

Speaking of SAP, HP and “The Most Inept Board in America” choose the former CEO of SAP to be HP’s next CEO. SAP fired the Germany-born Leo Apotheker after a disastrous seven months as CEO, although some say he was the scapegoat for a terrible company strategy that predated him. HP is paying him like he’s a star: $1.2 million in salary, incentives of 200-500% of that with $2.4 million guaranteed, $72 million in options, a $4 million signing bonus, and $4.6 million in moving expenses (that’s a lot of U-Hauls). I’ll go with the summary of Oracle CEO Larry Ellison: “I’m speechless. HP had several good internal candidates…but instead they pick a guy who was recently fired because he did such a bad job of running SAP.” Their pre-Hurd CEO pick was an ultra-expensive termination, too: HP’s value dropped in half after Carly Fiorina orchestrated the company’s merger with Compaq. She was let go in an ugly fight about the time the company admitted that it spied on the personal phone records of journalists and its own board members trying to find out who was leaking information about its strategy.

The Dallas Business Journal summarizes the “long, expensive, and full of twists” EMR implementation projects of local hospitals. The hospital costs and associated taxpayer-funded EMR bribes: Texas Health Resources, $200 million, $70 million; Baylor, $200 million, $45 million; Parkland, $70 million and no stimulus funds. Parkland said they won’t go after ARRA money because their upgrades were underway before ARRA was passed, which seems puzzling since HITECH money doesn’t require spending anything, just demonstrating Meaningful Use (unless the reporter or I misinterpreted).

University of Virginia Medical Center goes live with Epic in its 140 clinics, with the big house going up in the spring. Cost: $122 million.

You, looking at the monitor – sign up for e-mail updates, Friend or Like us on Facebook, send me rumors. That would make me happy.

The VA will test 20,000 thin client devices using desktop virtualization, hoping to reduce maintenance and energy costs of its 325,000 PCs.  

In Spain, Andalusia will require hospitals to record birth records electronically within the first 24 hours of life, giving the child full health benefits that are independent of the mother and allowing pediatricians immediate access to the records. The centrally maintained information will support monitoring of infant morbidity and prenatal mortality.

The Canadian Medical Association says the $500 million that the Canadian government will give Canada Health Infoway in 2010 to goose EMR adoption isn’t enough. CMA wants another $423 million, which it says will increase adoption to 100%, apparent embarrassed over the high EMR adoption rates of other countries (Netherlands 99%, UK 95%, Australia 95%). I guess they weren’t consoled by US adoption, which comes in at anywhere from 4% to 40% depending on whose definition and survey you like.

My Health Care Manager gets a $1.2 million NIH grant to develop a search engine for geriatric health issues.

The bailout-happy federal government agrees to throw taxpayer money in the general direction of Massachusetts hospitals, especially Boston Medical Center, giving them $335 million. Cynics like me might point out that Massachusetts leads the nation in healthcare (percentage of insured citizens, use of electronic medical records, fancy hospital buildings housing bowtie-wearing academic doctors) and yet (or more likely, because of) has the highest healthcare costs. According to the article, Sen. John Kerry strong-armed CMS and Don Berwick to use our money without consulting us first, which I guess we might as well get used to as healthcare “reform” starts tapping an already wildly indebted Uncle Sam, who gets a lot of his healthcare ideas from Mass, even the fantasy that reform will somehow lower costs while insuring dozens of millions of new people. Maybe Uncle should be looking at the sensible, practical middle of the country instead of the extremes on the ends. From its most recent federal tax records, BMC paid its previous CEO $1.3 million and she got another $3.5 million when she left last year right before the hospital’s big profit turned into a loss. Somehow, that doesn’t make me feel better about my involuntary donation.

E-mail me.

News 10/1/10

From Allscripts: “Re: the note from Clinical Wisdom on KLAS. We agree that there is a conflict of interest in having vendors pay large fees to the same company that is producing the ratings. We reached the same conclusion a few years ago and discontinued the practice. After our recent merger with Eclipsys, we inherited an existing Eclipsys contract that was in place with KLAS, so the information reported by the writer was technically correct. However, we have now canceled that contract and we do not currently pay KLAS anything. We realize that is counter-intuitive as we currently are and have consistently been highly rated across many product categories by KLAS, but ultimately we didn’t feel it was right to pay a firm that was also rating our products. Over the last two years, we have re-invested those dollars in a ‘Net Promoter Score’ process, which is widely considered across many industries to be the ‘gold standard’ for measuring customer loyalty. Using this rigorous, statistically valid methodology (developed by Satmetrix and Bain & Company), we get client feedback directly in a very methodical way and then act immediately on what we learn. The bottom line is that we agree with the Consumer Reports analogy from the writer – KLAS should provide a full accounting and disclose what they receive from every vendor. In that same light, we would encourage other vendors to disclose how much they are paying KLAS – complete transparency is critical when you’re talking about the core technology that providers use to make decisions vital to every American’s health.”

From Ben Cannoli: “Re: IOM’s study of HIT best practices. The IOM report is incredible even after a decade. I’m glad they are leading. HIMSS has been weak, negligent, and pathetic on this issue, but I don’t believe they can strong arm the IOM.” Inga mentions it below. The IOM gets an ONCHIT grant to look at how HIT affects patient safety. It will cover some industry hot buttons: surveillance and reporting of HIT-related patient safety issues, discussion of the possible roles of federal agencies like FDA or AHRQ, and impact of certification bodies and trade associations (HIMSS, you’d expect). I’d bet that Don Berwick made this happen. I don’t know how much they’ll get done for $1 million, but I’m interested to find out.

From Digital Bean Counter: “Re: real-time claims adjudication. Is it taking off yet? Any big players?” Little help, if you know.

From VaHooGirl: “Re: Martha Jefferson Hospital. No longer a rumor – they are merging with Sentara to become its 10th hospital.” Verified.

From TuTu True: “Re: Mrs. HIStalk. A source tells me that Inga is Mrs. HIStalk. Be honest – true or false?” False. And to answer the other occasional rumors: (a) yes, there really is an Inga – it’s not just me pretending to be her;  (b) yes, she really is a woman, and (c) yes, the Inga picture at the end of her posts really does look like her since I paid some offshore artist $15 to draw it from a photo.

From Luke O’Scyte: “Re: correction about the Canadian government spending $500 million on EMRs. Please replace ‘spending’ with ‘wasting.’ I’m highly skeptical of the value that will be generated from that half a billion dollars.”

From Portly Gentleman: “Re: Allscripts. A couple of executive suite offices are about to become vacant.” PG provided credible names and I’m sure his information is correct, but I feel funny about mentioning names of people leaving jobs. Watch for announcements early next week.

From MSFTGUY: “Re: McKesson Paragon. Just went live at 391-bed Lake Charles Memorial. Several big hospitals have gone live on Paragon this year. Maybe folks have a choice between a system that doesn’t work and is only 1/3 of an HIS (Cerner) and one that’s ridiculously irresponsible to purchase (Epic)?” I did some work at that hospital once. Nice folks. None of the systems you mentioned are for everybody, so it’s hard to criticize their choice, especially if it was a lot less expensive.

From Perineal Flowers: “Re: [name omitted] is one of two finalists to be CIO of Tenet.” I’m expunging the name since I’d sure hate to get someone fired if they don’t land the rumored new job after all, but I did manage to contact them. They humorously (or so I assume) told me the rumors also have them going to Allina, Duke, and Partners, all of which have open CIO jobs along with Tenet. I’m pretty good at reading between the lines, so I think there’s fire underneath that smoke. We’ll see from which direction soon, I’m betting.

Listening: The Tyde, obscure, Byrds-like LA jangle surf. 

A scrappy Austin-based non-profit investigative publication runs a pretty good story on the ongoing sale of de-identified hospital patient data by the Texas Department of State Health Services. Among their customers: GE and a company that runs background checks for border security. Deborah Peel MD was quoted as saying that a HIPAA loophole allows selling patient data to any entity that claims to be doing “research”, which isn’t defined. Now this is funny: the only parties that stay anonymous aren’t the patients, but rather the people who download the free data files covering 1999-2003. The article wanders all over the place and is predicated on your believing that de-identified data can be re-identified (which it definitely can to some reasonably high percentage, but some people refuse to believe that fact). If newspapers weren’t going broke, they should fund a re-creation of that experiment where patient data was re-identified by linking to common fields from other government-sold databases, such as driver’s license records.

Here’s another fun tidbit from the Austin article, even though I don’t believe its accuracy. The guy who wrote The Long Tail estimates that free EMR vendor Practice Fusion takes in $250 million per year from selling the de-identified patient data stored in its systems, dwarfing any possible revenue it could make by selling software. It cites a Practice Fusion job ad on Craigslist for a Data Sales Director, someone with experience creating “an aggressive data monetization strategy” who can pitch to “pharmaceutical companies, medical device companies, insurance carriers, government entities …” and “establish a fair market price for EHR data and negotiate effectively with buyers.” That position is still being advertised on Practice Fusion’s site, but the language has been dialed back a lot.

Cerner caves in to patent trolls Acacia Research (“research” meaning “writing threatening lawsuit letters to companies to see who will pay up”) and will pay that organization for the privilege of selling PACS, which Acacia’s often-waved patent claims they invented. Acacia’s strategy is smart: they threaten to sue, but offer a license for less money than it would cost to mount a legal defense. Most companies pay up and the threatened suits rarely go to court, although Epic mounted a swift legal counterstrike for being threatened. I never heard how that turned out, but it doesn’t matter – I still admire their willingness to fight for what’s right.

This is brilliantly funny: You may know Ross Martin, MD as the guy behind the HITECH Operetta and Meaningful Yoose Rap in his role as President of The American College of Medical Informatimusicology, although he has a less interesting but probably much more lucrative HIT consulting job. He writes a hilarious letter to the editor of The New York Times for not publishing a previous letter of his, threatening a class action suit by rejected would-be authors and signing it, “Yours in the quest for wealth creation through victimization, President, Literary Mediocrity Association.” They whittled his piece down to a paragraph, but they did run it. I think the HIStalk audience is more appropriate for his type of humor than that little New York paper.

WorkflowOne, which claims to be “the nation’s leading name in healthcare document management,” puts that leading name on a Chapter 11 bankruptcy filing. Premier just renewed its contract with the company, claiming that “no one is better prepared to help Premier members reduce costs and gain efficiencies across their entire print lifecycle than Workflow One.” Doh! Still, the company has big revenue and EBITDA, so I’m sure they’re not going anywhere. It seems odd that they even filed, frankly.

Lots of good jobs on the HIStalk Sponsor Jobs Page: Eclipsys Pharmacy Consultant, Natural (Software AG Product) Programmer Analysts, McKesson Workflow Clinician. On Healthcare IT Jobs: Product Manager, Lead Epic Analyst, Senior Clinical Systems Analyst, Solutions Marketing Specialist.

Sharp Healthcare chooses Aternity Frontline Performance Intelligence to monitor application user experience.

Vanderbilt launches its first preventive genetic screening program, testing all cardiac cath patients for clopidogrel metabolism problems and storing the results in their EMR so that a different blood thinner can be used if needed, avoiding expensive and dangerous blood clots. Several other drug-affecting genetic traits will be tested as well. Now that’s just cool.

Several national pharmacy organizations launch the Pharmacy e-Health Information Technology Collaborative, which will work to get pharmacist-needed functionality into EMRs.

CMIO interviews one of my favorite CIOs, Denni McColm, from 74-bed Citizens Memorial Healthcare in Bolivar, MO (the only one of very few HIMSS EMRAM Stage 7 hospitals, a standout on the list dominated by big, rich health systems). CMH has a bi-directional CCR interface with Google Health that Denni says will meet Meaningful Use requirements, saying interoperability doesn’t necessarily required an HIE. They’ll use Google Health to make sure patients who ask get a copy of their medical record within the MU-specified timeframe.

ChartLogic earns EHR certification from Drummond Group.

iSoft convinces its bankers to reorganize the company’s debt. Shares are still at 13 cents. You would think those two events might attract takeover interest, but the company’s chair says conditions remain “challenging.”

A Chicago cardiologist will pay $20 million and spend five years in prison for defrauding Medicare and private insurance of $13 million, turned in by another doc who gets $3.5 million as the whistleblower. The cardiologist submitted 14,800 false claims that added up to more than 24 hours a day of work from 2002-2007, so he enjoyed a lavish lifestyle until the case finally ended. When the Feds raided his house, they found $6.7 million in uncashed insurance company checks.

E-mail me.

HERtalk by Inga

The Allscripts/Eclipsys crew sent over an invite to EUN 2010 Outcomes Through Innovation, which is the user meeting for Eclipsys clients. Wish I could go because it’s in one of my favorite cities, San Diego. The event is October 10-13 at the Manchester Grand Hyatt.

The board of governors of Good Samaritan Hospital (IN) approves the $400K purchase of McKesson’s PACMED and MedCarousel pharmacy packaging systems. At the same board meeting, the director of IS says the hospital is on target to earn nearly $7 million in ARRA incentives over the next six years.

St. Vincent’s Healthcare (FL) extends its seven-year partnership with TeleHealth Services. The health system will implement TeleHealth’s TV and interactive patient education solution at St. Vincent’s and St. Luke’s hospitals.

I noticed that Intellect Resources posted this article about the current shortage of IT professionals in the Nashville area. Middle Tennessee is home to a number of large HIT employers, including HCA, HealthSpring, Cogent Healthcare, and ICA. Several companies are working with on training initiatives at area colleges to help increase the pool of professionals with both healthcare and IT expertise.

Merge Healthcare adds two new perioperative solution clients: Exempla Saint Joseph Hospital (CO) and Kalispell Regional Medical Center / The Surgery Center of Northwest Healthcare (MT).

If you are headed to the American Academy of Pediatrics show this weekend in San Francisco, say howdy to HIStalk Practice’s Dr. Gregg Alexander. He’ll be directing the Pediatric Office of the Future exhibit, which will showcase technologies available for pediatricians. Dr. Alexander is pretty darned excited by the project, as evidenced by his  latest Intelligent Healthcare Integration post.

ONC awards the Institute of Medicine a $1 million contract for a year-long study of HIT’s effect on patient safety.

The Tiger Institute for Health Innovation celebrates its one-year anniversary and provides an update of its work to date. The Tiger Institute is a partnership between Cerner and the University of Missouri Health System to create new technologies. So far UMC has implemented bar-coded medication administration and is rolling out CPOE in a couple of months (not sure why that would be considered innovative) and is working on several prototype projects, including a mobile app that allows physicians to review clinical data and give orders via smart phones.

CIGNA and St. John’s Mercy Medical Group (MO) launch a 12-month accountable care organization pilot program. The pilot will target patients covered by a CIGNA health plan and receive care from one of St. John’s 165 primary care physicians. Physicians have the potential to earn bonuses for meeting quality improvement targets and lowering medical costs.

Mayo Clinic and five other health systems form the Mayo Clinic Center for Social Media, dedicated to the use of social media to promote health, improve healthcare, and fight disease. The Center will offer educational conferences and webinars and develop social platforms to share training and resources. The website www.socialmediahealthnetwork.org will launch October 25.

Baptist Health (FL) partners with Vitalz to provide provider-to-provider portal services between 13 Solantic Baptist urgent care centers and 40 Baptist primary care offices.

Texoma Medical Center (TX) implements Skytron’s RTLS to track and manage 200 hospital assets. When reading the press release, I was amused that either the hospital or vendor thought it was noteworthy to mention that Texoma is also using the RTLS technology to monitor vendor sales rep visits.

This week on HIStalk Practice: BlackBerry thumb, cell phone elbow, and Facebook depression; medical students say having an EHR is a very important factor in their decision what to practice; Phreesia and a few first impressions.

Sponsor Updates

• Fred Castillo, VP of healthcare mobility sales for AT&T and Eleanor Chye, executive director healthcare mobility product management at AT&T will participate in separate panel discussions at the CTIA Everywhere Healthcare event next week in San Francisco.
• Methodist Hospital of Southern California goes live with API Healthcare’s Human Resources and Payroll solution.
• Sharp Memorial Hospital (CA) selects GetWellNetwork’s bedside education/entertainment system. GetWellNetwork’s patient education and communications tools will be interfaced with Sharp’s Cerner EMR system.
• Susquehanna Health (PA) plans will add the perioperative information management system of Surgical Information Systems to its three-hospital system. Susquehanna will integrate the SIS solution with its existing Siemens Soarian applications.
• Albemarle Hospital (NC) selects the Access Intelligent Forms Suite to bar-code patient forms for auto-indexing via a document management system into its Meditech EHR.
• Ingenix CareTracker earns CCHIT Certified 2011 Ambulatory EHR certification.
• Zac Fritz joins My Health Direct as SVP of sales and marketing.

Here at HIStalk, we love well-intentioned works of charity. Thus, I applaud Cincinnati Bengals wide-receiver Chad Ochocinco for promoting contributions to Feed The Children. Ochocinco has his own personalized “OChocinos” cereal and includes a Feed the Children phone number on the box. At HIStalk, we’re also about getting the little details right, so bummer that Ochocinco didn’t get Mr. H to proof the cereal box. Perhaps he could have caught a certain typo before the box it hit the production line. Mr. H likes the occasional smut reference, so I’ll mention that the Feed the Children phone number listed was actually a phone sex hotline. Oops.

E-mail Inga.

Readers Write 9/30/10

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

"Granularity" — A Detailed Analysis
By Robert Lafsky, MD

“Granular” is turning into a buzzword. And that’s not a good thing.

It was a perfectly respectable, albeit not very useful term in the analog days, referring usually to a physical material composed of — you know, little granules. You’ll actually see it used sometimes as a descriptive term in pathology and endoscopy reports, and in general use it describes some thing’s particular type of grainy texture.  But then, of course, computer people got hold of it and gave it a much more specific, albeit metaphorical meaning, which I’ll get to in a minute.

Recently, writers in the mainstream media, with their ears always pressed to the ground and desperate for novelty, have picked up on this word and are starting to use it to describe more abstract things, in a way that fails to grasp the IT meaning at all. For instance, the other day political pundit Michael Gerson described a Karl Rove critique of Christine O’Donnell as “granular and well informed.” If you substituted “detailed” for “granular” in that sentence, you wouldn’t have changed the meaning a bit.

But IT people don’t use “granular” to mean just “detailed.” Hard copy or scanned documents can, of course,  be very detailed. I remember a couple of old docs from my training days who would sit with pen and paper and do beautiful two- or three-page, single-spaced handwritten reports on their patients with every bit of the history, physical, and labs on them. It was impressive effort, very detailed, but even if you found those reports now and scanned them into your EMR, the information in them wouldn’t be granular.

No, for a computer, detail is necessary for granularity, but it’s far from sufficient. The computer has to be able to do something with the details so that it can store them in an orderly way and then use them for searches and reports. That sort of thing, of course, is the “use” that at least has the potential to be “meaningful.”  

So if, say, a particular drug for hypertension is found to be dangerous for everybody over 60 with diabetes, I don’t have to go manually through a thousand records. They are recorded in a yes-or-no fashion in a database. I can query my system and get an immediate list of all my patients who meet those criteria, with their addresses and phone numbers.  

That’s granularity. Facts have to be detailed, but in a fashion where computers can take advantage of them.

Maybe this is obvious to the IT business readers out there, but I sure spend a lot of time in the doctor’s lounge painstakingly explaining this to medical colleagues. And granularity is at the heart of all the arguing about workflow issues in EMRs, as well as interoperability and the coherence of automated reports that rages in the comment sections of this website and elsewhere.

I can’t offer a resolution of any of these arguments. But to get anywhere, we need commonly defined terms, and granularity is a pretty useful one. General media people out there, if you mean “detailed,” say “detailed.” Leave “granular” for those that really need it.

Robert Lafsky is a gastroenterologist in Lansdowne, VA.

A HCIT System Architecture for Cloud Computing
By Mark Moffitt

Note: This article uses a fictional story about Google and Meditech as a backdrop to describe a healthcare IT (HCIT) system architecture for cloud computing.

(Oct. 1, 2020) Today marks the eighth anniversary of Google’s purchase of an obscure private company know then as Meditech that marked the beginning of the transformation of the HCIT industry into what it looks like today.

At the time, the purchase shocked everyone. Over the years, Meditech had repeatedly rejected any notion of a buyout by another company.Then Google offered $1.5 billion, more than a 50% premium on the estimated valuation of the company. The offer, it turns out, was too good to turn down. Neil Pappalardo of Meditech walked away with a $400 million payout. Google’s market cap at the time: $168 billion.

The Vision

Google’s vision for the future of HCIT was straightforward: provide all IT services to healthcare system as a cloud computing service at a price much lower than market rates as a strategy to capture 60% of the worldwide market by 2020. Google’s service included applications, data management, and integration. Google architected the system from the ground up for cloud computing, so they were able to offer the service at a much lower price while realizing higher margins than competitors.

Google bought Meditech for its customer base and use case models that had been hardened by use over many years. Google took Meditech’s functional specs and enhanced and implemented them in a new architecture. In addition, Google purchased several other HCIT vendors and integrated them to provide a total HCIT solution to customers.

Data Storage

Google did not use a relational database management system (RDBMS) as was common at the time, and instead used schema-less, key-value, non-relational, distributed data stores, aka as NoSQL.

RDBMS scale well, but usually only when that scaling happens on a single server node. When the capacity of that single node is reached, you need to scale out and distribute the load across multiple server nodes. This is when the complexity of relational databases starts to bump up against their potential to scale.

Goggle’s key-value data store model improves scalability by eliminating the need to join data from multiple tables. As a result, commodity multi-core server hardware can be used that are far less expensive than high-end multi-CPU servers and expensive SANs. The overall reduction in cost due to savings in database license fees and maintenance and hardware is around 70% when compared to using a RDBMS. Database sharding and the “shared-nothing” approach is ideal for managing large amounts of data at a low cost.

Three Data Types

Another concept introduced by Google was segregating data into three buckets — transaction data, results data, and analytic data — and managing each differently. Competitors at the time combined all three into one big, complex RDBMS.

Transaction data — what was ordered, when and by whom, what tests were performed, or what meds were given to a patient — are persisted to a transaction data store. At some point, all of the transactions related to a patient encounter are collected in a single electronic medical record file and compressed to about 10% of original size. Results are also contained in this file but not images, due to size, as was the case with the original paper medical record and film file.

The compressed medical record file provides an interactive view of the patient’s encounter to satisfy legal and payment inquiries. These electronic medical record files are stored securely in the cloud. Records are never transferred between organization; rather, access is authorized and the record viewed from the cloud.

Data is purged from the transaction data store once the electronic medical record file is created. The transaction data store remains a constant size and, as a result, it retrieves data faster and is easier to manage than if the transaction data store grew in size. Transaction data is concurrently stored in a separate analytic data store and is not purged.

Google partnered with several business intelligence vendors to offer advanced analytical services from the cloud using the customer’s analytic data store.

Results such as images, labs, reports, and waveforms are also stored in schema-less, key-value, non-relational, distributed data stores.

The three buckets — transaction data, results data, and analytic data — are each stored across multiple commodity server hardware using a “shared-nothing” approach. Scaling any individual bucket for a customer is almost as simple as adding server hardware.

Integration

Google used a derivative of their search engine technology to integrate a patient’s records and results across multiple providers and systems.

Application Development Framework

Google used an application development framework that was easier to build and deploy software. In a RDBMS, application changes and database schema changes have to be managed as one complicated change unit. Google’s key-value data store allows the application to store virtually any structure it wants in a data element. Application changes can be made independent of the database.

In addition, Google used a scripting language for code that changes most often — user-facing code. Both of these features combined to make software development easier and allowed applications to iterate faster. In software development, the rate of innovation is directly related to the rate of iteration.

Mark Moffitt, MBA, BSEE is the former CIO at GSMC in Texas and is working as an independent consultant while he searches for his next opportunity.

Software Upgrades – To Be or Not to Be? That is the Question
By Ron Olsen

The day your facility installs a new piece of software, you rarely think about the upgrades that will inevitably come later. You probably ask if such upgrades are included in the maintenance agreement, and then shuffle away that information for future use … or not.

Many times an upgrade is more than just a requirement from the vendor — it’s a welcome relief that offers bug fixes, provides additional functionality, and many times, increases productivity, which equates to money-saving. Hey, any time we humble IT/IS guys and girls can do something to keep the CIO happy, we’ve got to jump on it! That’s what IT should be all about — increasing the ability to save money and/or help other departments increase revenue streams.

Most of us have been caught in the XP vs. Vista vs. Windows 7 debate. The old adage, ‘If it ain’t broke, don’t fix it’ seems applicable here. XP works fine. Vista is, well, Vista. Windows 7 has generated a lot of hype. Windows 7 offers many enhancements, but if your organization’s PCs aren’t up to it, the new bells and whistles aren’t available. To get the full feel of the new Internet Explorer 9 beta release, Windows 7 is now required.

This is just one example of how an upgrade is never a simple, single-issue vote. There are dozens of interrelated concerns that an IT department must evaluate before pulling the trigger on a software upgrade.

And then the software compatibility issues. How many times have we heard from a vendor, “It’s not certified for (fill in any number of OS versions) yet!” This causes a push me – pull you effect. Some vendors are pushing you to move forward, and others you have to pull along with you.

Things to consider before upgrading your software:

1) Can you adjust your current processes to take advantage of new functionality? Many times we take an upgrade and claim there is not enough time to do a full evaluation prior to going live. Then, we certainly do not have time to go back and look again. This could actually cost your company money in the long run, instead of delivering the benefits of a well-planned project.

2) Downtime can be a deal-breaker for upgrades. No department ever wants to experience downtime unless it’s unavoidable. How will each department test the new upgrade? Do they have a full test system to work with? If all of the issues are thought out beforehand and these questions answered, upgrading shouldn’t be that painful.

3) Does hardware need replaced? Could this be a great opportunity to replace some old PCs and servers? Is this the catalyst that moves your facility to server virtualization …finally?!

4) What vendor software (enterprise forms management, ECM/EDM, etc.) will need to be upgraded simultaneously?

Thoughtful software and hardware upgrades are usually embraced by end users and the C-level alike. Personnel get new PCs that increase productivity, which keeps the Powers that Be happy once they’ve overcome the initial sticker shock. Just the idea of new PCs gets most staff members feeling like the hospital is moving forward technologically.

Server virtualization condenses the physical footprint of the server room, decreases power and cooling costs, and in most cases, reduces server administrative duties. And with your software running faster with full functionality from vendors’ latest compatible releases, IT/IS will (hopefully) get less end user complaints. Hey, it sounds good in theory!

Just make sure you plan well in advance; get buy-in from department heads, super users and (if you’re lucky) an enthusiastic executive; and communicate openly with vendors and you’ll be good to go.

Ron Olsen is a product specialist at Access.

News 9/29/10

From Waterkeeper: “Re: CPOE reality. Another example.” A study finds that electronically preventing entry of CPOE orders for concomitant use of warfarin and sulfa drugs did great at preventing the potential drug interaction, but also delayed treatment in patients for which the simultaneous use was appropriate, causing Penn researchers to stop the study early as being unethical. Says the lead author: “[It] worked extremely well, but putting it in place actually hurt people … it’s naive to think that CPOE 1.0 is going to be perfect. This is a clarion call for continual evaluation of whatever we’re doing in terms of electronic interventions.” You’ve read it here in various interviews, but it’s worth reiterating: CPOE isn’t done just because it’s live and doctors are using it. That’s where the scientific work should begin, but unfortunately usually doesn’t as everybody declares mission accomplished and moves on to some other fire du jour that requires extinguishing.

From EMR Salvage Here, Can’t Bill There: “Re: downtime in Pittsburgh.” Included was an August e-mail to providers purportedly from Medical Service Associates, apologizing for problems in which a network failure led to the discovery that backups couldn’t be restored from either their own two backup systems or the two of their vendor. At the time of the late August e-mail, they still hadn’t restored anything from before the downtime. All unverified and most likely not the final word on the situation there, but my takeaway from experience is the same as always: backups don’t work at least half the time.

Inga e-mailed our sponsor contacts today about a little get-together we’re having for them in Orlando at HIMSS, separate from our Monday night HIStalk reception (nothing too fancy since it’s on a blogger’s budget, but sincere nonetheless since we really appreciate our sponsors). Response has been brisk, so if you’re the boss and haven’t heard about it, check with your internal person before we run out of space. If your company is on the fence about sponsoring HIStalk, we can probably make room if you sign up soon. Plans for the Monday night reception are progressing nicely as well. Expect a big evening that will go a bit beyond our usual food, drinks, and HISsies (running until late, so pace yourself). Stay tuned.

New readers sometimes get confused about who writes what on HIStalk, e-mailing the wrong one of us about something the other wrote. Here’s the deal: Inga writes the part starting with “HERtalk by Inga.” I write all the rest. I do most of the interviews, but I should mention that Inga did the most recent one with Doug Ardoin. And it’s all Inga on HIStalk Practice. Clear as mud, right? She and I are kindred spirits anyway, so we’ll figure it out.

Medical office patient check-in vendor Phreesia completes a $20 million Series D equity financing round. Jumping in is Ascension Health Ventures, the $325 million strategic healthcare venture fund of Ascension Health. 

Strange: a hospital trauma nurse gets a 2 a.m. call on her cell phone from the California Donor Network, with which she’s familiar because of her job. They tell her that her brother has died and they need her permission to harvest his organs. Agitated, she goes to her other brother’s house and they call their sister-in-law to console her, only to hear the sleepy voice of her I’m-not-dead brother asking what they want. The hospital had given the donor group the wrong contact information, that of a patient with the same name but spelled differently. The hospital can’t explain the mistake except to say that the information was wrong when they switched computer systems in 2005. The coroner’s office claims they would have caught the mistake before taking the organs of decedent with the wrong family’s permission.

HHS’s open source CONNECT program wins the 2010 Wall Street Journal Technology Innovation Award for health IT. Runners up are diagnostic image sharing platform vendor lifeIMAGE (I interviewed CEO Hamid Tabatabaie a couple of weeks ago) and Disease Precursor Identification from Ingenix, which identifies people at risk for chronic diseases. 

Munroe Regional Medical Center (FL) says it dropped ED-door-to-balloon time for heart attack patients to 48 minutes, below the national average of 62, by using incident command management software from LiveProcess to manage the Code Blue calls.  

A Weird News Andy find: NewYork-Presbyterian/Columbia University Medical Center admits that someone accidentally opened up a server containing ICU patient information to the Internet. A patient’s family ran across the information via a search engine and told the hospital. I can’t decide which is more annoying about the hospital’s name: that it’s absurdly long with dashes and slashes or that they insist on conjoining New York into a single word for no apparent reason. 

RIM previews its BlackBerry PlayBook tablet device. Like the Torch, I doubt it will generate much consumer interest, especially since it may work only on WiFi, not 3G/4G. That’s speculation since it’s not coming out until next year, making the video a bit premature in its lost cause of convincing iPad prospects to hold off. Businesses will probably like it, though.

The National Quality Forum endorses performance measures and preferred practices for care coordination. Among the latter is electronic medical records.

Ed Marx has updated his Tool Time post with responses to your comments.

Here’s another bad HIT press release, replete with enough odd phrasing, incorrect punctuation, and bizarrely missing information (like the names of the company’s president and the customer who are both quoted) to make it seem highly unlikely that the writer speaks English as a first language. Not that there’s anything wrong with that, but the company is in Minneapolis, where English is pretty common (albeit with a cute accent, like in this horrible, sappy movie that I just played from Netflix for Mrs. HIStalk while I pretended to watch while daydreaming).

The Canadian government will spend $500 million on EMRs in the next fiscal year, with $380 million of that going toward implementation.

ClearPractice announces GA of Nimble, which it says is the first comprehensive EHR for the iPad. It connects to the company’s cloud-based system by WiFi or 3G. Or maybe it’s not the first after all: an updated press release omits the “first” reference and fixes other unspecified errors in verbiage. The release came from a PR company, but it’s never encouraging (in a “Quality Is Job 1.1” kind of way) for a software company to let obvious mistakes get out the door. And in another tactical error, there’s a beautifully made demo video on their site (where I grabbed the screen shot above) that you’d be watching right now if they were smart enough to make it embeddable like everybody else does who wants widespread exposure for free (it’s called YouTube, people). Now I’ve lost interest.

Deborah Peel, MD of Patient Privacy Rights comments on an Information Week article about healthcare data breaches.

I don’t need a cell phone, but I’m thinking about getting the new model of the iPod Touch for running apps, checking e-mail where there’s a WiFi connection, and playing music and video. Good idea or not? I thought it was perfect until I read that Apple had to downsize the camera resolution from 5 megapixels to one to fit into the slim case. Still, it seems like a good deal for $299 for the 16 GB model.

Mohit Kaushal, MD joins West Wireless Health Institute of EVP of business development and chief strategy officer. He was a key player in developing the healthcare portion of the FCC’s national broadband plan, which includes mobile health, when he worked for that organization.

Bob Mitchell, former editor of the dearly departed ADVANCE for HIE, interviews John Glaser about his new job as Siemens Healthcare CEO.

Deaconess chooses Omnicell for medication management.

The Greater Dayton Area Hospital Association (OH) signs up with the HealthBridge HIE.

It’s funny today how many car problems are fixed with a software update. The same is true for implantable defibrillators, for which a new upgrade checks for electronic problems that indicate wire integrity problems that could cause patients to be shocked inappropriately.

Costs of Care, a Boston-based non-profit whose goal is to reduce healthcare costs by giving providers pricing information as they make medical decisions, announces a national essay contest. The best anecdotes from doctors, nurses, and patients illustrating healthcare cost awareness will earn $1,000 prizes. The judges are former HHS secretary Mike Leavitt, Atul Gawande, Tim Johnson of ABC News, the dean of the Harvard Medical School, and Mike Dukakis. Entries are due by November 1. The group, founded in 2009 by medical resident Neel Shah MD, plans to create smart phone and Web apps to provide pricing transparency.

A nurse at Seattle Children’s Hospital kills an ICU baby by mistakenly administering a tenfold overdose of calcium chloride. A 15-year-old died from a narcotic overdose at the same hospital last year.

InterSystems announces Cache’ 10, which adds database mirroring and a high performance solution for Java applications.

I’m totally behind, so be patient if you’ve e-mailed me. I’ll be vacating soon, which will dig the hole I’m in a week deeper, and then attending the mHealth conference to make the backlog worse, but my lack of timely response doesn’t mean I love you any less (that’s my go-to excuse when Mrs. HIStalk catches me paying insufficient attention to her or her movies).

E-mail me.

HERtalk by Inga

From Jellico Jerry: “Re: reality check. Loved your point today about Cerner and Epic, and which deals Cerner won vs. Epic. Cerner won sites with no $$ (UHS, Tenet). Although they are still significant wins, they are very different client bases.” In case you aren’t up to speed, KLAS recently reported that nearly 70% of 2009 hospital EHR purchases were for Cerner and Epic. A reader then noted that if one were just reading HIStalk, you’d think Epic had “cleaned everyone’s clock.” We countered saying Epic got the bigger, more lucrative deals that really count. Anyone who’s dealt with either or both companies knows that Cerner will darn near give the software away to avoid losing a deal, while Epic won’t discount a penny.

The Ohio Health Information Partnership (OHIP) names its five preferred EHRs from the 40 that were considered: Allscripts Professional; eClinicalWorks Unified EMR/PM Solution version 8; e-MDs Solution Series 6.3.0; NextGen Healthcare EHR; and Sage Intergy suite 6.0. Interestingly, OHIP requires that the selected vendors conduct all technical support within the United States.

Quality Systems, NextGen’s parent company, strikes a deal with Pricedoc.com to incorporate PriceDoc’s online search marketing tool into the NextGen Practice Management system. Pricedoc.com is basically a medical version of the travel site Priceline.com, giving patients the chance to name the cash price they are willing to pay for particular procedures or services. Sounds like the deal gives Pricedoc.com access to NextGen’s PM client base and Quality Systems gets a spiff when physicians and patients connect.

T-System releases DigitalShare, a new solution made possible through a strategic partnership with Shareable Ink. DigitalShare allows clinicians to document patient encounters on T-Sheets using Shareable Ink’s digital pen to capture the data. I first saw the technology at MGMA a year ago and made the Mr. H-esque observation/prediction that it would be great technology for the ER.

Lehigh Valley Health Network selects QuadraMed’s Quantim computer-assisted coding solution to help prepare for its ICD-10 transition.

Confer Health Solutions acquires MediHealth Outsourcing, an HIM and clinical revenue cycle company.

Providence Health & Services hires Summit Healthcare to provide dictionary management and data migration services as it moves to Meditech 6.0. Providence also purchases Summit InSync and Summit Scripting Toolkit technology.

GE was the overall leader in the US ultrasound market last year, according to Millennium Research Group. GE increased its lead over Philips and Siemens and now holds about 27% of the $1.2 billion US market.

Former Cerner Eastern US general manager Greg White is promoted to VP and managing director of the company’s Middle East, Africa, and India region. He replaces Rich Berner, who returns to KC as VP of client development.

Axolotl introduces Elysium Discover, a suite of reporting and analytic tools for HIEs.

Northwestern Medical Center (VT) goes live this week on its first phase of Meditech.

ChartWise Medical Systems signs a strategic agreement with 3M Health Information Systems to integrate 3M’s Grouper Plus Software the clinical documentation tool ChartWise:CDI.

Frederick Jelinek, one of the pioneers in the field of voice recognition, died earlier this month. I had never heard of him before reading this article, but he’s credited with enabling computers to understand English. While that accomplishment is significant in and of itself, Jelinek’s challenging background makes his work even more laudable. He was born in what is now the Czech Republic and his dentist/physician father died in a Nazi concentration camp. After his death, Jelinek’s mother moved her family to the US. He graduated from high school and took a job working in a factory to help support his family Jelinek later enrolled in night classes, studied engineering, and eventually earned a doctorate from MIT. He spent his career with IBM and Johns Hopkins University, creating the bones for today’s voice recognition systems. Isn’t that a great story?

Friday marks the first day of the hospital payment year for implementing certified EHRs and using them meaningfully. Guess it would help to have some certified EHRs out there.

Sponsor Updates

• eHealthAlign selects ICA as a strategic partner to technology and infrastructure for its multi-state HIE.
• maxIT Healthcare earns a spot on Modern Healthcare magazine’s list of Best Places to Work in Healthcare.
• Voalte VP Trey Lauderdale will participate in a panel discussion at next week’s CTIA Everywhere Healthcare event in San Francisco.
• MEDecision announces that its Nextalign iEXCHANGE 8.0 solution is now generally available.
• BridgeHead Software wins a contract with The Rotherham NHS Foundation Trust for healthcare data and storage management.
• Picis and The Sullivan Group (TSG) will integrate TSG Clinical Rules risk management solution with Picis ED PulseCheck.
• HealthEast Care System (MN) implements Ingenix Web.Strat medical coding technology, integrated with its McKesson HealthQuest billing system.
• EDIMS announces that its ED EMR clients can access the admission review service of Proven Healthcare Solutions, which offers a 30-minute guarantee.

E-mail Inga.

HIStalk Interviews Doug Ardoin MD, Physician-in-Chief, Memorial Hermann Healthcare System

Charles Douglas Ardoin Jr, MD is physician-in-chief of Memorial Hermann Healthcare System and president of Memorial Hermann Medical Group of Houston, TX.

What are your responsibilities at Memorial Hermann?

I’m involved with physician integration, physician strategy, business development, physician employment, that kind of thing.

Is Memorial Hermann considering creating an Accountable Care Organization?

Absolutely. Our goal at a company level is to continue to follow what changes, or what additions get addressed through those statements throughout the law that said, “The secretary shall.” We’re waiting to see what kinds of things may occur between now and January 1, 2012, but our goal is to definitely be prepared.

Here’s what’s interesting about this whole ACO thing. There are bundle payment demonstration projects going on around CV surgery. There are some of these ACO pilots that are occurring right now.

What I think is really interesting about this whole concept of Accountable Care Organizations is where in the law they describe what kinds of entities will be able to participate in some of these ACO demonstration projects, or will be able to call themselves Accountable Care Organizations.

What hasn’t come out yet, and I’m sure is going to have to come out from the federal government — almost like a Joint Commission certification or the NCQA designation for Patient-Centered Medical Home — that includes a real set of criteria that says, “OK, we’ve told you from a structure standpoint what’s necessary and what we’re going to allow.” But there’s got to be certain benchmarks that you have to hit so that when you apply to one of our ACO demonstration projects, we can say, “Yes, you meet our certification designation or whatever they’re going to call it to be an ACO and to participate in our ACO demonstration project.”

The thing is, none of that’s really been finalized. In the mean time, we’re keeping our ear to the ground saying, “What is that going to look like down the road?” But in the mean time, we know that we’ve got a very large hospital system in Houston, Texas with a very nice geographic footprint. We have acute care, post-acute care, emergency care, trauma care. We’ve got so much of the aspects of care covered. We have relationships for long-term acute care, and skilled nursing home help — all that stuff covered.

We have a relationship with our academic partner, the University of Texas, which has a large clinical practice group. We have our own employed physician organization. We have a very large IPA with over 3,000 physicians that is part of the Memorial Hermann system. We think we have all of the pieces of the puzzle, if ACO was a puzzle and you had to have all the pieces. We think we have it all to be able to connect it together.

I think we’re still waiting for the federal government to come out and say, “Here’s how you connect it. Here’s how you fill out the application so that you can get in the game.” I think we have minimal stuff we’ve got to go build or buy, so to speak. I think we’ve got just about all the pieces that are going to be necessary to put it together. That’s not to say that in some ways we’re not already engaged in or doing things that fit within the model of an Accountable Care Organization.

Like our family practice residency program. The Memorial Hermann Family Practice Residency Program was the first family practice residency program in the country to receive NCQA designation for Patient-Centered Medical Home. The things like that that we’ve done have been fortuitous. Things we’ve been working on over the last few years that we think, “Wow, OK, this positions us very well for this.”

Another good example is our independent physician organization, which is called the Memorial Hermann Physician Network. We’ve been, for the last four years, developing and engaged in our clinical integration model. So, much like the Advocate Physician Group in Chicago that’s probably been at it for over 10 years now, we’ve been at it for about four years. But, we’ve consistently followed all of the FTC guidelines and recommendations on developing our program.

We do have one clinical integration contract now and we’re looking at developing others. Our independent physician organization — the whole basis of clinical integration — is about high-quality, cost-effective healthcare where you get otherwise independent physicians to come together and agree to develop a quality platform amongst the physicians that’s both specialty-specific and for the organization as a whole. It buys a higher-quality care that we think creates a real differentiation in the marketplace.

In the ACO model that Memorial Hermann is considering, what would the governance structure be?

Right now, the law is not very specific, other than that they say that it has to be a shared governance model. Our intent would be to create a shared governance model so that you have — I don’t want to say ‘equal’ — but the correct representation of physicians and hospitals, and maybe the academic medical center and all of the right components.

We like the concept of the shared governance model. We strongly believe that it’s going to need strong physician leadership in that governance model.

As you’ve looked at what’s being proposed and the goals of the ACO model, what would you say are some of the bigger implications for both hospitals and individual physicians?

For years, hospitals and physicians have wanted to figure out ways to better align incentives around patient care, managing costs, and driving good revenues and things like that. I think physicians and hospitals have looked for some kind of a model that really pulls it all together. I think the ACO can potentially do that because the ACO, at the end of the day, is very much focused on the patient, where it’s really about how do you give the most highly coordinated, highest quality care you can give. Quality from the standpoint of process and outcomes.

How do you really give that high-quality care in a model that’s most cost-effective that can be efficient? I think it’s a way for hospitals and physicians to be fully aligned in that regard, because I wholeheartedly believe if you focus on the patient, you do the right thing by patients, then you shouldn’t have to worry about the money.

If you’re doing the right thing for patients, you’re giving them high-quality care. You’re not over-utilizing. You’re not wasting. You’re not ordering tests that they don’t need. You’re not leaving them in a hospital longer than they need to be where they can get an injury or an infection or something of that nature. You’re truly doing the right things for the patients. If you do that, I think the finances will follow suit.

But I think there are some issues here. I think there’s some upside and downside for patients. The upside for patients is the fact that patients will be able to get a sense that their providers are better connected, a better flow of information. That the continuum of care should be more seamless and patients should feel comforted by the fact that the federal government is not going to relax its quality standards. As a matter of fact, it will only enhance their quality standards over the years, so the ACOs will still have to give high-quality care.

I think the issue, though, is that there may be some impact on provider choice for patients. Because what may end up happening down the road — whether it’s through CMS or private insurance plans that decide to follow the same model — is that you’re going to see, in order to achieve the level of connectivity, information flow, quality, and cost savings, these networks are going to have to be rather exclusive to some degree. I think patients are going to have to be willing to accept the fact that, whereas there will be choice within the network, going outside of the ACO, outside of the network, is going to be detrimental to the whole purpose. I think there will be some impact on provider choice to patients.

I think some of the issues that the federal government needs to work through is this whole concept of continuing to pay fee-for-service for some kind of a bonus for cost savings because I don’t think that’s going to work. I see the government having to migrate quickly to fixed payment for certain procedures, like a bundled payment, and some other type of a fixed, bundled payment for populations of patients — almost like a capitation model — in order to really control costs.

I still think within both of those, there can be rewards for achieving certain quality benchmarks and cost savings as well. But the fee-for-service model, I don’t think it’s going to lend itself to the level of cost saving that the federal government is looking for.

Could the fee-for-service model, in time, go away?

I don’t know if it will go away or become significantly modified. Look, if doctors and hospitals continue to get paid on a per-click basis, then what’s going to prevent them from adding up clicks?

So that’s my concern about rolling this out and continuing to have it in a fee-for-service model. I don’t know that it’s going to drive the level of efficiency and cost savings that could be achieved without suffering the quality.

As healthcare moves more to the ACO or Medical Home models of care, what will hospitals and health systems need to do in terms of physician alignment?

I think what you’ll see are increasing models of integration. In other words, you may see more physician employment. You may see more PHO development — Physician Hospital Organization development — where physicians are still independent, but either through a PHO or an IPA model, they declare their loyalty to a hospital or hospital system. I don’t think that ACOs will necessitate employment of physicians, but I think it is going to necessitate a unique level of loyalty or exclusivity for private, practicing physicians who want to engage with a specific ACO.

What are some things that Memorial has done, or things you think need to be done, to effect change in physician behavior when implementing new models of care or even new technology?

Two completely different kinds of questions there. The technology issue really has to do with how disruptive the technology is. At the end of the day, you’ve got a certain generation of physicians who maybe aren’t as IT adept. Therefore, sometimes they have a hard time adjusting to new technologies. I think a lot of the physicians coming out of residency and fellowship today, because they grew up in the Internet age, are much more accepting of new technologies. Therefore, I don’t think that’s as big of an issue, but technology’s one thing.

Models of care .. I think what you have to do there is really work on the alignment of incentives. I think that when you start talking about creating a new model of care, it can’t be a zero-sum game, obviously, to the physician or to the hospitals. There’s got to be a consensus that drives a win-win so that both the hospitals and the doctors can benefit from a new model of care and the incentives can be aligned.

That means just as what’s been described in the ACO. Developing ways that cost savings can be shared back with the providers, both the physicians and the hospitals, is important. Or, rewards for reaching levels of excellence and quality. I think that’s important, too, where you can reward and align incentives around reaching certain quality benchmarks.

What are your thoughts on incorporating decision support tools into the care process?

Let me just say this. I’m a big proponent of always learning how to work smarter and not harder. In other words, why does a physician, every time they admit a patient to the hospital, have to sit down with pen and paper and go through the ADCVAANDIML of writing admission orders?

If you believe a patient has pneumonia, then why don’t you use a common pneumonia order set to admit the patient, or a pneumonia pathway that has flexibility within it to adjust it for the uniqueness of the patient? All of the basic things that happen every time are there. They get covered. You know they’re going to happen, therefore they don’t get forgotten.

I’m a big believer in using admission order sets or care pathways, these kinds of things. I think they’re smart. I think they work. There’s evidence in the literature that patients do very well when they’re placed on these things.

Regarding clinical decision support, I think their only issue there is that you have to worry about alert fatigue. I think you can overdo clinical decision support where physicians will be able to ignore the suggestions. I think that there’s a fine balance there as to how you offer that in the electronic medical record setting without creating alert fatigue, but I think it’s smart stuff.

I think any time you’re about to prescribe a medication that’s going to interact with the patient’s blood thinner and you hadn’t thought about it, you get a nice alert that says, “Whoa, didn’t you know they were on Coumadin?” or whatever. I think that’s perfectly fine. You’ve just got to be careful how often those things trigger and at what levels.

Does Memorial have much in place in terms of clinical pathways?

Yes. Not all of our hospitals are on computerized physician order entry. We have a few that are, and they use order sets and there’s clinical decision support tools and things like that that are being rolled out.

Shifting gears a bit, how will recent healthcare reform affect Memorial? Are there changes being considered or that are being put in place to control cost and improve efficiencies?

I would say Memorial Hermann is always engaged in continuous improvement around being more efficient, controlling costs better, etc. I don’t necessarily know that the healthcare reform law has changed what we’ve always done around here. We’re a not-for-profit, community-owned healthcare system. We always practice good stewardship of our resources, so there’s always that opportunity to look at how we’re doing things.

I think it’s going to impact us, though, just like it’s going to impact everyone else. You’ve got up to the 26-year-olds that you have to be able to offer insurance for under a family plan. The issues of the no-lifetime max, when that kicks in; issues of the no pre-existings, all these kinds of things.

Our health plan is self-funded and I don’t think we’ve ever, for employees or dependents, turned anyone down for pre-existing illness, but we’re going to have the same kind of pressures. We are a healthcare provider and healthcare system, so I think we will always do our best to provide a benefit for our employees.

But unlike us, I think there are going to be, maybe not so much in healthcare, but certainly other industries, where large employers and even small employers are going to have to weigh the option of — do I provide a benefit or do I pay the fine? Which is less expensive for me? Then let the employees get out there and get insurance on their own.

The other thing we worry about is really how strong will the individual mandates be? What are the chances that instead of more people having insurance, actually less people have insurance? You know, there’s always that chance that actually, individuals, if they’re not being provided insurance through their employer, may say, “Well then, I’m not going to go buy it on the open market until I absolutely need it.” So what are the chances that actually the uninsured will go up?

There’s just so much uncertainty and potential unintended consequences that the best I can say is we’ll just kind of hunker down and try to do our best to be prepared.

How is the health system positioned for qualifying for Meaningful Use?

I’m not the expert on that, but I can tell you according to our chief informatics officer, we are extremely well-positioned for Meaningful Use. I think we’ve hit all but one of the last remaining checkmarks. We’ve been named one of the most wired companies in America and all that kind of stuff.

Trust me, we’ve got an ISD team that’s second to none. We’ve got a leader there who is really, just a rock star, and he’s been with us for several years. Very well respected. We’ve done a lot of work in that area and I can assure you, we’re there. We’ve done a lot of work on that one.

What are your priorities for the next five years?

I can tell you that my boss, the president and CEO, Dan Wolterman, said that my number one priority is learning everything I can about Accountable Care Organizations and preparing all aspects of our physician organization to be prepared to move in that direction. That really is the number one thing.

A lot of it is working with our IPA and our clinical integration model to use that as a tactical platform to get us toward an ACO strategy. Also, to integrate with our employed physician enterprise to basically do the same. It’s about helping the physician organization develop all of those aspects of high-quality, cost-effective care in partnership with the healthcare system.

Healthcare IT from the Investor’s Chair 9/28/10

Capitalizing a New Venture: So Many Choices…

I appreciate everyone who reads, especially those who leave comments. A comment on my previous post asked, “Isn’t it ALL about the patient?” 

As I pointed out in my response, for better or worse, healthcare in America is all about entrepreneurship — from medical spas to physician-owned hospitals and imaging centers to million-dollar salaries for hospital execs (I agree wholeheartedly with Mr. H on that topic, btw) to software entrepreneurs like Neal Patterson (Cerner), Judy Faulkner (Epic), or Randy Lipps (who realized that supply storage could be improved while his child was in the hospital and so founded Omnicell).

Anyone in the healthcare system, from physicians to business people to lab managers, who realizes that the current system they are using or experiencing just isn’t working as well as it could or should can decide to take the risk and form a company, develop a product, and go to market. Even before ARRA, HCIT attracted more than its fair share of entrepreneurs. That’s what makes this sector my favorite playground.

That said, I think it’s more like the playground of my youth. Before safety was the law and springy floors and safety teeter-totters came into being, it has historically been an area where start-ups thrive, but a disproportionate amount of investment dollars have been lost. Never a dull moment.

Hopefully someone reading this has started or is thinking of starting a new venture. Let’s explore their options along the continuum to finance it.

Friends and Family

Just what it sounds like. It’s going to Mom and Dad, Rich Aunt Joan, Crazy Cousin Bill, your stoner college roommate who was employee #55 at Google, and all the other friends you ask to put money into your new venture.

This is clearly a mixed bag. While their terms will likely be the most generous and they’ll likely value your new venture at the level you think is fair, these shareholders can be demanding in a psychic way. Family gatherings could turn into business updates. You’ll get calls on nights and weekends.

There’s the risk of that feeling in the pit of your stomach that if it goes wrong, you’ll have to face these people for the rest of your life. Hmm, sounds like a more expensive form of capital then I originally thought.

Angels

“Angel” typically refers to high net worth individuals who invest in private companies for themselves, as opposed to within a fund.

Angel investing has been on an upswing over the past few years for several reasons. First, with the stock market’s mixed performance over the past five years, this class of investor is looking to enhance their returns with some non-traditional investments. More importantly, angels are filling a gap that has resulted from the decreased popularity of traditional venture capital (discussed below).

Angels are typically much closer to the friends and family investor. They also have some of the same pros and cons.

On the positive side, they’re typically easier on valuation and they’ve often been entrepreneurs themselves. On the other hand, they’re not professional investors and so might lack some of the dispassionate views that a VC can bring. While they might have run companies, they might not know healthcare or software at all and might insist that their great success running a plumbing supply business obviously translates to your venture.

Their lack of a traditional venture fund (and its limited partners) cuts both ways as well. Where a VC might care only about an ultimate sale (or IPO), an angel might care more about receiving cash distributions. If you want to invest for growth, that could be a source of conflict.

If you have a choice of angel investors, as the knight in Indiana Jones and the Last Crusade said, “Choose wisely”. Do they bring experience and industry knowledge and contacts, or are they just a source of funds? Whichever it is, would they answer that question the same way that you would? How active do they want or plan to be? Will they want a board seat? Even if not, what will they require for ongoing communication as well as general care and feeding?

The importance of clarity and alignment of goals, vision, and timing here simply can’t be overstated. More than ever before, angels are starting to organize around their activities. Many top-tier business schools and tech associations have formed quasi-official angel groups.

Venture Capitalists

Traditional venture capitalists (VCs) are professionals at investing in private companies. Typically structured as a partnership, the investors (limited partners) tend to be foundations, pension funds, endowments and often high net worth individuals.

Research (and my observation) shows that VCs can bring much more than capital to their portfolio companies. They typically have strong networks in the sector and a great ability for pattern recognition, often having seen similar companies grapple with similar issues.

One of the most successful HCIT entrepreneurs I know once told me that, after herself, she attributed her company’s success most to the VC involved. This clearly suggests that valuation (and even terms) shouldn’t necessarily be the key factor in selecting one’s financial partner.

Beyond that, however, I’ve observed a huge continuum of both personalities and skills. I’ve seen VCs add tremendous value and insight. I’ve also seen VCs where I’d suggest the entrepreneur sell a kidney on eBay before taking their money.

Another factor to consider is that different funds tend to invest at different stages of a company’s life cycle. Loosely defined, these stages range from: (a) a good idea and founder (Seed Stage); (b) great team and product (Series A); (c) proven product and critical mass of customers (Series B); and business seems to be working, but needs growth capital (Series C and beyond).

While topnotch venture capital funds are continuing to fund early stage companies (and HCIT is no exception), for multiple reasons (to be discussed in a future post), fundraising has become more of a challenge to earlier stage companies than ever before. Hence the significant growth in angel investors to fill the gap.

None of the Above

What other options might exist for funding early stage ventures? I’ve seen companies of all stages think creatively to help bridge funding gaps. Government grants (especially lately) are a source of capital. Sourcing expertise from academia can help reduce the burn (many business schools and engineering schools have programs for students to consult).

One of my favorites is customer or partner financing. Perhaps a distribution partner or a few customers will pre-purchase software licenses, allowing you to combine a revenue and capital event. This win-win scenario serves to both build a customer reference and development partner and help your balance sheet.

Many hospital systems now have internal venture funds as well. These range in terms of stage of company they invest in (some are more risk-averse than others), but can also provide an appealing imprimatur to the marketplace of both customers and ultimate investors.

As I said, even though I don’t guard the Grail, my best advice here is to choose wisely. From my research days to now, when I’m looking at a company, one of the first things I do is see how they’re capitalized and who their investors are. Whether it’s shallowness or just a lesson learned, I find that it can tell me a great deal about a company. Is this a fund with a reputation for thoughtful investing and management, or an investor that typically throws companies to the public before they’re ready to maximize their own returns? Are there angels involved with experience and reputations for success?

While perhaps not the best way, assessing the backers is sometimes an efficient way of coming up with preliminary judgments about companies and their management teams.

Thanks for reading, but I’m afraid I’ve run out of space before even getting to Private and Growth Equity investors (who are sometimes also known as leveraged buy-out investors). While I touched on this in my Take Private post, it probably warrants its own, so let me know if there’s interest.

In the mean time, I’ll be attending the Health 2.0 Conference in San Francisco. That will be the topic of next month’s Investing Chair post. If you’ll be there and would like to chat, drop me a note.

Ben Rooks spent ten years as a sell-side equity analyst covering HCIT and related sectors before spending six years as an investment banker where he closed transactions ranging from $40 to 365 million. Seeking to make an honest living, he then founded ST Advisors, LLC where he works with healthcare companies and their sponsors, most often on issues around strategy, financing, and outcomes/exit planning. After all this time, he still can’t wait for HIMSS!

Monday Morning Update 9/27/10

From Sara Dippedy: “Re: crass KLAS. Our company suffered for years under KLAS ‘extortion.’ If we didn’t pay to belong, we were relegated to an asterisked account, insinuating that we were hiding something. All it took was one ticked off IT underling to nail you with an anecdotal crack, even though they were often happy as a bird 24 hours later. Opinions vary due to overambitious vendor guarantees and unrealistic customer expectations. We need an independent, not-for-profit testing authority, like Consumer Reports.”

From EHR Geek: “Re: proctologist. Did I beat Weird News Andy to the punch?” You did. A New York proctologist is arrested at his oceanfront condo for submitting $3.5 million in false Medicare charges, including charging for 85 hemorrhoidectomies performed on the same patient and procedures adding up to more than 24 hours in a single day. My mind immediately offered several witty comments, but I’m sure yours has already done the same.

From Me So Corny: “Re: eHealth Align. The Kansas City HIE’s board approved signing with ICA’s CareAlign as its HIE solution on Friday. It will be announced this week.” Verified, apparently, since it’s on ICA’s Twitter feed.

From The PACS Designer: “Re: ResolutionMD Mobile. The reading of image files on the iPhone is getting easier with ResolutionMD Mobile. The app is free from the iTunes Store. One of the key features is the DICOM processing, and storage stays on the server with window and level manipulation residing on the iPhone.”

Listening: a 1995 CD from obsolete harmonic Canadian power poppers Zumpano. Sounds great.

The California Academy of Family Physicians will use (warning: PDF) a $145K grant from The Physicians Foundation to create an online EMR resource for physicians, including a readiness assessment and tools for EMR selection. “We liken it to changing the tires on a moving car. Our physicians struggle every day to keep the doors open and keep patients healthy. Look, the office doors are open, patients are coming in, it’s flu season — and at the same time you have to adopt an EMR?”

I ran across a cool open source laptop security app called Prey Project. You install its invisible client on your laptop or mobile phone. If the device is stolen, the app phones home via the Internet or text message, sends you its location determined from geolocation services, takes the thief’s picture via webcam, grabs a screenshot of whatever the thief is doing, and locks down the PC. It will look for any open WiFi hotspot if the device isn’t connected to the Internet. If you’re feeling vengeful, you can annoy the thief by remotely triggering an alarm or an onscreen warning.

Doctors in Australia are warned by the New South Wales medical board not to make “flippant and derogatory” comments about patients after a patient complains. Related: the Australian Medical Association questions whether it’s a good idea for doctors to accept the Facebook friend requests of their patients, saying it’s inappropriate for them to blur the professional-social line.

This week’s company-wide e-mail from Kaiser chairman and CEO George Halvorson makes the point that by collecting ethnicity information in HealthConnect, Kaiser can uncover important ethnicity-specific health risks. He makes an interesting point: since every Kaiser patient has the same coverage, treatment, and providers, the only variable is often ethnicity.

Lisa Busby, CIO of Inter-Lakes Health, is named interim CEO after Kevin Haughney quits.

A couple of readers offered software alternatives for mind mapping. Luke O’Scyte recommends for the iPad and iPhone Headspace ($3.99) and iThoughtsHD ($9.99). For the desktop, he’s trying the open source Freemind, which Les also recommends. Ben suggests the free XMind. 

The Health 2.0 conference will be held October 7-8 at the Hilton San Francisco. Companies sending speakers include O’Reilly Media, Microsoft, HHS, Executive Office of the President, Wired Magazine, The New York Times, Cerner, Google, Kaiser Permanente, and WebMD. Other events during Health Innovation Week include a developer’s challenge at the Googleplex, a REC/HIE summit, and HealthCampSFBay. Early bird registration ends Thursday. You can save an extra $100 by using code “HIStalk” when you sign up. I have no financial interest – I’m just being nice in mentioning it.

Epic UGM photos from Wisailer.

Hyland Software, the OnBase document management company, acquires Computer Systems Company of Cleveland, OH. CSC offers document imaging, revenue cycle, and OB/GYN workflow and EHR tools.

Northern Ireland electronic document management vendor Kainos wins its third NHS contract in the last few months.

The Government Accountability Office appoints 19 members to its Patient-Centered Outcomes Research Institute, which was authorized under the Patient Protection and Affordable Care Act. It’s a big deal: this group will get $500 million per year of the $1.1 billion in ARRA money set aside for comparative effectiveness research, including setting research priorities and overseeing clinical trials. CMS can use its results for what sounds like setting co-pays that will encourage more effective treatments. The dean of UCLA’s medical school will head the group.

A patient sues Medical City Dallas (TX) for mishandling her electronic medical records after being called by collectors claiming she owed money for psychiatric treatment. The hospital had mistakenly chosen her medical record for that of an uncooperative psych patient with the same name, then merged the two accounts. Afterward, the hospital sent her a letter saying they would fix the problem, she got more collector calls, and she found the same patient had been admitted again and the same mistake had been made.

Greenway announces the start of its two-day, regionally-offered Meaningful Use training sessions for customers.

It would be fascinating to know why (heavy vendor response?) 75% of readers wouldn’t use a free, ad-supported EMR. New poll to your right: are the product ratings offered by KLAS representative of product performance in a way that’s useful to providers?

An ISMP survey finds that providers are exasperated with never-ending drug shortages. For those unfamiliar, let me explain why that’s a big deal for hospitals. Sometimes there’s only one source of a given drug, meaning doctors are forced to order alternatives they don’t know much about, often drugs that are less effective or more dangerous. Nurse are suddenly looking at unfamiliar drug packages, increasing the chance of medication error. From an IT standpoint, systems have to be changed: automated dispensing cabinets have to be set up for the new item, CPOE and pharmacy systems may require modification, and any systems that read drug bar codes must be re-programmed. Imagine being a high-acuity patient and finding out that your anesthesiologist or surgeon can’t have his or her critical drug, which they know inside and out from years of predictable use, and instead will be rolling the dice on some alternative they’ve already judged inferior, all because a drug company is mysteriously out of the A-team product. Nobody seems to know why shortages happen, but speculation usually runs to the cynical in my hospital: scumbag pharma tactics, wholesaler market fixing, and hoarding by other facilities who hear shortage rumors (that hoarding is often by us, I should add, since we’re just as unhappy about running out of drugs as anyone else and we don’t hesitate to use our clout to jump the line).

The FCC opens up “super WiFi”, the white space airwaves formerly taken up by analog TV signals, a boon for wireless device and service vendors (including those selling hospital technology). An early adopter is rumored to be Microsoft, which supposedly needed only two towers instead of thousands of routers to cover 500 acres on its Redmond campus. Strange: country singer Dolly Parton filed a complaint – she’s worried about the effect on wireless microphones.

This should fuel the usual HIT takeover rumors: Oracle’s Larry Ellison says the company’s string of acquisitions will selectively continue with semiconductor companies and vendors of industry-specific software.

This is scary, especially since it’s probably true here: the #1 organization that graduating college students in Canada would most like to work for is the federal government.

E-mail me.

HIStalk Interviews Paul Brient, President and CEO, PatientKeeper

Paul Brient is president and CEO of PatientKeeper of Newton, MA.

 

Describe what PatientKeeper does.

PatientKeeper focuses very much around automating the day in the life of a physician. We started out about 11 years ago with the observation that physicians weren’t using technology, in hospitals in particular. Some physician practices invested more and more in automating their core workflows, but physicians were largely left out. The general response was to blame the physicians.

We’ve taken a bit of a different tack and said maybe if we blame the technology or looked at the technology differently, we could get physicians to voluntarily adopt technology. Eleven years ago, we weren’t sure that was going to work. Today, we’re pretty excited that we’ve got about 23,000 doctors that have voluntarily adopted our product.

When you look at the Meaningful Use requirements, do you think they put the proper on emphasis on physician utilization?

Certainly the brilliance in Meaningful Use is that it focuses on at least one of the two third-rail workflows in hospitals, that being CPOE. Without it, I know that our organization wouldn’t be spending as much time on CPOE as we are now. I’m certain that our clients would not be spending as much time on CPOE as they are now. That’s one of the last pieces of physician workflow — the other piece being physician documentation — that has really not been adopted in any meaningful way.

If the goal is to get physicians to fully automate their workflow, having focus on it is a good thing. I think, obviously, it’s a very difficult task to come up with the right way to structure those incentives and structure that motivation. I don’t envy anyone in Washington that had to go through that.

In your mind, was it good news or bad news when they throttled back the CPOE target percentage?

It’s certainly a very odd metric for the inpatient hospitals to focus on one medication — I think it’s now ‘per year’ is the interpretation — that needs to be entered electronically. It’s more of a, ‘Hey, this is important — let’s get started.” Here’s a hurdle which I think that it would be pretty unnatural to try to even achieve that particular hurdle because that’s a bit of awkward workflow for doctors. Again, I think it’s a very difficult thing for them to do. I think the key thing is it’s a stake in the ground that says CPOE is important.

Stage 2, hopefully, will be much more significant in terms of really requiring meaningful adoption of CPOE. I think that if that isn’t, then there may be some organizations that don’t really go full-bore. I mean the goal here is to get most of the doctors in a hospital using CPOE. It’s the ultimate goal. One hundred percent is unrealistic given most community hospitals, but 80% and 90% is pretty realistic. How you get there is a little baby step. Hopefully the next step is a bit bigger.

What would you advise hospitals to do now to be ready for the next stage or to accomplish more than just the minimum requirement now?

The timeframes are getting compressed and we spent a long time getting ready. I think it’s a year and a half from the ARRA legislation to the final ruling of Meaningful Use in an overall six-year timeframe, so we spent a lot of time starting. I think that if an organization said, “Hey, I’m just going to try to do the letter of the law here,” there are lots of crazy ways that people have conjectured that an organization could get to the letter of the law in Phase 1.

I think they’re missing the gift of this. The gift is, “Hey, we’re going to give you some more time to get a proper rollout in place. We’re also going to give you some money, because if the first round is relatively easy to comply with, you get the money from that so you can invest in your ongoing rollout.”

I think if you just said, “We’re going to try to maliciously comply,” or “comply to the letter of the law” and don’t have your eye on the prize, you’re then going to get caught in the same squeeze everyone was complaining about when it was a hard hurdle early on.

So unless you’re intending just to say, “We’re going to do Stage 1 and not do Stage 2 and 3,” which I guess would be a strategy, I think that you really need to be focused on how are you going to get to real adoption of CPOE in the provider community, which is still not an easy task just because you have a little more time to get it done.

Will it be different for community-based hospitals whose physicians practice at their discretion versus hospitals that have employed physicians?

I think very much so. We think of the world as three kinds of facilities. As the academic facilities with a large resident population where CPOE has been most successful — where you have the most control, obviously. Then there’s the more employed model hospital in the community setting, although they overlap. And then there’s this, we’ll call it the “classic community hospital,” where you’ve got physicians that are non-employed and in many cases practice at multiple institutions that are your competitors.

That’s obviously the most difficult environment in which to implement these advanced kinds of workflows and get physician adoption. It’s also the environment where we spend a lot of our time because physician adoption of IT has been particularly problematic in those areas. That’s not all of our customer base, but it’s certainly where we can solve some pretty big problems for our customers.

How are hospitals using technology to attract physician business?

It’s interesting. If you put yourself in the seat of a CEO of a community hospital and you’re not employing physicians, you’re trying to get physicians to refer to your facility. There aren’t very many levers that you can pull to make it more attractive for physicians. Most of the levers, really, are around making the physicians more productive and more efficient. Everything from, “Here’s some nice food or doctor’s lunch, they don’t have to go out and get food” to “Here’s some OR block time” and things like that.

We’re seeing a lot of organizations rely on technology and say, “Look, we can put technology in place. It’s going to save you time when you practice here and reduce hassle.” That’s a big win for doctors because essentially, what they do is they sell their time. So if you make them 10% more efficient by coming here versus going there, that translates pretty directly into more patients, more revenue, a more effective physician. We work with a lot of organizations that really have physicians-facing technology as part of their competitive differentiation in the marketplace.

People aren’t paying much attention to is the fact that the majority of community-based physicians practice in multiple facilities. Are there going to be concerns or push-back from doctors that they’re expected to learn more than one system for more than one hospital?

Very much so, and unfortunately, not just more than one from more than one hospital.

We’ve done some studies of community physicians. When you start adding up all the different systems they have to use, even in a hospital, and then you replicate that at two or maybe three hospitals, it’s just chaos. Early in the day when PDAs first started coming, a lot of them had PDAs just for their usernames and passwords. Of course now they’re on their iPhones and Android phones, but it’s a real problem.

If you think about something as critical as order entry, you have to learn two different user interfaces with potentially two different order sets. Since we talk a lot about evidence-based medicine — which is great, except that 70% or so of the orders in the order set aren’t evidence-driven — two hospitals in the community might have very different-looking order sets.

That’s a real challenge and something that I think people … I know our customers in those situations fully appreciate the challenge, but it didn’t really resonate as much, I think, in the Meaningful Use dollar.

You mentioned evidence-based order sets. It’s interesting that in most hospitals, all they’ve done is to take the market basket of every possible order already being used, dump it in an order set, and say, “OK, we’ve accomplished something.” How do you see that progressing to get to where it is more evidence-based and not just reflecting current practice?

It’s really interesting and very challenging. Especially if you start with a notion, which I think is pretty well-documented, that the majority of the orders in an order set aren’t evidence-driven. You end up with these crazy order sets, which is here are all the personal preference items for all the physicians in one order set, so it’s like nine pages long. Clearly that’s not useful really to anyone other than you can check a box and say, “Yes, I have an order set here.”

I think where things are going, and why people are trying to push this, is the core evidence around conditions are reasonably non-controversial, not necessarily practiced by everybody, but at least when you present it to someone, you don’t get a lot of push-back. There’s starting to be organizations like Zynx and Provation and others that have evidence-based order sets you can purchase and you can say, “Here’s the evidence piece.”

The trick is what to do about the rest of the orders. I think that’s where you can end up with the simplest, from a technology perspective. It’s, “Let’s go with doctors together and we’ll agree here, in this medical staff, on all the non-evidence-based orders and which ones we’re going to put in and make it more reasonable.”

Again, that works great in an academic setting where you’re trying to teach everyone to practice medicine, so it’s good. In a community setting, especially one with splitters and voluntary physician staff, it’s almost impossible to get the bandwidth to do that.

I think you’ll see organizations really want to try to say, how do we take evidence and then allow the physician convenience items to be managed separately from the evidence so that we still have a nice evidence-based, consistent practice of medicine here, but if I want the nurse to call me when a temperature is 102 or their hematocrit hasn’t gone up by more than 10% every hour or whatever the triggers I like to use. They’re different with another doctor. I don’t necessarily think that we try to homogenize that across all the surgeons in the community.

Is it reasonable to expect, given the status of the technology today and how people are likely to deploy it, that we’ll see an immediate improvement in healthcare delivery with an increased utilization of technology?

That is the $20 billion question. Clearly with Stage 1 Meaningful Use, we’re not going to see a significant impact on the cost or quality of healthcare delivery. The requirements aren’t such that that’s going to make a difference. It’s a process, and I think that the people that put together Meaningful Use really recognized that process.

I think that in order to really get a big impact, we have to change behavior, and that isn’t just a technology problem. You can put all the standard order sets in the world in front of physicians, but unless they do something different as a result and you’re able to change the way they practice or the way they interact with information or the way they operate with the care teams, then this isn’t going to make a difference at all. Except for perhaps to save some time with ward clerks and save some paper and things like that.

I believe that technology’s a really critical tool. With a fully electronic environment, you can see in real time what’s being ordered. You’ve got computer systems that can generate alerts and understand things. Used properly, it can make a huge difference, but it’s got to be used properly. I don’t think we’re going to see those impacts until the late stages of Meaningful Use, and probably thereafter.

I’m sure you’re familiar with the studies that show in some cases, increases in mortality as a result of putting in CPOE systems. Obviously, that’s using things improperly, but it is not a given and it’s not just a, “Check the box, it’s automated. Look, wow, it’s better!” It’s not like factory automation. It is really something that’s going to become part of the process, part of the culture, but you have to have it in place in order to do that.

If I were to read intent into the Meaningful Use approach, I really think that’s what’s going on here. I think that it’s an investment that will pay off, but it’s not immediate. My fear is that the world at large is looking for an immediate kind of increase and improvement. Just like, frankly, many other automation tasks in other industries, the improvements aren’t that immediate, but they’re there.

Do you think this is the carrot and there’s a stick yet to come?

I don’t know. Certainly, the stick is an important part of the legislation. The stick isn’t that big, frankly. You can take away the Medicare increases for organizations, but of course people remind us that Medicare’s been going down recently. I think it’s going to be difficult, politically, for the government to impose much of a stick. That’s just my conjecture.

I think the stick will come, probably more from peer pressure, if that’s the right term — competition of industries — but these hospitals are geographically separate. But I think if we can get 60-70% of the hospitals in the country to whatever Stage 3 Meaningful Use is, then it becomes a, “Look, you have to do this to keep the doors open.”

Hospitals have adopted all sorts of things. We don’t give them credit for basically going filmless in the imaging side. Most nursing workflow automation, pharmacy automation, lab automation — all these things have happened. Bar code meds administration — all these things have happened without Meaningful use, so I think there will still be pressures in the industry.

I think what this has done is brought these applications that probably would have been very low on the list of priorities to the forefront. I think if there can be a real effort to get most of these hospitals going, the rest will fall in line without a stick.

How big a game-changer is mobile access going to be?

We think it’s fundamentally important for so much of physician adoption. Not so much because it’s the only way, or even the primary way someone would put data in or look at data. But just like your e-mail and your BlackBerry are so fundamentally important to the way knowledge workers work today, without my BlackBerry, my e-mail’s a very different thing.

Likewise with physicians, when we give them desktop access and mobile access, it gives them the ability to work in ways that fit so well the way physicians work, especially these physicians that have multiple, different hospitals. Great, we’ve got lots of computers at our hospital. You go to the next hospital, in some cases they’re a huge pain to get at. Sometimes you can’t get into your other hospital system –  you’re not comfortable on the floor pulling up some of the hospital’s stuff. You get a call — you can’t get access to information in your car, so it really is a really important, critical part of the physician workflow.

If you go into the CPOE world in particular, you see a lot of adoption challenges with CPOE around the simple orders, the bedside order, where you walk in and the nurse says, “I want to give the patient a medication for nausea.” Today, that’s a simple thing. I’ll just note in the chart because I’ve got it here in my hand. It takes 5-10 seconds to write down the order. In the CPOE world, now I’ve got to go get a computer, I’ve got to get logged in, I’ve got to get the order in. Maybe that’s only a minute and a half, but I do that times 20 and now I’ve wasted a half hour of my day being annoyed.

Whereas on my iPhone or my Android, three taps and the person’s got the medicine. That’s even easier than the chart and I know that it’s checked so I don’t have to think about what meds they’re on already. So in cases of contraindication, it comes right away so I can be confident in that. I think it’s a game-changer in CPOE. I think it eliminates some of the real issues that we’ve heard from physicians, even in organizations that have been successful in the CPOE world.

Any final thoughts?

Well, it certainly is an exciting time to be in healthcare IT. I know you’ve been in this industry for quite a long time. I have been my entire career. Up until about two years ago, I showed up at a cocktail party and told people I was in healthcare IT and people kind of looked at me funny and we’d talk about something else. Now, everyone’s excited about it. They’re like, “Wow, this is going to really make an impact,” and I think that’s both a blessing and a curse.

I’m hopeful that, as an industry, we’re able to deliver the impact, the ultimate impact. Bending the cost-curve, improving quality, and frankly, helping make it less painful for patients and doctors. But ultimately, for patients to access the healthcare system. I think technology holds a lot of promise for that.

We didn’t talk a lot about HIE, but I think that’s another area of opportunity for the industry, where it could really become a really important game-changer around patient engagemen,t a reduction in patient frustration that I think can also save a lot of costs.

News 9/24/10

From Clinical Wisdom: “Re: KLAS. A friend told me that Eclipsys paid KLAS $300K per year. Can KLAS accept mega-bucks from vendors they evaluate without being influenced by their cash? Imagine Consumer Reports taking money from car companies. I think they owe those who buy their reports a full accounting of what they earn from vendors and what those vendors are promised.” We’ve been around and around the KLAS business model over the years. Providers don’t usually pay KLAS for the reports; they get them free in return for providing data, so they would not be surprised to find that vendors pay big bucks (i.e., it’s the HIMSS “ladies drink free” model). I asked Adam Gale in my 2007 interview if the company would be willing to have its survey and ranking process audited by an outside expert. He said yes, but that hasn’t gone anywhere as far as I know. He offered this comment when I asked if being paid by vendors is a conflict of interest:

I would say we have one of the world’s strangest business models, where internally, if you ask anyone at KLAS who our customer is, they’d tell you it’s the provider. That sometimes irks the vendors because they pay a reasonable amount of money to have access to the subscriber data. One vendor, as a mistake, sent us an e-mail intended to be internal that said, “Doesn’t KLAS understand who the customer is based on how much money we spend?” We hold that up and cheer. The vendor is not our key customer. The provider is. We frame every vendor question in terms of, “Will it help providers make a better decision?”

From Spell Czech: “Re: CareFusion Pyxis. Are they really struggling against Omnicell? I hadn’t heard that. Love the blog — been reading for a couple years now!” I’m sure Pyxis still holds most of the market, but it wasn’t long ago that they never lost customers. Both my current and previous hospital employers reconsidered whether Pyxis was worth keeping (clunky software, arrogance, bad support). In one case, we begrudgingly stuck with them because McKesson’s product wasn’t fully baked and Omnicell was struggling. In the other, we dumped Pyxis and never looked back. My conclusion is that, finally, Pyxis has some real competition from both of those now-acceptable alternatives and the market is reacting at least somewhat to that, even though those competitors share some of the same flaws (too many engineers making design decisions and worrying about moving parts instead of nurse-friendly software). I haven’t heard anything about Cerner’s entry into that business. Competition is good for everyone, especially the customer and patient.

From Mighty: “Re: ED denominator for Meaningful Use. CMS has finalized it, though I don’t see it mentioned in many places.” The CMS clarification says that only ED patients who are admitted as inpatients or who are treated as observation patients count toward the CPOE requirement and other parts of MU.  

From Computer Giant: “Re: UPMC. Can the EMRs not solve this problem?” That was tongue in cheek, in case you couldn’t tell. UPMC howls when a state report finds that flagship UPMC Presbyterian-Shadyside has a higher-than-expected mortality rate for CHF, septicemia, respiratory failure, and stroke. Their excuse is the standard: “our patients are sicker,” but when the state responded that everything was severity-adjusted, UPMC then commented that their younger patients throw off the stats. I’ve yet to see a hospital that took the news constructively that it’s underperforming. Be comforted: in their own minds, every hospital is above average.

From Peggy: “Re: Epic co-op. I love your site. I read it religiously! Our hospital is evaluating vendors to replace our clinical core and Epic is (of course) one of them. I’m interested in the consulting co-up you mentioned. Would you mind sharing more information?” I don’t have details, but I’m sure they will emerge publicly at some point.

From Slidell Computer: “Re: executive director of Physician Hospitals of America. She’s leaving. Rumors are circulating that changes will force physician-owned hospitals to sell out or close. Maybe she sees the writing on the wall.”

From Not Quite: “Re: GOP’s Pledge to America. It returns the country to the 2008 budget, ARRA stimulus money for EHR systems will end, and according to polls, the GOP will take over Congress. Shouldn’t all EHR purchases stop now since they won’t get their incentives?” I’ll stay out of the political debate since I distrust all politicians equally (except maybe Chuck Grassley and Ron Paul), but I would say that anyone buying an EHR solely because of Uncle Sam’s promised largesse should think twice even without the Pledge to America. CMS is like a devious cat owner waving a laser pointer around: they love to see providers jump around in reaction to ever-changing and mind-bendingly complex policies that address what initially seemed like simple, good ideas to make sure no payouts actually occur.

Wisailer, a reader attending Epic’s UGM, shared some of the interesting aspects from the meeting so far (his or her words, not mine):

• According to Judy, one of Epic’s goals is "to improve health care for the world," based on their estimate that 30% of the US population is covered by an Epic EMR.
• She says “do what Epic says" and your implementation will succeed.
• Epic has spent 66,000 hours on Meaningful Use, which Carl Dvorak seemed to imply has slowed down their transition to Web-based applications.
• The customer base is 224, up from 190 last year, and many of the sessions were oriented to new installations.
• 200,000 physicians use Epic.
• Vendor ally — boring. Lots of suites and pretty smiles. More consultants, fewer device and service providers.
• Swag consisted of pre-washed, BPA-free water bottles with special refill funnels at water coolers.
• The Haiku iPhone app will be extended to the Droid soon.
• Canto, a new Epic iPad application, will be released in the near future. LOTS of buzz about this product.
• Horse-drawn carriages are giving tours of the campus and bikes are available directly across from Epic Farms, thought by many to be the production source of Epic Kool-Aid.

The pic above of some of the Epic festivities, which looks like a more affluent, less crowded, and much colder (highs in the 60s this weekend) version of Woodstock, is from Dave Yost’s blog.

As Inga told me, we’ve been outed by Google. I set up HIStalkTV a few months back on a slow Sunday afternoon just to play around with posting HIT-related videos that I found amusing or useful. The site is suddenly popping up on search engines for some reason and readers are e-mailing us about it. It’s definitely beta and I haven’t really decided what to do with it if anything, but feel free to send me your thoughts. We even had one of our favorite PR people ask about sponsorship opportunities, which I appreciate even though I’ve given that zero thought.

I was motivated by Ed’s CIO Unplugged post about his use of MindManager for mind mapping, list making, etc. (maybe because he featured HIStalk prominently in the picture). I tried some of those programs years ago and lost interest, but figured I would look again since I really like the concept for creativity. I lost interest in MindManager again when I saw that it has become Visio-ized (tons of overly complex functionality added for corporations and priced accordingly — $349), so I found a simpler alternative that seems to work great: MindVisualizer ($79). I’m running the free trial and will probably buy it because it’s pretty darned slick. I used it today to make a few plans for the HIStalk reception at HIMSS and the tool didn’t get in the way of my thought process, which is the most important criterion.

This seems remarkably open minded considering the source: on the HIMSS blog, the senior director of federal affairs (Tom Leary) asks for comments on the federal government’s role in ensuring the safety of HIT products. Supposedly the only reason the FDA doesn’t regulate HIT today is because of some fancy, long-ago behind-the-scenes political footwork by various groups and vendors, so maybe HIMSS is considering taking an official position. Why not chime in?

A fun Medgadget post: the National Space Biomedical Research Institute has developed an astronaut EMR that combines a mobile monitoring device with software. The EMR is iRevive from 10Blade, which was designed for EMS users (you mean astronauts don’t enjoy the benefits of a certified EHR?)

Continuing my rant on badly written press releases, this HIE one speaks for itself. For the love of God, doctor and press release writer, take a breath! In addition to the hopelessly dense text, it starts off with (1) a mini-editorial; (2) a snooze-inducing history lesson; (3) a ton of quotes, apparently all so equally significant that none could be omitted to make it readable; and (4) in the VERY LAST paragraph, one long sentence that contains the only real news in all that fluff. There is a reason that companies pay experts to craft their communication instead of doing it themselves.

Precyse Solutions will unveil its new Automated Clinical Documentation software and Computer Assisted Coding software engine at AHIMA in Orlando next week.

Weird News Andy entitles this as “Half a woman is better than none.” Doctors in Canada take a drastic step to save a 31-year-old woman with untreatable bone cancer: they cut her body in half by removing her leg, lower spine, and part of her pelvis, then do a “pogo stick rebuild” in fusing her remaining leg back to her body. I wish I had her positive outlook: “I have no problem getting around. If I need to, I’ll crawl (up stairs) or scooch like a kid.” The most bizarre aspect of the story in my mind, however, was how the doctors described the size of the tumor: they said it was the size of a calzone.

Welcome and thanks to brand new HIStalk Platinum Sponsor T-System of Dallas, TX, which created and sells what is surely one of the most effective, well-accepted, and ingenious paper documentation solutions ever devised: the famous T-Sheets, on which over 30 million ED visits are documented each year. The company offers other versions for ED nurses, order sets, urgent care, and primary care, but I’m sure they would also want you to know about T SystemEV, the company’s emergency department information system (with modules for patient tracking, status board, nurses, physicians, and CPOE) that’s used by 240 hospitals. It offers comprehensive physician and nurse documentation, clinical content, a short learning curve (often just one shift, they say), status board, prescription writing, discharge instructions, CPOE, lab integration, real-time coding capture, and patient satisfaction and reporting tools. All are important for Meaningful Use, of course. Former McKesson MPT President Sunny Sunyal recently joined T-System as CEO, so I’d say he did his due diligence and liked the company’s performance and potential. Thanks to T-System for supporting HIStalk — Inga and I appreciate it.

All adult hospitals in Milwaukee County, WI will use My Health Direct for ED referrals to community health centers, courtesy of an agreement signed with the Wisconsin HIE. I interviewed Jay Mason, the chairman and CEO of My Health Direct, in June.

I was checking up to see what’s happening with long-time HIStalk bestie Scott Shreeve MD, formerly of Medsphere and now building Crossover Health, a member-based medical practice that will provide individualized urgent, primary care, and online health services from clinics in California (Newport Beach, Foothill Ranch, and Aliso Viejo). I didn’t think I’d be interested in the construction video above, but it’s pretty fascinating to see how that company and others are taking a very different approach to healthcare delivery for those who can pay for it themselves.

Some unusually juicy jobs on the HIStalk Sponsor Job Page: Sales Director, VP of Solutions Marketing, McKesson Consultants, Head of Quality Systems, Sales Director. On Healthcare IT Jobs, Senior Account Executive for VA, Sales Professional – North Carolina, Clinical Systems Analyst III, Epic Project Managers, Eclipsys Documentation Consultant.

Home care mobile solutions provider CellTrak Technologies announces the latest version of its smart phone system, which includes Android capability. It’s also sold in Canada by TELUS Health.

The US Army awards a research grant to InterSystems to look at its HealthShare platform to exchange data between Madigan Healthcare System (WA) and South Sound HIE.

Medical College of Wisconsin spinoff Imaging Biometrics gets an $800K NIH grant to develop its software that helps clinicians distinguish tumors from healthy tissue.

Odd: a woman’s iPhone is stolen while she is hospitalized and in labor.

E-mail me.

HERtalk by Inga

From Hamlet: “Re: KLAS, Epic, etc. KLAS found that nearly 70% of new 2009 hospital EMR purchases were for an Epic or Cerner integrated solution. Reading HIStalk, you would think Epic cleaned everyone’s clock.” They cleaned a lot of the clocks that counted, i.e. the big, influential hospitals with lots of beds and big dollar volume.

From A-Rod: “Re: on the move. Long-time healthcare CIO Bob Kaplan has been appointed EVP and CIO of Audax Health Solutions in Washington, DC. Bob has been CIO of WebMD, NCQA, IFMC, National Preferred Provider Network, and PHP Healthcare Corp.”  According to the Audax Web site, the company is an early-stage startup developing products that “change how patients and providers interact.”

From Sunshiney: “Eclipsys wins. Mercy Memorial Hospital System in Michigan is replacing McKesson with Eclipsys and Sidra Medical and Research Center in Qatar picks Eclipsys’ inpatient EHR.” Both verified.

Capario promotes sales and marketing VP Jim Riley to president. He replaces Andrew Lawson, who will be moving to another company within Martin Equity Partners, the entity that owns Capario. Riley was previously VP of sales and marketing for Payerpath, where he also worked under Jim Brady, Capario’s executive chairman.

Saint Barnabas Health Care System (NJ) picks EDIMS and its EDIS software for its six-hospital system.

Scribe Healthcare Technologies introduces Scribe Mobile, a new dictation app for the iPhone, iTouch, and iPad.

Yet another entity announces its ICD-10 conversion strategy. Global IT service provider HCL Technologies will use Health Language’s Language Engine solution as part of its end-to-end ICD-10 conversion solution.

Central Jersey HIE Project selects Advanced Data Systems, Greenway Medical, and MDTablet as its recommended EHR vendors. Well, at least that is what I think was said in the HIE’s very rambling press release.

Holy Redeemer Health System (PA) will implement MobileMD and its 4D HIE technology to provide connectivity among the hospital, community physicians, and other area care providers.

This week on HIStalk Practice: InfoGard provides an update on when they’ll begin EHR certification and testing. A medical office janitor lands in jail after selling patient charts to a recycling company for $40. Theories on why medical office hiring is up despite declining revenues. A new study reveals the top EHR/PM companies in the ambulatory world.

A sign of the times: San Juan College (NM) says it will shut down its medical transcription program at the end of the school year. School administrators admit that computers are increasingly taking the place of traditional medical transcription, so the school will instead focus on modernizing its coding and HIT degrees.

The local press highlights Rapid City Regional Hospital and its migration to Meditech. The hospital has implemented bedside medication verification and is now moving to physician documentation. The transition is not without its opponents, including one neurologist who is apparently not a big fan of EHRs:

They are good for insurance companies and good for controlling data, but it’s not necessarily good for patient care. The travesty is, so far the systems are bad. You’re not talking to the patients. You’re talking to the computers. If the doctor has to type, they’re not going to add very much information. Either you input data or you take care of patients, but you can’t do both well.

KLAS finds that the oncology market has been mostly ignored by enterprise software vendors, with best-of-breed vendors dominating the market. Enterprise vendors are more focused on the medical, rather than radiation oncology market, and often vendors are less interested in functionality and more focused on integration with other systems. Epic is named the closest enterprise system to delivering an oncology solution. Cerner, Eclipsys, GE, Meditech, and Siemens offer varying functionality as well.

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CIO Unplugged 9/22/10

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

Tool Time

This is a picture of my home workbench. I think you can tell from it that I’m not a productive handyman. I learned some time ago that power tools were not my thing. I leave that work to those who have a passion and talent for it.

What does stoke my fire is leveraging IT to enable improved clinical and business outcomes. Thus, I have a much greater interest in my career “workbench.”

What follows is what works for me. Perhaps it will inspire some new ideas for you. Either way, share what works for you in the Comments section.

A common thread throughout my life is the principle of simplicity. Hardware, software, or systems that are robust, yet easy to use,are my tools of choice.

Software

Texas Health is a Microsoft strategic partner and my applications largely reflect this. I use the Office suite exclusively, including OneNote. Everything is integrated and I can easily move in and out of these apps without any format or compatibility challenges.

I use Office Communication Server (video, voice, IM) as my communications tool for all of the aforementioned reasons. It is very simple and easy to have all of my primary business applications on the same platform.

Two exceptions include Yammer and Mindjet Manager Pro. Yammer is our internal collaboration software, often referred to as “Twitter for Business.” The use of Yammer has helped our enterprise in some incredible ways, including responding to emergencies (H1N1, power disruptions) and leveraging the wisdom of the crowds.

Mindjet is a tool to help me organize my thoughts for presentations, meetings, and yes, my blogs.

Hardware

Texas Health is also a HP strategic partner and my device is my office, so I currently have a ProBook 5310. I love that my video and communications devices are all built in. No air cards, phones, or cameras to mess with. It’s all included and very lightweight for travel. Because I like to mess with people’s minds, I have an Apple logo affixed to the black casing, which causes people to scratch their heads.

Mobile

I’ve had a BlackBerry for years and do not plan to change anytime soon (sorry, partners). I upgrade each year and currently have the Storm2. On more than one occasion, I have gone without my ProBook and just leveraged my BlackBerry. I am trending this direction as a permanent solution, albeit I think we are a couple of years out.

What I absolutely will not carry around is a laptop and a mobile and something akin to an iPad. This is way too many devices. I know people who function like this and in some cases, add a pager and/or office phone to boot. That’s just plain silly and gives IT a bad vibe. If you use more than two devices, your life is unnecessarily complicated.

Manbag

Since I operate within a virtual office, another key tool is my leather briefcase. People make fun of my soft-sided manbag because it is worn and weathered. Well, there’s good reason for its scuffed look — I’m always on the go, visiting my team and my customers. It is practical and durable.

Systems

The least tangible but most important of all the tools is what I call “systems.” A system is a well-established routine that you no longer have to think about that enables your highest level of productivity. You can have the greatest tools in the world, but you hamper your effectiveness by not automating manual and routine processes. Sound familiar? Think EHR/CPOE.

One of my “systems” is to have everything I need for the next day’s adventure ready and updated the evening before. When I wake up, I am out the door and driving to the gym in five minutes. Manbag included.

What about you? What’s on your workbench? What tools work best for you?

Update 9/27/10

Thank you for your comments and input on tools that work for you. There is no single perfect tool for everyone, but it is critical that you find one that works best for you.

There were some great suggestions on HIStalk for mind mapping-like software. You should certainly give one of these a try and see if it helps you organize your thoughts and work.

As for “where’s the beef?” as one reader asked, I have posted on more technical subjects like cloud computing, mobility, and virtualization, but I tend to focus more on leadership oriented topics. In my journey, I have found plenty of great technical expertise in our industry, but believe what is lacking to make us more strategic is fundamental leadership.

My focus is on leadership, service, partnerships, and strategy. I will sprinkle in a few thoughts on the more technical side, so stay tuned and keep letting me know what you would like to see.

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.”

UnitedHealth Group To Acquire A-Life Medical

UnitedHealth Group announced after the market close Tuesday that it will acquire computer-assisted coding vendor A-Life Medical of San Diego, CA. Terms were not disclosed.

UnitedHealth Group will add A-Life Medical to its Ingenix Health Care Delivery business, extending a strategic alliance formed between the companies last year to develop advanced coding solutions.

A-Life Medical’s products include the LifeCode natural language processing solution, which analyzes clinical documentation to identify diagnoses and procedures and recommend ICD-9 and CPT-4 codes to coders. Its Actus computer-assisted coding product will allow Ingenix to market services to providers transitioning to ICD-10 by the mandatory October 1, 2013 date.

The acquisition is UnitedHealth’s fourth technology-related buy so far this year, having previously absorbed Picis (high acuity systems), Executive Health Resources (medical necessity and compliance), and Axolotol (health information exchange systems).

News 9/22/10

From Medicament: “Re: Epic UGM. Announced attendance is 5,500 vs. 3,800 last year. Surreal. This panorama is from the auditorium just after Judy’s keynote.” If you are there, send me a report of any newsworthy developments. Sorry the pic is small, but that’s the point: the meeting isn’t.

From Neils Bohr: “Re: Accenture. I heard they got the HHS contract for use case for the Standards and Interoperability Framework last Friday.”

From Epic CoOp: “Re: Epic consultants. Given the huge demand, 20 of them are forming a consulting co-op to keep the cut that temp agencies take.”

From Blue Danube: “Re: video. Even though it’s an ad for Centricity, it paints a pretty accurate picture of primary care and the need for EMRs.”

Listening: new (released just today) from John Legend and The Roots, a collaboration between the modern R&B/hip hop singer (John Legend) and the Philly funk band (The Roots), updating socially conscious soul songs from the 60s and 70s. I can’t describe just how awesome this album is, sounding as fresh and uncomplicated as Motown circa 1968. If you don’t like soul or hip hop music because it’s over-produced, non-melodic, and fixated with trite subjects like lust or fame, let this rekindle your hope for the genre. I usually condition my recommendations knowing they aren’t for everyone, but this one’s for everyone.

UnitedHealth Group makes another buy, announcing plans to acquire coding vendor A-Life Medical. I covered it in a news blast here. UnitedHealth Groups is obviously on an HIT tear, bagging four companies so far this year. That’s a good reminder to sign up for updates using the Subscribe to Updates box on the upper-right of this page and/or to Friend/Like us on Facebook since I usually post new stuff there too.

The San Diego office of the FBI announces that El Centro Regional Medical Center (CA) will pay $2.2 million plus interest to settle Medicare fraud allegations brought forward in a former employee’s whistleblower lawsuit.

Rothman Healthcare hires Richard Sommer as CEO. I hadn’t heard of the company, so I checked it out. It markets products based on The Rothman Index, an automated system that collects 26 observations and results for each patient every hour and graphs the score so caregivers can quickly see who’s crashing. The trial was at Sarasota Memorial (FL). The Rothman brothers found the company after their mother died after post-surgical complications that were subtle and therefore undetected in the hospital. According to the company’s site, nurses at its first hospital site identified a patient going bad within five minutes of bringing the system up in test mode, reacting to a patient whose pulse-ox had dropped from 98% to 85% over two days without alarming anyone.

Jewish General Hospital of Montreal, Quebec will use education and clinical image sharing tools from Aurora Interactive to create an online pathology education network.

McKesson, HP, and Intel launch a site that mixes HITECH resources with preconfigured EHR hardware/software packages.

Transcend Services announces BeyondAlerts, which extracts clinical data from transcribed narrative to trigger provider alerts.

Panasonic will offer data encryption from Mobile Armor in its Toughbook notebooks and mobile clinical assistants. That includes self-encrypting Seagate drives, centralized management, pre-boot authentication, and auditing. Smart.

I made fun of a Brainware sales announcement a few weeks back because it didn’t name the customer (for contractual reasons, no doubt, but I still questioned the newsworthiness of an anonymous customer sale). They sent me their latest announcement this week, joking that this one names names, that being Gundersen Lutheran Health System (WI). Brainware and Ascend Software are providing the Brainware Distiller intelligent data capture tool along with business process automation for the health system’s Lawson accounts payable system. Brainware’s tools pull data out of unstructured sources such as invoices without templates or indexing. For AP, that means speeding up processing and providing a near real-time view into liabilities. It uses fuzzy search to assign GL codes and vendor numbers to non-PO invoices. Its Gateway product is a portal for vendors to check the status of their invoices online.

Since I shamed Brainware, let’s move on to the next poster child for bad press releases. Does this headline roll off your tongue? The Institute for Transfusion Medicine(SM) (ITxM)(SM) Deploying BIO-key(R) Fingerprint Search and Identification Solution for Donors and Patients. Marketing people can’t even introduce themselves without holding up little trademark and service mark signs. I guarantee that nobody could read this even 2-3 times and have the slightest clue what it’s about with all the unnecessary, lawyer-paranoid clutter.

Covisint, the portal vendor owned by Compuware, acquires DocSite of Raleigh, NC, which offers PQRI, registry, decision support, e-prescribing, progress notes, and integration tools. Roger Sterling tipped us off in the 9/1 HIStalk, although Inga couldn’t get Covisint to confirm.

Children’s Boston will use Allocade’s On-Cue Operations Management software in radiology. It pulls data from existing systems to create a rule-optimized patient itinerary and provides caregiver collaboration tools and business intelligence.

New Jersey’s HITREC contracts for physician practice consulting services from Nit Health. Being a hospital guy, I couldn’t help but think of small combs and Kwell shampoo.

Maimonides Medical Center (NY) goes live with InterSystems Ensemble for rapid integration and development, using it to develop new interfaces to/from Sunrise Clinical Manager.  

An interesting debate at the VA: should tech-savvy doctors be allowed to store limited patient information using cloud-based Web tools if they appear to be secure and if the VA’s systems can’t meet their needs otherwise?

A study finds that a heart attack risk calculator used by consumer health sites is not very accurate, misclassifying 15% of patients as needing medications when they really don’t (check out the screen shot I took above from the American Heart Association’s version of the calculator to see why that’s not too shocking). Epocrates is mentioned as offering physician treatment applications based on the flawed formula.

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HERtalk by Inga

From Heresay: “Re: certification pricing. I’ve heard CCHIT is charging $40-$60,000 for EHR certification compared to Drummond’s $20K.” If anyone thinks they have a solid handle on the pricing from the three ONC-ACTBs, please step forward. InfoGard has yet to publish any details, but here is how I am interpreting the pricing from CCHIT and Drummond:

• Complete EHR Ambulatory: CCHIT $34,300; Drummond $19,500.
• Compete EHR Inpatient: CCHIT $32,550; Drummond $19,500.
• If you don’t need testing for the full EHR and just need individual modules tested, CCHIT has assigned a per-module fee for testing that ranges from $650 to $2,000, depending on the module’s complexity, plus a $7,000 base fee that includes the mandatory security criteria.
• Drummond charges $11,500 for up to 19 modules, include the mandatory measures, or, $16,000 for 20 or more modules, including the mandatory items.

To summarize: Drummond is less expensive if you need complete EHR certification and testing. If you need module testing only, CCHIT could be less expensive. The CCHIT folks would probably add that their fee includes a comprehensive testing and certification toolkit for vendors, which they will sell to non-applicants for $1,000. Also, vendors with CCHIT 2011-certified products will not need to pay additional fees for the ONC-ATCB certification through CCHIT, though additional testing is required.

I happened upon this blog post by an Epic User Group Meeting attendee. He shares details of Sunday night’s round-the-campfire wienie roast, complete with s’mores, dogs, and employee-provided entertainment. Very cool. Epic is expecting over 5,300 customers to hit Verona this week for this year’s theme, “UGM: The Musical.” In addition to 300 educational sessions, the meeting will  feature Epic staff singing Broadway tunes, Les Feud game show, and a tug-of-war tournament.

KLAS finds that nearly 70% of new 2009 hospital EMR purchases were for an Epic or Cerner integrated solution. Overall EMR sales nearly doubled last year in the 200+ bed hospital market. Meditech and Siemens saw limited growth and McKesson’s Paragon product outsold McKesson’s Horizon solution.

RCM company NHPN appoints David Garber SVP of managed care. Garber has held leadership positions in a number of managed care organizations, including CompServices and Coventry Health Care.

A third of office-based providers are now e-prescribing, according to Surescripts. However, only 12% of all prescriptions were written electronically last year. The number of providers using electronic prescribing grew significantly from 2008 to 2009, from 74,000 to 200,000, while the total number of e-prescriptions jumped from 68 million to 190 million. Massachusetts had the highest e-prescribing rate at 57%, followed by Rhode Island and Delaware.

Corey Hall joins REACH Call as EVP of medical informatics, coming over from the College of American Pathologists.

Sponsor Updates

• iMDsoft and Medical Web Technologies (MWT) partner to integrate their technologies. iMDsoft will offer MWT’s One Medical Passport pre-op workflow solution as part of its MetaVision AIMS product.
• Greenway Medical Technologies introduces its Allergy Module for PrimeSuite EHR, which includes injection record tracking, allergen testing, serum development, and lot administration and reporting.
• API Healthcare says that 35 provider and contingent staffing clients have gone live with its workforce management solutions this year.
• NextGen Healthcare provides VHA members special pricing on its clinical and financial software.
• Vanguard Health Systems deploys Medicity’s Novo Grid HIE technology to 850 physicians across four states.
• Parkview Medical Center (CO) selects RelayHealth’s RevRunner to improve its revenue cycle performance.

E-mail Inga.