News 3/18/11

Top News

A lawsuit against Walgreens focuses on the selling of medical information gleaned from patient prescriptions. Previous lawsuits focused on patient privacy violations, but this one charges Walgreens with depriving patients of the commercial value of their own prescriptions by selling their de-identified information to drug companies for marketing purposes and keeping the money for itself. The plaintiff argues that Walgreens doesn’t own the information, so it shouldn’t be selling it. The suit cites a 2010 SEC filing by Walgreens that lists “purchased prescription files" as an intangible asset worth $749 million.

Senator Sheldon Whitehouse (D-RI) introduces legislation that would expand EHR stimulus incentives to include eligibility for behavioral health, mental health, and substance abuse treatment professionals and facilities.

Harris Corporation and Johns Hopkins Medicine announce a joint venture in which Harris will develop medical image management solutions for Hopkins that it will then commercialize.

Reader Comments

From Stephen Yoder: “Re: appointment scheduling. I’m an applications specialist with Cerner and Epic experience and have also worked with a Mammo RIS from a small company called PenRad. It does something that Cerner and Epic can’t – it allows scheduling two or more successive appointments ordered by one provider from different locations (or organizations) and then correctly routes the signed results via fax back to the location from which they were ordered. Those other systems send everything to one location, or require entering dummy doctors. Faxing isn’t going away and neither is FNPs, PAs, and MDs working on multiple locations. Comments welcome, even statements that I’m silly for expecting the big dawg HISs to perform as well at a specific task.” Unverified. PenRad is the #1 KLAS-rated mammography information system, according to the company’s site.

From Lamprey: “Re: CTIA. The wireless conference is hyping the conference in saying that healthcare billionaire Patrick Soon-Shiong will make some kind of major announcement during his keynote.” He’s buying lots of companies (and a chunk of the LA Lakers) so that could be the case, although I don’t know why he’d tip his hand to a conference organizer in advance. He’s made other big announcements about healthcare, society, etc. that haven’t amounted to much so far. We’ll seen next Wednesday.

From Mr. Sandman: “Re: Qatar. Two big deals are going down, with Sidra and Hamad Medical Corporation choosing systems. These are right up there with Cerner winning Abu Dhabi awhile back and the Dubai meltdown where Epic won and then had the contract cancelled. Eclipsys won the Hamad bake-off, but last month Allscripts told Hamad they were withdrawing. That’s walking away from possibly the biggest deal Eclipsys ever had as vendor of choice, essentially giving Cerner the business and a major foothold in the Middle East. I don’t know if Epic will jump back in due to the huge expense involved and their experience with Dubai.” Unverified.  

From Former Eclipsi: “Re: new Allscripts India-based offices. Not sure why they are referred to as new. Eclipsys was doing development and support for Sunrise at that same Pune location and Allscripts has been in Bangalore for almost that long.” I wondered that, but I assumed they were moving additional services there. I heard from someone who should know that the offshoring works well to eliminate the US-based resources from doing drudge work, but things go downhill fast when problems go off script (this person swore that a senior Windows engineer in India had to be walked through finding the Windows Start button). Eclipsys had apparently replaced all of its American remote hosting help desk analysts with India-based staff, resulting in some clients demanding that their calls not be routed there after service problems (not unheard of with offshoring in general, sometimes for good reason, sometimes not).

From Perry Natal: “Re: Inova Fairfax. Any idea why they de-installed GE Centricity and switched to Epic?” Here’s the much-appreciated response from Inova SVP/CIO Geoff Brown:

We have not deinstalled GE Centricity and switched to EPIC. As of 3/16/11 we do not have an agreement with anyone other than GE and McKesson as our core HIS vendors. We did conduct an assessment of our current and future state requirements which led us to issue an RFP to GE, EPIC and other vendors. The catalyst for this centered on our 10 year projected business plan goals and objectives. Drivers included health reform / mu, aco, enhanced analytics requirement, 5010 / icd-10, ambulatory & inpatient system interoperability, physician, patient care and patient experience requirements. I won’t hood wink you because we are strongly considering our options but as of today while rumors are swirling nothing has been finalized. If something should happen I’ll be happy to update you.  Obviously I’m a fan of HIStalk and have found it viable as a useful source for information and insight relative to industry activity.    

From Will Weider: “Re: Ministry Health Care. In response to the earlier post, we are running a system selection process to choose a single HIS with a single patient database. Today our hospitals run eight HIS instances, and we want to simplify this environment and improve the patient experience. Thus far the selection is limited to our two incumbent partners, Meditech and GE. We have not made a decision and we have not made a commitment to upgrade to GE Centricity Enterprise 6.9. Regarding HITECH EHR Incentives, our current plan is to certify ourselves using our combination of EHR technologies, rather than rely on a single certified EHR.” I’ll call this “verified” since Will is the CIO.

HIStalk Announcements and Requests

Listening: I can’t get enough of Deer Tick (goofy name aside), which I know I just mentioned, but I’m hooked. It’s the best thing I’ve heard in months and I’m playing it constantly. This song is amazingly good and world-weary considering the band is made up of kids in their early 20s (and a little Googling raises the strong possibility that the hard-miles singer is the son of Rep. John McCauley Jr. of the Rhode Island House of Representatives). I’ll be shocked if they don’t blow SXSW away this week.

The first day of spring is Sunday, just so you know. I’m definitely spring feverish.

On the Job Board: Regional Sales VP- West Coast, Account Manager, Content Writer/Media Specialist. On Healthcare IT Jobs: Physician Informaticists, RN Systems Analyst, Marketing Technology Programming Analyst, Implementation Consultant.

Acquisitions, Funding, Business, and Stock

Document management vendor Accentus acquires speech-to-text technology vendor Mrecord. Accentus acquired two transcription-related companies in December.

Sales

Franciscan Health System chooses TeleHealth Services to provide interaction patient education and entertainment services at its new St. Elizabeth hospital in Enumclaw, WA.

The board of directors for Sharon Regional Health System (OH) approves a five-year, $13 million Cerner purchase. The health system also hires Donna M. Walters as senior director of IT to lead the EMR project and other IT efforts.

Also choosing Cerner: Sheridan Memorial Hospital (WY), in a $9.8 million deal. The hospital’s CFO anticipates receiving $3.1 million in stimulus funds after its August 2012 go-live.

The William W. Backus Hospital (CT) will use a charitable foundation’s donation to fund a two-year extension of its subscription to MyHealthDIRECT, which allows referring non-emergent ED patients to the appropriate level of care by searching the open appointments of community-based providers.

St. John Providence Health System (MI) selects Intuit Health to provide a patient portal to its physician practices.

St. Peter’s Hospital (MT) picks SeeMyRadiology.com for the sharing of images with patients and physicians.

Georgia Hospital Association signs a purchasing agreement with Prognosis Health Information Systems that gives members special pricing for the ChartAccess Comprehensive EHR. The solution includes hosting on a shared server at Georgia Hospital Health Services.

NextGen reseller TSI Healthcare partners with The Center for Arthritis and Rheumatic Diseases (TX) for the NextGen EHR, PM, and Patient Portal solution.

Creative Testing Solutions (FL) picks Mediware Information Systems’ LifeTrak software to manage blood testing procedures.

Pine Rest Christian Mental Health Services (MI) chooses CareLogic Enterprise EHR for its 18 behavioral health facilities.

UMass Memorial Health Care (MA) selects Informatica EMR Data Migration Foundation as a key component of its five-year, $140 million upgrade of core clinical and financial systems. UMass is implementing Siemens Soarian clinicals and financials.

People

Healthcare portal company Omedix hires former IntraNexus VP Tom S. Visotsky as VP of sales and marketing.

Insurance industry business intelligence vendor Intelimedix names Michael A. Newman as chief informatics officer. He was previously VP of medical informatics at BCBS Florida and was already on the board of Intelimedix.

Announcements and Implementations

Orlando Regional Medical Center and MD Anderson Cancer Center Orlando go live with PerfectServe’s clinical communication system.

EChart Manitoba, the first province-wide EHR system in Canada, goes live on the first stage of its $22.5 million EHR sharing project. IBM is the project manager for the initiative and dbMotion is providing the software platform.

A data review by Curaspan Health Group finds that 168 eDischarge customers studied in 2010 saved an average of $1.5 million each by having a preventable readmission rate of 14% vs. the national average of 20% .

Evangelical Lutheran Good Samaritan Society will collaborate with WellAWARE Systems, Phillips Lifeline, and Honeywell HomMed in offering wireless sensor technologies to help senior citizens live independently at home. They will study the effectiveness and cost benefit of sensor technology, personal emergency response systems, and telehealth applications.

Baltimore’s technology incubator and its graduate company WellDoc are named finalists for incubator and incubator graduate, respectively, of the year. WellDoc develops chronic disease management applications.

Government and Politics

The second most highly paid local government official in California is the CEO of Palomar Pomerado Health at $1.15 million, according to a review. Eight of the top 20 mostly highly paid employees are hospital executives. At number one was an administrator from Bell, California, population 37,000, whose exorbitant employee salaries triggered the salary review in the first place. The former Bell administrator (now facing charges) made $1.25 million. A similarly outraged article in the New York Post lists the salaries of state hospital executives, with the top end exceeding $3 million.

Technology

Doximity launches its smart phone application for physician collaboration and networking (text messages, photos, telephone dialing, physician locator, provider lookup).

The Toronto paper mentions Ottawa-based Epiphan Systems, which sells a video “frame grabber” used for remote medical image viewing, but also distance education, security monitoring, and navigation. Henry Ford Health System is named as a customer, which uses the company’s $700 device to capture 30 frames per second video from a laparoscopic tower on a standard laptop via USB, where it’s converted to MPEG-4 video and e-mailed as an attachment.

Other

The EMR market was valued at $15.7 billion in 2010, but no single company dominates the market, according to Kalorama Information. It calls Cerner, GE Healthcare, McKesson, and Siemens “established hospital IT giants” and says Allscripts will build share this year. The press release does not mention Epic as one of the big players. Buy your copy for only $3,500 and maybe you can find out why.

Now for something completely non-HIT related: the average women owns 17 pairs of shoes, yet only wears three of those on a regular basis. She also purchases (only) three pairs of shoes a year. I can confirm that I am well above the mean. The editor-in-chief of ShopSmart provides an excellent analysis of why women love shoes:

Shoes never make your butt look big, you don’t have to worry about squeezing into them if you’ve put on a couple of pounds, and they can instantly make you feel sexier.

The photos above, by the way, were sent by readers who support my shoe fetish.

The former CEO of closed Parkway Hospital (NY) is charged with bribing a state senator to help him acquire to other hospitals. He was working with John Krall, CEO of HIT vendor Pegasus Health Restoration, to re-open Parkway. Krall says he has $70 million of capital to reopen the hospital and will serve as its CIO. A community board member wasn’t impressed that Krall declined to name his funding source, saying, “He just came out of the blue. You can’t just come and open a hospital.”

I don’t usually do this, but I thought I’d mention a friend of HIStalk who happens to be a marketing executive looking for a gig. She’s got senior-level HIT experience in working with brand image, brand awareness, social media, PR, product launches, etc. She got our attention as a sponsor contact and definitely raised the visibility of the company she worked for. I offered to forward to her any inquiries sent my way.  

VisualDX diagnostic decision support software outperformed ED docs in diagnosing cellulitis, according to a research study that also found that 28% of admitted patients with cellulitis were misdiagnosed in two hospitals.  
 

Sponsor Updates

• United Medical Centers (TX) will implement Sage Intergy for its eight-practice community health centers.
• Desert Sun Gastroenterology (AZ) selects ProVation MD software from Wolters Kluwer Health for its gastroenterology procedure documentation and coding.
• ProHealth Solutions, a new ACO formed by ProHealth Care hospital system (WI) and the Waukesha Elmbrook Health Care IPA, selects MedVentive Population Manager and Risk Manager.
• Microsoft says that since its purchase of Sentillion in February 2010, deployment of Sentillion products has expanded to 575,000 total users across 220 organizations. Over 50 new customers signed up for Sentillion products in 2010 and Microsoft is now distributing Sentillion solutions in the Asia Pacific market.
• Medworxx will distribute perioperative and critical care systems from iMDsoft’s MetaVision suite in Canada and iMDsoft will offer the Medworxx patient flow, compliance, and education systems outside of Canada in a just-announced reciprocal distribution agreement.
• Several applications of 3M’s eHealth Documentation Solutions are awarded certification as EHR Modules.
• MedAssets announces that it will market the PatientSecure palm vein biometric system from HT Systems to customers of its Access Integrity suite, giving patients faster check-in and more accurate medical records retrieval.
• CEO Jennifer Lyle of Software Testing Solutions will participate on the Meaningful Use panel of the iHT2 Health IT Summit in Atlanta next month.
• Workforce and incident management systems vendor Concerro announces a joint marketing agreement with Sydion LLC, which offers tracking technologies for emergency response organizations.
• Healthcare Management Systems earns ONC-ATCB certification for its HMS Ambulatory EHR, following the recent certification of its inpatient EHR and EDIS.

EPtalk by Dr. Jayne

Despite the spring flowers peeking through after the long winter, my week started with more snow. A bit depressing until the FedEx driver appeared with a package destined to lift my spirits.

The RelayHealth “gift basket to welcome Dr. Jayne” contest goodies had arrived! Chocolate, red wine, great hand cream, and fuzzy slippers. What more could an overworked CMIO want? As an added bonus, the “basket” is a waterproof nylon cooler/tote with an integrated bottle opener which will be great for my local Concert in the Park series this summer. (Yes, dear readers, I do have a life outside health IT, although sometimes it doesn’t feel like I do).

Mr. H alerted me over the weekend to an article by David Blumenthal in Health Affairs. I’m not sure he ever sleeps, but I’m glad when he makes sure I don’t miss interesting things in my ever-expanding inboxes, whether electronic or paper. After snuggling up with the aforementioned red wine and fuzzy slippers, it was an interesting read.

The subtitle is a little underwhelming: “The Benefits of Health Information Technology: A Review of the Recent Literature Shows Predominantly Positive Results.” Where’s the flash and bang? I’d love to see something more like “A Review of the Recent Literature Shows HIT is kicking ass and taking names.” But then again, that kind of concrete statement would require a lot more data than what we have here.

The first thing you note is that all four authors are currently or formerly with the Office of the National Coordinator (although they did list Blumenthal last). Nothing like a little potential author bias to start an article out right. I’d have been more impressed if the same data and conclusions were arrived at by someone independent, such as a university. Although the authors state that over 92% of recent HIT articles were positive, they recognize the cold hard reality that providers are unhappy with EHRs and adoption is a significant barrier.

Building on two previous studies which looked at data from 1994-2007, they examined the months between July 2007 and February 2010 using the same methods and selection criteria. Ultimately they looked at 154 studies (with 100 of those studies being from the United States). Outcomes were ranked as positive, neutral, mixed-positive, and negative based on the proportion of improvement in at least one aspect of care vs. whether any aspects were negatively impacted.

I give them full credit for noting their limitations. The first is publication bias, where negative findings aren’t published as often. The second is weighting all studies equally – independent of study design or sample size. These are very real concerns when performing a meta analysis, whether looking at EHR outcomes or some other parameter.

Reaching the lengthy section on statistical hypothesis testing, I felt myself slipping and had to self-medicate with some of the RelayHealth chocolates, STAT! That got me through to the Discussion section, which was more relevant for most of us. The authors validate what some IT departments seem to forget: “that the ‘human element’ is critical to health IT implementation.” One tidbit that most of us already know is how strongly correlated provider satisfaction is with negative findings.

One key finding is that the data hasn’t changed much from the previous reviews. There’s no real benefit to being an early adopter and slow-moving groups are seeing the same outcomes. For those of us that live every day on the bleeding edge, that’s not a big comfort. Maybe we need to remember The Tortoise vs. The Hare.

I think the best thing they clearly stated that I wish I could make required reading for every CIO, CMIO, CMO, and physician champion: negative findings can be a good thing if they’re used to figure out how to do health IT better / faster / stronger / safer. My spin: don’t take criticism personally – use it to do your job better.

If we’re ever going to get to that “Healthcare IT is kicking ass and taking names” article (which I will happily co-author under my real name with any of you) we need more studies on how to address the challenges we all face and what training and implementation strategies make for the most successful outcomes.

Have questions about CPOE, clinical decision support, or which shapes of chocolate candies have the best middles? E-mail me.

Contacts

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

Readers Write 3/16/11

Privacy and Security
By Glen F. Marshall

The primary issue with healthcare privacy and security is the lack of ongoing risk management as a routine business practice, plus the failure to share data from existing risk analysis in a form that the general public can understand. For example, while anecdotal evidence says that provider employee snooping is the largest threat to privacy, real data are harder to find.

The evidence I have of this is anecdotal. I continually get questions from HIT people about what technology to implement or whether the latest gadget is a good thing to buy. If there was a body of risk analysis information to draw upon, the selection and implementation of mitigating technologies would more often be an informed business process. So would the selection and implementation of physical and administrative controls, e.g., locks on doors, privacy training for employees, or privacy-enhancing advisories for health care consumers.

It is more convenient for the general and HIT press to focus on sound-byte instances of breaches, versus the actual threats and outcomes in comparison to other threats to privacy. It is more readable to assess blame for breaches than identify and celebrate good privacy and security practices that provably prevent, detect, limit, and disclose breaches before damage occurs. The eagerness of the general public, provider community, and political leaders to consume this lazy news reporting amplifies the problem and crowds out the solutions.

Glen F. Marshall is the principal of Grok-A-Lot, LLC of  Berwyn, PA.


Patient Privacy and Information Accessibility: A Necessary Balance
By John Tempesco

In the original HHS privacy rule, a core component of HIPAA’s purpose was the ability to protect patient privacy while at the same time allowing the sharing of personal health information to facilitate patient care. And while healthcare has finally been dragged, kicking and screaming, to a more comprehensive use of technology, a serious divide has emerged between advocates of patient privacy versus the free flow of data needed to improve patient care.

As EHRs become more widely used by physicians and health information exchanges (HIEs) become more commonplace, the debate between privacy and the sharing of information for the purpose of enhancing patient care and lowering the costs of care delivery will only intensify.

As guidelines continue to be developed, it will be important to consider the mechanisms of how patients will determine the exchange of their health information. If restrictions are too severe, the goals of ARRA and HITECH will be in jeopardy. Patients will be driven by policy to “sit on” their data which will nullify the ability of the healthcare system to achieve its goals of improving patient care and safety, and reduce costs. But if data is exchanged too readily, patient privacy will certainly be in jeopardy. This dichotomy is the essential conundrum.

Opt-Out most closely resembles the state of fair and controlled information exchange as it exists today. Opt-Out protects patient privacy and enables the sharing of health records unless the patient specifically opts out. The Opt-Out provision requires that the patient is given an adequate amount of time to make a decision about consent, including urgent need of care. It also requires a clear explanation of consent choice that must be provided by the physician or hospital as well as the consequences of opting out.

Opt-In, on the other hand, would stop the sharing of patient information unless the patient opts in to the system enabling the transmission of health data. This option not only severely restricts health information exchange, and limits the ability of health information technology to improve patient care and reduce costs, it demolishes many of the core benefits of health information technology, particularly the multi-organizational and multi-community benefits of HIEs.

The ONC is still deliberating a final ruling on information exchange. While patient privacy must be attended to, clearly the critical exchange of patient information through HIEs is a central and key component to achieving the reforms of ARRA and the HITECH Act. There are numerous studies that point to health information technology as providing the necessary tools which enable improved patient safety and the improved efficiencies desperately needed to lower healthcare costs.

Let’s not throw out the baby with the bath water. Let’s move forward with a rational, forward-thinking approach that will ultimately get us to where we want and need to be.

John Tempesco is chief marketing officer of Informatics Corporation of America of Nashville, TN.

HIStalk Written on an EMR
By Robert D. Lafsky, MD

Given the mixed feedback regarding the recent HIStalk format change, it occurs to me that all available options have not been explored. The following sample report represents a modest proposal, which if adopted would allow Mr. HIStalk to enjoy the same efficiencies utilized by most EMR users. Apologies to 1960s-era MAD magazine and the late Jonathan Swift.  

SUBJECT
Goniff Group

CHIEF COMPLAINT
“Cash flow problems”

HPI
The COMPANY is complaining of INSUFFICIENT INCOME. DATE OF ONSET: 1/15/2010. DURATION OF PROBLEM: 14 months. The problem is made worse by LOWER SALES. The problem is made better by HIGHER SALES. The problem is aggravated by EMR WORKFLOW ISSUES. The EMR WORKFLOW is felt to be SLOW. The EMR WORKFLOW is felt to be TEDIOUS. The problem is aggravated by EMR DESIGN ISSUES. The DESIGN is felt to be AWKWARD. The DESIGN is felt to be UGLY. The problem is aggravated by LEADERSHIP ISSUES. The LEADERSHIP is felt to be INCOMPETENT. The LEADERSHIP is felt to be INDIFFERENT TO USER COMPLAINTS. The LEADERSHIP is felt to be INDIFFERENT TO USER FEEDBACK.  

PAST HISTORY
Problem List
1.  Insufficient capitalization
2.  Insufficient programmer staffing
3.  History of SEC sanctions

MEDICATIONS
1. Bank loans
2. Penny stock
3. Overdue payroll

FAMILY HISTORY
CEO’s brother doing 3-5 in Allenwood for stock fraud

ALLERGIES
Revealing stories in HIStalk

REVIEW OF SYSTEMS
Obfuscatory logorrhea (last stockholder’s meeting)
Bilateral buttock pain (participants last board meeting)
Spastic torticollis (CFO explaining financial picture)
Chronic corporate latrocinosis

PHYSICAL EXAMINATION
Blood pressure:  60/30
Pulse: Undetectable
Head: Spinning
Neck: Horizontally positioned
Chest: Heaving
Heart: Absent
Abdomen: Distended and firm along course of colon
Extremities: Erythematous from red ink stains
Genitalia: Numerous, especially CEO and CFO

DIAGNOSTIC IMPRESSION
537926 Corioliform Hydrodynamic Gravitational Descent (“Circling the Drain”)
872035 DDI: Database Design Defects, Congenital
472653 Ugly Interface Syndrome

PLAN OF TREATMENT
First class ticket purchases to BRAZIL for CEO, CFO
Cash transfers to OFFSHORE BANK ACCOUNT in CAYMAN ISLANDS
Urgent resume production by employees
Reduce thermostat settings in office during cold weather
Discontinue free coffee in break room

Robert D. Lafsky, MD is a gastroenterologist and internist in Lansdowne, VA.

News 3/16/11

Top News

Allscripts opens two offshore development centers in Pune and Bangalore, India that will provide customer support and other services.

Golden Gate Capital offers to acquire Lawson Software for $11.25 per share, but significant shareholder Carl Icahn suggests that the company shop around for the highest bidder (probably hoping to bait Oracle and SAP into a bidding war).

Reader Comments

From Yeah But … “Re: Ministry Health Care in Wisconsin. They were already a GE Centricity Enterprise customer. They will be upgrading to version 6.9 this year, which is the MU-certified version. It is true that GE has not had many new customers. In the past two years, they have made a small number of sales of the ASP version of Centricity Enterprise. Despite this, their total number of customers has dropped to around 27 on Lastword / Carecast / Centricity, down from 55 when they bought IDX.” Unverified.

HIStalk Announcements and Requests

It’s just me (Mr. H) today since both Inga and I are on our respective spring breaks, although most of mine will involve working on HIStalk. Dr. Jayne pitched in to help cover by writing a great piece for HIStalk Practice called Meaningful Use: 15 Things Your Practice Can (and Should) Do Now.

Listening: Deer Tick, no-nonsense, hard-living Americana rockers from Providence, RI. They’re good.

I’ll probably run a Readers Write Wednesday evening, so now’s your chance to get something to me that will appear quickly since I have just a couple of submissions so far.

Acquisitions, Funding, Business, and Stock

The Greenville, SC newspaper writes up VidiStar, which sells a PACS system and Web portal for remote reading of digital images. 

The Wall Street Journal profiles Castlight Health, started in 2008 by Giovanno Colella MD (founder of RelayHealth) and Todd Park (now CTO of HHS). The company, which helps consumers understand the costs of their care, has attracted $81 million of capital funding so far, including an unnamed amount from Cleveland Clinic.

People

Streamline Health names Rick Leach, formerly with A.D.A.M., as SVP/chief marketing officer.

Announcements and Implementations

Children’s Denver (CO) will implement RemedyMD’s OutcomeTrack disease registry and outcomes tracking solution.

The local paper mentions the federally funded, six-month HITECH Workforce program offered by Indian River State College (FL), adding that Martin Memorial Health System had to fill almost all of its 60 Epic project positions internally because they couldn’t find anyone else.

Government and Politics

Dr. HITECH (aka Ross Martin MD of The American College of Medical Informatimusicology) releases the production video of The Meaningful Yoose Rap. You saw the live debut of the song at last year’s HIStalk reception at HIMSS in Atlanta, now check out the video, apparently filmed on location in Washington DC, including in front of the Capitol and HHS headquarters. Video credits here, lyrics here. Ross has kind of a Marky Mark thing going on that’s pretty cool. He’s obviously musically brilliant, like you didn’t already know that from his amazing Interoperetta. He also has some kind of HIT day job, but hey, we have plenty of people who do whatever that involves but not many who can entertain the industry.

Sponsor Updates

• Quality IT Partners is celebrating its 10th anniversary.
• MEDecision will incorporate Health Language Inc.’s Language Engine into its health management portfolio to help customers with the transition to ICD-10.
• Dutch imaging solutions distributor Fysicons signs a deal to incorporate imagine viewing tools from Merge Healthcare into its EVCOS Web viewer for the BeNeLux market. The company is also reviewing Merge’s vendor neutral archive and kiosk products.
• Technology from Carefx will be used by Northgate Managed Services to develop a clinical portal for a group of UK hospitals in a $10 million contract that Northgate just won. 
• Capario announces that VP Angela McKenna has been appointed president of the executive committee of Cooperative Exchange, an association for healthcare transaction clearinghouses.
• Zynx will offer content from Thomson Reuters Micromedex in its evidence-based order sets.
• Main Line Health (PA) is implementing eClinicalWorks for its affiliated physicians.

Other

I was thinking about paper towel dispensers while in the airport restroom today, the kind where you wave your hand in front of the red light to have it dispense some preset length of towel. Some machines give an impossibly short length while others are more generous, leading me to speculate that they are networked devices using artificial intelligence (maybe adopted from slot machine technology) to determine the optimal mix of how much to dispense initially vs. how likely you are to begrudgingly accept the too-short length and leave with still-wet hands vs. just waiting until the red light comes back on to request another round by re-waving.

A UK woman dies of breast cancer after a doctor says her breast lump is benign, but then sends two appointment notices to the incorrect address, typing 16 instead of 1b for her street. Nobody followed up from the doctor’s office.

A family physician urges the same female patient to seek emergency care on two different occasions, once for an aneurysm and another for uterine swelling, after reviewing mislabeled CT scans belonging to other patients. The doctor says her actions were correct based on the information she was given, but the jury finds that she should have known the CT scans were someone else’s. They award the patient $75K for emotional distress. The two hospitals and the radiologist had already settled.

E-mail Mr. HIStalk.

HIStalk Interviews Tom Carson, CEO, MD-IT

Thomas Carson is president and CEO of MD-IT of Boulder, CO.

Tell me about yourself and about MD-IT.

I’m a product of a Midwestern farm upbringing, so I’m probably a little bit conservative. I’m an operations and finance exec by formal training. I’ve been very, very fortunate in my professional career to have been part of several companies that grew from humble beginnings to plus-billion dollar revenue experiences.

Right before starting MD-IT, I was the chief financial officer for a computer products company that grew from $40 million on startup in 1990 to over $2 billion eight years later. In the three companies I was with before MD-IT, it’s not that we came up with something that was so revolutionary the world couldn’t stand it — it was that the markets we were in were changing dramatically. The changes were largely driven by customer demand and technology availability to satisfy that demand. That’s a key point when I look at the healthcare industry.

What prompted the founding of MD-IT ten years ago was a customer experience in the last company I was with. It was a VAR for Medical Manager. I went out to get acquainted with the guy and he gave me my first education into the healthcare space. Frankly,  I was astonished. I had seen several industries make technology adoption a priority and it changed the way they worked, and here was the largest industry in the country that was clearly underinvested.

I remember thinking to myself at that time that this should be another opportunity to ride what has to be an impending wave of technology adoption and dramatic change. Nothing quite prepared me for the sort of resistance to change that I experienced when we got into it.

I think one of the big observations that I had after getting into MD-IT was that it wasn’t really market driven. The things that were being imposed on doctors – or attempted to be imposed on doctors – weren’t anything of their choosing. The dynamics that I saw occurring in other industries weren’t occurring here. 

MD-IT was started ten years ago to provide doctors in the ambulatory space with easy ways of completing the chart note. We believed that we had a better idea for doctors. We embedded speech recognition into a relational database system that doctors could put in their offices, complete their own documentation in real time, and have access to their charts. It would be faster and cheaper than the traditional transcription model.

We had modest success in finding early adopters who were excited about this. But what we discovered was that most doctors actually had pretty legitimate reasons for preferring a dictate-transcribe model. We said that if they have legitimate reasons for that preference, and if the technology is all that good, we should be able to accommodate that preference on the back end and create the digital useful records that all the rest of us have legitimate reasons for wanting, and to provide a solution that the doctors and the rest of society need.

That was what changed our business model five years ago. It was realizing that if you ever wanted to get adoption of electronic medical records in the ambulatory portion of the market, then it was going to require a melding of the service portion – the transcription portion – with the technology portion — the EMR. It wasn’t because we were in love with transcription. It’s because the doctor, who was our customer, preferred dictation. 

Whether that dictation happens with a human, some kind of a technology, or a combination of the two didn’t really matter to us, but the second realization is that transcriptionists fill a pretty important quality role in the process. Recent studies support the fact that doctors, left to their own devices, aren’t terribly accurate documenters. The combination of dictation and experienced transcriptionists creates a high quality product.

So the elevator pitch is that your application is built around text documents and search technology, It’s not doctor-entered information and it’s not scanned documents information, it’s documents built from transcription.

The reality is that we accommodate all of the above. Effective medical documentation can come from all kinds of places. Doctors document this stuff in all different kinds of ways.

If they want to scan in documents, which typically happens when we take on new customers, we can accommodate that. We can scan them and parse them and get the data collected to be useful for archival and search purposes. If they want to import data from other sources, such as lab reports or images, that’s fine. We certainly accommodate that and import those electronically and tie them to a specific visit. If the doctor prefers to write by hand, that’s fine, we can accommodate that through a forms process and tablet technology. But certainly the bulk of the 20 million documents in our system are dictated and transcribed notes.

It seems that transcription firms are consolidating and I know  MD-IT has acquired a number of them over the years. What do you see as the role of transcription? Are other EMR vendors wrong when they say that transcription and document management are not the way to move the EMR forward?

We’ve taken a whole generation of doctors, some 600,000 or 700,000 of them, and tried to move them from the way they’ve been taught. Most of them learned dictation as the primary means of documenting patient visits. All of a sudden, we’re trying to flip them from a process that they’re very familiar that drives how they were taught about clinical encounters. We’re saying all of a sudden that, yep, you have to change all that, and you have to change it now.

I think there’s a much more pragmatic approach to getting to electronic records. If we’re serious about trying to get everybody to usable records, it strikes me that step one is get doctors to use a system of some kind.

What MD-IT is all about is providing an incremental or gradual approach for a practice. And even doctors within a practice, because it’s not uncommon for a six-doctor practice to consist of maybe a couple of young guys who want to do their own input, maybe an older guy or two who isn’t going to change or will retire before they have to, and some folks who are sitting on the fence.

The experience we had with MD-IT early on was that we needed to find the early adopters, but in reality, that’s a problem for a practice. Now you’ve got different ways of doing things. The records end up in different places. If you provide a system that anybody can use, regardless of where they are in the adoption curve, then the possibility of getting everybody on is much higher. It may be that transcription diminishes dramatically as a part of this and we’re perfectly fine with moving that along. At the core of it, what we have is a medical documentation system that’s agnostic to how the data gets in.

Your competitors probably use eliminating transcription costs as a selling points. They probably also don’t really want to open up their products to transcription. Is it hard to make your case when competing with them?

No. For years, EMR vendors have sold as a key part of their value proposition the elimination of transcription costs, but it’s an argument that breaks down under examination. I think people are starting to catch on to that.

One of the things that just absolutely appalls me is that we read account after account of the economic benefits of practices adopting electronic medical record systems, yet I know first hand that what goes on in those practices is that doctors are all of a sudden spending a lot of unpaid time documenting and learning to use these systems. There’s a permanent productivity loss that just doesn’t go away.

If anybody really sat down and tallied up those costs in physician dissatisfaction and extra time spent, I don’t think it will be a bargain. You’ve got the most expensive resource in the healthcare delivery chain who’s doing an awful lot of clerical entry. It just doesn’t make sense unless they happen to have time on their hands. 

There’s something peculiar to me about this notion that you’ve got a vendor group that tells their customers, “Look, suck it up and get used to this. This is how the world is changing.” At least in the last year and a half, people have begun to have that conversation. We have EMR vendor partners with whom we have deep interfaces and we’ve been very effective in creating what we think of as EMR optimization on behalf of those vendors.

Do you think the idea of doctors as data entry clerks won’t play and they will refuse to buy those systems, or do you think they’ll buy them but replace them down the road when they realize the HITECH money wasn’t worth it?

Probably a combination. A recent study found that there is an appallingly high rate of rescission once people get into this. The vendors aren’t stupid, but people aren’t talking about the bad experiences as much as they need to. 

The way I think it finally gets resolved is that you’ll have a new generation of vendors such as MD-IT and others who are much more responsive to what the real needs of the customer are. Shareable Ink is one. If you look at Stephen Hau’s attitude about supporting his customer, it’s very much what a real world commercial transaction should be like. Listen to what the customer needs, and if they don’t like what you’re trying to get them to take, then give them something else. Don’t keep insisting that it’s their fault, not yours, that they aren’t adopting your product.

What about certification?

We’re in the process. We have a relationship with SLI in Denver, which is one of the six certifying bodies. We’re in the queue for sometime later this month to begin that whole process. We don’t see certification as an issue.

As an issue meaning for you to get certification, or that you don’t really need it?

Oh, no, we think you need it. You wonder if people really care about it, but I think it’s one of the validations that you’re committed to the EMR direction and that you plan to be around and you’re willing to make the investment in that. So no, I think it’s very, very important.

We’ve been challenged on how you certify a product that depends on a narrative. It’s just not a problem that we can tell. We begin the process at the end of March.

You have an HIE application that I saw mentioned on your website. Tell me how that works.

We generate something on the order of 450,000 chart notes a month. Some fairly significant number of those, perhaps 25 or 30%, get delivered to other parties. It may be a referring physician, to and from a surgery center, or maybe to a billing company. The vast majority of that stuff moves around by fax or postal service.

We realized that since it’s all in our Web-based platform, you don’t really have to fax this stuff. Why don’t we just give the recipients electronic access to our platform as guest users? That was the birth of our own little HIE. We think of it as an intra-state or the state highway system. Everybody who’s either a customer or affiliated with a customer can get access through our own HIE. 

We’re also members of the Verizon Medical Data Exchange for getting to other states, if you will. They’re the federal highway system.

I wanted to ask you about that. How big of a deal is the Verizon Medical Data Exchange?

I think the Verizon Medical Data Exchange has the potential for being huge. It solves just a ton of problems that individual vendors would find very, very expensive to get at.

Let me give you an example. One of the requirements for Meaningful Use is that you be able to deliver selected medical records to appropriate state or governmental agencies, regulatory bodies. If you discover bubonic plague, you probably have to tell somebody. If you had immunization records, there’s probably a county agency that gets those, but nobody’s going to go out and write interfaces to the 5,000 or so of these entities. 

Verizon can, because they can do it one time for each of those. They’re big enough to have the resources to do that kind of thing. They even have a manual process to assist their regulatory agencies that don’t have that capability. So, if you can get into the medical data exchange, you just solved that whole problem for all the reporting requirements of the country. That’s an example of the kind of clout and quick answers they can bring.

Looking at the provider purchasing decisions and vendor product decisions, where you see it being in 5-10 years?

People will make bad decisions today, but they’re not unrecoverable. I see the technology getting far cheaper than it’s been in the past. If you look at the legacy vendors, you see an awful lot of high expense in the form of client server applications that are expensive to purchase, that are time consuming, and are high risk to implement.

I think that generation starts changing, and the reason it starts changing is that there’s been so much attention to the need to adopt electronic medical records. Even if the government hadn’t come along, I think consumers were going to insist on it anyway.

The good thing about the HITECH act — we can quibble all day whether the government should be paddling around in this kind of stuff –  but at the end of the day, they got the conversation going and out on the table. It’s brought a lot of voices and lot of folks in to mediate the discussion.

I think it will lead to a new generation of folks who are a little more nimble. They can take advantage of technologies that weren’t there 10 or 15 years ago, much as we are, to deliver products that are more use-appropriate. I see price points for ambulatory EMRs down somewhere in the sub-$500 a month range, probably delivered as a Software as a Service model. 

For our customers, the implementation period is measured in a week or two, if you’re not a current customer, as opposed to six to nine months. There are no upfront costs, I think you’re going to see more of that kind of a model than out there. I think that the interface capabilities are going to be much, much stronger. 

A lot of this stuff may start forcing even doctors to be more consumer-oriented because those are likely to be the maybe a more important driver than everybody else. I’m currently involved with care for an aging parent. The difficulties I’ve had trying to get information out of a fairly sophisticated EMR is very, very frustrating. It becomes a huge, time-consuming part of the whole process. That’s not where people ought to be spending time. There’s certainly not a problem to get information out of other systems and to share that easily.

But I see all that changing. I’m a huge optimist about how technology solves problems and people are very creative at applying technology when it’s available.

Any final thoughts?

It’s a very, very exciting time to be in this industry because I do think a lot of changes will happen. I don’t even believe, like a lot of people do, that it’s going to be a $4 trillion industry in ten years. Those kinds of projections are based on assuming that nobody learns, nobody grows from the experience; but I doubt that will happen.

Growing up in farm country, I know that the real cost of corn, beans, and wheat really hasn’t changed much in the last 40 or 50 years. It’s because we’ve gotten better at meeting the demands for food production That’s just one examples of many, many examples out there. You can see this, and this is something that technology does for us.

I see healthcare as the same. I think we will all be much smarter healthcare consumers. I think a new generation of companies is solving these problems will be able to create a nimble and cost-effective way.

Monday Morning Update 3/14/11

From Tobias: “Re: privacy and security. Local and state legislatures are afraid of HIEs and other electronic data because they perceive that because data is electronic, it will be easier to hack. I’m curious if you have any data or can use your network to find any that speaks to this.” I’m interested in anyone’s contribution. The question made me ponder – why do consumers fear healthcare data breaches, which have no financial ramification, and even though despite splashy headlines, haven’t resulted in much of anything other than some tabloid articles and lots of free credit checks? My conclusions: (a) people trust banks a lot more than healthcare providers when it comes to privacy, probably rightly so because banks have a much more straightforward mission that is aligned well with security investments; (b) they still incorrectly believe that the greatest threat to electronic data is mysterious foreign Internet hackers instead of inquisitive provider employees; and (c) a financial breach affects thousands of people scattered everywhere, but friends and neighbors wouldn’t know you were affected, while medical disclosures have far less dramatic outcomes (instead of draining your bank account, someone finds out you’ve had a yeast infection) but involve the people you see every day. I don’t trust hospitals either, but not because of their electronic systems – any organization that believes that a shower curtain drawn between the gurneys of ED patients provides adequate privacy has already given up the charade. Not to mention that people fear being denied insurance coverage or being fired because our hodgepodge medical system encourages dumping the expense of their care on someone else. Electronic data hacking is the least of healthcare’s privacy and security worries.

From Bobby Orr: “Re: Francisco Partners. Running away from HIT? That’s API, AdvancedMD, and Healthland all in about 3-4 weeks.” I ran Healthland as an unverified rumor, but I wouldn’t be surprised. What better time to cash out an HIT company than right now? It’s like selling your house at the market top. You can make money by buying at the right time, but even more by selling at the right time. What’s more interesting to me is where they invest the proceeds.

From The PACS Designer: “Re: OsiriX HD. OsiriX has been a popular open source DICOM viewing platform for a long time and now has recently migrated its software to the mobile platform. OsiriX HD V2.0 was released last month for iPhone and iPad. This new release should gain popularity amongst mobile users for the speedy processing of image files, and also promote collaboration between radiology and referrers to enhance the interaction of radiologists with other departments.”

From Hank Redmond: “Re: Microsoft HSG. I work there and the reader got one part right – the move to MBS happened. We like this change because we’re out of the incubation phase. The company’s commitment to healthcare remains as strong as ever.” Unverified.

From Wowed in Wisconsin: “Re: Ministry Healthcare. Hear they’re considering putting GE inpatient at all their sites. Does anyone even buy GE any more?” Unverified.

From A Fan: “Re: survey. I am an avid HIStalk reader and was wondering if your readers could help a team of MBA students assigned to perform a brand analysis on Google? Survey time is less than a minute. I am also trying to prove a point to my professor about how powerful social media are (he does not think it’s of any value) and that with the right following, a la HIStalk, great insight could be obtained. Our goal is 100 respondents and we only have 35.” I took the survey and it take even less than a minute, so willing readers can do the same. 

I’ve decided to use the old layout for the Monday Morning Update post, as you can see. This is for several reasons: (a) it’s only me (Mr. H) writing for the MMU, so it’s not hard to follow whether an item is Inga’s or mine; (b) the MMU has less hard news since it’s really a catch-up from Thursday night on, so it has fewer items and fewer categories; and (c) it’s easier for me to put together on the fly, like right now as I sit in a hotel room watching the Pacific Ocean and quietly writing while Mrs. HIStalk slumbers peacefully a few feet away. It also occurred to me that I’ll then be using the new format two days a week and the old one once, matching the proportions of poll respondents who preferred those formats.

A 2,400-bed hospital in India that treats 15,000 patients a day loses all of its electronic medical records when five of the seven HIM department computers get nailed by a virus. The surviving computers don’t have the HIM software loaded, so the only thing the seven HIM employees can do is keep a paper log of admissions, discharges, and deaths. The Indian newspaper article also mentions that its “medical records officer” position has been vacant for years since nobody in the entire state is qualified for the job, so nurses have to create the records themselves and they’re short on nurses too. The hospital can’t load the medical records software because they don’t have IT people.

A Yale study finds that the rate of prostate surgery goes up when hospitals buy expensive robotic surgery gadgets that have no proven medical benefit. The lead author’s conclusion is common knowledge, but a refreshingly blunt indictment of the US healthcare system: “Policymakers must carefully consider what the added-value is of costly new medical devices, because, once approved, they will most certainly be used.” He wasn’t referring to information technology, of course, which has the opposite problem.

Welcome to HIStalk Platinum Sponsor H/P Technologies of Phoenix, AZ. The company provides direct permanent staffing and consulting for all the big healthcare and managed care IT systems. On the provider side, that includes Epic, MEDITECH, Allscripts, eClinical Works, Siemens, GE Centricity, Cerner, McKesson, and NextGen. They can help with clinical transformation, workflow analysis, technology, architecture, ERP, integration, application development, ARRA, and ICD-10, to name a few. For the payor market, Facets, Trizetto, Amisys, DST Health, QNXT, Diamond, Paradigm, XCELYS, and more. They’ve been around for 12 years, are on the Inc. 5000, have more than 200 consultants, and are standing at the ready to provide the highest quality professional services to allow their clients to focus on their core mission. If you’re a highly trained professional, you can search their jobs database for that next step up the career ladder. Thanks to H/P Technologies for supporting HIStalk.

Thanks, too, to our recently renewing sponsors, who also deserve a little shout-out for keeping the keyboards clacking around here:

• iSirona, medical device connectivity experts. This is a pretty hot company, right in the sweet spot of medical device integration into EHRs. They just announced at HIMSS a software-based connectivity solution that runs on standard computing hardware.
• iMDsoft, which offers proven clinical information systems globally such as its MetaVision solution for ICU and anesthesia and the mvCentral tele-intensivist patient monitoring system. I was impressed when I interviewed CEO Phyllis Gotlib just over a year ago.
• Software Testing Solutions, the automated software testing experts. I interviewed CEO Jennifer Lyle in January. You may recognize her and account rep Kara if you were at HIStalkapalooza because they were our lovely and quick-witted red carpet interviewers.
• Wellsoft, which focuses on doing one thing very well – supporting the emergency department with its top-ranked EDIS. It’s been Best in KLAS since 2006, which is a nice arrow to have in your quiver when you’re trying to turn your ED clinicians into Meaningful Users.
• CynergisTek, a renowned provider of business-driven IT security consulting (risk management, IT security, technical security, compliance and audit, and managed security services). CEO Mac McMillan is well known in HIMSS circles for volunteering in a number of roles related to privacy and security.
• Salar (pronounced SAY-lar since I don’t know how to make the little bar-over-the-long-A character). I’ll try to stay neutral, but I really like these guys (VP Greg Wilson was our polished King and Queen judge at HIStalkapalooza), they impressed me with their poise when I anonymously cruised their HIMSS booth, and President Todd Johnson’s interview a year ago was one I really enjoyed doing. Their clinical documentation product seems cool and I think we’ll be hearing more about it.
• Vocera, a Founding Sponsor of HIStalk Mobile and a Platinum Sponsor of HIStalk, is the company with the Star Trek communicator gadget that I swear conveys instant power when you caress it in your hand like I did at HIMSS. Their 700 hospital customers enjoy instant, portable access to the information and resources they need, improving patient flow, safety, and staff efficiency. Business must be quite good because they have made several acquisitions lately.
• Access, a Platinum Sponsor of both HIStalk Mobile and HIStalk, is known worldwide for its e-forms solutions that turn paper into seamlessly interfaced electronic, workflow-driven, EHR-integrated information. Its Intelligent Forms Suite provides money- and environment-saving forms on demand with pre-filled text and barcode information ready for indexing in your ECM system. And they have an award-winning championship Texas barbeque team that I keep trying to convince them to bring to HIMSS in a variation on Willie Nelson’s Fourth of July Picnic (music, smoked brisket, and beer – who doesn’t like those? That could be the next HIStalkapalooza.)
• The Huntzinger Management Group, led by the ultra-successful George Huntzinger, former president of CSC Healthcare and president of Superior Consultant. HMG’s consultants help organizations run better through services that include business strategy, IT assessments, vendor management, project management, and procurement. They have a few juicy job openings, too. They’ve been a sponsor for quite awhile, which I appreciate.
• EHR Consultant, EHR Scope, 1450, EHRtv, and related businesses from the very smart mind of one of our favorite people, Dr. Eric Fishman. Dr. E can help you find an EMR, buy and implement Dragon in your medical practice, or use the Frisbee system for digital dictation and transcription between author and transcriptionist. EHRtv contains interviews, EHR news, reviews and demos, and that highly sought after HIStalkapalooza 2011 video that includes the full HISsies presentation with Billy Bush’s funnier brother (I’m watching it now and snickering all over again at JB). I’ll put that directly on HIStalk once Dr. E’s video whizzes get it loaded up to YouTube.
• Healthcare Growth Partners was one of HIStalk’s first sponsors. They provide investment banking and strategic advisory services, not to mention that Jon Phillips is the first guy I e-mail when I need help understanding some business announcement or financial transaction. I’m sure their phone is hot from calls related to mergers and acquisitions and corporate strategy these days. I always forget that Jon’s kind of a big deal since he’s pretty funny and casual when I bug him about something, but in addition to founding HGP, he’s the board chair of Streamline Health.
• MED3OOO and InteGreat. Their list of offerings for physician practices is extraordinary – EMR and PM, revenue cycle, coding and compliance services, data warehouse and decision support, third-party administrator services, and a variety of management services and technologies for hospital-employed physicians. They are Platinum Sponsors of both HIStalk and HIStalk Practice.

A reader asked about RSS feeds for for HIStalk and HIStalk Practice. I always forget to mention those since Google Reader finds them automatically. If your reader doesn’t, just click the Archives link at the very top menu of either HIStalk or HIStalk practice, then look on the lower left of the page for a list of RSS feeds.

Inga and I have been talking about the need for a consultant-type person to write for HIStalk Practice to provide detailed advice to practices about increasing their efficiency with any kind of technology, signing agreements with hospitals to provide an EMR, and specific recommended actions to meet Meaningful Use. Tell Inga if you’re interested and would like gain some major exposure.

Most folks aren’t all that keen on banning the usual HIMSS exhibit hall shenanigans, but if they were, they’d pick the related activities of booth babes and suggestive dress. New poll to your right: are the proposed Stage 2/3 Meaningful Use requirements too hard, too easy, or about right?

Speaking of Meaningful Use, CMS will hold a May 17 session on that topic for New York City hospitals.

Former Sage COO and Cerner VP Lindy Benton is named CEO of National Electronic Attachment / Medical Electronic Attachment, replacing retiring founder Tom Hughes. The Norcross, GA company provides technology for providers to submit electronic attachments with dental and medical claims. I had meant to Google her since I saw her at HIMSS.

Former St. Luke’s Northland Hospital CEO James Brophy is named the first CEO (and only full-time employee) of eHealthAlign, a Kansas City HIE.

Microsoft announces that Tampa General Hospital (FL) will use its Exchange Online and SharePoint Online, while Advocate Health Care (IL) has moved to Exchange Online.

I can’t decide if this is the stupidest press release ever written, but I’m sure it’s right up there. I blurred the names because I don’t want to give the company any exposure. When your key news item is “interest continues to grow” and your big accomplishment is that 600 people connected with you on social networking sites (not that I saw: 10 Facebook likes and 16 LinkedIn connections, almost all of them company employees). The release includes no contact information and no PR company (which surely would have advised them to rethink putting this drivel out), so there’s a cautionary tale against do-it-yourself PR.

Microsoft’s Connected Health Conference will be April 27-28 in Chicago. Registration is $699, but you get two for the price of one if you sign up by Friday, March 18. The speaker list is long and has a few moderately big names. 

I see the visit counter rolled over the 4 million mark on Saturday. Thanks for being part of that.

E-mail Mr. HIStalk.

News 3/11/11

Top News

The Center for Health Information and Decision Systems at the University of Maryland announces its HIE Evaluation Framework, which assesses HIEs on sustainability, organizational structure, technology, community engagement, and trust. The announcement points out that of 200 HIE initiatives, only 18 are covering expenses.

Carilion Clinic (VA) will collaborate with Aetna on an ACO initiative

Reader Comments

From Klaatu: “Re: Healthland. About to be acquired by [company name omitted]. [company name omitted] is also about to be acquired.” Unverified. I redacted the company names because both are publicly traded and I don’t want to be like the bawling Bud Fox (Charlie Sheen) getting hauled off in SEC handcuffs in Wall Street. I’d rather be Tiger Blood Charlie, the male equivalent of a smarter but even goofier version of Meltdown Britney. Winning!

From HITChat: “Re: HIEs using the Practice Fusion or RealAge model of selling de-identified data. What do  you think?” First, I don’t think there’s any such thing as sure-fire de-identified data. If there’s enough information to be useful, it can probably be matched back to patients. That you don’t hear of that happening isn’t a confirmation that the information is secure – it’s that there’s not much payoff for re-identifying it. Otherwise, my main objection is that I don’t trust companies that buy data, not because they aren’t operating legally or ethically, but because they’re looking for new ways to increase healthcare costs by lining their own pockets. Providers, unfortunately, are often illogical consumers who just happen to be wearing white coats and suits, and they are often unreasonably susceptible to data-fueled sales pitches. We discussed that in a hospital benchmarking meeting today – drug vendors are getting some very detailed information on our treatment outcomes from somewhere and trying to use benchmark data to shame us into using their product. You wonder, too, with everybody and his brother peddling de-identified patient data, how does the purchaser know they aren’t buying duplicate information?

From Dabney: “Re: former Sentillion exec departures from Microsoft. Microsoft transferred their 800 Health Solutions Group people into the small-to-medium commercial sector group (Microsoft Business Solutions) last Monday. Peter Neupert and his whole organization have been pushed out of the incubation group in Microsoft Research with the guys who sell Microsoft Axapta ERP and CRM for small commercial customers. That will mark the end of acquisitions and spending of Microsoft on health because they haven’t had any significant sales of Amalga UIS in the past year after already withdrawing Amalga HIS and Amalga RIS/PACS from the market. Microsoft is slowly edging towards an exit stage left in health IT.” Unverified.

HIStalk Announcements and Requests

Two-thirds of readers prefer the category-based layout you’re reading now, so we’ll stick with it for a couple of weeks (and fine tune along the way). A suggestion, however: don’t get so enamored with the categories that you skip everything else – we wouldn’t include something if we didn’t think it was worth reading. From our end, we promise not to lose our quirky and sometimes funny commentary, although it may have seemed like it last time since I was really struggling to get finished with the changes right up until I had to go to bed.

Speaking of which, a reader suggested tagging each item in front with a tiny avatar, which sent Inga furiously to her photo editing software. We won’t tag most of the posts, such as the straight news items. We’ll save that for when we write something that might be clearer if you knew who was “talking.” We’re willing to experiment to make HIStalk as good as we can make it, so bear with us – we’re day job amateurs. 

What you missed this week if you aren’t properly tuned into HIStalk Practice: the first-year cost for EMR in a five-physician family practice averages $233,927, or $46,659 per doctor. Vermont and Alabama RECs add to their preferred EHR vendor lists. Emdeon triples its revenues in the Q4. NextGen VP Dr. Jan Lee heads to the Delaware Health Information Network. ONC recruits Meaningful Use champion providers. By the way, 78% of readers say HIStalk Practice helps them do their job better; ergo, sign up for the instant updates on HIStalk Practice and perform your job better.

The comfortingly familiar usual reminders: (a) put your e-mail address in the Subscribe to Updates box so I can tell you immediately what’s new; (b) check out HIStalk Practice and HIStalk Mobile; (c) show your love on Facebook, that thing that just put six kids on the billionaire’s list; (d) send me rumors, news, secret e-mails, or whatever you think we’ll enjoy; (e) support our sponsors by perusing and clicking in the obvious locations; and (f) send us good karma on occasion, which we’ll reciprocate. Thanks for reading.

On the Jobs Board: Clinical Project Manager, RVP Sales – Western Territory, Performance Management and Revenue Cycle Director. On Healthcare IT Jobs: Business Intelligence Lead Developer, Epic Clin Doc or Orders Analysts, IS Manager General Financial Application, Programmer/Analyst III.

Sales

Catholic Health Partners (OH) signs a multi-year agreement with RealMed to provide RCM products to its affiliate providers.

Beloit Health Systems (WI) selects TeleHealth Services as its interactive patient education and entertainment partner for its 10 locations.

People

UK-based Clarity Informatics Group replaces its CEO founder with Tim Sewart, a 32-year-old law firm partner who leads a technology practice (and who will continue in that role as well). The company provides the NHS Clinical Knowledge Summaries (evidence-based medicine clinical information) and the Clarity Drugs Suite drug database. Ian Purves, the professor who founded the company, seems like fun: his company bio lists titles of MBBS, MD, FRCGP, MIoD, DRCOG, DCCH, RYA Ocean Yachtmaster.

Announcements and Implementations

Hoboken University Medical Center (NJ) is scheduled to go live on Medsphere’s OpenVista EHR March 22. Pharmacy already made the switch in January.

St. Luke’s Health System (MO) deploys Central Logic ForeFront to facilitate logistics and documentation requirements for patient transfers in and out of its 11-hospital system.

University of Utah Health Care System goes live with Epic’s MyChart for patient records access on smart phones.

Meridian Health (NJ) goes live with ICA’s CareAlign solution for its multi-county HIE.

Government and Politics

Grace Community Health Center (KY) secures $150,000 as part of Kentucky’s Medicaid EHR Program. They have selected but not yet implemented NextGen’s Ambulatory EHR, and thus got HITECH money without having yet achieved Meaningful Use. I mentioned this on yesterday’s HIStalk Practice and commented that if I were selling EHR, I would be knocking down the doors of all eligible Medicaid providers and telling them to sign my contract because that’s all it takes to get their money from the government. A reader suggested that I didn’t have my facts right and that providers were in fact required to “install” the certified EHR technology. However, a CMS representative confirmed that I’m correct and forwarded this link from the CMS website. A couple of key passages:  “a provider does not have to have installed certified EHR technology” and all a provider must do is demonstrate the “acquiring, purchasing, or securing access to certified EHR technology.”

The state of North Carolina and CSC successfully implement the first phase of the state’s EHR Medicaid Incentive Payment System. The system is scheduled for full release in April.

Innovation and Research

Jardogs, an 18-employee subsidiary of Springfield Clinic (IL), is profiled in the local paper for its FollowMyHealth patient portal. Says John Pacione, the company’s president, “We’re creating data exchange, just like an HIE, but we’re putting the patient at the middle of it, to authorize that information to be released.” The company has eight large customers, including its parent organization, of course. Most intriguing is the company’s name, which it declines to define, saying only “it’s a closely guarded secret.” A smart one, since every Google search hit is theirs (something to think about when choosing a company name). Also interesting: CEO James Hewitt is also CIO at Springfield Clinic and formerly held that role at Allscripts, which was also the previous employer of both John Pacione and chief architect Ron Ward.

Researchers at the University of Minnesota are using Xbox Kinect in project to improve diagnosis of mental disorders in children. Said the researcher, “Is a $100,000 system being outsmarted by a $150 toy? Indeed this is the case … I don’t think Microsoft has realized that [Kinect] is something that could change medicine.”

Technology

VMware announces availability of its free VMware View Client for the iPad, which allows users to run their virtual Windows desktops from anywhere. The announcement mentions Children’s Hospital of Central California, which will use the technology to provide “follow-me desktops” for iPad users.

A column in The Atlantic covers the InstyMeds vending machine for drugs, leased to physician practices for dispensing prescription medications.

Other

I feel like I have barely unpacked from Orlando, yet HIMSS is announcing the deadline for HIMSS12 proposals. The proposal form will be available March 21 through May 23. I wonder how many relevant topics are overlooked by having a deadline this far in advance?

The average cost of a data breach in the health care sector jumped from $301 per compromised record in 2009 to $345 last year.

Listening: the debut album of Beady Eye, the Beatles-esque reincarnation of Oasis. It sounds as though it could have been recorded straight to four-track tape in 1965, which is refreshing if you’re tired of electronica, music written for hammy dance moves instead of listening, and writers who can’t write songs for singers who can’t sing. And watching (sometimes painfully): the lowbrow but hilarious Fat Actress. Kirstie Alley is fearless, I’ll say that.

University of Toledo’s medical school is placing first- and second-year medical students in a scribe program in its ED. They transcribe into the EMR, keep an eye on lab and rad results, and get 100 hours of ED experience before their clinical rotations start.

A patient sitting in an overcrowded doctor’s waiting room sues the doctor, claiming a heavy filing cabinet toppled over on her, causing head, neck, and back injuries. I guess you could say that it was paper medical records, not the electronic kind, that reached the tipping point.

Sponsor Updates

• COSSMA, a Puerto Rico-based community health center, selects Sage Intergy EHR and PM to replace its existing HealthPro PM system. Sage says it’s not charging the clinic for the new software.
• dbMotion and Matrix Knowledge Group partner to market and deploy the dbMotion solution throughout the UK.
• Space City Pain Specialists (TX) chooses the SRS EHR.
• Parkland Memorial Hospital (TX) picks ProVation MD from Wolters Kluwer Health for its gastroenterology procedure documentation and coding.
• Pacific Oral & Maxillofacial Pathology Laboratory (CA) increases its collection rates from 55% to 90% after contracting with Orion Health for billing and practice management services.
• HANYS Solutions, the for-profit-subsidiary of the Healthcare Association of New York State, expands its relationship with RelayHealth as the preferred partner for RCM solutions. The agreement includes the RelayClearance, RelayAssurance, and RelayResolution offerings.
• Speaking of RelayHealth, the company just upgraded its Website. Very 2.0-ish and easy to navigate.
• Windham Hospital (CT) chooses the Intelligent Forms Suite from Access, the Siemens Strategic Alliance Partner for electronic forms management, to create barcoded electronic forms on demand form MS4.
• Merge Healthcare announces the release of Financials 6.1, which adds ANSI 5010 and PQRI capability.

EPtalk by Dr. Jayne 

HIStalk’s new Curbside Consult feature has generated a good discussion. I value reader input and response and had a few thoughts in follow-up.

From Charles Babbage: “You say vendors are trying to make their products better and better and then list scores of issues that should have been fixed decades ago… More important, after the hospital spends $150 million on the system, and $500 or $600 million implementing it … the vendor has little worry about making the customer happy.”

Looking at some of the vendors and products in question, they weren’t around decades ago. Don’t get me wrong, some were, and they should be appropriately criticized.

I’m sure there are some organizations out there that fall into the figures you specify, but not the vast majority of implementations. Even with smaller implementations, given the dollars out there and the competition, vendors seem to be keenly aware of the need to make the customer happy. The last thing they want is for a significant install to fail. They know it takes ten happy customers to make up for one aggressively vocal and unhappy customer.

I don’t disagree that there are bad apples out there, but I also don’t believe in painting all vendors with the same brush. Even with their flaws, many systems provide measures of patient safety that couldn’t exist in the pre-electronic world. (Think allergy and drug interaction checking – it just didn’t exist on paper. How many people were killed by those kinds of basic medical errors?)

Like many of you, I’m a practicing clinician too (not just a suit) and have seen both good and bad systems. But then again, I’m an active and constructive participant in my organization’s choices and decision-making and understand why things are the way they are. I’ve spent most of my efforts in improving the system, not just yelling. That has allowed for real change to come, not only with my hospital, but with our vendors. (Although believe me, I’ve done some yelling, and sometimes that’s what it takes.)

From Sherry Reynolds: “One challenge that we see with OBs who deliver and work at multiple clinics and hospitals is the cognitive overload when they have to learn multiple different systems and workflows.”

I hear you! This is extremely frustrating. Coming from a “best of breed” hospital, that’s my reality. Different vendors for emergency department, labor and delivery unit, inpatient units, etc. … and this is within a single hospital. Add on the different ambulatory system and it’s even worse. And then if you are on staff at multiple hospitals in different health systems? Forget making sense of it.

I think this is why Epic has done so well with their integrated platform — it’s a really strong selling point. On the other hand, the so-called integrated platforms of some vendors really aren’t that integrated at all, but people keep buying them.

Looking at other technology platforms, those with great usability lend themselves to emulation (think Apple phone technology). Since we are still in an unregulated industry and this is a free market economy, customers need to vote with their checkbooks for the vendors that support cross-vendor standardization and uniform workflows.

From MIMD: “Many vendors are working hard to remedy these and to implement aggressive protocols to bake quality into their products and design defects out. What took so long for them to do this?”

I agree this question deserves an answer. For some of the products out there, there is NO excuse. Patient safety-related defects should be fixed — end of story. And they should be fixed in a timely fashion.

The short answer: vendors didn’t clean up their act because they didn’t have to.

I don’t believe in blaming the victim, but there are customers out there whose actions reinforce bad vendor behavior and vendors take advantage of it. Customers can band together through regional or specialty organizations and apply pressure to vendors to change the way business is done. They can refuse to accept releases that are known to be problematic at other institutions.

When vendors don’t respond, consider exercising contractual remedies. Unfortunately, too few people have done this — it’s messy and time-consuming when your goal is caring for patients.

The market has also reinforced this. People continue to purchase systems from dysfunctional vendors due to pricing, perceived product sexiness, etc. I’ve helped some small practices select systems and have seen them choose systems that their consultants specifically advised against (due to known defects, poor service, etc.) just because the price was right. Ultimately, you get what you pay for, although there are some expensive lemons out there, too.

No one wants to de-install and go through it all again. Having done it myself, trust me, it’s not the worst thing that can happen.

If you choose wisely, it just might make you go from spending four hours a night entering your notes after dinner to finishing on time and walking out the door before the last patient has left the building.

Contacts

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

CIO Unplugged 3/9/11

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

Biggest Blunders

Experience is not always the best teacher. Learning from other people’s experiences is better. Another person’s evaluated experience trumps them all. Unfortunately, I am prone to learning “The Hardway” (DC Talk). Some of the following examples will humor you, but most are serious.

To keep this post short, I focused only on my professional blunders. My personal mistakes would take up too much space.

People

Hiring too quickly. In an effort to fill a role expediently, I compromised standards. I failed to vet candidates adequately. The person I hired caused pain for everyone. I recall spending more time counseling and repairing damage to a particular senior staff person than accomplishing business. As one known for having the most competent senior team, my credibility took two steps back. As a result, I’m more deliberate today in making sure the fit is solid, even if that means leaving a position unfilled.

Firing too slowly. Way too slowly. I have allowed people to stay, causing more harm than good. I’ve also let others dictate who I keep. When I finally mustered the courage to make the fire, the person was more relieved than I was. I learned that the energy required to salvage the wrong person is best put to use in developing my top performers.

Process

Emphasizing the need for physical security, I had our security analysts make a habit of gathering unsecured, unattended devices. The analyst left behind a card instructing the owner to retrieve their device from my office. Analysts had the green light to confiscate unsecured executive laptops as well. When the CEO came to my office for his … awkward moment, I learned to think about my audiences and make adjustments while still enforcing protocol.

I spent a weekend in Colorado presiding over a management meeting for a successful rock band. We spent time knocking out an internal contract about royalties and responsibilities as well as rules of the road. In an effort to disseminate quickly, I sent the documents from my work e-mail. I inadvertently sent it to my IT department. Embarrassed, I learned not to send personal documents from work.

Dress the part. I did not pick up on the fashion hints offered by my CEO. Finally, the CFO pulled me aside and said, “Ed compared to your predecessor, you have two shortcomings. One is experience (I was 35), which we knew when we promoted you, and that’s not a concern. But the second is … you don’t dress the part.” He handed me a business card for the clothier the exec staff used. Message received, and I revamped my wardrobe. Your clothes and style do speak volumes.

The wrong position. “But it’s the dream job, the one I’ve been waiting for.” I minimized the red flags. I recall vendor executives as well as former employees giving me fair warning, but I dismissed these. As I soon found out, they were right, and I had to deal with the consequences. I made the best of a compromised situation, but in hindsight, I would have listened to wise counsel and proceeded differently.

Leadership

Walking in authority. I had been promoted internally to CIO, and other employees (including myself) still saw me as the Deputy CIO. This attitude diminished the strategic nature of our division, and I allowed one executive in particular to mistreat my team. Not until a couple of years later did I begin to walk in my authority and confront the situation. I stood up to the schoolyard bullies, and then things changed.

Pay me now or pay me more later. Capital investments are limited, and every division wants some. I placated to politics, which put our technology infrastructure at risk. If I had fought harder to ensure the funding, we would not have faced the crisis that later arose from my error. Given the impact of IT in clinical and business operations, I vow not to fail here again.

This is not an exhaustive list, but it contains the mistakes that came top of mind. Several direct reports, past and present, also added to the list. What about you? What mistakes have you made that would benefit readers so they don’t have to learn the hard way?

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.

News 3/9/11

We’re trying a new way of organizing our posts in response to reader survey suggestions, so don’t panic that you flipped to the wrong channel.

We tried to figure out an orderly way to arrange everything to allow quick skimming while letting you know whether Inga or I wrote a given item (thus our names at the end of each) since that means we can’t have separate sections a la HERtalk by Inga and you may want to respond specifically to whomever wrote something. We may ditch that later, or shorten the identifier. We’ll see.

You get a little more white space on the page, which is nice. Easier on the eyes.

I’m sure we’ll be fine tuning and getting comfortable with it. It’s extra work for me, so you can help me decide whether it’s worth it. Comments welcome. UPDATE: vote your preference below. We’ll go with the majority starting with Thursday’s post.

Top News

The Children’s Hospital Informatics Program (CHIP) and Harvard Medical School make their SMART platform and interface available. The app store-like system, built with a $15 million ONC grant, is open to developers to create Web applications with specific applications that are scalable and substitutable. They’re offering a $5,000 prize to developers who build the best application as reviewed by a panel of judges, with the winner to be announced in June. Project co-leaders are Kenneth Mandl, MD MPH and Isaac Kohane, MD PhD. [Mr. H]

Paul Concocenti, CIO of NYU Langone Medical Center, steps down as SVP, vice dean, and CIO to “pursue broader healthcare IT opportunities that simply are not available at one medical institution.” Nader Mherabi will move from his current role as VP and CTO to serve as interim CIO. NYU Langone is in the midst of a $200 million Epic implementation. [Inga]

Even though nearly 83% of office-based physicians are eligible for Medicaid or Medicare EMR incentives based on the number patients seen, over 70% of eligible physicians don’t have a basic EHR. A Health Affairs study also finds a disparity in eligibility among different specialties, with the vast majority of family practice and internal medicine providers likely to qualify, but fewer than two-thirds of pediatricians, OB/GYNs, and psychiatrists. Researchers recommend broader eligibility requirements to help more specialists qualify and encourage more EHR adoption for smaller practices. [Inga]

Reader Comments

From Walking in Memphis: “Re: booth babes. Let’s see…your avatar is a nubile, stylish, attractive female whose passion is shoes of the spiked variety and your problem with booth babes is the exploitation of their gender? Really?” Really, and this really is going to be my final comment on the subject. I am pretty sure Walking in Memphis is suggesting that I am a hypocrite and I won’t argue that point. However, I will add that just like my avatar, I am a nubile(ish), stylish, attractive female. I also happen to have a passion for shoes of the spiked variety. The difference between me and booth babes, however, is that the lovelies’ raison d’etre is eye candy. I do hope that I offer more value than that. [Inga]

From Steve: “Re: FirstNet problems. What has struck me toward the end of the article is that it sounds like this health system doesn’t have a good change control process in place. I got that impression reading the part about ‘constant minor setting changes’ leading to changes for everyone. I think of the change control process as something like taxes. Everyone hates it, and yet it is also insanely important for proper running of the system. Outside of that, I can also see many truths in the problems they are having with Cerner’s own departments not talking to each other to coordinate build, etc.” I don’t doubt technical and vendor issues contributed to the situation there, but I’d bet any amount of money that the client isn’t guilt free. First and foremost, they’re the ones who bought FirstNet, so complaining how it works now implies lack of due diligence (not to mention that it works fine in a lot of other places, with the variability being the driver, not the car). The decision was made top-down from what sounds like an out-of-touch bureaucracy, a sure predictor of user pushback whether it’s Cerner or SAP. I’d bet the schedule was pushed, the communication was poor, and the project oversight left to IT or other departments out of touch with what people really do. Not to mention that everybody loves the system that’s going away and being the new stepmom brought home by a beaming dad to meet the kids is a tough situation. [Mr. H]

From BeKind: “Re: University of Cincinnati. HIStalk said 8/2/10 that they would spend up to $100 million on a clinical system. The decision: Epic.” No surprise there – if  you had $100 million to spend, what else would you buy? UC says they’ll be live everywhere in 18 months. [Mr. H]

From England Dan: “Re: Ohio Health Information Partnership. Announced today that Medicity will be their HIE vendor.” Unverified. I couldn’t find a press release, but I knew a state announcement was coming up this week. I’m told it went out via a statewide telecast. [Mr. H]

From Toledo: “Re: NextGen. Acquisition announcement coming, maybe more than one.” Unverified. [Mr. H]

From Mogall10: “Re: Rob Seliger. Rumor has it that the former CEO of Sentillion has resigned from Microsoft.” Verified. Moving to Redmond was imperative, yet undesirable, we hear. [Mr. H]

HIStalk Announcements and Requests

We have found video of the stage portion of HIStalkapalooza, including the full HISsies presentation with Jonathan Bush that people keep asking for. Coming soon. [Mr. H]

Acquisitions, Funding, Business, and Stock

Clinical documentation service provider Transcend Services enters negotiations to acquire medical transcription company DTS America. The purchase price is expected to be $7.9 million in cash, plus an earn-out of up to $4.2 million payable in 2012. DTS generates annual revenues of approximately $12 million. [Inga]

CPSI shares hit a 52-week-high Monday. The market cap of the small systems vendor is $628 million. [Mr. H]

Cerner will take over parts of the electronic medical records projects at two hospitals in Ontario, resulting in a 27 FTE reduction in hospital headcount with an additional nine IT positions eliminated. Opposition parties had criticized the arrangement claiming it allows Cerner to sell the hospitals’ de-identified patient data for a profit. [Mr. H]

Sales

Wake Forest University Baptist Medical Center (NC) will upgrade its radiation oncology technology with Elekta, adding the MOSAIQ EHR, oncology information system, practice management, and oncology PACs, plus the SYNERGISTIQ workflow management system. [Inga]

People

Continuum Health Partners names Mark Moroses CIO and corporate VP of IT. [Inga]

Athenahealth CEO Jonathan Bush is featured in an Economist panel discussion called It’s a Smart World. The whole think is worth a listen, but I’m a sucker for the pop culture references. “The idea of ownership of data … it’s like that guitar in Spinal Tap that you’re not allowed to look at because it’s just too fragile or too special. It’s just a guitar, right? It’s just some information. The thing that I think we worry about is somehow being outed or treated poorly and I think that if you are given information under certain conditions, that’s why it’s important that there be buy-in through every layer of intelligence that gets added to the healthcare cloud that those conditions be honored.” [Mr. H]

CareFusion appoints Carlos M. Nunez, MD as chief medical officer. He was previously with Picis. [Mr. H]

Vendor Announcements and Provider Implementations

Eastland Memorial Hospital (TX) implements Prognosis ChartAccess Comprehensive EHR and readies for participation in the Texas RHIO. The 52-bed hospital anticipates a rapid implementation: software installation was scheduled for March 1 and the hospital plans to start its Meaningful Use attestation May 31st. [Inga]

Greenwood Leflore Hospital (MS) implements DBTech RAS e-forms and converts 500 paper forms to an electronic format. The hospital estimates the conversion will save $145,000 annually. [Inga]

Reliance Software Systems (RelWare) says it raised over $1,000 for TEAM FOX at HIMSS, benefitting the Michael J. Fox Foundation for Parkinson’s Research. RelWare had the Back to the Future DeLorean Time Machine parked in its booth and accepted visitor donations. [Inga]

SCI Solutions announces GA of its Arrival Manager kiosk, which provides patient check-in, registration, card swipe, demographics and insurance validation, document review with signature, and wayfinding. It integrates with SCI’s access management solutions for order processing, enterprise scheduling, revenue cycle, and self-service. [Mr. H]

UCSF goes live with robotic pharmacy dispensing and IV preparation, said to be the most comprehensive in the country. [Mr. H]

RiverView Health (MN) partners with Sanford Health to deploy Epic’s EMR. Unless the community-owned RiverView partnered with an entity like Sanford, the health system would be an unlikely Epic shop: RiverView includes a 25-bed critical access hospital, 22 employed providers, a 70-bed LT care facility, homecare, and lab services. [Inga]

Altru Health System (ND) also wants to share its Epic EMR with smaller hospitals. Altru is in discussions with nine hospitals across North Dakota and Minnesota.[Inga]

Government and Politics

A study by the HHS’s Office of Inspector General finds that 92% of nursing homes have at least one employee who has been convicted of a crime, with nearly half having five or more such employees. I can’t say I’m shocked since Mrs. H was a director of nurses in a pretty good facility and even the RNs there often had records, not surprising given the low pay and the bad working conditions. My advice: stay on good terms with your kids so you can reduce your chances of requiring one. [Mr. H]

Innovation and Research

A regenerative specialist who has found a way to create human tissue using an inkjet printer with cells as the ink uses the technique to build a biocompatible model of a human kidney on state at the TED conference this week. [Mr. H]

A self-taught inventor who has earned FDA approval for his medical imaging system that uses NASA satellite imaging technology lacks only one thing to bring it to market – the $500K needed to build a manufacturing facility. The MED-SEG system, built in his basement from scrap computers, enhances existing images. He claims it can reduce false positives in mammograms by 80%. [Mr. H]

Technology

Syracuse area hospitals are embracing the iPad for remote OB monitoring, documenting observational handwashing monitoring, and remotely controlling the heating and air conditioning systems. One hospital will give iPads to board members “so they can access online documents during board meetings,” which in my experience means they’ll get cool gadgets and superb IT support (at home if they need it) just to make sure they provide their rubber stamp approval to whatever the hospital executives have already decided to do. That’s what I’ve seen, anyway. [Mr H]

Microsoft will pay Nokia a reported $1 billion to convince it to use Windows Mobile on its phones instead of the free Google Android, which was announced this week as the leading US smart phone platform with 31.2% of the most recent quarter’s market share, followed by BlackBerry (30.4%), iPhone (24.7%) and Microsoft (8%). [Mr. H]

GE partners with MedHelp to provide free apps (iPhone, iPod Touch, iPad) for pregnancy, diet, sleep, and moods. [Mr. H]

Other

From KLAS: an increasing number of providers are heading towards enterprise scheduling solutions that integrate with EMRs versus best-of-breed solutions. Best-of-breed solutions average higher customer satisfaction, but aren’t necessarily part of providers’ long-term plans. Unibased ranked highest in satisfaction scores, followed by Epic and SCI Solutions. [Inga]

Healthcare organizations added 34,000 workers in February, including 17,000 in ambulatory care centers and 2,100 in hospitals. [Inga]

A hospital claims HIPAA wasn’t violated when a doctor faxed the names of 12 high school students involved in a bus wreck to a local law firm. He got off with mandatory privacy education. [Mr. H]

Strange: a female paramedic and former Firefighter of the Year who took a man’s foot from an I-95 crash scene is sued by the man, who claims his foot could have been reattached if the paramedic had taken it to the hospital. She says she took it to train her body recovery dog.

Sponsor Updates by DigitalBeanCounter

• Greenway Medical’s PrimeSuite 2011 EHR, practice management, and interoperability suite is selected for ONC’s Direct Project.
• maxIT Healthcare launches a Canadian division and names Bob Betts as head of business development for the operation.
• Resurgens Orthopaedics selects Merge Healthcare for its enterprise imaging solution.
• North Highland continues to expand in the Midwest, adding a St. Louis office.
• Coastal Connect HIE selects Medicity for its community-wide HIE across five independent hospitals in eastern NC.
• UniNet chooses MedVentive to support its ACO initiative.
• MED3OOO is offering a Webinar, Steps to Successful Physician Affiliation, on March 16, featuring Tenet COO Stephen L. Newman, MD.

Contacts

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

Curbside Consult with Dr. Jayne 3/7/11

Welcome to HIStalk’s new Monday feature, Curbside Consult. For those of you not familiar with the term, a curbside consult happens when another physician wants to ask your opinion about something, but doesn’t want to write a formal consultation request in the chart or actually send the patient to see you.

Curbsides have a certain appeal for both sides. When busy subspecialists like infectious disease (ID) docs are in short supply, they don’t want their time wasted by what they consider simple questions, like validating an antibiotic selection for a hospitalized patient. If the request is made formally, they have to see the patient and write a note, when often it’s an answer they can just give off the top of their heads (and are happy to do so).

My favorite ID consultant requires that you call his cell phone to curbside him prior to writing a formal consultation request. Eighty percent of his business is in curbsides, because he likes to save the “real” consultations for patients who are truly complex. I think it’s also his way of having some semblance of a home life. If he formally consulted on everyone he was called about, he’d never see the outside of the hospital. (It probably would be a different story if there were ID specialists around every corner, but there aren’t, at least in my market.)

For those of us that ask for the occasional curbside, often the question is one that we know the answer to, but want a colleague to validate. Maybe it’s not something we see every day, or we want to confirm that we’re operating with the latest and greatest information.

The worst kind of curbside is when a non-physician tries to ask for one — also known as the Supermarket Consult. Definitely to be avoided, as no physician ever wants to try to diagnose a rash in the frozen foods aisle.

The worst one of these I ever experienced was when I worked for a small-town hospital that had a float in the town’s Founders’ Day parade. Waving and throwing candy from my Astroturf-covered perch (wearing a white coat and scrubs, no less) a patient stepped out of the crowd in the middle of the parade route and asked me if I had an update on new medications for constipation. (With patients like that, who needs HIPAA, anyway?)

On HIStalk, Curbside Consult is about sharing physician opinions on the hot topics, not only from me (Dr. Jayne), but from the HIStalk Medicine Cabinet. Response from potential Cabinet members has been good. I haven’t gotten back to everyone yet since I worked entirely too much this weekend, so stay tuned.

When Mr. H offered to run my posts on their own night, it was exciting, yet a little bit nerve-wracking. I appreciate the opportunity and think it will be a chance to have more focus on CMIO/CIO/CMO/physician topics independent of the news, rumors, and updates. And so, here we go!

A Study of an Enterprise Health Information System

Mr. HIStalk opened the door on this one in his Monday Morning Update, so I’m going to walk right through.

For those of you who haven’t seen it: Jon Patrick, Professor at the University of Sydney’s Health Information Technologies Research Laboratory, wrote about implementing Cerner FirstNet in emergency departments in New South Wales. 

(As an aside, you can take the CMIO out of clinic, but you can’t take the clinic out of Dr. Jayne. The author also had an article about extracting data from narrative pathology reports on melanoma patients, which I downloaded to read on my way to the beach later this month. Using optical character recognition and concept tags to gather data and improve care? Fabulous!)

I agree with Mr. H though. Forget Cerner, as this applies to vendors and applications that are too numerous to count. Being the person who often has to have the less-than-pleasant conversations with vendor CMOs and physicians when there are issues at my hospital, I’d like to share my observations.

Although there are some significant defects out there, many vendors are working hard to remedy these and to implement aggressive protocols to bake quality into their products and design defects out. The best of these organizations are adopting techniques long used by manufacturing to ensure quality. This is still a relatively emerging industry, though — some folks are building Model T Fords, while others are building models that will go for 200,000 miles.

Vendors are under the gun from clients and prospects to make their products pretty, which translates too frequently into something that might look nice but isn’t clinician-friendly, usable, or safe. Vendors are also pressured to make their systems “fully customizable,” which often means allowing users to do things which are, for lack of a better word, stupid. I’d love to see a rebuttal of the article addressing what parts of the system were implemented against Cerner advice or best practices.

Some additional thoughts:

• Too many systems allow clients to “customize” patient safety out of the implementation. When I learned that there was a preference in my system to disable allergy and drug interaction checking, I cringed. (This was years ago when I was but a mere Physician Champion, before some of my colleagues decided I was an “IT sellout” and had crossed from “us” to “them.”) Within a few months, some of my colleagues demanded that we allow users to turn it off. Their reasons (no kidding) included “I know what medications interact with each other” and “I know what the patient is taking, I don’t need the computer” and “I hate it, turn it the [bleep] off.” There’s no class in medical school that teaches you how to deal with peers who act like this. The only thing you can do is make sure your patients and loved ones don’t go see them.
• User errors can be reduced, but they can’t be eliminated. At our hospital, we aggressively track errors in documentation and look at trends between physician offices and across the system. Good staff training, low turnover, and accountability all lead to fewer errors. Surprise!
• Patients give bad information, which no amount of decision support or application design can fix. Until we have fully integrated interoperable platforms that remove human memory or manual data entry from the equation, this is going to be an issue. On the other hand, when everything is fully automated, errors can become magnified and nearly impossible to fix. Talk to anyone who’s been the victim of medical identity theft and you’ll know immediately how horrible this can be.
• The ability to review longitudinal patient data is sorely lacking in many systems. In this world of accountable care and shared risk, the concept of episodic care needs to die a quick death.
• Data integrity has to be paramount. It doesn’t matter how slick your user interface might be or how few clicks it takes to document — if the data gets vaporized, it’s game over. My first EHR had this handy little feature: the templates accommodated unlimited input, but the documents only accommodated X number of characters. Not knowing any better, I trusted my vendor (ha!) and didn’t discover this undocumented functionality until patients came in for follow up visits and many Assessment/Plan sections (traditionally done at the end of the note) were missing. My risk management consultant loved that one, let me tell you. On the other hand, that EHR was extremely easy to use, was highly standards-based, and had a workhorse scanning solution that I still miss. But it ate my notes, so it had to go.
• Several vendors still use design philosophies that revolve around the individual visions of key leaders regardless of user needs. Granted, they’re baking in the Meaningful Use requirements because they have to, but the world has changed and what was cool 20 years ago is no longer what healthcare needs. There are peer-reviewed studies on usability and user interface design, and some of these folks must never have seen the articles. HIMSS did a piece on EMR Usability a couple of years ago and I know the systems that have design elements that hopscotch all over the place or color schemes that induce vertigo are designed by people who haven’t seen it.
• Vendors should spend the money to hire medical proofreaders to look at their products. Nothing screams “we rushed this to market” like misspelling medical words. I saw this more than once at HIMSS in the nether reaches of the exhibit hall. Once you lose providers’ trust with something like that, it’s extremely difficult to get it back.
• Allowing existing users to beta-test your product, if they’re willing to donate the time (or if you’re willing to pay for it) can make a huge difference in the quality of releases. This allows for detection of those issues that are particular to the way individual clients use a system. Otherwise, there’s no place like production.
• Vendors need to disclose their defects. More and more are doing this in a meaningful way. On one hand, I understand the call to have the FDA regulate systems. On the other hand, as a physician, I know that the FDA is, in many ways, a joke. Deserving products can’t get to market because of the complexity of the process, manufacturers with deep pockets continue to slipstream their products, and the vitamin/supplement industry got themselves classified in a way so they can say what they want, produce what they want, and generally get away with it.
• Hospitals and practices need to thoroughly test their systems prior to go-live, regardless of what the vendor says or how many clients they have live. Your staff will find shortcuts and features that no one has seen and will rapidly become dependent on these, much to the consternation of your call center, trainers, analysts, and the vendor. The only way to trust the system is to test the living daylights out of it before taking it live.

Unless physicians and their IT teams understand these points, they aren’t ready to leave paper. Those who do understand need to play an active role pushing vendors to improve and vendors need to address core functionality.

If progress isn’t made, the likelihood of a federal mandate increases. We’ve already seen what Meaningful Use has done to the industry. As Scotty once said, “She can’t take much more of this, Captain.”

E-mail Dr. Jayne.

Readers Write 3/7/11

Meaningful Use Does Not Have to Burden Physicians
By Evan Steele

As the CEO of an EHR technology company, I am driven by an unwavering dedication to physician productivity. As readers no doubt recall, the preliminary version of Meaningful Use generated an outcry from physicians — specialists in particular — regarding the burden they would have to shoulder to qualify for the government’s EHR incentives and the resulting effect on their productivity. Many physicians decided that they would not comply, and would simply forgo the incentives.

In response to significant lobbying efforts and to the more than 2,000 comments the government received last summer regarding the Proposed Rule on Meaningful Use, the Final Rule included considerable easing of the requirements for physicians in general, and significant accommodations for specialists in particular.

I want to share with HIStalk readers my view of Meaningful Use from a workflow perspective. The pie chart above illustrates how Meaningful Use is achievable without negatively impacting physician productivity, taking advantage of the exclusions available (to most specialists) and shifting the bulk of the burden away from the physician to the staff.

The implications of demonstrating Meaningful Use vary by specialty. For most specialists, the available exclusions make it relatively easy for a physician to comply. For primary care physicians, there is more to do to meet the requirements.

However, the pie chart illustrates how everyone can achieve Meaningful Use through a practical and efficient use of staff resources, combined with a productivity-focused EHR. This chart is for a typical orthopaedist, but similar charts for other specialties and primary care are also available.

The physician him/herself has four areas of responsibility. The act of ePrescribing alone addresses five of the Meaningful Use measures, and good ePrescribing software increases physician productivity. For example, we have documented that it takes to 23 seconds for a physician to prescribe on paper and a mere fraction of that time using our ePrescribing module.

Maintaining a problem list could be done by the nurse or MA, but we recommend that the physician at least review it, so he/she can view the clinical decision support alert at the point of care.

For some specialties, there are no (or few) relevant clinical quality measures, but where there are relevant measures, most of the work is done in the normal course of the visit: documenting the problem and ordering tests and/or medications.

As illustrated, the rest of the Meaningful Use measures can be handled by clinical and support staff, and some measures are excludable. So, with the right EHR and the right workflow, Meaningful Use is definitely achievable by specialists and primary care physicians alike.

Evan Steele is CEO of SRSsoft of Montvale, NJ.

Usability = Adoptability: What if Facebook and Amazon Built an EMR?
By Dale Sanders

Below are screen mock-ups based on Facebook’s and Amazon’s user interfaces. Borrowing ideas from them is comfortable because they parallel healthcare processes quite nicely, but also because the user interfaces on today’s EMRs are abominable, and adoption rates are terrible (without financial coercion) as a result. People flock to Facebook and Amazon by the millions, without financial incentives. Why? Because:

Total Value of Software Applications = Functional Value x Usability

If either Functional Value or Usability drop to zero, the overall value of the application drops to zero as well. EMRs might be functional, but they are not user friendly, so their Total Value to healthcare is very low.

In Facebook, we have a perfect framework for longitudinal documentation, collaboration, messaging, and scheduling between a patient and members of their entire care team, including family and friends. We also have a framework for easily integrating data from other sources to enhance the value to the patient’s healthcare — there’s no equivalent of HL7 interchange going on in Facebook. It references data located in other sources and systems. Can you imagine Facebook surviving if it required itself to house all the data that it presents? Facebook takes great advantage of referencing and pointing to data in the source systems to build rich content.

In Amazon, we have a perfect and familiar metaphor for ordering tests and procedures; tracking them; assessing their costs; rating them and seeing how other clinicians rated those orderables and referrals; and adjusting orders based on the behaviors and ratings of other clinicians, etc.

Here are the screen shots.  Let’s start building these, eh?  Think Mark Zuckerman or Jeff Bezos would help?

(Note: click the pictures to enlarge them).

Dale Sanders is CIO of the Cayman Islands National Health System. He writes about healthcare IT on his blog.

Monday Morning Update 3/7/11

From Harvey: “Re: Mediware. Shares of MEDW popped 15% after hours Friday on no news.” That is interesting, especially on a down market day and for a stock that trades in a fairly narrow range. Maybe a deal is in the works and word leaked out. Or, maybe someone is buying up shares after the company’s recent good performance. I haven’t heard anything, but if you have, let me know. The two-year share price chart is above. Shares nearly tripled in a steady run despite poor market conditions.

From ClinicalWonk: “Re: Wayne Smith, CEO of for-profit hospital operator Community Health Systems, quoted from a Wednesday investor conference.” Here’s what Wayne, who holds $37 million worth of CHS stock and makes $10 million a year, had to say.

We’re all working on Meaningful Use. We’re working on it in terms of IT piece of this, which I absolutely think is a black hole when it’s all said and done. Everybody is talking about they have a zillion dollars worth of expense here or cost here, and the government is going to give them back a half a zillion. I don’t know how that works for other people, but it leaves you half a zillion short as far as I’m concerned, when it’s all said and done. And return on investment here is not all that great. We are very careful about how we think about how we deploy our capital, so the return is not all that great, either. So, that’s one piece.

From Dave Magadan: “Re: VITL chooses Medicity for Vermont’s HIE. That means GE Healthcare lost their contract in a state where they have a big footing. This wasn’t just a new contract – it was a complete replacement.” GE Healthcare was announced as the technology provider for the RHIO (as HIEs were known back then before they gave themselves a bad name that needed changing) back in 2006. GE is strong in Vermont because of its IDX acquisition.

From CMIOFlorida: “Re: AT&T. Looking for a CMIO to run its healthcare solutions division.”

From Luke O’Cyte: “Re: Dilbert. Today’s strip sums up many of the booth babe comments about HIMSS.” Nice! Maybe Scott Adams was writing from experience – those few folks who stuck around until Thursday of HIMSS 2005 in Dallas saw his keynote presentation that year (the other keynotes were John Chambers of Cisco, Barbara Bush, David Brailer, and the no-show Scott McNealy of Sun).

From Peter Groen: “Re: COSI Open Health site. It provides information on open source or public domain health IT solutions and might be of use to some of your readers.” I’m not big on giving sites free PR, but I’ll allow it in this case.

From Punxsutawney Phil: “Re: Pennsylvania Health Information Exchange (PHIX). Medicity won the contract. AT&T protested like they did when they lost the Florida bid to Harris. PA state procurement turned them down so AT&T sued the state. They cancelled the contract and will re-bid it, but project work has stopped and PHIX’s ONC money is threatened because the state hasn’t finished its selection.” Unverified.

Listening: the not-yet-released new album from R.E.M., streaming free on NPR until its Tuesday release. They had a dull spell in their 30+ years, but they’re sounding good again. Watching: a depressing commercial featuring Jamie Lee Curtis, who went seemingly overnight from a scream movie hottie to a gray-haired, Activia-swilling AARP cover girl.

I’ve posted the hot-off-the-press results of my reader survey. It’s a fun read, with some interesting stats (my favorite being that 87% of readers say reading HIStalk helps them perform their jobs better), some great suggestions for changes (improving the mobile device format and giving Dr. Jayne her own post, both of which I’ve already done as a result), and comments (“I’ve always wondered if you had a deal set-up where your identity will be revealed after your death. Similar to Deep Throat of Watergate fame.”). Thanks to all who responded, except for that last comment which forces me to contemplate my own mortality, especially since Inga just innocently asked me, “What happens if you get hit by a bus?” Bloggers don’t usually have succession plans, so I have no idea.

Here’s a to-do from the survey. If you want to help, let me know. The real value in this suggestion is requiring a new company looking for exposure to provide at least one happy client’s testimonial, which goes a long way in separating the wheat from the chaff:

Open a channel for "new" companies to provide a brief description of what they do. Kind of a "what’s hot or what’s new" type section. Companies would have to be small (five or less clients?), have proven success (one client testimonial), and be ready to expand. Might give the company and your audience a chance to connect. Would also allow the rest of us to learn about new things and maybe push us all to be better. I would offer to help edit/review submissions and I bet others would as well.

Lots of people went to HIMSS without attending any educational sessions, which is easy to do since the schedule encourages heading off the exhibit hall profit center. Few of those who did found the education sessions excellent, but most said they were at least OK. New poll to your right: of the booth features people have complained about, which (if any) should HIMSS ban? You can choose multiple answers and the poll will accept your comment.

Here’s a virtual tour of the Nashville Medical Trade Center, where HIMSS is the big signed tenant on the fourth floor, right next to the vendor showrooms (in a seamless and slightly uncomfortable blending of a supposedly patient-centered non-profit flanked by its purely commercial members). From the video: “Visitors for hospitals, clinics, professional practices, and other provider organizations move swiftly toward activities and informed purchasing decisions.” Sounds like a cross between the HIMSS conference exhibit hall and Cerner’s hard-selling Vision Center. Somehow as a HIMSS dues-paying provider member, I keep feeling more and more like a fresh meat prospect for its higher-paying vendor members in the business model that I always call Ladies Drink Free.

DrLyle wraps up HIMSS with a list of innovative companies to watch (congratulations to the several HIStalk sponsors who made his list) and a wrap-up of the HIT X.0 sub-conference, including winners of the HIT Geeks Got Talent competition.

Speaking of HIMSS wrap-ups, several people e-mailed to say that I needed to read that of the PACSman, a friend of HIStalk and master of radiology (a Black Sabbath pun that just popped into my head) trying to find his place in the IT-centric world of HIMSS. Pretty funny stuff.

Also funny: a high-ranking exec of a big vendor that was the subject of a unverified rumor I ran awhile back chastised me by e-mail, saying that “tabloid-type rumors” threatened the integrity of HIStalk. I responded nicely, saying (a) at least 80% of the rumors I’ve been running for eight years now turn out to be true to some degree; (b) if I’m hearing the rumors, chances are everyone else is, too; (c) rumors are, from the reader survey, the #2 most-liked HIStalk feature, barely behind the news; and (d) quite a few big industry news items came to light only because I’d run a rumor that turned out to be true. I liked the exec’s follow-up admission: “I am truly a fan of the service (and yes, I follow the rumors). It just sucks when it’s about us :-).” That’s an honest answer – every company loves reading rumors as long as they’re about someone else.

In a remarkably bold marketing campaign, the vendor of a system that transmits ECG readings from ambulance to hospital boasts that its product actually makes heart attack patients wait longer for treatment. That or the headline writer for the San Antonio paper isn’t very good.

Amcom Software, which provides paging and messaging software for a large number of hospitals, is acquired for $163 million by USA Mobility, the largest wireless medical paging operator.

Image Stream Medical raises $2 million in funding. The Massachusetts company sells OR video solutions that include a server-based video repository and broadcasting. Other than the new money, it must be pretty quiet there since their latest news release is from 2006. I’m not sure I’d trust a technology company that can’t keep its Web site updated.

Medical waste handler Stericycle apparently acquires NotifyMD for $50 million. The company provides call center services and automated calling applications for physician practices.

E-mail me.

From Aussie: “Re: Jon Patrick’s article. Mr. HIStalk, I have never seen a dissection (without anesthesia) of Cerner going to this depth. Unbelievable, although in the USA, one would be professionally dead in the HIT industry if even contemplating talking about these long known issues. Hope you will have the courage to publish something about it.” Professor Jon Patrick of the Health Information Technologies Research Laboratory of University of Sydney expands his writeup (currently in draft) about problems with the implementation of Cerner FirstNet in emergency departments in New South Wales.

You’ll love it if you sell against Cerner because everybody from doctors to software validation experts tears into FirstNet (and, by implication, Millennium in general) from every angle — usability, software and database design, and implementation methods. FirstNet competitors could create a fat anti-Cerner prospect piece just by excerpting from it.

On the other hand, I wouldn’t say it’s necessarily unbiased, it focuses on implementation of a single department application that didn’t go well for a variety of reasons (despite many successful FirstNet implementations elsewhere), it uses the unchallenged anecdotal comments of unhappy users who make it clear they liked their previous EDIS better, and it nitpicks (I wasn’t moved to find a pitchfork when I learned that the primary keys in the Millennium database aren’t named consistently).

But it is interesting when it tries to associate user-reported problems with observed technical deficiencies, such as why information known to have been entered sometimes disappears (problems with non-unique primary keys and referential integrity are mentioned – certainly the latter is a problem with many systems). 

In other words, it’s not just about Cerner or some ED project in Australia. The real message is that design and support patient care software is the Wild West at this point since we’re arguably still in the first generation of systems claiming to be clinical (even though they often are really business systems masquerading as such).

Products have long-uncorrected design flaws that were created in an urgency to get product to market regardless of the required compromises, all known to clinicians who work for those vendors (clinicians are often the booth babes of the vendor world — hired to attract prospects but given no real authority). There’s no oversight or accountability beyond what vendors choose to provide and that decision is often made based on vendor staffing, budget, or individual managerial prerogative. 

Here’s my conclusion. Start with Part 7, which is definitely worth a read. Forget Cerner specifically and focus on sloppy software design practices and poor usability. We know it exists throughout the industry and this is a good primer on what can go wrong. Examples:

• Using time values as unique database keys, such as the assumption that a single patient could not have multiple lab orders with the same timestamp
• The problem whereby even integrated systems build modules in silos, which can make them as inconsistent and fragile as interfaced systems
• Free text entries are allowed for problem lists, allowing staff to create entries that nobody will be able to find
• Mandatory terminology selection doesn’t match common usage, such as staff looking for “CTPA” when Cerner calls it “CT chest PE”
• Entered information is lost when users get pulled away and the system times out for security reasons
• The application shows only the clinical notes of the current episode, giving clinicians no longitudinal feel for the patient
• Trainers advise that users never use available functions because they will cause problems (happens all the time at our non-Cerner place — “don’t do that even though the system allows you to”)
• Staff found they can change some information and re-save under the original doctor’s name

The takeaway is that patient care software is far from perfect, but we already knew that. What’s more interesting is how vendors respond to well-documented reports of specific software problems that impact patient care.

I see it every day. My hospital’s vendor has a huge list of problems we’ve reported that don’t get addressed for a variety of reasons: the problems are limited to sites that use a system in a particular way (i.e., the vendor doesn’t think it’s worth fixing since few clients are complaining), they don’t want to tackle the issue because doing so would require an expensive rewrite of a badly designed system, or they don’t have the resources. All of these are logical answers unless you are one of our patients harmed as a result.

I spend a lot of my time on looking at patient safety related to IT and it’s not pretty. Much of it relates to user error, but that, too is a reflection of software design. If IT systems were drugs, you’d see quite a few black box warnings and probably some recalls. The resulting negative publicity would push the vendor in ways no single hospital can do.

I’d like to see mandatory public disclosure of known patient-impacting software defects using a standardized classification system, whether vendors do it themselves or someone else (FDA) has to step in. We customers and our patients often find out about known problems the hard way, and we don’t have much clout to get problems addressed since we’ve already signed on the line which is dotted. This article, if nothing else, is a good reminder of where the industry stands and a reminder that we have the opportunity to make it safer.

Like clinicians, vendors don’t harm patients intentionally, however, and nothing is ever as easy as it looks from the cheap seats outside of vendor-land. The same naysayers who predictably and monotonically chant the “HIT is evil” mantra at every opportunity haven’t been all that effective because their only implied solutions are naive: every software vendor should just drop everything (including profits) and rewrite systems with the involvement of self-proclaimed experts such as themselves, thereby fixing everything (they obviously haven’t seen the horrors of newly written software or applications designed by ivory tower informatics experts).

Somewhere between “we vendors are doing the best we can given a fiercely competitive market, economic realities, and slow and often illogical provide procurement processes that don’t reflect what those providers claim they really want” and “we armchair quarterbacks critics think vendors are evil and the answer is free, open source applications written by non-experts willing to work for free under the direct supervision of the FDA” is the best compromise. Obviously we’re not there yet.

That’s why I advocate transparency before anything else. Let the industry know the extent of the problem and let that information drive the solution. This article (and others) are building a case for that level of openness about patient-impacting systems.

HIStalk 2011 Reader Survey Results

I run a reader survey once a year, right around HIMSS conference time. It helps me see the big picture better. I get a lot of good ideas, although I don’t have the time to implement all of them.

I consider HIStalk yours as well as mine, so I always share the survey results. Here are some points from this year’s survey that interested me.

• 32% of readers have worked in the industry 10 years or less, 29% have 11-20 years, 24% 21-30, and 15% more than 30. That’s a nice mix of fresh faces and hard-won gray hairs.
• 33% of readers work for a provider organization and have purchasing authority greater than $10,000.
• 78% of readers get the e-mail update when I publish something new.
• Most readers read HIStalk whenever they get the e-mail (38%), although 24% read daily or more often. Only 3% read less than weekly.
• The most important elements to readers are news, rumors, humor, and Inga (all had similar scores).
• Interviews were the lowest-scoring element (3.58 on a five-point scale) but I’ll add this: the interest tends to be selective based on who I’ve interviewed. I also consider interviews to be essential since nobody else runs full transcriptions of answers in response to questions asked by someone who actually knows the industry, so I think of them as a public service to some extent. Some are duds, of course, and I don’t like reading those either.
• 83% of readers say they have a higher interest or appreciation for companies I write about.
• 35% of readers say they have a higher interest or appreciation for companies that sponsor HIStalk.
• HIStalk’s influence on the industry: none (1.7%), not much (6.6%), some (43.9%), a good bit (40.3%), a lot (7.6%).
• Always my favorite stat: 87% of readers say reading HIStalk helped them perform their job better in the past year. Magazines would kill for that number.

Suggested Changes

• Change nothing. This was by far the most common of the 155 suggestions. I really appreciate the ideas below and will implement some of them, but I’m also aware that the majority of readers like HIStalk just fine as it is and would rather I not tinker with it too much. That works out well since I don’t have time to get ambitious.
• Make the Web page look better. I have to say that I’m neutral on that, as are those readers who urged me not to try to slick things up and design by committee. I like being amateurish in appearance but expert in content.
• Layout is awful! Make it easier to read, sometimes I can’t figure out what story belongs to what pictures.The text is always below the picture it goes with.
• Make ads less annoying. I give sponsors a strong hint not to use annoying animation, which some take to heart and some don’t. I have a lot of sponsors and I can’t apologize for that since I don’t solicit sponsors in the first place, but maybe it’s time to implement stricter guidelines on ads (limited transitions, no animation within a single frame, etc.) I’m comfortable doing that as long as the effective date gives them time to re-make their ads when necessary since I know that takes time and costs them money.
• Implement an RSS feed, tweet links on updates. Both are in place and have been for quite some time.
• Don’t let the sponsors influence the news. Sponsors get one editorial benefit only – I’ll mention their not-so-newsworthy news on occasion without comment (and we usually put those mentions in the Sponsor Update, making them easy to skip if you’re not interested). They get no advantage otherwise, but I can understand how those non-newsworthy mentions could give that impression. I choose the news items without regard to who sponsors and who doesn’t.
• Better mobile site for BlackBerry, iPhone, Android, etc. The content is perfect – wouldn’t change that for the world. I acted immediately on this suggestion, especially when I checked HIStalk out in an iPad. The mobile layout should work now for all major devices.
• Categorize news by topic. I’m mixed on this because I tried headlining stories before and it was pretty miserable to read. I cover dozens of stories in a single post (to make it an easy and fast read) and there’s just no good way to logically segregate the stories. I’ve considered running a second version of the site with one post per story tagged by topic. Sounds like a lot of work, though. Here are a couple of less drastic ideas – let me know what you think: (a) start off with a fast read of only a one-sentence-each summary of the top “real news” stories (maybe 3-5 of them), then drop into the usual format, or (b) break out the post by broad topic, such as Rumors, New Deals, Stock News, etc. Both would give a more consistent format without requiring much extra work on my end.
• CIO profiles with real-world info. I really like doing this, but my appeals to CIOs to be interviewed or write articles don’t yield many responses. Everybody likes to read, nobody likes to write.
• Do shorter interviews. I agree totally and continue to shorten the conversations that get transcribed. I started out with 50 minutes or so, dropped to 30, and now shoot for 20 minutes. If someone gets long winded, I wrap it up without finishing my prepared questions. I may drop to 15 minutes since it takes up a big chunk of my time to write the questions, conduct the interview, clean up the transcription, post, etc. I’ve also been sending out a “How to Do an HIStalk Interview” before each interview so the subject is clear on what I need, i.e. stop pitching product and your background and let’s talk broad industry ideas. That has worked pretty well.
• Love the new column from Dr. Jayne. She has been excellent at connecting with readers, both physicians and others, and I think she adds a very nice dimension that Inga and I couldn’t really do, just like Dr. Gregg does on HIStalk Practice.
• Move Dr. Jayne’s column to her own day like Ed Marx. I like that idea a lot. I needed to get a feel for her style and acceptance and I now know that both are excellent, I’m moving her to a Monday post on her own. Thanks for the suggestion.
• Tighten up the prose. We have to wade through a lot of stuff to get to the meat of the articles. Every story is one paragraph long and I do my best to summarize accurately in that space, which isn’t easy to do when the original article ran dozens of paragraphs. Sometimes I get on a fatigue-induced roll when I’ve worked 9-10 hours at the hospital and then sit down for another five hours of writing HIStalk, so it comes out just like I think it. I barely finish by bedtime, so a first draft is all I have time to do. I’ll try to run fewer less-important pieces to trim the overall length. Even that’s not a slam dunk since every item is important to someone.
• I don’t find much value in Readers Write. I don’t either all the time. It’s like the interviews – some are really good, some blow. Most of the vendor-written pieces are self-serving, but I’ve learned that anyone who takes the time to write, vendor or not, has an agenda of some kind (pitching product, angling for a new job, etc.) I may put up a survey on whether Readers Write should stay or go since I’m indifferent to it, although there have been some nice posts that I would have missed reading. I could accept only provider-written pieces, which might cut down on the pitches. Good idea?
• Organize the sponsor ads so I can find companies offering something specific. I like that idea. It would be hard to organize the ads themselves since many companies serve multiple product categories, but I can see some kind of an online guide sorting them out. Thanks – I like that and have already started working on it. I know some readers are conscientious about supporting HIStalk’s sponsors when searching for vendors (because they’ve told me so themselves) and I appreciate that.
• Axe daily e-mails. Most people read when they get an e-mail and I send one only when I’ve posted something new, so I’d be cautious about just not e-mailing even with a new post up. I’m open to suggestions, but I’ll toss this out: some readers want more frequent posts and some want less, so that may be the issue rather than the e-mails themselves.
• When performing a search at your site, sort it by date. Great idea if anyone can help me figure out how to do it. I’ve worked on this after reading this suggestion and found that there’s no way to do that automatically since HIStalk “pages” are generated dynamically from the database – they are not static HTML pages. Apparently the only way to incorporate a reliable date is to manually tag each post inside its HTML source, which would be a lot of work.
• Have a focused section on M&A and private funding of companies at all stages (especially the early ones). Maybe once per month. There are a number of incubators (they’re back) and angel communities that are funding early stage companies and it would be nice to have an easier way to see what’s happening in this area. Knowing who the healthcare focused VCs, Angels and Incubators are would be nice as well. I love the idea and would need help figuring out how to do it. Input welcome.
• Perhaps open a channel for "new" companies to provide a brief description of what they do. Kind of a "what’s hot or what’s new" type section. Companies would have to be small (5 or less clients?), have proven success (1 client testimonial), and be ready to expand. Might give the company and your audience a chance to connect. Would also allow the rest of us to learn about new things and maybe push us all to be better. I would offer to help edit/review submissions and I bet others would as well. Brilliant. I’m going to do this. If you want to help, let me know.
• Skip telling us what you’re listening to. Aw, c’mon, are you so pressed for time and so laser-focused on work that you’re not willing to let me have one easily skipped sentence out of the thousands in a week’s worth of posts? I mean, it’s some guy’s blog, not JAMA.
• More on HIStalk about financing – the best series you have is Health IT From the Investors Chair! That’s not my area of expertise and I don’t know how much free time Ben Rooks has, so I’m open to volunteers. I should mention, too, that my experience with even well-intentioned volunteers isn’t so good. Everybody likes the idea of helping me write until they realize that it’s a multi-hour commitment on a set schedule, not a “when you get some free time” thing. I know from the incoming domain names that I have quite a few readers from Wall Street investment banks, private equity firms, etc. If you are one of them, can write well, and want to pitch in (anonymously if necessary), let me know.
• Stop being so damn addictive. Making me stay up too late. Me too.

Some Representative Responses to “If You Have Thoughts to Offer About HIStalk, Please Let Me Know”

I promise these are representative even though they are mostly positive. There just weren’t many negative comments.

• Absolutely love it – and your rumor posted about my current client really made an impact at the site, so your work has actual consequences. Keep it up!
• Conversational, respectful of your readers, open to clinicians’ involvement.
• Overall, LOVE IT. Huge fan and read all the time.. definitely helps in the sales process to know the scoop about the industry, competition, and trends
• You are a creative, humorous, bright spot in this industry. Thank you for choosing to spend your valuable "off" time to generate this very entertaining blog!
• Great publication. You are the current standard in the industry.
• I would be interested in hearing about healthcare providers’ experiences with their use of consulting firms.
• Since this isn’t your ‘day job’ it’s amazing how well supported and well-written this site is.
• HIStalk is priceless and I want you to know that your dedication and devotion does not go without notice. I know what you must go through to constantly update your blog and bring your brand of sophistication to the HIT world. I only hope you take some time for yourself as well. You are truly appreciated from this guy.
• Love this site!! I have recommended to many colleagues and customers as it is a realistic view of our crazy industry
• Would prefer less-biased reporting and comments from Mr. H, but I understand the nature of blogging….
• I’ll admit it, I’m surprisingly hooked on EPtalk with Dr. Jayne. She provides good insights and her "pieces" are well written.
• HISTalk has helped me to be knowledgeable on a broad range of topics, one stop shopping shall we say? Thank you!
• Might be fun to consider holding HISTalk events in different parts of the country throughout the year – not necessarily tied to HIMSS. Would give sponsors a chance to strut their stuff, and readers a chance to connect.
• Create a HIStalk white paper link, sort of like ‘readers write’, where you can post HIStalk approved white papers. You could solicit white papers on specific subjects, for example "Checklist/Considerations for purchasing hardware for EMR implementation". To make it valuable and avoid ‘salesy’ submissions, you could require that customer and vendor/product names be left out.
• Hugely valuable, just very well done.
• The new sponsors are getting out of hand – a wall of ads and now a weekly commercial "within the lines" for each new sponsor and an even longer sponsor update section that includes mostly very unimportant updates. The signal to noise ratio is being thrown off – I’m starting to skim more and more to find all of the gems that used to jump out at me.
• I love, love, love the humor! Not only is Mr, HIS Talk an accomplished healthcare IT professional, but he’s a really funny guy. I know I’m feeding your ego now, but the infusion of humor in reading this blog is what makes my day. The color commentary at HIMSS or other tradeshows is wonderful, especially for those of us who are not able to attend. Keep it up – love the blog!
• I really appreciate the level of the writing that is done. I am not a techie person, nor do I want to be. TPD’s comments are way above my head (although I’m sure they serve a good purpose for many), but the majority of your writing is understandable. It also makes me look smart when I can send information to answer a question to my bosses (of course, I credit you). HIStalk is actually something I read on my days off and I typically avoid email like the plague when I’m off. Thank you (all) very much.
• It’s difficult enough to keep up with the information you are putting out. No way I could possibly sift through the raw information that you distill into digestible nuggets. You’re the best, and cheapest, personal assistant I have. And for someone learning the business of HIT, you’re indispensible. Thanks!
• I’m amazed and so appreciative of the fine job you’ve done. Who knew? There really is no other source I rely on for important info. A couple observations….you do seem to pander more to sponsors than I think you realize (sorry, what are friends for?). I’ve also noticed you’re working more hours over the last months (and I confess, I worry about you, and no, Mrs. H did not put me up to that!)
• Attempt to do interviews with members of the Office of the ONC.
• Publish more often.
• Keep up the good work. I’m an in-the-trenches grunt and I really like HIStalk. It’s not just for vendors and management types.
• Love it. Don’t stop
• Excellent! Not sure how you keep it all going, but please, please don’t stop.
• I just wanted to let all of you know – Tim, Inga, Dr. J and Ed – you do a fantastic job and it is greatly appreciated. Thank you!
• Twisted humor is best.
• I like the way that you stay pretty neutral on topics – objective, fact based and or present an opposing opinion to show two sides.
• Keep up the great work! I love Inga! (i’m female). Not sure about Dr Jayne yet? She sounds like she’s trying to impress us.. hey we’re already impressed she’s working with you guys – she should be herself.
• As a CIO, HISTALK was one of my best sites to visit and helped me manage vendors, alerted me to some solutions. Now I’m in consulting and it is helping me stay up to date with the industry happenings without having to read extremely boring online magazines.
• Congratulations on getting the help of Inga and Jayne (and others); you had been working far too much. HIStalk is not the only blog I read, but it *is* the one I read first (usually as soon as the facebook note comes out); whereas the other blogs are more of a "when I have time to look at them". Thanks
• Great work. I really like your take on the academic articles that are published. I know it is hard, because I used to try and do it, but your reviews of these articles are my favorite bits on the site.
• The reports of wins by big EMR vendors is a major leg up (e.g. EPIC wins Cedars & UCLA). In one instance you knew before I did about my own enterprise’s plans. Keep up the great work.
• Remain objective and do not forget the smaller health care IT companies who are struggling to survive in the MU clinical sales crush.
• I really enjoy the quick read and the fact that you point out "unverified" comment.
• CIO Unplugged – hate it one week, love it the next – keeps me coming back.
• Reduce the number of sponsors to keep the sense of "unbiased" as true as possible. Cut down on the use of first person pronouns from Mr. HISTalk. The only blogger in healthcare that uses more I’s, me’s, my’s, and mine’s in their writing is John Halamka. It makes it sound like you have an inferiority compensation complex. But, on the positive side, keep shaking things up. Healthcare and healthcare IT is the most self-congratulatory industry in the world, especially considering the horrible state of affairs of both. Keep rocking the boat and calling a spade and spade. You’re good at that.
• Spend more time with Mrs. H.
• Incredible effort – especially as part-time. Always informative, usually something to smile about and terrific contributors. What ever you do, do not add open reader forums where trolls and vendors trade insults and "IMHO" BS tirades. Stay on HIMSS’ a$$! They are such a lovely target.
• It may be interesting to have more discussion about the state of the industry from the point of view of the employee. For example, myself and friends are being squeezed to do more work with less, all while taking multiple years of no pay increases.
• Thank you for handling the trolling from late last year so very well. Oh! And for being nice over e-mail. You’re a sweetheart.
• LOVE your blog. There isn’t another industry news source that’s worth reading.
• Less Epic cheerleading; maybe more on consulting (I’m biased as a consultant);
• I love this blog. Seriously. I read it more consistently then anything else I keep up with on the web. It is smart, funny, opinionated but not preachy, and ethically done. Awesome job!
• The content is succinct, accurate, and as non-biased as one could hope for. most importantly it is witty and lighthearted. We work in a fast moving, dynamic and challenging industry where it’s hard to catch your breath. It’s hokey but you remind me to have fun
• HISTalk has introduced us to ProVation order sets and the news/rumours I read about vendors that we have interacted with has helped! I’m new to health IT and stumbled upon your blog by chance. I have learnt a lot from leadership to vendor to product talk. Keep up the good work (but don’t sacrifice your family doing it!) as I don’t look forward to your emails! Thanks a bunch!
• Not only do I love your news and fodder, as a fellow music lover I appreciate your taste. Please don’t ever stop telling us what you’re listening to. You’ve turned me on to a few great bands and reminded me of some forgotten ones as well
• I absolutely love you guys. You’ve made me laugh, you’ve helped me do my job, and my customers & colleagues think I’m a knowledgeable and insightful person because of you. Please continue to keep up the good work, I hope that all of your readers appreciate you as much as I do
• I’ve always wondered if you had a deal set-up where your identity will be revealed after your death. Similar to Deep Throat of Watergate fame.

News 3/4/11

From KoolAidKid: “Re: vendor market share. Numbers I’ve heard suggest that Epic gained 100 new hospital customers in the past year. Nobody else was close and GE and Meditech both had a net loss of sites.” Unverified.

From Mintonw: “Re: Allscripts ED standalone. Receives certification as a Complete EHR for version 7.0, the first and only best-of-breed EDIS to be a Complete EHR.” It’s listed on CCHIT’s site as such.

From Genius Bar: “Re: GE. Searching for a new CTO to drive innovation, also looking for strategic partners and acquisition candidates. Good timing since they are freezing development of some of their products.” Unverified.

From @cascadia: “Re: Sarah Kramer of eHealth Ontario. Is it coincidence that the comments about her were followed by a picture of women’s shoes? Wonder if the recent negative press is the reason her LinkedIn profile was deleted and exists only in a cached version?” Here’s the story we linked to that mentioned her involvement in UCLA’s EMR implementation. I don’t assume she did anything all that wrong given the general fiscal fuzziness that seemed to envelop eHealth Ontario (and who knows what pressure she was under to get work done, even if it meant going with consultants you know instead of going through government procurement processes). Her boss quit the day before the auditor’s report came out, so I’d say he was involved. I think we should let the woman make a living – nobody said she wasn’t a good EMR advocate and she’s not in a management role at UCLA.

From Sharlie Cheen: “Re: AdvancedMD. Can your investor guy inspire us daydreamers with an estimate of how much CEO Morgan and VC Francisco made for less than two years’ work flipping AdvancedMD?” Winning! I’m waiting to hear back from Ben Rooks, although I’m sure the best he can do is guess like the rest of us.

From Curious George: “Re: Jonathan Bush’s Sam Kinison-esque rant at the HISsies. I keep hearing about it – is there any public video available anywhere?” I know Medicomp filmed it from multiple cameras, but I don’t think it’s been posted. He was definitely on, and most impressively, was up the next morning and on national TV at 7:30 talking business.

From Peter the Rock: “Re: Dell Services. Has frozen all Meditech hiring for an undetermined amount of time for them to review their financial stability.” Unverified. Update: Dell says this isn’t true. I’ve offered to run their response if they want to provide one.

From Mitigator: “Re: Medicity. Big plans, looking to branch out into the apps business. Rumor is they are working on an app store model. Given the recent Allscripts announcements, will we see app wars in HIT?” Verified. Medicity started work on an app model for its iNexx platform two years ago. They’re piloting a free referral app, a free virtual care team record that is similar to a provider’s social network centered around the patient, and a fee-based Meaningful Use app. Third parties have expressed interest in writing to the iNexx API. I found the above on Medicity’s site.

From Lawrencium: “Re: Siemens. They are gaining momentum, especially in small hospitals looking to replace Meditech and considering Soarian. New deals coming toward the end of this quarter and new key talent being recruited.” Unverified.

Dr. Jayne is doing a fine job, don’t you think? So much so that I’m moving her to her own post on Monday nights, although she’ll continue to write here on Thursdays. That excellent idea came from a reader responding to my survey. This will give her the space to create her own identity and will shorten the always-full Tuesday posts. She’s looking for advisory board members who can give her quick feedback on ideas (she calls it “the HIStalk Medicine Cabinet” – isn’t that cute?), so if you are a CMIO, CMO, CIO, physician, or other clinician interested in swapping ideas with Jayne, shoot her an e-mail or connect on Facebook. I’m really happy that she joined Inga and me. You never know how someone will work out, especially if you hire them without so much as a telephone conversation first (OK, I’m the trusting type) but she’s smart, sassy, and has a commendably dry and cynical sense of humor, not to mention that she and Inga were quick to advance to BFFs. She’s been an HIStalk fan for a long time and therefore gets what we do. What more could you ask?

Listening: Iced Earth, The Glorious Burden: patriotic, American history heavy metal that sounds like Iron Maiden. Not many metal bands would do an 30-minute, multi-part composition about the Battle of Gettysburg. Trivia: Richard Christy from the Howard Stern Show was the drummer on that album.

Jobs on the HIStalk Job Board: Performance Management and Revenue Cycle Director, Healthcare Informatics Analyst, Implementation Project Manager (Remote). On Healthcare IT Jobs: Systems Administrator III, Senior Software Engineer, Senior Systems Analyst – Clinical Apps.

Reminders of stuff you can do: (a) sign up for e-mail updates like 7,117 of your peers have done; (b) send me stuff: rumors, news, photos, or anything else that would interest readers; (c) use your social networking power in friending Inga, Jayne, and me on Facebook and liking HIStalk so we can brag to our mothers that we have an Internet following; and (d) support our sponsors by looking over the ads occasionally and clicking those of interest. Thanks for reading.

Thanks to Chris Rauber of the San Francisco Business Times, who cited HIStalk in today’s writeup about McKesson’s planned acquisition of System C. Lots of press people and online sites get their ideas and information here, but few give credit. Thanks!

I wouldn’t say you missed much if you weren’t at the HIMSS keynote of HHS Secretary Kathleen Sebelius, but the full text is here if you’d like to decide for yourself.

Everybody’s weighing in on HIMSS – the booth babes, the giveaways, and the general silliness in the exhibit hall. My take: it doesn’t bother me. Surely nobody’s naive enough to think that traipsing through the exhibit floor constitutes any kind of research or due diligence, not that all that many research-driven decision-makers go to the conference seeking vendors anyway. Vendors and freebie-seeking non-prospects might as well make it fun without lofty expectations either way. I do feel bad for the rent-a-babes (and female attendees who feel demeaned by their presence, which I get totally), but like most cases of the non-involved protesting bad working conditions, I’m pretty sure the subjects themselves would not be in favor of even a well-intentioned ban on their presence (good news, you get your dignity back; bad news, you now have no income.) I keep thinking exhibit hall excesses will be self-limiting since they have no ROI and don’t impress prospects, but vendors are so scared of each other that nobody will blink first in cutting down on booth sizes, doing product demos instead of card tricks, and letting people buy their own cookies and popcorn. Vendors are providing what prospects (or at least booth-cruisers) respond to, rightly or wrongly. At least I saw no mimes or Richard Simmons this year. Next year I may ask the youngest and cutest booth decorations outright – are you an employee of this company, and if so, what’s your job the other 51 weeks of the year?

Speaking of exhibitors, above are the top 10 vendors by HIMSS points, which lets you pick a better booth location by spending money elsewhere with HIMSS. If you don’t play the game, you get to be one of those vendors in booth Siberia, wondering where all those 31,000 attendees are since you won’t see more than a handful and those will be directionally challenged, not product curious.

Nine of the 10 companies above either sponsor or are in the process of sponsoring HIStalk, I just noticed (all but Epic), so I can’t get too self-righteous about their payments to the not-for-profit HIMSS. At least I don’t charge much and I think I probably appreciate it more.

Vermont Information Technology Leaders selects Medicity’s HIE solution for its statewide project.

Thanks much to new HIStalk Platinum Sponsor MediServe. The 26-year-old Chandler, AZ company focuses on specialized software for inpatient and outpatient rehabilitation (documentation, functional scoring, intake, scheduling, charge capture, and order management), respiratory (staffing management, protocols, clinical and financial reporting tools, charge capture, electronic documentation), and a specific application for managing Spontaneous Breathing Trials to improve patient outcomes through protocol compliance, electronic documentation, and reduced ventilator length of service. You may have heard of a few of its customers: Hopkins, Cleveland Clinic, Vanderbilt, Duke, UNC, University of Michigan, Sutter, and Baylor. Thanks to MediServe for supporting HIStalk.

Vanderbilt launches My Cancer Genome, an online tool for physicians and researchers that allows them to look up tumor profiling results to find the clinical implications of the specific gene. Lung cancer and melanoma are up and running, with capabilities for breast, colon, and other cancers coming soon.

Saint Barnabas Health Care System (NJ) is enforcing content control restrictions on its PCs using Symantec’s policy-enforcing hosted data loss prevention agent. I found information on Symantec’s site about its product, which I assume it obtained in its 2007 acquisition of Vontu.

We new iPad 1 owners (thanks, HIMSS vendor contests!) aren’t missing too much with the just-announced iPad 2: it has faster video, dual cameras, Facetime, a gyroscope, and a lighter and thinner case. Same price. Otherwise, there’s not much new – no improved video resolution or anything major that would make you want to toss your new one to buy an even newer one. My iPod Touch has all those new features already plus the Retina display and longer battery life, so if you don’t already have one of those, that’s where I’d spend $225 instead of putting $500 and up into a new iPad – I still use the tiny iPod Touch 10 to 1 over the iPad. The fact that tons of people will be clogging up Apple stores next week and victoriously waving their expensive replacement of a product less than a year old tells you all you need to know about Apple as selling a vicariously hip lifestyle instead of technology. People gripe about spending $100 to replace a ten-year-old Windows XP, but can’t wait to muscle through the line to conspicuously consume anything that Steve Jobs has touched on a stage.

An incubator formed to commercialize software and other technology from Mayo Clinic is being disbanded after blowing through all of its $8 million in funding in 18 months, mostly on excessive corporate headcount, not to mention that Mayo charged Healthcare IP Partners with misusing Mayo’s name to raise money. “Distance medicine services” vendor Rainwater Healthcare already appears to have been shut down. Another portfolio company is Kardia, which sells a cardiovascular imaging and information system. The only good news is that an audit found no evidence of rumored financial shenanigans, which a former director says came from an employee he fired for indecent exposure.

A man who scammed Medicare for $10 million in phony medical equipment claims says it’s “incredibly easy” to commit such fraud, saying anyone with basic computer data entry skills can do it.

E-mail me.

HERtalk by Inga

From NotFromTheAgency: “Re: trade show models. I work for one of the large HIT companies. About six years ago, one of our company lawyers was walking the floor at HIMSS when he was approached by a couple of very attractive representatives from another large company. They asked him if he wanted to come in and learn about ‘Sorio.’ When he told them he worked for the other guys and offered to helped them learn the name of their own product, they confessed that they didn’t care – they wanted to talk to him because he was ‘young and good looking’ and they were tired of being friendly to other people they described in not as kind terms. Turns out they were professional models. This might not be a surprise to many, but it was to us — we had never hired people to work in our booth. After learning this it was fun to watch the models from Company A congregate in the halls with other nice-looking ‘employees’ of Company B & C during breaks, apparently friends from the same agency.” I’ve been trying to decide how I really feel about this whole booth-babe-for-hire thing. There’s a part of me that believes that if a company is spending hundreds of thousands of dollars on exhibiting, they better figure out a way to draw prospects in. In general I don’t take issue with the companies who hire appropriately dressed attractive women or hunky guys if they think it makes a difference. On the other hand, I find it degrading as a woman to witness the girls in the company-sanctioned (and paid for) super short skirts and skin-tight jumpsuits. It says something about how these companies value women and lead me to conclude that I would never want to work or do business with one of these organizations. Wow, sounds prudish, especially coming from someone who likes fancy clothes and all. But, there is a time and a place for everything, and the time and place for a skin show does not include the HIMSS exhibit floor.

From Lady In Red: “Re: John Halamka. I noticed this image posted by Engadget during their live blogging coverage of the iPad2 event. It was shown in the segment of the presentation where Apple was talking about how much of a success the iPad1 has been. Is there anywhere the man in black *doesn’t* turn up?” Now that you mention it, I don’t think I ever had a John Halamka sighting in Orlando. I believe I heard that he was in Japan and not at HIMSS. However, when I was with Mr. H at the opening reception, we spotted a Halamka wannabe in one of those black, mandarin collar shirts.

The Indiana HIE announces that its Quality Health First Program has enrolled over 1,500 physicians in 50 communities. It provides summaries of clinical patient information and flags patients needing provider intervention.

This week on HIStalk Practice: the full interview with AdvancedMD CEO Eric Morgan, whose company was acquired this week by ADP. The AMA wants more flexibilty with Stage 2 Meaningful Use. New iPad options from Practice Fusion and GE. An Arkansas doc opens a barter clinic (Chickens for Check-Ups.) Dr. Gregg pimps HIStalk Practice to the industry. Show a girl some love and sign up for e-mail updates while you are there.

The VA awards Harris Corporation a multi-year contract to continue providing software engineering and enterprise support for the VistA Imaging System.

Axial Exchange, a provider of clinical data sharing tools, raises $1.15 million from a $1.5 million offering. Axial CEO Joanne Rhode is the former CEO and director of HIT strategy at Red Hat.

IBM introduces its Patient Empowerment System, a “next evolution” patient portal.  The portal is designed to be hosted by health systems and includes such features as drug interaction warnings, alerts, and examination of genetic profiles. IBM will continually enhance the system by adding analytics from public sources. IBM is previewing the system at CeBIT in Germany this week, leading me to wonder why they chose not to preview at HIMSS. Or did they and I just missed it?

Two senators, including Mr. H’s man-crush Chuck Grassley, introduce legislation that would require Medicare to publish what individual physicians earn from Medicare. The bill would overturn a 1979 court injunction barring the public to see what individual physicians receive from Medicare. The court ruling was designed to protect physicians’ financial privacy, but Grassley and Senator Ron Wyden are pushing for more government transparency and more provisions to fight Medicare and Medicaid fraud.

A Birmingham paper chats with Boyd Douglas, the hometown CEO of CPSI. He explains why he is bullish on continued market growth beyond 2015:

I am confident we will see sales of our electronic medical record system continue for some time beyond 2015, which is when the stimulus fund payments are scheduled to end. First, I don’t believe there is sufficient capacity amongst all the health care information technology vendors combined to implement EMR systems in every hospital in the United States by 2015. In addition, moving the medical records for an entire nation from paper to an electronic record that is both standardized and secured, yet can be shared as needed, is a massive and complex undertaking. I believe it will create additional demands and opportunities beyond 2015 as the whole dynamic of how clinical information is captured, stored, and communicated continues to evolve. Finally, my feeling is there are a number of EMR systems that will be put in hospitals that satisfy the letter of the requirements to receive stimulus fund payments today, but are not necessarily satisfactory long-term solutions. They lack the integration with other information systems that is essential for a seamless flow of information throughout the hospital and to their physicians.

Congrats to Jill Krcatovich, manager of nursing informatics & infusion center at Allegan General Hospital in Allegan, MI. She won a Sonos Music System, courtesy of the wonderful folks at Enterprise Software Deployment who held a special HIStalk reader-only drawing at HIMSS.

Kane Community Hospital (PA) goes live on Healthland EHR.

Twenty years ago today, Rodney King was caught on video being beaten by LAPD officers. After ensuing riots, King spoke the famous words, “People, I just want to say, you know, can we all get along?” Perhaps that is what members of the Tri-City Healthcare Board of Directors (CA) are saying to themselves after fellow board member Kathleen Sterling had to be physically restrained by five guards during a recent meeting. Because of frequent outbursts and verbal assaults in recent months, Sterling was made to stay in another room during board meetings and communicate through a speaker phone. When she attempted to walk into a recent meeting, she fought body guards to be allowed entrance. Hospital administrators intend to file a restraining order against Sterling so if she tries to walk into another meeting, she can be arrested. All members of the board are publically elected, by the way.

E-mail Inga.

Sponsor Updates

• SCI Solutions tells us that one of their customers, Atlanta Medical Center, has increased their CT appointments 46% since their November go-live of Schedule Maximizer in replacing STAR. Part of the reason is the flexibility of setting appointment slots for times less than 30 minutes. They’re offering a series of Webinars that includes Physician and Patient Connectivity: The Southwest Airlines Way, How Can I Make My Customers LOVE Accessing My Hospital, and Creating a Patient Financial Access Center-If you build it, they will come! Many of their Webinars are presented by their customers.
• e-MDs reports that 2010 was a record year in terms of revenue and employee growth. Employee count grew 31% to 275.
• Happy 10th anniversary to sponsor maxIT! Founders Parker Hinshaw, Robert Moore, and Jennifer Arthur are still with the organization, which now supports over 550 consultants and recently earned a spot on the Inc. 5000 Fastest Growing Private Companies.
• Resurgens Orthopaedics (GA) selects interoperability and surgical planning software from Merge Healthcare. The solution will allow Resurgens’ physicians to view images directly from within their EHR.
• Brielle Orthopedics (NJ) picks the SRS EHR for its 12-provider practice.
• Erlanger Health System (TN) will implement GE’s eHealth Information Exchange platform.
• Albemarle Health (NC) chooses the MetaVision AIMS from iMDsoft for its pre- and intra-operative environments.
• Baylor Medical Center at Frisco (TX) purchases PatientKeeper’s clinical and documentation software products, including PatientKeeper CPOE and NoteWriter. Baylor will integrate the PatientKeeper software with its existing Meditech system.
• Advanced Pain Centers (MO) selects McKesson’s Practice Complete for physician billing, coding, and reporting.
• Henry Mayo Newhall Memorial Hospital (CA) chooses Access Universal Document Portal (UDP) to integrate EKG results from its Epiphany system into its EHR.

EPtalk by Dr. Jayne

American Medical News reports that “degree of patient’s online access” is a new vital sign, based on data from the Pew Research Center’s Internet & American Life project. Apparently searching for health information on the Internet is the third most common online activity. Most of us who see patients regularly already know that, based on the volume of Internet printouts patients bring to their visits, along with “ask your doctor about our drug” ads ripped from the pages of Reader’s Digest.

Although the piece initially elicits moans and groans from those of us who have been on the receiving end of a consult request from what the article jokingly calls “Dr. Google”, the point it tries to make is that those of us delivering healthcare should not assume all patients have Internet access. An interesting thought, since Meaningful Use is driving us to provide more and more information electronically (and doubly so based on what seems like every hospital and health system’s initiatives to have patients access their patient portals).

Ultimately, I was relieved that this was the spin of the article. For a minute there, I thought there was going to be some new federal agency making me score online access in the chart along with blood pressure and BMI, much like JCAHO did with “pain score” as an additional vital sign. There is some interesting data in the article, though, looking at demographics and how income, race, ethnicity,and  gender correlate with access. Worth a quick peek.

Their other headline was “EMRs, quality efforts key to viability of practices, Obama officials advise.”  Whether you agree with the changes that have come to all of us recently or not, this is the new world we live in. Unless you’re a physician ready to switch to a concierge practice, practices that want to continue to see Medicare and Medicaid patients will have to comply. And for those who have already opted out of those programs, the commercial payers are lined up right behind them, cloning the programs, but with their own unique twists.

Looking at some managed care contracts the other day was almost enough to make me contemplate the benefits of a single-payer system. With vendors barely able to keep up with federal guidelines and policies, what is it going to look like when every payer (and their regional variants) has their own pseudo-MU program? I guess on the bright side, it’s some degree of job security for many of us in the healthcare IT trenches.

Save of the week: my HIE helped identify a patient who showed up in my office and failed to mention the controlled substances he had received from several other providers in the region. Oops! I always love the looks on their faces when you ask them, “So, tell me about the Percocet you got last week from Dr. Smith — how’s that doing for you?” It gives me a thrill every time. Hooray for discrete data and medication reconciliation!

Funny thing, the HIE rarely finds that situation for antibiotics, or blood pressure / cholesterol meds. I guess there are not many people looking to score those.

In other news, as Mr. H mentioned, I’m hoping to keep you entertained and informed on Mondays. I’m looking for CMIOs, CIOs, and physician informaticist types to share advice and ideas. Whether you have the title or not, if that’s what you do, we need your opinions on fast-breaking issues and hot topics. E-mail me if you’re interested in joining the HIStalk “Medicine Cabinet.”

E-mail Dr. Jayne.

McKesson To Acquire British Software Vendor System C

McKesson announced Thursday morning in Europe that it will acquire British IT vendor System C Healthcare in a $140 million cash deal. The price represents a 51% premium to System C’s closing price last week before the company announced that it was in takeover discussions.

System C offers the Medway suite used in 40 NHS and private hospitals. It includes electronic medical records, patient management, departmental, business intelligence, and portal applications. Its Liquidlogic subsidiary sells software for social services agencies involved with children, domestic violence, housing, and mental health.

System C was in the news recently when a modified version of Medway was implemented as part of the Whole Hospital Information Systems project of the Ministry of Defence, supporting UK military and NATO personnel in the Camp Bastion hospital in Afghanistan.

The company lost money in the first half of the year after NHS changes affected its revenue.

System C had made a string of its own acquisitions, including IQ Systems Services (software for private treatment centers) in 2007; Care Records Unlimited (clinical systems) in 2008; Bluestar UK Group (healthcare RFID) in 2009; Conscia Enterprise Systems (web portals) in 2009; and Liquidlogic (social services software) in 2009.  

With the NPfIT decision to decentralize its system selection process, NHS trusts are no longer obligated to buy systems from approved vendors iSoft and Cerner. McKesson, whose patient management and administrative systems are run in several UK hospitals, had previously announced plans to localize its Paragon system for use there.

More HIMSS Wrap-Up 3/2/11

HIMSS: A Vendor’s Perspective
By Reefdiver

It’s interesting to read the reviews of others who endured the combination Iron Man / Survivor / Amazing Race / carnival / musical chairs / walkathon that is called HIMSS. Over 1,000 exhibitors, 31,000 attendees (do those two numbers overlap?), dozens of hotels, a virtual whirling vortex of shuttle buses, limos, taxis, and rental cars. What, no planes with banners overhead?

Of the many who have published articles reviewing HIMSS, each had his/her own way of parodying (is that a word?) the excess, the overkill, the awesome size yet questionable utility of the show. Or in the case of Dr. Alexander, whether it has meaning at all for practitioners in smaller practices. We’ve heard the reviews from bloggers, journalists, a few clinicians, some industry celebrities, a Palooza-event organizer, and even a dignitary or two. Is it more ironic or revealing that an unabashed CEO-cum emcee is more memorable than a Cabinet member’s speech?

So far, everyone’s perspective seems to converge around the notion that it is too large, too broad, too unfocused and too spread out to have much value. That it lacks the innovation or creativity it once touted. That it is most memorable for the after-hours events. These reviewers have commented that food, magicians, games of chance, or even a sports bar is what attracted them into the endless matrix of booths. Are these the criteria by which the event should be judged?

I’d just like to offer a vendor’s perspective for a moment. Not that anyone would really care, but perhaps offering a vendor’s view may help to shed light on why this fertility rite called HIMSS continues on, against any logic worthy of a Harvard Case Study.

First, we vendors pay a fortune to exhibit at these shows. At more than $33/square foot for just the footprint (a small 20 x 20 booth is over $13k), plus between $15,000 and $1,000,000 for the booth construction, the tab is just beginning.

Don’t forget all the rental furniture, phones, and $1,500/day for Internet hookup (can you believe that?). Shipping each booth from storage to the show costs thousands of dollars – the larger ones must run $50,000 or more. Dealing with the crews that do setup and delivery (including the “game” to get priority among the laborers)

Second, there’s the travel costs, living costs, and time away from doing what we do every other day — serve our clients and work hard to create new ones. For those in sales, a trade show is a torture chamber by another name unless there are new business opportunities to pursue or clients to entertain (at night). For “the brass,” it’s pushing the corporate image with the media and “looking for mindshare”.

Whatever. Spending a huge amount of money normally expects a greater return. Love to survey all the vendors to see how many actually get a major ROI in a tangible way.

Third ,there’s the show itself. Attendees have the option to wander wherever they like and even go outside to take a break to relax, play golf, or see an attraction. They can dress how they please, whether they are comfortable in jeans and a T-shirt or prefer something more upscale.

Vendors are locked to their booths in the prescribed uniform. Many have an assigned station or function. And don’t think of leaving it! Taking even a 10-minute break for lunch to inhale something can lead to evil eyes, a recall by cell phone, or a scolding by the Booth Nazis in charge. Somehow, you are told that the booth is always jammed just after you decide you need coffee, a smoke (ugh), or to make a phone call to a customer in need of something back home.

A vendor’s world is the size of the booth and a walking path around it, hoping for someone looking for YOUR product. The clock moves very slowly when traffic is light, when classes are in session, or when it’s sunny and warm outside. It’s agony. The feet and backs ache.

But we are counting down to closing time each day, for whatever event is happening that night. Mostly a place to sit, relax, and talk about something other than product. Enjoy a beverage without guilt. To eat something besides a $20 stale sandwich or tasteless salad from the hall vendors, all graduates of the Cooking with Cardboard academy. 

Of course, there is a shuttle bus, a long taxi line, or a long walk to the parking lot to redeem the rental car and some horrendous traffic to get back to the hotel first. Do you dare lay on the bed for a short nap before heading out?

By the time the evening is over, it’s late. Feet are still barking and the head may be hurting. But the booth opens again early next morning. Got to be there for that ONE prospect who could make the whole trip worthwhile, knowing that most wander in for the pen, the chocolate, or the chatchka intended to lure them. And the cycle begins again. It’s a good day if you are 20th or less in the Starbucks line. The caffeine main-line to chase the cobwebs. And the new day begins.

Most vendors don’t know much about what goes on in the other booths. The Booth Nazis like it that way. They want you to think that it’s not about having fun, it’s hard work. We need to make this look like a place of business and that we are serious about our customers and are better than our competitors. And we try.

It’s a pleasure to spend time with those very few who are seriously looking for good information, who recognize the need for a product like ours, but aren’t sure how to choose. Those are the gems we live for, the chance to fight for. And for every 20 ID badges we scan, we know probably only two or three will be serious potential for us. But we live for them. We conduct a painful, all-day vigil for them.

And we keep paying the price and coming back to be there for them. Because if we don’t, our competitors probably will!

Dr. Gregg "1 to 3 Docs" Goes to HIMSS (Part 2)

For an all-around overview of the healthcare tech tools world, HIMSS is perhaps the best remaining venue. But unless some refocus by the HIMSS planning peeps is implemented, it probably isn’t a very good investment of time and dollars for the majority of 1-3 provider practice folks. Other venues, though not as complete, provide a better understanding of the 1-3’ers’ needs.

Right up front, I need to say that I may have a bit of bias when it comes to making such a statement. As the director for the American Academy of Pediatrics’ Pediatric Office of the Future exhibit at the AAP’s annual conference (NCE), it is just exactly that hole in the end users’ educational options which we seek to fill. Our exhibit – which is growing by leaps and bounds, I’m happy to say – is designed specifically to supply a hands-on, interactive, educational opportunities, exposure, and functionalities overview.

We try to make it very clear to our sponsors that it is all about the educational value for attendees. Of course, we know vendors sponsor us in order to drive sales, but we ask them to try to keep sales pitches subtle, directing attendees who may be interested in deeper sales or product-specific chats to their company’s primary exhibit hall sales booth or to post-conference follow-up.

From what we’ve seen, and from the responses to the post-conference surveys we’ve received – an extra special thanks here to Dr. Eric Fishman and EHRconsultant who did one of the best – it appears that the 1-3’ers are more than interested in learning more. Indeed, they seem more interested than ever, but they also have some very specific needs, few of which would be met by a junket to HIMSS.

Here are a few quotes from attendees to bolster that assertion:

• “Hands-on experience was the best way to learn the EMR.”
• “Although we have not adopted EMR, it was very helpful to see the advantages and utilization of the EMR.”
• [It enhanced my understanding of HIT by seeing] “different formats for EMR organization – both information entry options and options for how the info entered in the past can be easily accessed and reviewed in a way that supports medical decision making.”
• “It is obvious there are better solutions than the ones we are using.”
• “A small part of a steep learning curve.”

1-3’ers are not slow, resistant to tech, or Luddite. They are just providers who want to provide the best care they can. Their focus is health — the world of medicine. They want the advantages of high tech tools, but don’t have any interest in going back to college to gain a degree in Informatics. There just aren’t many booth or educational session combos at HIMSS which would be of any use for such folks. Most are just too tech-heavy or too tech-specific for 1-3’ers’ needs.

If HIT is as smart as some want us to believe, providers shouldn’t have to pass HITECH 501 just to use an EHR. Indeed, healthcare providers are some of the biggest users of smart phones, but I’ll bet very few docs spent more than twenty or thirty minutes before they were texting, e-mailing, and apping away happily with any new iPhone, Droid, or Pre. And, these “phones” are powerhouses, capable of tons of techno-wizardry. If HIT is so smart, EHR adoption shouldn’t really take so darn much time to learn how to deploy.

So, between a relative dearth of relevant and easily digested content, the costs of attending coupled with the costs of taking premier days away from the office, the snobbish disdain many vendors evidence toward anyone without a massive checking account, and the tremendous amount of time it takes to find “1-3’er value” amidst the mainly big toy shows on the exhibit hall floor, is it any wonder the 1-3’ers are so few and far between at HIMSS?

Top that off with the massive learning hurdle that most EMR/EHR implementations require and the answers to those questions circulating about how to engage the 1-3’ers’ interest in HIMSS, and in EMRs in general, seem to become clearer:

1. Hold more of HIMSS, including the exhibit hall stuff and not just the pre-HIMSS stuff, on the weekend (maybe including Friday which is usually more doable than Monday for 1-3’ers) so that it isn’t as financially prohibitive for us grunts.
2. Hold some super-friendly-for-super-small-practices seminars. Grunts don’t typically find much use for keynotes highlighting the wondrous things HIMSS has accomplished or panel discussions on NIST and NICE.
3. Establish some sort of positive reward system for vendor reps who actually talk with 1-3’ers, not just VCs, reporters, and other vendors.
4. Consider a cooperative between HIMSS and any and all medical academies and organizations to help spread the HIT message across more shows, in more towns, at more moments in time. (The Medical Records Institute tried this with their “EMR Road Shows,” but the shows were too small, too few vendors attended, and scope was too narrow to be sufficiently advantageous or enticing.)
5. Smarten up HIT and make it smart phone-esque. (I’m still so in awe of how Medicomp’s Quippe has really made a quantum leap along this path.)

Two cents from the 1-3’er trenches…

“Be faithful in small things, because it is in them that your strength lies.” – Mother Teresa

E-mail Gregg.

News 3/2/11

From Less Than Grand: “Re: Dr. Gregg’s HIMSS review. I could not agree with you more. The show is lopsided with regards to the audience they are targeting. Though I have attended HIMSS many times in the past, it never fails to disappoint me that the show continues to leave out the physicians who represent the majority of physicians practicing (NOTE: these physicians also represent the majority of those without an EMR.) Great summary!”

From Kubrick’s Rube: “Re: Blue Cat Girls at HIMSS. I thought HIMSS had sunsetted those displays ten years ago, when an exhibitor no one remembers had a small Asian woman in a practically transparent body suit doing mind-blowing contortion. I heard HIMSS got the word out that this kind of entertainment wouldn’t be allowed, but I guess anything to fill the halls …”

From RIFeree: “Re: Vanguard Health Systems. The for-profit laid off 10% of corporate employees on Tuesday.” Unverified, but what appears to be the CEO’s internal e-mail is above (click to enlarge).

From Rockville: “Re: HIStalkapalooza. What a fantastic event! I have never laughed so hard at a trade show in all of my career. Jonathan Bush was one of the funniest, irreverent, and most ‘real’ executives I have met in a long time. I would enjoy working for him. The HISsies and other awards were very entertaining. Thanks for giving healthcare a personality!” His employees in attendance were sure having a swell time, I’ll say that, and that’s a good sign. He looks good in a sash, too (but doesn’t everybody?)

From StatMan: “Re: HIStalk stats. What’s the February number?” I don’t pay too much attention, but it was a record and greatly increased over February 2010. I’m beginning to think it’s like running a publicly traded company – you start to suck once you fixate on the numbers instead of doing whatever it is you’re supposed to be good at. I will have detailed reader survey results up shortly, though, which I do pay attention to. Otherwise, we just do our thing and anyone who wants to read is welcome.

From Art Vandelay: “Re: iPad. Awesome work on the iPad-themed version of HIStalk. You always amaze me with how current you continue to be with trends, news, tech, and I like your music picks too!” Art is observant. I upgraded the mobile format of all three sites (HIStalk, HIStalk Practice, and HIStalk Mobile) this week to provide a rich, functional, fast presentation for iPad, Android, BlackBerry, Palm, and Samsung (it was iPhone and iPod Touch only before). Once I pulled HIStalk up on the iPad I won at HIMSS, I was like, “This looks crappy,” and then realized I could probably figure out how to fix it in my vast amount of spare time. Which I did, and happily so since I know quite a few of you new iPad owners from HIMSS will be checking out HIStalk on your new toy.

From July Johnson: “Re: consumer group’s letter to ONC. I may be overly dramatic, but I believe this is a watershed moment. The battle lines have been drawn between the consumers of all walks of life who won’t accept the system as is any more and expect more for their $30B vs. the providers and IT vendors who want to get billions of $$$ to deliver what they should have delivered without incentives years ago. Reading these positions, it make all the flash and boat showmanship of HIMSS seem extremely hollow when you see what consumer/patients actually want from the system. Now that the mighty consumer/patient has been awakened, providers, vendors, and HIMSS will have no idea what hit them.” The groups include AARP, AFL-CIO, Consumers Union, SEIU, and several others. Their most interesting recommendations:

1. Make all Stage 1 Menu items required as Core for Stage 2.
2. Improve e-prescribing by encouraging fill-status messages from pharmacy back to the physician.
3. Raise the bar for use of evidence-based clinical decision support.
4. Require documentation of advance directive.
5. Raise the secure messaging bar in Stage 2 to 50% of patients who prefer electronic communication.
6. Hold providers accountable for using, not just offering, a patient portal.
7. Raise the bar on use of electronic tools for communicating with patients from 20% to 30%.
8. Add required experience of care patient and family surveys to Stage 2.
9. Require in Stage 2 a care plan that includes a list of team members, problem list, medication list, allergies, advance directive status, and patient preferences for language and communication.
10. Don’t let providers meet the HIE requirement in a “test” – make them provide a summary of care record for 30% of their patients who are transitioning to another care setting
11. Advance the incorporation of lab results into EHRs.
12. Provide a mechanism for patients to flag and correct their health information.
13. Encourage accessibility and usability standards so that disabled people can consumer health IT innovations.
14. Don’t be tempted to let providers slide on Meaningful Use just because their quality scores are good because quality measures aren’t meaningful to consumers and patients.

Also writing to ONC: eHealth Initiative, which wants increased emphasis on HIEs and better coordination between CMS and ONC on timelines. They make good points about needed clarifications (who’s a license professional when it comes to CPOE? how do you define “structured” lab data?”)

From The PACS Designer: “Re: Apple’s iOS 4.2 release. Apple’s iOS 4.2 has many new features that users will most likely want to use to expand the capabilities for their remote viewing activities. The free iOS 4.2 update brings all-new features to not only your iPhone 4, but also the iPad and iPod Touch.” Above is a video that TPD found.

From Privacy Concerns: “Re: EMR. This represents a creative use.” A PGY1 resident at Christiana Care performs unauthorized physical exams on six women and throws in some no-extra-charge fondling, all undocumented in the chart. Investigators found that he had checked out the electronic medical records of the women before the grope-fest. He’s been fired and warrants are out for his arrest on charges of unlawful sexual contact and patient abuse.

From MarylandSnow: “Re: RealAge. Not news, but since you mentioned it, they sell patient data to pharma along with ads.” I knew that upfront (it’s clear in the sign-up agreement) but I’m actually OK with it. I’m not so gullible that just getting a drug company’s e-mail pitch is going to make me doing anything I don’t want to do.

From Flatlander: “Re: reader’s comment about Lewis & Clark Health Information Exchange (LACIE). Since it wasn’t even mentioned in the article about Kathleen Sebelius, that probably came from the Cerner PR machine. LACIE uses a heavily subsidized HIE platform in exchange for being a national sales reference, and with all participants except one being from Heartland’s normal referral area, it’s hardly impressive and bears no resemblance to a self-sustainable HIE. MU’s Stage 1 HIE requirement is so low (strap a USB drive with one patient’s data on a pigeon’s leg), the one other LACIE participant (St. Luke’s) will be out of there once the incentive check is cashed since its northernmost hospital is a direct competitor of Heartland. St. Luke’s probably got a no-cost deal for the name recognition – they check the HIE box, take the money, and avoid system entanglement and getting their patients recruited.” Unverified.

Also from MarylandSnow: “Re: National eHealth Collaborative. Funding on the line? Although set up with a membership model, their sole funding is ONC – grandfathered in prior to HITECH. Standards and Policy committees with their own multi-million dollar funding have effectively taken over NEHC’s role.” That’s the AHIC Successor that does NHIN stuff.

From Without a Trace: “Re: Usability Symposium Sunday of HIMSS. The whole day was great, but Dr. Friedman from ONCHIT started the day with some big news: usability would be included in Stage 2 of Meaningful Use. The symposium also included speakers from AHRQ, FDA, NIST, Access Board, and big names like Dr. Rob Kolodner and Dr. Dean Sittig. The HIMSS Usability Group announced the release of a new white paper. I expected to read about the ONC’s announcement and news form the symposium in the HIMSS newspaper, but nothing. I can imagine that big vendors wouldn’t be happy about this – I wonder if they were behind squashing the news?” I’ve been darned impressed with the HIMSS Usability Task Force, especially since I bet the HIMSS suits grit their teeth every time they observe that the usability of current clinical software, much of it produced by their cash cow Diamond Members, isn’t very good. I found what appears to be the new white paper, Promoting Usability in Health Organizations: Usability Maturity Model, on the HIMSS site. I haven’t had time to review it yet, so jump in if you’d like to summarize (or I suppose I could try to swing an interview with someone involved in creating it). I still recommend a more dramatic first step: hire an independent firm to evaluate the usability of the top three EMRS in each of the hospital and practice markets and publish the results (you don’t need the permission or involvement of the vendor). Think that wouldn’t put the debate in the public eye?

From HISJunkie: “Re: Texas Health Resources offering HIT consulting services. Epic is doing what IBM did 35 years ago, turning every client into a hosting site (see SHAS circa 1975). Epic is allowing / encouraging the large medical centers to distribute its app on a host basis to almost any remote client (particularly if they are under 150 beds) without incurring a new acquisition or license fee. Just add more work stations and pay a small seat license increment and you can buy them in ‘bulk’. I spoke to several CIOs at HIMSS that are doing this for owned, managed, and non-affiliated facilities. All other vendors require you to pay a sizable new facility license fee. Epic says … not necessary. Oh, but along with the seat charge, they bump up your monthly support fee. How can Epic do this? If you’re a private company, cash is king, not revenue recognition. That’s why you do not see Cerner, McK, Allscripts, etc, do this — Wall Street wants the rev NOW! Epic can wait. Why would Epic forego a possible meaty license fee? They view this as incremental revenue that they would otherwise never see since it’s too costly to sell and support the small or mid-sized facility. (Watch out Healthland, CPSI, HMS, et al.) I predict in the next year you will see many IDNs that are running Epic do the very same as THR. Only trouble is, running a software / service operation is very different than running a facility-focused HIT department. I know, I’ve done both, and the balancing act can make you pull your hair out!” Even Judy critics have to admit she’s brilliant in turning high-paying customers into dealers who can make a little of their money back selling their services to small sites, and in doing so, spread Epic’s reach wider. It’s like creating an Amway sales downline – let someone else do all the sales work on your behalf. I bet the number they watch isn’t revenue or profit, but rather the number of beds or encounters covered – if that number keeps ramping up, the company has endless ways to monetize it down the road. It’s like viral marketing with high switching costs, not to mention that customers aren’t likely to complain publicly about Epic’s solutions when they’re trying to sell them themselves, either internally or externally.

Here’s the Siemens announcement of the hiring of Marc Overhage from Regenstrief and the Indiana HIE as the CMIO of Siemens HSBU under John Glaser.

Capitol Regional Medical Center (FL) will pilot a consumer smart phone app from Healthagen that lets patients who are headed to the hospital fill out information forms and indicate any special needs on their way. Not while driving and clutching their infarcted chests, hopefully.

Bethesda Health Group (MO) is working with Cerner to implement its BeyondNow software in a skilled nursing facility. Cerner acquired BeyondNow in 2003.

Megan provided this pic of her HIStalkapalooza prize-winning shoes since I know the ladies are following that intently. Inga posted a gallery on Facebook.

I ran the news blast earlier that ADP has acquired PM/EMR vendor AdvancedMD. That’s big news because it’s ADP’s first foray into healthcare, other than doing HR administrative work for practices, and they’re a huge company. AdvancedMD had arranged an interview with us beforehand. Below are some snippets from Inga’s notes of her call with Eric Morgan, president and CEO of AdvancedMD. I’m sure she’ll have more later.

I wanted to let you know you were the first ones we thought of. ADP, a company that most of us know, has done a lot of homework in looking at the marketplace and made a decision. They have had a strategy in place to look at adjacent opportunities to grow their business and this is one they have been looking at for well over a year … meaning the smaller to medium-sized physician space AdvancedMD targets and serves.

The matchup between the two companies is very strong. They are certainly focused on our cloud-based, SaaS offering. In fact, they narrowed the field of opportunities down pretty quickly by saying that was the way they wanted to go. They were not going to offer an on-premise approach, so this is very much compatible with what they do with the rest of their business.

The key is they saw value in the business we built here in serving these smaller physician offices. What we do is not easy to do efficiently and effectively. Certainly a lot of vendors in this space have struggled in this. They saw tremendous value in that. This is a big statement for healthcare IT that a company the likes of ADP has made a big commitment and investment in moving into the space from outside the traditional list of folks that you and I are used to talking about.

We will look how we work together and integrate products. All that is part of the plan. We are going to be rolling that out over time. For an ADP client who is interested in practice management or EMR, this makes a very good opportunity for the client to connect very quickly … physicians, much like on the hospital side, more and more will be looking to a trusted leader and a trusted brand. And that scaling of an organization is going to matter more and more … we believe this puts us in a very strong position to be able to give our customers the confidence that they are going with a very, very strong reputable organization like ADP and know that they have a long-term commitment and relationship and investment in the marketplace.

The reaction from the employees has really good. A lot of excitement and buzz here …We are of a size now that they are only a handful or two of folks that are actually bigger than us, yet there are hundreds and hundreds that are smaller than us. I think this puts us in a position to stake a claim among the leaders of the industry.

Inga and I expressed our mutual amazement at how many of our sponsors have been favorably acquired in the last year or two. She wants to get tee shirts made with a list. We can’t decide whether (a) desirable companies disproportionately sponsor HIStalk; (b) we help raise the interest level slightly among potential acquirers; or (c) companies intentionally raise their profile by sponsoring as a signal they are willing to talk, knowing that we have a lot the money people as readers (VCs, private equity, and investment bankers). Regardless, the number is a significant chunk of the total industry acquisitions. Not good for us, of course, since sometimes one sponsor buys another and that means we lose one.

Scottish charge master vendor software vendor Craneware, fresh off an acquisition that gives it a broader US presence, announces record performance for the first half of the year: revenue up 25%, profits up 30%. 

Deborah Gage is named president and CEO of MEDecision, replacing founder David St. Clair, who will remain on the board. She was previously CEO of healthcare payment technology vendor GTESS.

HERtalk by Inga

From DrLyle: “Re: Post-HIMSS. I agree with you about noticing that the buzz is shifting away from the big vendors and we are seeing the rise of the ‘peripheral companies’ which are creating products that build an ecosystem around the bigger HIT infrastructure. The base level is being set (just like Microsoft and Apple did with operating systems) and it’s time for the next generation of HIT companies to start creating the products that actually move the pointer from ‘up and running’ to actually usable and useful. The good ones will thrive and likely be acquired) while the bad ones will fade away quickly. There are books to be written and movies to be filmed about it all in the years to come.” I like the idea of movies being made about the thrilling world of HIT in the age of MU. Maybe Mr. H and I could cameo (for a large fee). I think I failed to say much about DrLyle as the Ryan Seacrest of the HIT Geeks Got Talent session. He was terrific and the brave souls who pitched their product in something like three minutes were all impressive. DrLyle will have to let us know who won.

ScriptRX raises $1 million of a $2 million offering. The 12-year-old company’s products include ScriptRx Writer, ScriptRX Discharge, and ScriptRx EMR for clinical documentation.

Madison County Memorial Hospital (FL) purchases Healthland’s EHR system. The 25-bed critical access hospital expects to be live and achieving Meaningful Use by July.

Elsevier/MEDai and dbMotion partner to provide dbMotion users with Elsevier/MEDai’s reporting and modeling tools.

HealthShare Montana partners with Covisint to for its statewide HIE.

Just another day at the office: a Georgia pain clinic patient becomes angry about her medication and chases her doctor and his female office manager down a hallway with her cane, threatening to rip the manager’s throat. The patient shoves another doctor trying to intervene before a second doctor is finally able to restrain her.

Gilbert Hospital (AZ) begins its implementation of Prognosis ChartAccess.

Surescripts, AHA, and the College of American Pathologists are awarded a grant by the CDC to connect hospital labs with public health agencies to electronically transmit data on reportable lab results. CDC is calling the initiative the Lab Interoperability Cooperative.

Anyone remember Sarah Kramer, the eHealth Ontario exec who left amidst charges of frivolous spending? ($25,000 to have a speech written; $50,000 to refurnish her office; $192,000 to a single consultant for five months of work.) She left eHealth a couple of years ago, taking her $317,000 severance package with her. She is now executive director of Strength to Strength, a third-party consulting team bringing Epic’s EHR to UCLA Health System.

A reader asked for some pics of the fabulous shoes at HIStalkapalooza. Here is a sampling. Not bad, huh?

New from KLAS: a first-time report on the infrastructure market, with an initial report on wireless communication systems. Execs at provider organizations are adopting VoIP cautiously and physicians are embracing new ways to use their mobile VoIP phones. Vendors included in the study are Ascom, Avaya, Cisco, Polycom and Vocera.

KLAS introduces two offerings that I wouldn’t mind having. KLAS Alert will give providers or vendors a monthly snapshot of satisfaction rating of one vendor or multiple vendors, depending on the subscription level. KLAS Connect will facilitate the connection between providers using similar technologies, giving them the chance to network or compare best practices (or perhaps collectively complain).

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

• Greenville Hospital System (SC) selects Oacis Health Data Warehouse from TELUS Health Solutions to provide analytics and reporting.
• Joe Mason joins Enterprise Software Deployment as VP of Strategic Alliances.
• Riverside Community Hospital (CA) chooses ProVationMD software for its gastroenterology procedure documentation and coding.
• Healthcare innovative Solutions introduces Pillars, a web-based CPOE workflow planner tool.
• Imprivata announces its integration with Epic’s authentication API.
• Lake Regional Medical Group (MO) will implement eClinicalWorks using implementation services from GroupOne Health Source.
• St. Joseph Health System (CA) joins with AT&T to implement a new telehealth project that will allow patients to consult with physicians remotely using AT&T Telepresence Solution.
• M*Modal partners with Greenway to integrate speech recognition into PrimeSUITE2011.
• DIVURGENT releases results of hospital industry’s first survey on business intelligence maturity.
• Novell partners with CynergisTek to create the industry’s first unified compliance and security monitoring solution for healthcare.
• St. Joseph’s Health System (CA) selects Allscripts’ Care Management and Homecare solutions to streamline patient movement through its 14 hospitals.
• Health Language launches LEAP I-10, a cloud-based ICD-10 conversion solution.
• University Health Systems of Eastern Carolina reduces labor costs using Concerro’s ShiftSelect.
• Madison Memorial Hospital (ID) chooses PatientKeeper’s CPOE to achieve ARRA-HITECH compliance.
• CapSite releases new research reports on PACS and teleradiology, with 21% and 31%, respectively, of providers looking to switch their current systems.
• Billian’s HealthDATA profiles Florida Hospital CIO Andy Crowder.

EPtalk by Dr. Jayne
 
There was an “Ask Dr. Jayne” question awhile back about those pesky doctors who insist on wearing their stethoscopes and white coats even though they rarely see patients. As I was camped out in the Orlando airport trying to catch a much-delayed flight to my frozen home, I witnessed not one, but TWO episodes of Health Professionals Gone Wild.

The first was an actual medical situation, where an inebriated would-be passenger took a spill and whacked her head on a large planter, splitting her forehead like a melon. An angel in pink scrubs jumped to her aid, applying Starbucks napkins to the wound until the gate agent arrived with first aid supplies, followed by the paramedics and lots of security folks who documented the event on film (alas, I didn’t, though, because that would be tacky). After the cleaning crew completed their multi-step decontamination process (which I was able to explain to several of the curious travelers around me who wanted to know exactly why it took so many people and so much stuff to clean it up).

I was waiting for something else to keep me from a post-HIMSS stupor when what to my wondering eyes did appear but three passengers coming off a flight wearing matching green scrubs, one of whom was actually wearing the white coat. Now this I had to photograph. I looked carefully and didn’t see any transplant coolers and they were loitering quite a bit before heading to baggage claim, so I don’t think they were in the organ procurement business. 

I never did figure it out. Maybe I should have one of those “submit a caption for this photo” contests. If you look closely, you can see one of the planters in the foreground. Sorry the second one is fuzzy — I was laughing too hard to take a decent picture.

After finally clearing the snow from my car (those of us who work in non-profit land park uncovered) I drove home through precipitation that was exactly the consistency of a frozen margarita. Hard to believe that a few hours earlier I was soaking up rays (with sunscreen, of course) in Orlando. As I went through the mail that had accumulated during the trip, I chuckled at the number of vendor and HIMSS-related mailings that were delivered on or after Monday the 21st. Nuance, SuccessEHS, and CapsaSolutions: you should ask for your marketing dollars back.

Now it’s back to the CMIO grind, with PQRS (aka PQRI) registry reporting at the top of my list. Having done claims-based reporting previously, many organizations are trying our hands at registry reporting this time around. It’s always interesting to wade through the data as it’s pulled out of the system, arguing with the doctors who insist they really did do everything for every metric on every patient even though the data says otherwise. It’s always the data that’s faulty, rather than the physician or the office processes, right?

Although some providers loathe clinical data reviews because it points out what they aren’t doing, I take the opportunity to remind them of the studies that have been done showing the sheer number of hours it would take a physician to deliver all the services that each patient could receive, based on the varying recommendations, guidelines, and mandates.

Frankly, without automated systems, I’m not sure how we kept it all straight. I used to have to wade through multiple flow sheets for multiple diseases rather than having a single cohesive presentation of the patient’s health status that could be graphed, manipulated, extracted, and e-mailed to the patient via a secure portal.

I’m hoping that my physicians who are “passive” participants of registry reporting enjoy the CMS payments they receive based on our data submission. Many of them have never participated in PQR-anything before, due to the annoying nature of claims-based reporting. Some of them have no idea that the hospital is reporting on their behalf.

I think once we go electronic, we tend to forget how painful it could be to document on paper and how arduous it was to extract data. (Not all of us, of course. I still have a couple folks begging to go back to the Golden Age of paper.)

And once the PQRI checkbox is complete, it’s onward to Meaningful Use. I’ll have to dust off my riot gear (and my favorite martini glass) because it looks to be an interesting year.

E-mail Dr. Jayne.

ADP Acquires AdvancedMD

HR, payroll, and benefits services provider ADP announced this afternoon that it has acquired AdvancedMD from Francisco Partners. The 200-employee, Salt Lake City-based AdvancedMD is a leading provider of practice management, revenue cycle, and electronic medical records systems. It has more than 10,000 physician users in 4,100 practices.

In the announcement, ADP positions itself as “an integrated, single-source provider of Medical Practice Optimization” for small- to mid-sized practices. The company’s Small Business Services group provides HR, payroll, and benefits services to 45,000 physicians in 13,500 practices.

ADP Chief Strategy Officer Jan Siegmund was quoted as saying, “With a trusted brand, best-in-class solutions, and experienced management team,AdvancedMD is a highly strategic fit with ADP and will enhance our offerings to small- and medium-sized medical clients.   A partnership with ADP means that physicians can dedicate themselves to what they care about most — patient care —while letting ADP take care of the rest.  With our newly combined team, ADP and AdvancedMD will compete effectively for the small- and mid-sized physician practice market, which is going through a rapid technology adoption cycle and moving aggressively toward outsourced solutions—clearly ADP’s strength.”

AdvancedMD was acquired by Francisco Partners in January 2008.

The acquisition appears to mark ADP’s entrance into the PM, EMR, and physician billing market. The company has $9 billion in annual revenue and a market cap of $24.5 billion.