News 2/11/11

From HL7RN: “Re: result messages. I’ve submitted two flavors of this question to ONC and received no response – do you think your readers would help me out with their opinions? My hospital interfaces our best-of-breed ancillary systems to our certified EMR. Since the EMR doesn’t rebound the results to outside providers, we use our interface engine to send exact HL7 copies of result messages to a third-party vendor, who then forwards them to physician offices. Does this qualify for sharing electronic data for other providers or do we need to send the data directly from the EMR?” The floor is open.

From Cabana Boy: “Re: penetration testing companies. Who are the top one or two firms in the healthcare market?” 

From DrFeiedFan: “Re: Craig Feied. Calling him a vendor hack just because he works for Microsoft misses the fact that he’s a giant in informatics.” I don’t think HITworker said that; he suggested that people with Microsoft ties were overrepresented on the PCAST committee that recommended a national healthcare architecture that’s darned close to what Microsoft is selling. I think it’s a fair question, just like you’d ask when Wall Street types help draft financial policy. He’s brilliant, no doubt – drag the video timeline above to about the 37:50 mark.

From Dr. Herzenstube: “Re: Primary Care Home. Making good on their threat, Joint Commission has come out with proposed requirements for their version of the Patient-Centered Medical Home. Getting my attention: (a) practices would have to provide language translation at their own expense; (b) they would have to ‘facilitate access’ to dental care; (c) they would have to use e-prescribing, which doesn’t have much to do with the PCMH model; and (d) they would have to provide 24/7 appointment scheduling, prescription refill requests, and general health information (they probably have online resources in mind, but can you imaging a 3 a.m. page for a Viagra refill or outstanding balance request?) It’s nice to see a truly grassroots movement in health care, proven in multiple controlled trials, getting some recognition. I suppose that some kind of accreditation is necessary  for reimbursement, but I do wonder how much the spirit of the thing will be lost in reductionism into atomic functions that this kind of approach fosters.”

Listening: the just-released first album of The JaneDear Girls. It’s classified as “new country,” meaning it’s radio-friendly, overproduced pop with an occasional hint of banjo or unconvincing Southern accent (one of them’s from Utah, for God’s sake). I’m not a big fan of the genre, but this is pretty good in a Lady Antebellum or Taylor Swift sort of way. They’re young, cute, and chipper, so naturally they’re going to be massively popular except with fans of real country music.

If you haven’t completed my just-once-a-year reader survey, would you mind? It’s all I use to plan HIStalk for the next year.

Is is my imagination, or is HIMSS spamming the heck out of my work e-mail? I’m getting multiple e-mails every day urging me to attend the conference, which would be coming a bit late if I wasn’t already signed up, but thus being pointless since … I’m already signed up. I promise I won’t forget to show up.

Community Healthcare System (IN) goes live on its $40 million Epic implementation.

RelayHealth is running a Facebook contest to send Dr. Jayne a welcome basket. You suggest an under-$25 “fun gift to give her to express support for her new role,” and if other Facebookers like your idea, you get a stainless steel mug and other goodies while Jayne gets the gift you suggested. Sure, it’s obviously social network marketing, but I thought it was pretty fun when they e-mailed me about it earlier today.

SCI Solutions is another non-exhibiting HIStalk sponsor who would be happy to meet with folks interested in their solutions for access management. Contact Stuart Hammond to set up a time.

Canada Health Infoway sets up a $380 million fund to co-fund EMRs and invest in peer support networks throughout Canada.

Thanks to Aspen Advisors for supporting HIStalk as a Platinum Sponsor. I just finished interviewing founder Dan Herman if you need some background. The Pittsburgh-based consulting firm offers services that include strategic planning, system selection, implementation, facility expansion, informatics, physician strategy, healthcare reform planning, infrastructure services, business analytics, IT service management, and Meaningful Use planning. They don’t send out noobs: 75% of their consultants have more than 10 years’ healthcare experience and 40% have more than 20 years. If you’re a non-noob yourself, check out their leadership team and I bet you’ll know at least one of them. Their site has white papers, case studies, and open consulting positions (including clinical informaticists). Thanks to Aspen Advisors for supporting HIStalk.

Here’s the transcript of Cerner’s Tuesday earnings call. Nuggets: (a) they bragged on beating Epic in both inpatient and outpatient in a Q4 academic medical center deal; (b) they signed two outsourcing deals in Q4; (c) non-US sales aren’t doing much; (d) they’re big on Healthe, their cloud-based tool that allows EMR searching and future “microapps”. I always like reading the Q&A since the stock analysts and company people start speaking in financial tongues, asking for “color” on some obscure financial number and continuously saying “sort of” and “kind of” to keep it casual. Neal popped in for his usual 20 seconds at the end. Shares jumped past $100 for a short time, then retreated.

Jobs on the HIStalk Jobs Page: CPOE/EHR Educator, Project Manager, Project Manager – Healthcare Implementation, CMIO. On Healthcare IT Jobs: EMR Systems Analyst, Business Development Manager, VP Business Development, Soarian Clinicals Consultants.

Christ Hospital (OH) promotes Alex Vaillancourt to CIO.

QNX Software Systems announces an extension to its real-time operating system that could allow FDA-approved devices to connect to the BlackBerry PlayBook tablet.

Florida Governor Rick Scott (that still just sounds wrong to anyone who remembers Columbia/HCA) wants to shut down the state’s in-progress doctor shopper database even though it won’t cost the state anything to keep tabs on drug seekers. Scott answered a question about it by saying, “That program has not been working,” which is not surprising given that it isn’t even live – bid protests have gone on for more than a year.

Australia’s $56 million JeDHI military health records system (cool name) will be developed by CSC Australia, which will modify a British primary care system from EMIS. Technology from Microsoft and Oracle will be used, while Health Language will provide clinical terminology support.  

Speaking of Health Language, they are supporting HIStalk as a Platinum Sponsor. The company, with offices in Denver, England, and Spain, has 4,000 installed sites of its HLI Language Engine, a medical terminology management solution. Terminology management has always been important, but is now much more so for two reasons: (a) the ICD-9 to ICD-10 conversion, and (b) the HITECH push toward interoperability and the resulting need to exchange not just bits and bytes, but medical concepts. The HLI Language Engine supports over 100 healthcare code sets (ICD-10, SNOMED, LOINC, RxNorm, MVX, etc.), can prompt clinicians in medical terms to complete problem lists coded in SNOMED and ICD, links lab codes to LOINC, maps proprietary drug terminologies to RxNorm, and creates Consumer Friendly Terminology from medical terms for discharge summaries and patient education. Co-founder George Schwend was an interface engine pioneer as co-founder of Healthcare.com and its predecessor companies and he’s applying those same concepts to terminology management. I appreciate the support of Health Language.

Children’s Hospital Central California gets a $5 million gift from the foundation of financier Kirk Kerkorian to implement electronic medical records.

The new government in Victoria, Australia kills a hospital trial of 500 iPads, claiming the former government did not provide the necessarily wireless infrastructure. The health minister also wants to end Victoria’s $360 million HealthSmart healthcare IT program, which includes Cerner Millennium.

Nuance reports Q1 numbers: revenue up 11.5%, EPS $0.00 $(0.28 before one-time expenses) vs –$0.02. Analysts were expecting $0.31. Healthcare was called out as a strong performer in the conference call. Chairman and CEO Paul Ricci says Nuance has disrupted the transcription model, causing consolidation among transcription firms, but that works against Nuance in the short term because those companies have dropped prices to survive.

The head of the $76 billion Ohio Public Employees Retirement System will resign to take a job in healthcare consulting with Ingenix.

E-mail me.

HERtalk by Inga

From Practice Consultant: “Re: Meaningful Use costs. One of my clients, a user of Allscripts Professional EHR, was told that even though they have upgraded to MU version 9.2, they need to purchase two Stimulus Sets. Phase 1, needed to run reports for the 15 Core objectives and the 5 menu objectives, costs $200 per MD per year. Phase 2, the Clinical Quality Solution that lets the practice pull numerator and denominator quality numbers, is $185 per provider per month. I guess if the practice doesn’t pay, they won’t be able to pull quality data. This seems unfair.” I shared this information with an Allscripts representative, who provided this official reply:

As you know, not every client is pursuing Meaningful Use. There is a development cost to make the additional functionality beyond the traditional EHR available. Allscripts bundled the necessary capabilities for clients to pursue Stage 1 incentives if they wished. We are not aware of any other vendor bundling and marketing this as an easy, off-the-shelf option. And, naturally, we make certain considerations available to clients to encourage adoption of advanced technology.

From Louboutin Lover: “Re: IngaTinis. I do remember a certain vendor started the now-infamous cocktail at HIMSS last year and hear they will feature The Original IngaTini at their in-booth happy hour.” Perhaps Surgical Information Systems should have copyrighted the IngaTini name since they did concoct the original drink for HIMSS last year (you can see the SIS logo on the glass above). I do recall sipping a most delightful drink last year and am pleased to hear IngaTinis will be back. I’ll be back sipping, too.

From Gals Wanna Have Fun: “Hot parties. I am wondering what other hot parties (not on Monday, of course) are happening next week. Care to share?” I am amused that at least one person thinks I am privileged enough to be a VIP at all the fun gatherings. Interestingly, I did receive invites for about half a dozen events on Monday, but I don’t think I have seen anything for the other nights. I know HIMSS is having an event Wednesday at Universal’s Islands of Adventure, but that’s  about all I have heard. I suspect that between HIStalkapalooza, education sessions, and the exhibit floor I will be too wiped out to do much more than order room service and write HIStalk updates. (That’s my story, anyway.)

The Valley Hospital (NJ) begins implementation of Webmedx’s QualityAnalytics solution for clinical documentation. The hospital also deployed Enterprise5, Webmedx’s outsourced transcription services.

Carter BloodCare (TX) licenses Mediware’s KnowledgeTrak software to manage training requirements and improve reporting.

Advocate Health Care (IL) deploys Certify Data System’s HealthDock to provide enterprise health information exchange.

Florida selects open source software provider Mirth Corporation to provide the interoperability platform to power the state’s HIE.

Butler Health System (PA) will implement GE’s HIE solution.

Coming this weekend: Mr. HIStalk’s Must-See Guide to HIMSS 11. Mr. H will be publishing a list of some of the hottest exhibitors this year, all of whom happen to be faithful HIStalk sponsors. In addition to short summaries of each company, we are giving you the heads up for some of the coolest giveaways, including several just for HIStalk readers. I love trinkets, but some of the goodies are trinkets on steroids, including  iTune gift cards, a Dell netbook, a Sonos Music System, a trip to the Masters, and quite a few iPads. In fact, with the plethora of iPads being offered this year, I will be bummed if I come home iPad-less.

Also for your weekend reading pleasure: several HIT vendor execs share their predictions for the hot topics of HIMSS11. I am happy to report that most participants provided thoughtful and insightful answers that reflect what’s going on in the industry, and not just what will be going on in their exhibit booth. Meaningful Use is the hottest of the hot, of course, but there will be plenty of discussion on other subjects, including ACOs and other health reform implications, interoperability, ICD-10, and mobile health. You’ll want to read up before you head to Orlando. If nothing else, you will sound really smart while drinking your IngaTinis.

More cocktail party fodder, perhaps? Between August 2009 and the end of 2010, there were 225 significant healthcare security breaches that affected six million people. More than half were due to malicious intent.

Phelps County Regional Medical Center (MO) selects Perceptive Software’s ECM solution to integrate with its Meditech application.

Sequoia Hospital (CA) says it reduced its mortality rate in cardiac surgeries more than 50% through the use of IBM predictive analytics software by reducing risk and offering personalized patient care.

Microsoft continues to expand its healthcare-related offerings with the introduction of its new state Health Insurance Exchange (HIX) solutions.

Apparently Epic’s existing 5,300 seat auditorium is not big enough, so the company is proposing a new 13,000 seat venue. Epic says it needs the facility for its annual user group meeting, which in recent years has had to use tents for the overflowing crowds. The Verona City Council must approve the project.

Cold? Going to HIMSS? Here is something to look forward to.

E-mail Inga.

Sponsor Updates

• The Huntzinger Management Group is hosting a (free) lunch February 21 at HIMSS to discuss the future viability of hospitals. Attendees are automatically entered to win one of five iPads.
• Southern Ohio Medical Center will deploy Wolters Kluwer Health’s ProVation MD software for cardiology procedure documentation and coding in the hospital’s cath lab.
• Merge Healthcare announces seven new contracts for its clinical trial solutions.
• Dan Underberger, MD joins MedVentive as vice president and medical director. He was previously a board-certified anesthesiologist and co-founder of Peminic, a developer of reporting and compliance software.
• Ridgeview Medical Center’s Two Twelve Medical Plaza (MN) goes live with Wellsoft’s EDIS. It’s Ridgeview’s second ED to implement Wellsoft.
• NextGen clients have secured nearly $2 million in 2009 PQRI reimbursements leveraging their NextGen Ambulatory EHR and HQM reporting module.
• Carefx releases a new white paper, “High-Performance Healthcare: Gateway to Accountable Care.” Download here or pick up a copy at Carefx’s HIMSS booth (#4543).
• DIVURGENT announces ACTIVATE!, a new management service offering to help organizations improve go-live project quality and reduce activation support costs.
• McKesson’s Horizon Ambulatory Care earns Complete EHR certification from Drummond Group.

EPtalk by Dr. Jayne

I don’t know if any of you are familiar with the book All I Really Need to Know I Learned in Kindergarten, which is a charming collection of essays by Robert Fulghum. After today, I think I’m going to start penning the companion volume, Everything I Needed to Know about Healthcare IT, I Learned Reading HIStalk. I’ve been reading for a couple of years now, and thank goodness for the search feature because I’m always looking for something that I think I read on one of the sites.

Today, I had one of those totally déjà vu experiences where life imitates art, living in a real-world version of the Accountable Care Organization clip that Inga shared on HIStalk Practice back in August.

Although I do distinctly remember sleeping through classes in medical school that had subjects like “101 Obscure Diseases You Will Never Ever See” and “Fungal Delights,” I must have also slept through the parts of CMIO school that covered the following: “Achieving ACO Status Without Physician Buy-In: Just Avoid the Tough Conversations”; “Blind Budgeting”; “Payers Know Best”; and my personal favorite, “How to Not Let Quality Interfere With Arbitrary Deadlines.”

The one class I did not sleep through, however, that the other folks on this hellishly painful half-day conference call apparently did: “Mute Features: Your Friend and Mine.” It’s calls like these that make me envy my friends who work at Critical Access Hospitals, where everyone works in the same building rather than the multi-state madness I cope with. Seriously people, learn how to mute yourself. I do not want to hear you emptying your dishwasher or snoring, both of which I have heard recently. If I cannot trust you with knowing how to mute, I am not going to trust you with a $200K interface project.

You may have noticed that I am a shameless fan of these clips created using Xtranormal. I’d like to issue a challenge to our readers who work the front lines of implementation with real, live users. Create a clip, three minutes or less, of the funniest scenario you’ve ever encountered during training. I’ll feature the best of the best, with the prize being eternal HIStalk bragging rights.

Obviously, the weather has been leading me to spend more time on the Internet than I usually do. I’ve been feeling a bit neglected when I see those Facebook updates that read “Tim Histalk and Inga Histalk are now friends with Joe Reader.” As a charming and sassy CMIO, why do I care if Mr. H and Inga have more friends than I? One snappy literature search later: Social Media: A Great Uncontrolled Experiment on Kids (and shame on MD Consult for trying to charge me for a subscription to read something that’s free on Internal Medicine News. Really.) Being a member of the social media as well as a scientist, I found it interesting.

Dr. Michael Rich, associate professor of pediatrics at Harvard, describes himself as a “Mediatrician” and educates parents about the impacts of social media (Facebook, Twitter, and texting) not only on behavior, but on brain development. His blog discusses the competitive nature of friending on Facebook and the fundamental shift in the concept of friendship that is happening because of these technologies.

Although I sympathize with the maladaptive behaviors that I see in some people due to technology (see comments on the importance of the mute button above), I’m encouraged by the potential for the human brain to adapt to a digital environment. For those of us in IT, if we hold out long enough, perhaps the doctors of the future will be a teensy bit easier to implement. (And if not, we can Tweet about them after class.)

Have a question about medical informatics, electronic medical records, or whether scrubs start to smell after 24 hours of resident on call? E-mail Dr. Jayne.

Dr. Gregg Goes to HIMSS
By Gregg Alexander

First things first: I must offer up my two cents to all the marketing folks who blast out pre-HIMSS emails attempting to engage the press and spread the love for their company.

Ladies, gentlemen, please – put a little effort into it. I realize you may be sending out scores, even hundreds of these e-mails, but that’s no excuse for using sloppy grammar. It’s no excuse for doing a poor job with your copy-n-paste when creating your reach outs. Honestly, with mixed fonts and blatant false personalization that looks as personal as an IRS form, who do you expect to impress? Some of these emails are constructed so poorly it prompted me to coin a term for my own use: “Mickey Marketeers.”

Now if a marketer or PR person puts a little effort in to insure that an e-mail promo: a) looks good; b) reads well; and c) has a little bit of real person, real outreach in it, well, then you’ve got a hook with some bait.

One of the best to hit my inbox was one from a rep who included personal info directed to me (we all want to feel a little important) and told an interesting, though brief, story. She mentioned a few IT biggies who were involved with this start-up: Jeffrey Wilkins, founder of Compuserve and Herb Smaltz, former CIO at THE Ohio State University Medical Center and recent HIMSS board of directors member. Also, the rep noted that the inimitable Ivo Nelson, chairman of Encore Health Services and highly successful 2010 HIStalk reception sponsor, had joined their board.

When Ivo talks, people listen. I did, too. I undertook a pre-HIMSS look into them, Health Care DataWorks, to learn more about what they do. (I had heard of them, but had only a passing familiarity.) What I found was that they aggregate more data than I even care to think exists within hospital systems and then create easily visualized and easily understandable reports, graphs, and drill-down dashboard items which allow for “Actionable Knowledge.” They create true ease of use for this mountain of collected data.

I don’t normally look forward to trickle-down technology from big centers – it usually works horribly in the private practice setting – but this tool appears so end-user useful, it’s one I hope eventually heads our way. (FYI – Incubated at THE Ohio State University, they have abandoned the academic nest to fly capitalistically.)

Another quality outreach came from GE Healthcare regarding Centricity Advance. The initial e-mail was short, but sufficiently descriptive, displayed enough personalization that I could tell the sender actually reads HIStalk/HIStalk Practice, and avoided the too formal business-speak so rampant among Marketeers. This approach enticed me enough to start a pre-HIMSS look at them, too.

Those styles, while less efficient for the sender, seem much more impressive and engaging. (They got me to take a deeper look.) I realize that corporate folks often speak to each other in a more formal fashion, even sending out press releases with the implied “you will want to talk with us” approach. Maybe that works for some, but I find I’m much more likely to want to set aside some HIMSS time (or pre-HIMSS time) looking into those companies whose outreach people come across more as people – and who look at me that way, too.

I know I’m no real HIT “reporter.” But, maybe what works for me might work for real reporters, too.

E-mail Gregg.

HIStalk Interviews Dan Herman, Aspen Advisors

Dan Herman is founder and managing principal of Aspen Advisors of Pittsburgh, PA.

Tell me about yourself and about Aspen Advisors.

I’ve been in the business for 30 years this month. I did an internship with Rich Correll of the Detroit Medical Center as a management engineer and I always credit him for getting me in this business. 

I worked in decision support, merging medical record and patient accounting data to come up with an early case mix system that I spoke about at HIMSS in the mid ‘80s. I then got into project management with a large revenue cycle implementation. I worked for consulting in the Big 6, or the Big 8 at the time, and joined a small firm called First Consulting Group back in 1991.

I started Aspen Advisors in 2006. We focus on healthcare, really three things. Helping IT executives with difficult decisions related to IT and strategic decisions with investment and planning. Managing large-scale projects and programs, particularly those on the clinical side, with revenue cycle and technology as well. Third, optimizing and looking at how we use the technology better through informatics, clinical content, and process enhancement.

What really distinguishes one consulting company from another other than the people that they employ?

It’s how they serve their clients and what services they focus in on. We’re organized as a multi-specialty group practice. It’s really practitioner-led and professionally managed and I guess I’m the head doc. I think it’s really having that experience of “been there, done that,” working in operations, working in IT.

It’s also core values, that professional integrity. Doing what’s in the client’s best interest and serving them first. And, making sure the associates share your core values and are continually growing themselves. It’s that understanding of what your client is looking for and doing one project at a time. It might be a small project. It’s developing that relationship over time.

With an apparent talent shortage, what makes consultants want to join a company and stay there?

It’s that challenge. It’s growth. It’s having mentors, people to look up to, people who have been there and can help them grow and guide them in their careers. It’s not “one size fits all.” Everyone has different needs and skill sets.

It’s looking for the talent and stretching people’s capabilities. I can make the analogy, “We’ll throw you out in the water, but you’ll have a life vest and we’ll be looking after you the whole time.” It’s getting individuals who are looking for a challenge, looking to grow their skills, and looking to do new things. You hear of consultants who get stuck at a client for a year, two years, three years. We don’t do that. We really look at what’s best for the client and what’s best for the consultant and make sure there’s that rotation there.

What are the pressing priorities and concerns of your clients and how have those changed over the last couple of years?

Going back 5-10 years, our clients have gotten the IT side. They have better leadership. They’re smarter. A lot of the clients we work with are former consultants. They come from the vendor environment.

What they are really looking for is expertise to fill a particular role for a particular period of time. Structure and discipline, whether it be project management or whether it be educating and working with them on a IT service management program. The third area is what I call the advisory – helping an organization with a decision where it’s difficult to make that decision themselves due to internal politics or various opinions such that you really need that outsider.

With respect to some specific areas, clearly the electronic medical record implementation is a priority. We don’t focus on the analyst, the builder side of things. We focus more on how we work with our clients to use the technology and get value from it. How do we shorten the length of stay? How do we reduce the errors? How do we improve the revenue cycle? It’s about the process and the technology coming together and putting methodologies in place for that.

Hospitals are spending up to hundreds of millions of dollars on clinical systems implementation. Do you think they have a solid plan for obtaining ROI and, given potential reimbursement challenges, can they afford those systems?

It depends on the organization. I’m working for one that has about 600 provider physicians and a financing arm associated with it. They’re very integrated from an organization and they have a very clear business strategy. They’re migrating to service line management and have very clear accountabilities.

They’re struggling right now because their IT environment on the EMR side is very, very fragmented. We worked with that organization to put a strategy together and a total cost of ownership model with respect to staying the course with a best-of-breed strategy compared with an integrated solution. Clearly it was in favor of the integrated solution.

Other organizations we’ll work with really don’t need to throw everything out and start from scratch. I’ve heard of some organizations that have recently thrown out Meditech and gone to another vendor. I just scratch my head sometimes if it’s an organization that doesn’t have a lot of capital and doesn’t have a lot case for change. Why throw out the technology? Why not just use what you currently have, better? It depends on the organization. 

Looking ahead, it might be a land grab right now with respect to “Everybody’s throwing money at healthcare IT, and in particular, EMRs.” I think that’s going to change in the next couple of years. With the reimbursement changes that are coming into play — Medicare and Medicaid cuts, some of the aspects of healthcare reform, or healthcare insurance reform, rather — I think there’s going to be big pressure in margins. It’s going to be time to say, “What can we do with what we have? How do we get value out of what we have already and improve things?”

Some predict that HITECH is pushing software sales that were premature and there will be a second wave of purchases to replace them. How do you see that changing the vendor world?

That’s going to be an interesting one. I’ve been in this industry long enough to see vendors come and go. Those vendors and organizations that are focused solely on healthcare, whether it be one niche or the other, will be able to expand services within that.

Those bigger companies with other lines of business — across healthcare, not only in IT but in supply chain and pharmaceuticals and whatnot — I think they might shift their priorities elsewhere. The question is, what’s going to happen to that vendor in the market as far as the support? They’ll be there, but how much R&D will go into that product?

It’s a niche area there are a lot of new vendors coming in. In the EMR area, there is still a Top Six or so on both sides. There aren’t many more if you’re a big place.

You mentioned system and workflow optimization in hospitals. Is that happening or will it happen eventually?

I think it will. It depends on the life cycle. Organizations that were early on with the EMR like Allina, NorthShore Evanston, and St. Luke’s in Kansas City have been at this a long time. They’re past the stage of the basic EMR, revenue cycle systems, and PACS. They are optimizing what they have, but they are also gathering data, the business intelligence side of it. That will continue to occur, but I think it’s going to take a while.

One of the early projects I worked on was decision support in looking at case mix. Today they call it business intelligence and data warehousing. Unfortunately, the tools have changed and have gotten better, but I think the way we use analytics to change behavior and improve outcomes is still lagging.

Are hospitals that engage your company becoming more data driven?

Yes, some of them clearly are. They’ve gone through implementation and are now saying, “How do we improve? How do we use this to improve medication safety? Particularly in a capitated environment, how do we reduce the length of stay and reduce tests?” I see more organizations doing it, but we’re still not at the tipping point.

Aspen works on Epic implementations. Do you have concerns that Epic has so many balls in the air all of a sudden with so many large implementations going on at once?

It’s Epic more than others because, at the expertise level of the builder, the people that have been there, done that are in short supply. It’s a challenge.

We have a client in Louisiana. One of their biggest concerns on the ambulatory side is where they can get those resources, especially since a couple of other organizations in the region are doing the same. It comes down to having some creative HR recruitment and retention policies. We worked with the University of Colorado and they hired up hired up about 70 people on their team. They’re using consultants in a very limited way and they’re done it with some innovative practices.

There are other organizations that have done things like fixed-term employees, to retain individuals for a period of time and then give them to option to stay or leave the project when it’s done. What it comes down to is how creative your organization is in attracting this talent, as well as what part of the country you’re in. That can render a challenge. I don’t think it’s insurmountable, but you’ve got to get a little creative.

Will Epic’s employees be capable of the clinical transformation and optimization work given that their employees are mostly young and focus on Epic’s applications?

What I’ve seen is that on the vendor’s side, that type of talent was a rarity. I was a project manager, but rarely looked at process. I don’t think you get that from the vendor. Where you get that is either the organization is process oriented or gets outside help to put together an approach and insert some expertise and hope the client can do that because it’s not a one-time thing, it’s continual improvement.

Vendors weren’t big on those resources anyway. They were focused more on getting the system in and the specific knowledge of those products.

IT demand has always outstripped supply in hospitals. Is that still the case, and if so, how are hospitals making the priority decisions?

Yes, that’s a big thing. Demand, especially now, is outstripping supply.

In working with a big organization recently, we talked about if they embarked on this big EMR and revenue cycle project, what would come off the table. You can’t continue to do 15 other projects. This is the big one, not only for IT, but for the overall organization. It’s a constant struggle with IT governance and how it ties into the business.

I recently worked with a Midwest hospital. It was the same exact thing. They wanted to do everything. They had two or three vendors that were doing the same function, patient tracking for example, and they wanted to buy another one. We worked with them to put together a governance process tied into their overall capital and operating budgeting process.

It’s a struggle. Having organizations focus is a struggle. Often, it’s a cultural aspect, and not only with IT.

Are you seeing changes in role of the CIO or the CMIO?

I don’t have a super-technical background. I took one programming course in college and barely got through it. I’ve had people come to me and say, “You should be a CIO.” I said, “I’m not technical enough.”

Executives tell me that that that’s not what they want. They want a business person, someone who really understands their business, understands their culture, and can lead an IT function. Get good leaders underneath them, get it structured, and help them prioritize and make sure they’re putting their effort into the right things and not throwing money out the door.

I see that more. Folks who can sit at the executive table, but if they need to, go deep into their IT organizations and call a bluff with their technical guys. Someone who can work with the management team and the board to help them understand why they can only invest in these three things versus these 15 things, and not get shot for doing that.

Any final thoughts?

We’re going to see less reimbursement and more cost pressure. We’re going to see mergers and acquisitions and consolidation. What’s the priority? It makes no sense to invest in an EHR when your management team knows that down the road a year or two, it will probably not be an independent organization any more.

How do we manage interoperability? Not everybody has the money to throw out to vendors and start from scratch with an integrated vendor such as Epic. How do we make sure systems stay up? We’re depending more on the electronic medical record and clinicians and doctors are using the technology on a daily basis — we can’t have down time. How do we start taking data out and converting it to information on which we can make decisions or hold people accountable?

I’d like to refer to a quote by author Jim Collins. “Information Technology is never the reason for an organization’s success or failure, but can be an accelerator of either.” There’s a lot of attention and funding being directed to healthcare IT. However, IT itself is not the silver bullet riding in on the white horse.

Truth is, few organizations can afford huge IT investments, even with the help of the Meaningful Use incentives. Organizational change is never as easy as investing in the latest technological advancement. 

I remember in 1998 the CEO of my client, an academic medical center, was complaining that test turnaround time hadn’t improved after the implementation of a new radiology information system. He laughed, but understood what I was referring to when I told him that they didn’t buy the cattle prod peripheral to alert the radiologists that it was time to read and dictate their results. IT is only a tool. Engaged leadership, skilled and trained staff, and effective operational processes are key to user adoption and extracting value from expensive IT tools.

Our philosophy at Aspen is to enhance the value of our clients’ IT investments. Whether we are leading an enterprise-wide EMR implementation or coaching the IT leadership team in instilling ITIL service management processes, the goal is always to save our clients money, help them get a return, and transfer expertise so they become self sufficient. Believe it or not, we want to work ourselves out of a job. It’s in the client’s best interest and our associates want to move on to other challenging projects. 

Readers Write 2/9/11

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

Comments on the PCAST Report
By HITworker

You don’t have to look very far to see evidence of just how much this PCAST report is a sophisticated marketing piece for Microsoft’s ailing Health Solutions Group.

The committee co-chair (note – not just a member, a full co-chair so presumably he had a lot of control over input and direction) is Craig Mundie. The Health Solutions Group was set up by Craig Mundie and the Peter Neupert, who leads the Health Solutions Group and reports to Craig.

Listed under expert input at appendix A are a list of 47 ‘experts’ who contributed to the report. Thirteen of those experts are from vendor companies, the rest coming predominantly from federal departments and health providers. Of the 13 experts, three of them are from Microsoft including:

• Craig Feied – Microsoft Health Solutions Group’s chief strategy officer, who joined Microsoft after selling the Azyxxi product he built to Microsoft, which later became Amalga UIS (which just happens to be a clinical data aggregation technology – so favored in the PCAST report).
• Sean Nolan – Microsoft Health Solutions Group’s chief architect, who admits to having no experience in health IT before he led the development team that designed Microsoft HealthVault (which is a personal health record, also so favored in PCAST).
• Peter Cullen – Microsoft’s chief privacy officer, who has a significant role around advocating in relation to Microsoft’s approach to privacy in cloud computing,  (the third and final favored technology in PCAST).

Then of course, there’s Craig Mundie.

I got to looking into this after reading a blog posting on John Halamka’s blog (Life as a Healthcare CIO), where Sean Nolan of Microsoft illustrated how he believed Microsoft had all the answers for a Universal Exchange Language for health using their products Amalga and HealthVault. This was only a couple of weeks after the PCAST report was published in which he was a named ‘expert’.

So curious, I dove a little deeper into the other 10 ‘experts’ and found that seven of them work for three companies (Ingenix, athena, Sage, and Medicity) who all have partnership relationships with Microsoft.

Now I’m not opposed at all to vendors contributing to these kinds of reports – industry often has expertise and insight that is not readily available within government — but something didn’t seem right. These just aren’t the companies that would leap to mind at all when I think of the leading vendors in health IT with the most expertise and insights to contribute. Something’s amiss.

We’re being asked to believe a committee chaired by someone who runs Microsoft Health Solutions group, independently and without bias sought input from experts, and that three of the 11 experts from industry consulted just happened to work for the chair of the committee within Microsoft. And that these three had direct responsibility for products that just happened to address the three key technologies called out as enablers of the PCAST recommendations. Furthermore, seven of the other industry contributors work for companies that are Microsoft partners.

Something is most definitely wrong with this picture.

Bill Bria for ONC
By Ann Farrell

Note from Mr. H: industry long-timer and consultant Ann Farrell is mounting a campaign to have Bill Bria, MD (CMIO of Shriners Hospitals for Children) considered for David Blumenthal’s replacement at ONC. Her reasons: he’s an industry thought leader, he is regarded for his work with AMDIS, he is not self-promoting, and he recognizes the value of informatics in areas other than those involving physicians. Ann believes that his appointment would unit the industry and signal an HHS commitment to patient-centric, benefits-driven, interdisciplinary, and workflow-friendly technology strategies. Her letter is below.

Greetings,

I am a career-long champion of EMRs as end-user at first US commercial implementation, EHR vendor VP and now Principal of Strategic HIT consulting firm. The news of Dr. Blumenthal’s departure while not totally surprising is nonetheless of concern with now third hand off of leadership in high impact initiative that is advantaged by continuity.  Nevertheless, this is an opportunity to look carefully at the character, characteristics and capabilities of the new leader so we can align the next set of challenges to the appropriate candidate and perhaps overcome flaws with current approach.

We recognize value of the next leader having directly supported ONC in HITECH initiatives. We also appreciate value of someone who has successfully supported change management with “hands on” experience in implementing EHRs in several diverse organizations who’ve achieved goals of HITECH in real world settings. The person ideally would be universally respected by vendors, hospitals, colleagues and the market – without political baggage and not part of “old boy network”.

In this regard, we think Dr. Bill Bria would make an exceptional candidate. His knowledge, passion and track record well position him for success. Perhaps most importantly, Dr. Bria recognizes that healthcare does not equal “MDs“ alone but requires a care team who execute MD orders as well as plans of care that together drive efficiencies and outcomes.  All caregivers contribute to EHRs and patient care. Till this time, a clear MD-centric bias is reflected in Meaningful Use content, phasing of criteria and messaging.  Ironically, this approach has had unexpected negative consequence for MDs as well as the program.

Dr. Bria has played a critical role in the “visioning” and design of several lead EMR/EHRs since the early days and played key leadership roles at diverse prestigious healthcare organizations and AMDIS. Bill is a hero to those of us who worked with him.  Dr. Blumenthal’s departure provides a chance to “reboot” HITECH – Dr. Bria could bring a new more realistic and a-political, patient-centric, interdisciplinary approach needed to optimize this once on a lifetime opportunity for HIT.  

Regards,

Ann
Ann Farrell
Principal, Farrell Associates
San Francisco , CA 94114

Five Things Hospitals Should Know About Backing Up Virtual Machines
By Charles Mallio

As more hospitals introduce virtualization to their data centers, they must incorporate virtual machines (VMs) into their backup and recovery strategies. How is backing up VMs in a hospital environment different? There are five things that hospitals should think about as they incorporate VMs into their overall DR program.

1. Don’t assume agentless backup. One of the most common misconceptions about VMs is that you will be able to perform backups on any machine without an agent. VMware does help in this regard, but it is often the case that you will need a backup client – virtual or physical – especially when you consider how you are going to recover applications.
2. VMware doesn’t reduce the importance of good DR planning. For example, virtualizing your server environment does not negate the need to fully optimize your backup routines. In every hospital, approximately 20% of data is dynamic (i.e. current, active content that is highly likely to be accessed and or changed), which should be given the highest priority in your DR cycle. Yet, around 80% of a hospital’s data is static (such as DICOM images from PACS, which will never change and are highly unlikely to be recalled again). Whether this static data is in a physical or VM is irrelevant – the fact is, if you don’t move it out of the primary backup stream, you will end up making unnecessary copies of copies, place a considerable, additional burden on your infrastructure and dramatically delay your backup processes.
3. VM sprawl will require more thorough DR planning. As VMs multiply within the data center, each hospital must align each VM with their overall DR strategy and assign policies for restoring mission-critical applications and data so that business continuity criteria are met.
4. VMware has produced some new features in vSphere, but these do not provide a DR silver bullet. vStorage APIs for Data Protection (VADP) offers great new facilities, such as changed Block Tracking, that may be applied in a VMware environment to enhance data protection and disaster recovery. These tools are ideal when protecting file and print servers, but you should always ensure they offer adequate facilities to RECOVER applications in your environment.
5. Choose backup hardware that meets your business needs. Although migrating from physical to VMs will bring new economies to the data center, it does not mean that you are restricted to disk-based backup. VMs can just as easily be protected on more affordable, portable tape media. Hospitals should choose the backup media that best meet their budgets and business processes.

Charles Mallio is vice president of product strategy and business development at BridgeHead Software.

Capitalizing on PQRI’s Financial and Quality Improvement Learning Opportunities
By John Nelson

It is not often that the Centers for Medicare and Medicaid Services (CMS) offers an initiative or mandate that allows doctors to receive extra money, deliver better care, and attract and retain patients without inflicting enormous pain and extra work on a practice. However, after a false start, CMS’s Physician Quality Reporting Initiative (PQRI) has become such a program, enabling us to easily collect a bonus while positioning us to learn what we need to do to further enhance quality and prepare for an era where payments will be based on outcomes rather than visit or procedure volume.

This was not always the case. When the program began in 2007, the Heart Center of North Texas, a nine-doctor cardiology practice in Fort Worth, Texas, found that collecting and reporting PQRI quality measures was so burdensome and expensive that we did not want any part of the program. But we changed our minds in 2009 after CMS, acting on physician complaints and feedback, not only made it easier for doctors to participate in the program but also enabled them to report quality measures through registries.

Another reason we participated in PQRI is that the Texas Medical Association offered a coupon covering nearly the entire cost of the fee we had to pay CMS to register our participating physicians.

It took a clerk only a month to collect the information from our electronic health record and clinicians, which she then forwarded to our registry. Her effort had no impact on clinician workflow but had a huge impact on our bottom line: CMS paid us $87,000 for the 2009 reporting year.

Collecting data for 2010 turned out to be even easier than in 2009 in part because CMS changed the definition of consecutively seen patients. Now, the reporting physician did not have to see 30 patients consecutively which allowed them to go back and gather the data. This plus the fact that we stand to receive another substantial bonus led us to participate in PQRI again. We urge our colleagues follow our example, as they still have plenty of time to meet the March 15, 2011 deadline for the 2010 reporting period.

Another reason to file for 2010 PQRI incentives is that the bonus will be at its highest level. CMS will reduce the 2 percent bonus to 1 percent in 2011. From 2012 through 2014, the bonus will drop to 0.5 percent. In 2015, the carrot changes to a stick: reimbursement for non-participating physicians will drop by 1.5 percent and by 2 percent in 2016. Why pass up the bonus when it’s so easy to participate now?

Additionally, we believe PRQI enables us to identify areas where we are strong and where we can improve, giving us a head-start on accountable care, bundled payment, pay-for-performance and other care models that CMS and other insurers are rolling out. It is my job to ensure my group is clinically, financially and administratively efficient. The bonus, information and electronic reporting help me achieve these goals.

John Nelson is practice administrator of Heart Center of North Texas, a nine-physician cardiology practice in Fort Worth, Texas.

News 2/9/11

From DoDer: “Re: McKesson and General Dynamics for DoD’s EHR. I don’t see anyone reporting that they picked their product, only that the companies are collaborating to offer one.” It is indeed an annoyingly vague announcement. The wording (and McKesson’s involvement) suggested that DoD is getting an existing McKesson product (“McKesson’s EHR Solution”), but surely they don’t have anything that would work off the rack for the Defense Department.

From Cohort Certified: “Re: Epic non-compete. They’ll only try to enforce it if they can get away with it. That’s why KP has so many former Epic employees. I’ve also heard that if you mention ‘tortuous interference in employment’ or the NLRB in an exit interview, they’ll drop it down to 90 days, in writing.” Unverified.

From HealthITGuy: “Re: Ingenix. I hear they are continuing their expansion by acquiring HealthTech Holdings, parent company of HMS and MEDHOST.” Unverified.

From Verge: “Re: EMR software for dieticians. Any thoughts?” I’ll ask readers to chime in. That’s a great question given the cost of diet-caused illness in this country, although it wouldn’t seem to require an entirely separate EMR.

From Bobby Orr: “Re: API/Kronos. I can’t see the API clients being very happy with this. API had a number of wins vs. K recently and now the decision to go with API has been overturned. Big win for clients would be to run all healthcare out of API office going forward, but I’m guessing that is highly unlikely.” One reader told me the acquisition gives them hope of better integration between the systems, so that would interest some customers.

I usually wait until right after HIMSS to do my annual reader survey, but the month of SurveyMonkey I paid for runs out soon. Being cheap, I’ll start the survey early. Inga and I would appreciate it if you would fill one out. We always get good ideas, implement some, and appreciate all. Thank you.

It costs megabucks to exhibit at HIMSS and many vendors don’t expect to get much value from it, preferring to invest that money into something more directly related to their core business. With that in mind, we asked our non-exhibiting HIStalk sponsors to tell us if they will be available in Orlando to meet individually with interested folks. Inga assembled a list that you’ll find at the bottom of this post.

Gary Wright, formerly of Vasanova and Omnicell (no, he didn’t do Dreamweaver as far as I know and I’m sure he’s sick of hearing that) is named president and CEO of Allocade. Their system, which is used at University of Utah and Children’s Boston, creates a dynamic patient itinerary.

The UnSummit for Bedside Barcoding will be held in Louisville on April 27-29. A trip to a minor league baseball game is included, which is always fun.

Cerner reports Q4 numbers: revenue up 7%, EPS $0.82 vs. $0.71, beating earnings estimates (excluding one-time charges) but missing revenue expectations slightly. Bookings for the year were a record $1.99 billion.

The piece Ed Marx wrote on mentoring drew a huge amount of interest, with more than 75 comments. Ed has updated that post with answers to some of the questions he was asked.

Michael J. Fox is a keynote speaker at HIMSS, although I hate that they stuck him with the Thursday morning time slot when 90% of attendees will either be back to work or heading home (be honest: wouldn’t you rather hear Alex P. Keaton on Monday morning than sit through the standard HITECH stump speeches of Kathleen Sebelius and David Blumenthal ? correction – Monday’s “big” keynoter is economist Robert Reich) Anyway, RelWare is raising money for Team Fox for Parkinson’s Research with a contest offering as a prize a ride in the Back to the Future DeLorean. If you work for a hospital, you can head over to the RelWare booth, make a donation, watch a demo of RelWare’s EHR, and you’re registered.

Thanks to Concerro, supporting HIStalk as a Platinum Sponsor. The award-winning (Inc. 5000, Red Herring, KLAS, SaaS) San Diego company offers a workforce management system. Specific offerings are  RES-Q (acuity, staffing, scheduling, and productivity management), ShiftSelect (open shift management and scheduling), and CommandAware (incident management for emergency preparedness and response). Benefits: dynamic staffing, improved employee transparency, improved productivity, cost savings, and increase employee satisfaction. Hospitals can calculate their labor waste opportunity online. Thanks to Concerro for supporting HIStalk.

Since I have a short attention span, I’d rather watch a video than read Web pages, so here’s an all-customer one about Concerro that I found on YouTube.

PC World runs an article on iPads in hospitals, doing a good job of explaining that doctors (like most consumers) want to use their iPads at work and caught hospitals off guard with their requests for immediate access, but that hospitals and their vendors aren’t really ready to provide applications securely and efficiently. John McLendon of Adventist Health System says that, unlike PCs, he can’t manage iPads centrally, he can’t lock them down, he can’t install anti-virus software, and he can’t prevent them from storing patient data locally. Doctors really want to run Cerner Millennium on them, he says, but until Cerner comes out with a native iPad client, the Citrix version is a pain to use because the screen is too small and there’s too much clicking. Good article.

Above is the dapper vision of what an HIT sales guy and man-about-town of yesteryear looked like: a plaid polyester three-piece suit with flared pants, a chest-width tie, rampant hirsutism, impractical platform shoes, and the elegant accessorizing of a watch chain. That’s not Mike Brady or a member of Iron Butterfly headed off for his drug possession trial, but rather Vince Ciotti, looking unfortunately typical of a 1972 businessman, in his case girded for battle as a Shared Medical Systems installation director (note to young readers – they called it “installation” back then instead of “implementation” and the roadies were called “installers”). Vince is doing a retro session on industry history at HIMSS (Wednesday at 1:00 PM) and in deference to the topic, is eschewing PowerPoint for overheads (or “foils” as you Epic employees may have heard them called by your grandfather, the hottest thing to threaten the more conservative slide carousels back then). Vince may let me run some of his foils here, which would be cool. Vince looks and dresses exactly like this today, so make sure to drop by and flash him the peace sign.

I got a nice e-mail from Paul Roscoe, HIStalk fan (“Insightful, thought-provoking, funny, and a great source of inspiration for my iTunes collection”) and president of Sentillion when Microsoft bought the company just over a year ago. Paul is now CEO of the Crimson business intelligence unit of The Advisory Board Company, which helps hospitals support physician-led quality and cost improvement through performance management analytics. He tells me the company made an acquisition last week, bringing in Cielo MedSolutions, a leading provider of ambulatory population management analytics and patient registry applications (based on technology developed at University of Michigan). ABCO’s Q3 numbers: revenue up 24%, EPS $0.28 vs. $0.27.

I appreciate the support of Awarepoint, joining HIStalk as a Platinum Sponsor. You can get some good background from the interview of new President and CEO Jay Deady that I just ran, but here’s the CliffsNotes version: real-time location systems (RTLS) used by 88 hospitals; SaaS-based and powered by a little gadget that plugs into a wall outlet and instantly joins the ZigBee network as a node; no WiFi dependency or interference; active tags can track equipment and people in real time; and a per-asset/per-month fee that does not require upfront or hardware costs. If you’re the IT person, all you need to do is give them a rack in your server room. Reported benefits: Thornton Hospital saved $450K per year on IV pumps; UCSF saved 1,600 OR employee hours in three months by not having to send them out to find missing equipment (white papers here). Thanks to Awarepoint for supporting HIStalk.

And of course, my obligatory YouTube safari, which found only this year-old TV piece on Thornton Hospital’s use of Awarepoint.

A Wall Street Journal venture capital article says that last week’s IPO of Epocrates is an indication of how hot the healthcare IT market is. It points out that the company withdrew its IPO in 2008, is growing more slowly than companies like Allscripts and athenahealth, and faces “a nasty bunch of competitors” like McKesson and Allscripts (those don’t sound like Epocrates competitors, but that’s what it says), and yet shares jumped from their original $16 price to $26 by the end of last week (currently at $24, with a market cap of $182 million). The author says HealthPort and Greenway should go public and McKesson should spin off Provider Technologies.

One of the University of Iowa Hospitals & Clinics employees who was fired for inappropriately accessing the electronic medical records of hospitalized Hawkeye football players is protesting, with the assistance of her labor union. She says her computer screen suddenly went black and she went to work on another one, but that someone else recharged the original computer’s batteries and looked at the records while still logged in as her.

Australia’s health department bans the use of the supposedly live national patient identifier, saying the $90 million ID needs more testing to be considered safe.

A small New York hospital doesn’t know whether it made money in 2010, blaming its newly installed computer system for the uncertainty. Said the administrator, “It has helped as far as electronic medical records, but it hasn’t been that adaptable to accounting and finance.”

E-mail me.

HERtalk by Inga

From Stu Wiseman: “Re: the recession has ended. Fashion footwear sales were up 7.2% in 2010 and women boots sales were up 21%. Analysts say the economic recovery is on its way!” A market research firm notes that the fashion footwear market is the last to feel the pain of recession and the first to experience recovery, which is another way of saying that shoe connoisseurs hate to cut back on their shoe investments. This is such excellent news that I may have to go do my part to further stimulate the economy.

Franciscan Health System (WA) implements the Elysium Image Exchange service, giving HIE participants secure access to diagnostic-quality medical images.

Ebix closes on its purchase of A.D.A.M for $66 million.

Microsoft says that multiple health systems are implementing HealthVault Community Connect, giving patients and referring physicians secure access to hospital-generated records. Microsoft is relying on six organizations to sell, deploy, customize, and support the HealthVault Community Connect product.

This is sort of like one of those mystery shopper set-ups, but in this case the shopper was real. Sumner Regional (TN) CEO Mary Jo Lewis visits the hospital’s ED after experiencing chest pains. The ED staff didn’t realize she was the CEO until halfway through the visit. Lewis was complimentary of the care received, but she concluded that wait times were too long and the same questions were asked multiple times. Lewis is now working with the ED staff to implement changes that will increase efficiencies and decrease wait times.

Healthagen acquires AppointmentCity.com, a provider of mobile and Web-based scheduling services. Healthagen will integrate AppointmentCity.com technology into its iTriage platform.

MedQuist Holdings completes a $36 million IPO, selling 4.5 million shares of common stock for $8/share. The company was originally seeking to sell 7.8 million shares between $10 and $12 per share.

The ambulance services company that fired an employee over negative Facebook comments settles with the National Labor Relations Board. American Medical Response fired an EMT who criticized her employer on Facebook. The company’s policy prohibits employees from talking about the company in any way on the Internet without permission. The Labor Board claims the EMT’s comments were protected speech under federal labor laws; the ambulance company claims the EMT was fired because of complaints with work performance. In addition to an undisclosed financial settlement, American Medical Response agreed to change its policy.

Hawaii and Alaska are teaming up on a telehealth initiative to expand coverage in their states. The University of Hawaii at Manoa’s John A. Burns School of Medicine (JABSOM) and the College of Social Sciences and the Alaska Federal Health Care Partnership sign an agreement to cooperate in the development and fielding of telehealth technology throughout the Pacific region.

The Office of Inspector General posts its first-ever list of of most-wanted health care fugitives. HHS is looking for over 170 individual,s but the top 10 have allegedly defrauded taxpayers of more than $125 million.

Odd: a surgeon rock hound maintains a collection of over 100 stones – all of which have been obtained from the bodies of his patients. The largest rock weighs about 9.5 ounces. Ick.

The US market for virtual reality applications in healthcare reached approximately $670 million in 2010, which represents a compound annual growth rate of over 10% from 2006 to 2010. Market research firm Kalorama Information predicts more accelerated growth through 2015.

Also from Kalorama: lab information systems represented an $800 million market in 2010 and will grow about six percent a year for the next few years. More than two-thirds of labs operate with less than half their instruments interfacing with an LIS.

Hard to believe no one thought of this before. A female internist starts PROcreation, a company that designs and sells maternity lab coats. Dr. Maria Tranto created the company after not being able to find suitable lab jackets during her pregnancy. She and her partners say the 18-month old company is already profitable.

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

• The College of American Pathologists (CAP) hires Charles Wagner as VP of its SNOMED Terminology Solutions division. He’s the former managing director of US healthcare operations and global healthcare application delivery at Dell Services and also served as VP of professional services for Eclipsys and EVP at HealthLink.
• Hayes Management Consulting announces that its MDaudit Hospital software is now preloaded with 150 audits based on regulatory auditors’ criteria.
• Stockell Healthcare Systems is awarded a US GSA IT Schedule 70 contract. The contract enables local, state, and federal government-managed hospitals and healthcare organizations to obtain fixed and discounted software and services pricing for Stockell’s InsightCS suite of solutions.
• University Medical Center at Princeton (NJ) will implement GetWellNetwork’s interactive patient care system. The health system will also install the GetWellNetwork system at a new hospital in Plainsboro when it opens in early 2012.
• KishHealth System (IL) selects Medicity’s HIE solutions, including the Novo Grid, ProAccess Community, and MediTrust Cloud Services.
• Heartland Regional Medical Center (MO) contracts for Voalte’s iPhone nurse communication solution.
• Tri-State Memorial Hospital (WA) and Pullman Regional Hospital (WA) select Greenway Medical Technologies’ PrimeSUITE EHR, PM, and interoperability solutions for their hospital-owned clinics.
• Capsule says that 2010 was one of its most successful years ever, with new installations in over 200 hospitals, an international footprint of more than 30 countries, and connectivity to over 50,000 devices.
• PatientKeeper experiences record growth in 2010, with a 200% increase in bookings over 2009 and a 73% growth in the number of physician users. The company has also expanded its employee base 21% over the last 15 months.
• FormFast is making headlines with their workflow tools as they gear up for HIMSS.
• Video: AllScripts CEO Glen Tullman is featured on FoxNews Business.
• Iatric Systems’ Clinical Document Exchange server receives ONC-ATCB 2011/2012 certification.
  

EPTalk by Dr Jayne

The icy blasts of winter are keeping me inside, where it’s toasty warm and I can do some serious pre-HIMSS prep. Luckily, the steady stream of e-mails inviting me to various Breakfast Briefings and Lunch and Learn sessions has kept me amused, as have the postcards and mailings that are appearing daily at Casa Jayne.

This is only my second go-round with HIMSS. Based on the total sensory overload that happened the last time I attended, I decided to try to actually plan in advance what I’ll try to accomplish. Whenever there’s large numbers of semi-repressed IT types in captive populations, there’s always the potential that too many IngaTinis or other libations will lead to less and less critical thinking as the week wears on.

I assume that the marketing people who craft these mailings have access to the job role data we provided when we registered, right? Or maybe wrong. Is it possible that they just decided, “Hey, she’s a CMIO, let’s send her anything and everything in an attempt to dazzle?” The sheer variety of things keeps me eagerly checking the mailbox each evening. I’ll be giving shout-outs to my favorites in coming days.

A few tips to the postcard creators (for those of us that are seriously thinking about the types of products our organizations are seeking to fill key business needs). It helps to say something on your card that explains what you are selling. Bonus points to vendors who make it clear what they are selling and what it does. Clear type and non-distracting graphics are also a plus. Negative points for cheesy doctor-looking models that bear no resemblance to an actual clinician —  these are a turn-off for those of us who work in the trenches on a daily basis. Feel free to use attractive people to get our attention, but don’t pretend they’re actual caregivers.

The winner of the week is Merge Healthcare, whose CEO was interviewed by Mr. H a couple of weeks back. Their postcard is clean, non-distracting, and has a summary statement that reads like the “elevator speech” format that many of us use daily to achieve buy-in on projects. It explains what they have and why you need it. Being from a best-of-breed organization, I’m a sucker for anything that looks like it might help tie it all together nicely with a bow, so I’ll definitely be checking out their offerings. Not to mention that kiosk is the buzzword of the day at my place and I’m frantically checking out as many as I can, theirs included.

The loser of the week (which I’ll leave anonymous, because I believe in public praise and private rebuke) is a consulting company whose ad uses so many stale buzzwords that it’s comical. Anyone ever played office BINGO, where you make a card of all the phrases people habitually use, then mark them off during a meeting? These guys would make us all winners. Maybe it’s intentional — the old axiom that even negative attention is still attention? Or perhaps they should seek out a marketing firm that provides better “expert, solution-driven strategies.” What does that mean, anyway?

I had another candidate for the marketing Hall of Shame but it was a victim of overzealous recycling, so I’ll just have to keep my eye out for more. If you have any personal nominees, do share by e-mailing me.

A challenge to my physician readers: If there is one product, add-on, or offering that you think is indispensable for your practice, send me their names and why you think they’re fabulous. I’ll be checking them out and reporting back on the best of the best.

This is my first time to a HIStalk bash, and even as a member of the team I was excited to open that HIStalkapalooza VIP e-mail. Looking at the pictures from the last event and after talking with Inga, the fashion bar has definitely been raised. Can’t wait to see all of you on the other side of that velvet rope!

Have a question about medical informatics, electronic medical records, or whether doctors share funny stories about naked patients after a couple of drinks? E-mail Dr. Jayne.

Non-Exhibiting HIStalk Sponsors

The following HIStalk sponsors will be attending HIMSS but not exhibiting. All are available to scheduling one-on-one meetings if you are interested in learning more about their offerings. And be sure to thank them for sponsoring HIStalk.

AsquaredM

Contact: Victor Arnold, www.asquaredm.com, info@asquaredm.com, 573.256.1135

We specialize in working with hospitals and their physician partners to better align interest, rewards and operations. We provide game-changing services in three areas: 1) finance operations advisory services, 2) revenue cycle improvement, and 3) integration with EHR products. In each of these service areas, we have a well-defined methodology consisting of assessment, advice, and transformation. Our mix of management and healthcare consulting experience helps you to choose a solution that works best for your unique organization to drive up revenue and increase operations efficiency.

CapSite

Contact: Leela Hauser, 802.922.9961, leela.hauser@capsite.com, www.CapSite.com

CapSite is a healthcare technology research and advisory firm. Our mission is to help our healthcare vendor and provider clients make more informed strategic decisions that will enable them to accelerate the growth of their business. The CapSite database is the trusted, easy-to-use online resource providing critical knowledge and evidence-based information on healthcare technology purchases. CapSite provides detailed transparency on healthcare technology pricing, packaging, and positioning.

CAP STS

Contact: Joe Schramm, Director, Business Development Services and Operations, 224.223.5464, jschramm@cap.org

CAP STS (SNOMED Terminology Solutions), a division of the College of American Pathologists (CAP), is a professional services provider with a diversified service offering related to health IT strategy and planning; clinical health information management; and health care standards. CAP STS is committed to improving patient care through the advancement of interoperable EHRs and works with provider organizations, hospitals, health IT vendors, health information exchange initiatives, universities, research centers, and government agencies throughout the world. CAP STS’ DIHIT (Diagnostic Intelligence and Health Information Technology) team advances health IT standards, practices, and tools, such as the CAP Diagnostic Work Station initiative; and standardized electronic reporting, including the CAP electronic Cancer Checklists (CAP eCC).

Culbert Healthcare Solutions

Contact:  Brad Boyd, Vice President, Culbert Healthcare Solutions, Inc., 781.935.1002 ext 13, bboyd@culberthealth.com, www.CulbertHealth.com

Culbert Healthcare Solutions specializes in assisting healthcare organizations with strategic planning, interim management, revenue cycle, clinical transformation, and information technology services. Our team of experienced healthcare professionals thrives on implementing best practices, optimizing technology, and guiding clients through the change management process.

DIVURGENT

Contact: Colin Konschak, Managing Partner, info@divurgent.com, 757.213.6875, www.DIVURGENT.com

DIVURGENT, a healthcare consulting firm focused on providing advisory services, revenue cycle management, project management, and clinical transformation services, will be attending the 2011 HIMSS conference Saturday, Feb. 19 – Thursday, Feb. 24.  They look forward to meeting new healthcare industry leaders and sharing insight on trending topics. DIVURGENT will be presenting at 11:15 am on Thursday the 24th; Presentation # 229. Reach out to info@DIVURGENT.com if you are interested in meeting.

Elumin Healthcare Solutions

Contact: Mark Williams, CEO, 866.597.5861 ext. 707, 425.369.8211, www.eluminhs.com, mwilliams@eluminhs.com

Elumin Healthcare Solutions is a privately held premier national technology implementation and project management firm serving ambulatory, acute, and post-acute healthcare providers. Our comprehensive range of programs and services includes system implementation, integration, optimization, project management, custom reporting, education, and knowledge transfer expertise. We primarily focus on the Allscripts, Cerner, Epic, and Siemens customer bases. We strive to successfully establish and maintain long term relationships by providing experienced professionals who consistently exceed their customers’ expectations. Come out of the dark and let our expert consultants shed light on your projects. Become Illuminated!!

Hayes Management Consulting

Contact: Joy Tewksbury-Pabst, Joy@hayesmanagement.com, 617.559.0404 ext. 235, www.hayesmanagement.com

Hayes works with healthcare organizations across the country to improve quality, efficiency and the bottom line. Our work ultimately leads to greater clinician, staff and patient satisfaction. Many of Hayes consultants are clinicians, and many have worked in hospitals and physician practices as business and clinical leaders. They are also certified and experienced in premier technologies such as Epic, GE Healthcare, Allscripts, and NextGen. On average, our consultants have more than 15 years of experience. We have been ranked Top Overall Professional Services Firm by KLAS for four consecutive years (2007-2010). Hayes is 100% focused on healthcare. Seventy-five percent of our annual business is from repeat clients. Hayes’ services include: IT strategic planning, ICD-10, 5010 migration, system implementations, data conversions, revenue cycle management, and interim staff.

Intellect Resources

Contact: Tiffany Crenshaw, President/CEO, tcrenshaw@intellectresources.com, Anne Sydnor, Manager Client Services, asydnor@intellectresources.com, www.intellectresources.com

Intellect Resources is a search firm specializing in full-time and contract placements in the healthcare It industry, primarily in core HIS implementations. We’ve been working exclusively in the industry since our inception twelve years ago and serve the recruiting needs of both hospitals and consulting firms.

maxIT Healthcare

Contact: Mark Fangman, Executive Vice President, Sales & Operations, 877.652.4099, www.maxithc.com, mark.fangman@maxithc.com

maxIT Healthcare, the largest privately held healthcare IT consulting firm, has been completely focused on Healthcare Information Technology since our founding in 2001.  With over 525 consultants, maxIT is the trusted technology advisor and partner to healthcare organizations, providing seasoned professionals and expert guidance to maximize quality, safety, and financial performance. maxIT offers implementation, project management, and management consulting expertise in healthcare information systems (HIS), electronic medical record (EMR) systems, enterprise resource planning (ERP) systems, payer systems, and clinical imaging and informatics systems.

MedAptus

Contact: Jennifer Crowley, Marketing Director, 617.896.4030, www.medaptus.com, jcrowley@medaptus.com

MedAptus’ offerings include powerful and easy-to-use Intelligent Charge Capture technologies and high-impact revenue cycle consulting services. Many of the nation’s most prestigious healthcare organizations rely on MedAptus for financial optimization; additional product benefits include EMR enhancement, manual process re-engineering and substantially improved productivity.

MedPlus, a Quest Diagnostics Company

Contact: Steve McDonald, President, Hospital Sales, 800.444.6235, ext. 2792, smcdonald@MedPlus.com

MedPlus, the healthcare information technology subsidiary of Quest Diagnostics, provides clinical connectivity for hospitals/IDNs and physician practices, helping bridge the gap between inpatient and outpatient worlds. Care360 EHR provides physicians with a step-wise approach to EHR adoption that helps transition key activities from paper to electronic with features like electronic lab order management, clinical messaging, ePrescribing, document management and multi-system interoperability. For more information, visit www.Care360.com.

MedVentive

Contact: Info@medventive.com, 781.290.2511

MedVentive – in the right place and now the right time. While healthcare was evolving the concept of an accountable care organization, MedVentive was busy operating as one. MedVentive was founded as the PSN in 1997 by the CareGroup Healthcare System, an integrated, at-risk network of 4,500 physicians and eight hospitals that cared for more than 450,000 at risk patients. Our origins as an ACO give MedVentive a deep understanding of provider organizations and the healthcare environment. Having been an at-risk provider network, MedVentive is uniquely qualified to support an organization’s transition from a fee-for-service payment environment to risk-based contracting, and provide the clinical integration/ population management infrastructure necessary to be successful under this new model.

Quality IT Partners, Bruce A. Werner, Director of Business Development, 828.635.6525, 828.234.0075, bwerner@qitp.com, www.qitp.com

Quality IT Partners (Quality) is a premier national healthcare consulting firm with an unparalleled reputation of taking good care of their clients and employees. We provide implementation and support services for healthcare applications such as Epic, Cerner, QuadraMed, Siemens, Eclipsys and McKesson. Quality also specializes in Meaningful Use, ICD-10, revenue cycle management, business continuity and disaster recovery planning, and new construction IT Infrastructure planning & management.

Renaissance Resource Associates

Contact: Maria McBride, Managing Director, 206.949.6011, maria@rraconsulting.com, Laura Noble, CEO, 425.241.9210, laura@rraconsulting.com

Renaissance offers over 20 years experience in meeting the challenges of HIT in an ever changing and evolving industry. We get it right the first time, saving IDNs time and money, and delivering optimized use of technology in a clinical care environment. Meaningful Use, ICD-10, clinical informatics, strategic planning, processs dedesign, implementation, upgrade, maintenance.

Stimulus Search

Contact: Dan Moriarty, Chief Sales Officer, 504.875.5172, www.stimulussearchllc.com, dan@stimulussearchllc.com

Stimulus Search LLC is a national search firm that helps healthcare software and services companies achieve optimum results by attracting, qualifying, and delivering high-performing sales and support talent.

Stockell Healthcare

Contact: Rich Lewis, Vice President of Sales, 800.786.2535, ext. 186 (Office), 314.616.2459 (Cell), richl@stockell.com

Stockell Healthcare Systems features InsightCS, our proven Electronic Financial Record (EFR) solution that effectively coexists and interoperates directly with the leading clinical/EMR systems, and provides end-to-end patient access, patient accounting, and revenue cycle management solutions to hospitals, behavioral healthcare providers, rehabilitation facilities, and integrated health networks. With InsightCS, you get the tools you need to more effectively manage costs via a patient-centric, workflow-driven approach which delegates the right work to the right person at the right time and place.

HIStalk Interviews Jay Deady, CEO, Awarepoint

Jay Deady is president and CEO of Awarepoint of San Diego, CA.

 

Tell me about yourself and about Awarepoint.

I’ve been in health IT for over 20 years, most recently at Eclipsys. Post the Eclipsys-Allscripts merger, I opted to take advantage of a few opportunities throughout the marketplace and ultimately selected Awarepoint. I had the opportunity to step up to be a CEO of a growth company and I’m pretty excited about it.

How would you characterize your time at Eclipsys?

I think in some ways, we had a lot of success, and in others … well, I think in the end it will be very good for clients. It was disappointing that we didn’t execute better ourselves.

When a number of us came to Eclipsys a little over five years ago, we had a great CPOE and documentation system with Sunrise. We had a revenue cycle business that had not been invested in. We had a decision support business that really had been ignored for quite a few years, and in fact, had fallen to the bottom of the KLAS rankings even though it was quite large.

When we looked at the clinical business, we filled out pharmacy, medication administration, emergency care, clinical analytics, and came out with ambulatory. Clearly, we didn’t hit the mark on ambulatory. Ultimately, that proved to be post the capability of gifting from acute care institutions out to non-employed physician groups. Once Meaningful Use hit, it was such a focus on ambulatory. We had made progress on ambulatory, but it was nowhere near where some of those other modules were.

Ultimately, for the benefit of our clients as well as to compete in the marketplace, we had to make a strategic move because there wasn’t enough time to market. Allscripts had a significant footprint on the Microsoft platform. We had a great footprint on the acute care side. I think the benefit post-John Gomez pulling together the development teams and the product management teams and pulling integration off … I think it can be a really great value proposition. But I wouldn’t be truthful if didn’t tell you that I wished we had executed better in the ambulatory space over the five years.

RFID solutions have been around for a long time and with mixed success, it seems. What differentiates Awarepoint?

Until I got into this, I didn’t realize that, from an RFID or RTLS perspective, there are about six or seven types of technologies being used to execute in hospitals. That was just on the active RFID side. There are many that are passive, so that essentially until an asset or a person passes a range point, you don’t really know that they attract on an active basis. The tag that’s attached either to a patient or a caregiver or a particular asset is actively pulsing out a signal being captured on a repeated basis.

From that standpoint, there are about six or seven technologies that are different. A number offer just the technology or the hardware. Others that are software players that utilize one of the hardware-only company’s technology.

Awarepoint is one of the few that actually crosses both bridges. We have the technology running on a ZigBee wireless network, which we think gives us an advantage in the marketplace. We combine that with SaaS-delivered software modules and back-end analytics so that we can come to market with a full solution versus just one or the other, or asking a client to patch the two together.

It seems that you’re productizing it a lot more in marketing a solution instead of just, “Here’s some technology that you can figure out what to do with.” Is that something that changed when you came, or was that already underway?

That was underway. There were a lot of software modules already here. I’m a big proponent of that, so we’ve stepped up that investment and also created a solutions group, which is fairly new. 

We have people, for instance, starting to deploy temperature tracking. One of the things we can do besides the active tracking is that we have tags that can monitor the temperature in all the hospital refrigerators. Joint Commission is very interested in that, whether it’s for food or particular types of drugs. 

You have a lot of institutions that are still manually doing that today by somebody walking around and looking at the thermometer and writing it down on a clipboard. If you’re a current client of ours, you can add that in and basically be up and running in less than a day on temp tracking.

But what we found is that causes a change in workflow. We’ve been working with pharmaceutical and biotech manufacturers, and while they recommend standard ranges for storage, they don’t give much guidance on when it’s out of that standard, what’s the shelf life? What should be done with the pharmaceutical or biotechnology agent? We have a number of people on staff that are clinical experts and working with them.

At any rate, we needed to develop the solutions teams to be able to work with clients versus just giving them a piece of software and giving them a piece of technology, but not helping them implement it effectively.

One area that hospitals probably want to talk about most often is asset tracking. What assets are most advantageous for a hospital to track?

Fairly expensive pieces of equipment, items that are leased, and those that are often lost to shrinkage or somebody walking out with them. Smart pumps are the clear winners. Our average hard-cost ROI is four to six months. We go in looking at the low-hanging fruit and where they’re renting equipment. In fact, we have one client who actually rented a smart pump that had been stolen from them previously. [laughs] The CFO didn’t enjoy that too much. 

We’re able to show them the inventory they have. In many cases, they’re contemplating buying more, because they can’t track what they already have, and so they’ll either buy or lease. We can help them right-size that solution pretty quickly and cut out the rentals. In large institutions, that’s a very fast hard ROI of the entire solution just based on that. 

Downstream of the smart pumps, you start to look at wheelchairs. We had one client spending $300,000 – $400,000 per year on wheelchairs because they were being stolen like shopping carts out of a store.

It also helps in terms of discharge planning. For effective discharge, you have to coordinate transport, and in some cases, valet parking at the front door. You need certain equipment to be present, like the wheelchair. So besides the ROI of not losing as many wheelchairs, it effectively helps the discharge process as well.

In the old days you had to wire all the door frames and find all of the dead corners of the hospital where assets might wander outside of the monitored zone. What’s the infrastructure requirement for the Awarepoint solution?

There are a multitude of technologies out there. A number of competitors use standard WiFi. In the US acute care hospital market, it’s only about 12% penetrated today, and of those, many are just a single department solution versus being enterprise-wide. We offer the ZigBee network.

Explain that.

ZigBee networks are used in many homes. They are starting to be deployed by power and gas companies and electric companies to measure flow. In some cases, it’s going inside the house for television and next generation wireless for entertainment within the house. We have a number of patents for using it in healthcare, specifically for using it to track location.

When you plug in our devices, they create a seamless virtual mesh network. They run on a different standard — 802.15 instead of  802.11. It separates from the standard WiFi that’s running in the hospital. It’s pretty efficient. It handles low-volume data, but you can multi-channel it. 

A standard hospital running their Epic or Cerner or Eclipsys enterprise clinical system and then a variety of other personal devices and other applications can start running it … you’re seeing stories about how, on standard WiFi, it’s very difficult to prioritize that data flow and who’s going to have the right of way.

With ZigBee, you can design channels so that specific types of communication protocols are running through each channel much more effectively. It’s low power, so it’s just plugged. It can’t handle the large data loads like an 802.11 standard WiFi can, but for telemetry data and for active RFID data, it’s a great protocol.

Because it’s such low power, our repeaters and access points actually plug into the wall like a Glade air freshener. There’s no big heavy investment required. You don’t have to pull cables, you don’t have to drop down repeaters through the walls, or go through a six- to eight-month implementation. You have OSHA requirements in terms of construction and hospitals and things like that.

With us, you’re literally just plugging them into outlets. Our average hospital install time is about 28 days to start tracking the first class of assets.

Early on, people worried about the use of locating technology to track people. Are hospitals doing that?

On the patient side, that seems to be less than an issue than on the staff side. On the staff side, particularly in a union institution, it becomes more of an exciting conversation to have. 

Instead of just tracking location by asset class, we allow defining caregivers across multiple asset classes, whether it’s a housekeeper, transporter, nurse, RT, PT, or whatever. You can decide by asset class how you’re going to track. We guarantee a 100% service level agreement within the hospital to within two and a half square feet. In some cases, you’ll track assets simply by location. In other cases, you can track caregivers based on interaction with other tags.

What we find is that when you talk to nurses and others, saying, “We’re not going to track you walking around and how long you were in the lunch hall or how long was your break, but instead, just the physical assets you came into contact with and/or what patients you interacted with,” they seem to get more comfortable with that.

From an infection control standpoint, if a patient gets an infection, you can pull that string back very quickly and see exactly what housekeepers, transporters, nurses, other types of staff had contact with that patient. What assets, like vents and pumps, touched that patient as well. Today in most institutions – because again, these systems are only about 12% deployed – that would take a multi-day, very manual effort of pulling charts or looking things up electronically and then trying to track back how you actually interacted across that space. Our clients can do it in a matter of minutes. 

That conversation, quality and infection control versus tracking every caregiver’s whereabouts, is one people are more comfortable with.

One company developed an OR supply cabinet that automatically charged patients as expensive items like implants were withdrawn. Are you doing anything with that or helping surgery coordinate the bringing together of people, equipment, and supplies?

Those were passive RFID tags. When the caregiver wore that and walked up to the cabinet to extract the material, it was only then that they got registered versus their location and broader interactions. Many of those are in place today.

From an OR standpoint for us, where we tend to get deployed is that we have a sterilizable tag. These surgical cases that have $75,000 to $500,000 worth of surgical instruments inside of them — and again, tend to get lost and go missing — you an actually track those cases all the way through the entire sterilization process and track them around the hospital. That’s more where we’re seeing our clients want to invest versus the passive RFID. Many of them have those and that’s fine, but that’s not a space where we play.

You mentioned that the company holds some patents. What do you see developing around the technology?

This year, we will really go upstream to start to affect workflow and process flow more effectively. I’ll give you an example. 

Prior executives here didn’t have a lot of healthcare experience. They were very, very smart technology and wireless folks. One of the things I found was that all of the workflows and tracking points for all the assets from all our clients are stored in the database, because we run SaaS model. 

When a smart pump is pulled out of a patient’s room, it’s considered dirty. It has to be cleaned, versus brought to another patient’s room. But 12 to 15% of the time, it’s brought to the next patient, which is clearly a potential for infection and outside of the protocol of what that hospital would like to see done. We can track that. We can show the client the data of how often it’s happening and where it’s happening.

We have an alert engine and a rules engine similar to EMRs. I asked the question, “If we have that data, the workflows, and a rules engine, can’t we fire an alert as soon as that asset is moved to another patient’s room instead of going back to be cleaned?” If you have the caregiver tagged, you can shoot an alert to that caregiver in real time that they have a dirty pump that needs to be pulled back out and cleaned.

That’s just one example where you start to think about the various assets that we can track as you get near real time in alerting people that their workflows are out of alignment with care standards. That’s where I want to take things. The company is on the way to doing that this year. It’s more than just tracking and driving the ROI, which is great as a starting point, but actually impacting workflows and patient care versus after the fact reporting on it.

Since you know from the active tags where personnel are, you could look at a dispatch model, such as during a code, locating the nearest respiratory therapist.

We’re working with two clients and they’re doing that exact thing with transporters. Those are unassigned resources that you have to get marshaled and deployed, but they flow all over the hospital and need to be directed where to go. I think that’s where we’re going to have the first documented results of that. It could be brought forward into broader care team capabilities. We’re going to need clients to lead us and the best way I know is to listen to clients. As they expand to the broader care teams, the technology wouldn’t be the limiting factor. It would be the desire of the clients to do that.

In the announcement the company made about your hiring, there was a mention of Gartner’s definition of the real-time enterprise. What is that how does it fit into the strategy?

Gartner’s model, after significant hospital adoption of Meaningful Use, sees a replacement of revenue cycle systems as pay-for-performance starts to occur. They see that through both analytics and an RTLS system you get an aware enterprise. Instead of looking at quality standards 90 days after the fact and changing best practices to make a positive impact on future patients, how do you use real-time analytics and real-time awareness and other new technologies to make a difference while the patient’s actually in the bed or in the waiting room to improve the patient outcome and experience?

We started that at Eclipsys with the combination of clinical analytics and looking at our costing analytics with EPSi. I definitely supported that model. We started to drive that integration from an analytics standpoint. Here at Awarepoint, we think we can play the role with the RTLS making those enterprises aware.

However healthcare reform ends up, I think there will be an increase in capacity. I don’t think there will be an increase in reimbursement. Hospitals will be asked to handle an increase in volume without getting additional staff and without getting the dollars for investment. I think there will be a convergence of HIT and analytic systems and RTLS systems.

It’s going to be interesting to see where that convergence comes and how the platform develops. That real-time awareness that Gartner talks about, or that real-time aware enterprise, is one that has as much of the enterprise automated as possible, then using it in near-real time to make decisions and workflows on the fly to optimize outcomes with the patient volumes.

Any concluding thoughts?

I think it’s an exciting space. I’m excited to be here.  We have a good amount of runway for the company to grow. I’m excited about the opportunities.

Kronos To Acquire API Healthcare

Workforce management systems vendor Kronos announced this morning that it has entered into an agreement to acquire competitor API Healthcare from Francisco Partners.

Kronos CEO Aron ain was quoted as saying, “This acquisition is great news for Kronos and API Healthcare customers, as well as the entire healthcare industry. Together we will leverage our complementary strengths to help organizations deliver high-quality patient care while maintaining tight control over their labor costs.”

API Healthcare President and CEO J.P. Fingado said, “This is a great opportunity to join the Kronos team and work together to drive additional value for our customers’ rapidly evolving needs. Kronos is dedicated to our commitment to innovation and customer support, and we look forward to this exciting new chapter for API Healthcare.”

Terms were not disclosed. The announcement states that “key API healthcare employees and resources” will be retained.

Monday Morning Update 2/7/11

From Secundum Artem: “Re: David Blumenthal. You should do a poll about his replacement.” I’m game. Nominate your recommended replacement here. I’ll put the responses together in a final vote once I get the most-nominated candidates. The result won’t carry any influence whatsoever, but it will be fun while we wait to see who gets the job.

From Asystole: “Re: 100-fold insulin overdose. Sorry, that’s not a function of low pay or working conditions. It’s a function of licensing incompetent people dependent on technology to cover their lack of knowledge. No math skills, can’t calculate a dose without a computer.” I don’t disagree, other than pay does figure into the equation. In many areas, nursing home RN salaries are at bottom of the food chain and, not surprisingly, so are some of their nurses. You have to be really dedicated (or in low demand for clinical or legal reasons) to accept being underpaid while dealing with the number of nursing home patients who are uncooperative, combative, and suffering from dementia. Obviously critical thinking skills were a problem here (“hey, does anybody know where we keep those 10 ml insulin syringes?”) and are no doubt in equally short supply elsewhere in healthcare. And for employees who like having a computer tell them what to do, nursing homes don’t use them much, so that’s another challenge. I don’t hear the technology advocates insisting that LTCs go digital for patient safety and efficiency reasons, probably because the largely for-profit nursing home industry has no money compared to non-profit hospitals (consider the irony).

From Lilliputian: “Re: Epic non-competes. For the folks who say they are illegal, the trick is that Epic swings a big stick with customers and consultants to make sure that folks within their year aren’t hired.” Unverified, but heard often.

From JustBecause: “Re: Ingenix. Charging its customers $25K to stay with them, if you want to upgrade to the claim scrubber version that supports ICD-10.” Unverified, but I’ll leave it to readers to weigh in on the general issue: is it unreasonable for companies to charge existing customers for upgrades necessitated by regulatory changes? Lots of EHR vendors are charging premium dollars for upgrades needed to meet Meaningful Use requirements, but those changes took away development time that could have been spent elsewhere and the timeline was short. I’d guess that most readers agree with me that maintenance fees probably weren’t scaled to cover government-mandated enhancements, but then comes the gray area: what level of surcharge is reasonable?

I’m in full HIMSS mode, assembling the HIStalkapalooza beauty queen sashes, salvoing e-mails with Inga about the work we need to do to prepare, and setting up all of our recently added sponsors. Someone said they envy me because of all the HIMSS fun, but it’s all work for me. The latest I’ve ever stayed for the HIStalk reception was 9:00 p.m. because I have to stay up half the night writing that day’s HIStalk (I ate nothing but Subway the last time the conference was in Orlando). Above is a picture from that HIStalk reception at the Peabody that year (2008) that I ran across. I never get many reception pictures, so I’m hoping I do this time around.

I’m happy to hear that so many readers have found work-life balance, with only around 16% saying they work 60 or more hours per week in their primary job. New poll to your right: what’s your take on the PCAST report’s recommendation of a universal healthcare exchange language based on tagged data elements?

A UK male nurse who prosecutors say killed his first wife and tried to kill his second, both times to collect insurance money, told a former lover that being a Cerner contractor in Saudi Arabia gave him a military rank of colonel. 

Maryland hospital is under fire for its delivery room policy banning cameras and cell phones and allowing no baby pictures to be taken until at least five minutes after delivery and only then with the medical team’s permission. The hospital’s stated concern: the privacy of its employees. The unstated concern: hospitals have lost malpractice lawsuits when videos taken by parents captured evidence of improper care. It’s interesting that some businesses record everything on video everything to protect themselves legally, while hospitals and practices are scared to death that cameras will catch them screwing up. Which they would, no doubt: you could do an interesting medication error study by putting a helmet cam on a nurse or a patient. In fact, I’ve just had one of my can’t-miss business ideas: a malpractice law firm could visit hospitalized patients and offer them a free stuffed animal Nanny Cam for their rooms in return for the inevitable lawsuit business that would result from a review of the images.

Thanks to new HIStalk Platinum Sponsor Merge Healthcare of Chicago, IL. We connected when I interviewed CEO Jeff Surges a couple of weeks ago. Merge is mostly known for RIS/PACS and innovative medical imaging software, but has expanded its product line to include radiology-focused solutions for billing, document management, and operational dashboards; cardiology and cath lab; clinical trials; master patient index; integration tools and services; kiosks; a laboratory information system; MRI; perioperative solutions; and a clinician access portal. Wall Street must like what it sees since the stock price has jumped 45% in the last 30 days. Drop by their booth at HIMSS and they’ll tell you about iConnect, the company’s comprehensive solution for interoperable image exchange and management. Thanks to Merge Healthcare for supporting HIStalk.

The VA announces the first four winners of its innovation competition, which will receive funds to run pilot projects: mVisum (cardiology data on mobile devices), Agilex Technologies (VistA on mobile devices), MedRed (collaboration tools for caregivers of traumatic brain injury patients), and Venture Gain (wearable sensors to detect heart failure).

Billian’s HealthDATA is supporting HIStalk as a Gold Sponsor, which I appreciate. The Atlanta-based company provides healthcare contact and facility data (hospitals, ambulatory surgery centers, and long-term care facilities, for example). I checked out their hospital information, which includes statistics, affiliated organizations, contact names and titles, e-mails addresses, and financial and quality indicators. Most interesting to me is that they also have information on IT installations and upgrade plans (sample here) that I would love to get my hands on since I’m always needing to know who runs which systems, who’s the IT contact at a given hospital, etc. so I may need to find out what that costs. Thanks to Billian’s for supporting HIStalk.

I found this brand new YouTube video from Billian’s that demonstrates the new version of its portal, which covers over 40,000 healthcare facilities. They’ll be showing it at HIMSS.

DrLyle provided some information on the HIT Geeks Got Talent sessions at HIMSS. On Monday at 12:15, eight contestants (vendor coders, spare bedroom programmers, whoever) will do two-minute demos of their cool software, judged by Jonathan Teich (Elsevier), Erica Drazen (CSC), and Dave Garets (Advisory Board Company) and voted on by the audience using cell phones (apparently non-cell users are disenfranchised). The top four will move to Tuesday afternoon’s finals round, where they’ll do 10-minute demos to pick a winner. DrLyle explained that he got the emcee job not only because he runs a healthcare innovation program, but because “I’m a shorter, darker, and hopefully funnier version of Ryan Seacrest.” I like the idea, especially when considering the non-spontaneous “dark room with monotonic, over-rehearsed people reading from slides” sessions that predominate.

Speaking of overly rehearsed speakers, I just now cracked myself up with memories of peering into the Speaker Ready Room at previous HIMSS conferences. It’s hilarious to watch a roomful of suited-up, badge ribbon-bedecked presenters warming up by reciting their presentations with eyes closed and practicing their histrionic podium gestures in a sparsely furnished room in front of nobody in between bouts of anxiety-induced nausea. Too much practice is why 90% of the sessions are like watching a motorized Abe Lincoln at Disney, with speakers moving and speaking awkwardly while losing the audience’s interest in about two minutes (imagine Audio-Animatronics Abe reading from PowerPoints crammed with bullet lists). PowerPoint encourages formulaic Ben Stein-like recitations, but it does allow audience members to just grab the slide printout and run if they don’t need to have the slides read to them books-on-tape style. In fact, if it wasn’t for going to parties, hanging out with pals, and taking an Orlando vacation on company time, you could probably bag HIMSS completely and just buy the audio proceedings for a few hundred dollars, thereby gaining the audio advantages of “attending” every session plus being able to use the fast-forward button that would be ever so handy in those meeting rooms.

McKesson and General Dynamics sign a deal to create a centralized EHR for DoD. The announcement implies that an existing McKesson solution is involved since it references “the proven capabilities of McKesson’s EHR solution.” I’d be interested in knowing which MCK product was so strong that it was an obvious DoD choice (and what taxpayers are paying General Dynamic for bringing it to the table).

A New York hospital named by the state as an overseer of a failing nursing home files suit against the nursing home’s owner, HCA/Genesis. The hospital claims HCA/Genesis is threatening to pull out all IT equipment and services, not too surprising since the hospital was already planning to build a competing facility when asked to manage theirs for 18 months. 

Labor management systems vendor Kronos announces Q1 earnings of $37 million on revenues of $176 million. Which reminds me: why does “revenue” require a plural form? Is “revenues” different from “revenue?” I could look it up in “The Free Dictionary,” but the entry above tells me I might not want to trust the result.

FDA approves the first iPhone/iPad app for viewing medical images, although its 510(k) clearance was qualified in saying it should be used only when workstation access isn’t available (right). Mobile MIM passed FDA’s tests and its review of radiologist usage under variable lighting conditions.

Germany’s big HIT vendor, CompuGroup, reports Q4 numbers: revenue up 9% and net income up 131%. Revenue was lower than expected, primarily due to poor US sales. Its previous US acquisitions include HealthPort, Noteworthy Medical Systems, and Visionary Healthcare Group.

This is unusual: Roundup Memorial Hospital (MT) asks the local clinic to help it run its operations after the hospital ends its contract with a hospital management company. The clinic will help the hospital install electronic medical records. Actually, the clinic already operates a hospital from a 1993 merger, so it’s not exactly just a medical practice. I assume from the hospital’s name that it refers to cowboys, not weed killer.

University Hospital (UT) apologizes to 700 patients whose statements contained a phantom $2 million charge item. I found this funny: before the hospital implemented its new billing system in December, it mailed out a sample of the new billing format to patients, showing a mocked up bill for phony patient Dora Billings. Several recipients sent in checks for Dora’s bill. The article didn’t say if Medicare was one of them.

Aetna beats estimates with its Q4 earnings of $255 million, up 58% over last year. The insurer says it has a $1.2 billion war chest for acquisitions, with an analyst predicting that Aetna will buy other companies like Medicity, for which it paid $500 million a few weeks back.

Sponsor Updates

• Orchestrate Healthcare aligns with L-3 Global Security & Engineering Solutions and its Ingia data translation platform to offer an HIE solution.
• 1450 is named the exclusive North American distributor of Frisbee, a transcription workflow system that routes physician dictation to a transcriptionist and then allows the final Dragon-generated and approved transcription to be sent directly to an EMR. The video demo is here. There’s an iPhone version, too.
• The Anson Group blog has a post called What The FDA Doesn’t (and Does) Regulate May Surprise You.
• Emergency department systems vendor EDIMS has a number of position openings: clinical site support specialist, project lead – application systems and data, senior interface analyst, and senior .NET developer..
• FormFast posts an article called Workflow Automation – Where to Start.
• MEDecision will showcase ACO and patient-centered medical homes technologies at HIMSS.
• Holon’s Central Order Entry Pharmacy medication management solution goes live at all facilities of Greenville Hospital System University Medical Center.
• Sentra Data Systems is attending the 340B Coalition Winter Conference in San Diego this week.
• Carefx and IBM will provide NHS trusts with a real-time patient portal for clinicians.

E-mail me.

Healthcare IT From the Investor’s Chair 2/4/11

Ask the Chair

Why does the financial community attend HIMSS?

The tickets are bought, the hotel rooms booked, and the excitement is near. Time to start the HIMSS prep. Inquiring minds want to know – what do members of the financial community do at HIMSS?

Yes, in addition to vendors and healthcare professionals, Orlando will be swarming with a bevy of equity research analysts, both those who follow stocks for money managers and for brokerage firms (aka buy-side and sell-side); investment bankers; venture capitalists (earlier-stage private investors); and private equity investors (later-stage private investors).

One might wonder. Why do they come? What do they do? What do they hope to get out of it? As with most conferences, the goal is a combination of market intelligence, networking, and seeking business opportunities. Let’s take each attendee group in turn.

When I was a sell-side analyst, I started attending HIMSS primarily to learn more about the sector and those who play in it. I still remember the great San Antonio registration system crash, in fact! Any analyst, buy- or sell-side, goes to major conferences to see products, talk to management of the companies they follow and, ideally, actually speak with users / customers to get information about a vendor’s products and prospects beyond what they hear simply from talking to company management.

As the sector got more interesting to investors, a number of companies started having actual analyst briefings at HIMSS where they could parade not only part of the management team, but often a happy customer or two. Several sell-side analysts (often working together) will host day-long tours, leading groups of investors from booth to booth where they can get personalized demos and presentations from management. The best analysts use this time to build relationships with companies and users to help them with later channel checks to see just how well a product or company is performing.

It’s a long day for the sell-side, with 7:00 AM analyst meetings and late-night receptions. Most then publish a research note (known as a FirstCall) to update their buy-side clients on what companies are doing (and how diligent the analyst is in reporting it).

When a company actually releases earnings during HIMSS, it’s particularly challenging to juggle. Some of my best conversations, however, were held in hotel bars in the wee hours with tipsy company employees. I met one high-profile CEO (whose company I later covered) at lunch near the exhibit floor. I had started chatting, thinking he was merely a young sales exec.

Investment bankers use HIMSS primarily to seek out new business. With all the CEOs in the sector in one place, it’s a highly target-rich environment. As I’ve observed about the recently concluded JP Morgan conference, it’s an ideal opportunity to get together, trade gossip, catch up on a company’s recent performance and goals, and brag about your firm’s recent activities. Not to mention hinting about some "big deals” you have in the market in the hopes of eliciting future transaction business (sales or capital raises).

It’s also a time when bankers can arrange meetings between their current clients for sale and potential buyers. At any given time in Orlando, look around and you’ll likely spot one (their Ferragamo, Hermes, or Burberry ties are a giveaway) looking frazzled and hurrying to their next meeting. Several firms (including my former one) actually spend the money for exhibit space. Why? Partially to demonstrate how seriously they take HCIT, but also to give them 24-hour access to the exhibit hall so they can meet whenever they want. It’s actually a huge time saver given that HIMSS (like Christmas) comes but once a year.

Investors, both venture and later stage, come to assess how their current portfolio companies are stacking up against their competitors and to learn more about the sector. More importantly, they come seeking "ideas", that is to say, investment opportunities.

Investors in both stages of companies will spend time on the exhibit floor, wandering around looking for companies with interesting products or prospects in the hopes of finding a quality (and ideally undiscovered) company which might need venture or expansion capital. In many cases they’ve made pre-arrangements to get demos and to chat. In others, they are simply hoping to broaden their network of potential companies and increase their understanding in general. Much like with the vendor / hospital dynamic, few checks get written at HIMSS, but the road to do so is more smoothly paved.

Ben Rooks is the founder of ST Advisors, a consultancy which has worked with dozens of HCIT companies and investors typically on issues around strategy, financing, and outcomes/exit planning. He has attended HIMSS as an analyst, a banker (albeit with no fancy tie), and on behalf of venture and private equity investors. He also looks forward to seeing everyone in a few weeks!

Blumenthal Resigns ONC Post

David Blumenthal, MD MPP has resigned his position as National Coordinator for Health Information Technology for the Department of Health and Human Services. He will leave office sometime in the spring to return to Harvard University.

Prior to his March 2009 appointment, Blumenthal was a practicing physician and Director of the Institute for Health Policy at Massachusetts General Hospital / Partners HealthCare System in Boston. He was also a professor of medicine and health care policy at Harvard Medical School.

News 2/4/11

From LaBido: “Re: Epic spinoffs. Spinoffs usually involve a better or new way of doing something. EHR vendors typically aren’t innovators of technology. They use someone else’s technology to develop an application. Given the complexity of developing a comprehensive system and the risk in  introducing it into a maturing marketplace, it’s not likely that there will be a lot of new entries in the EHR world. There will be opportunities for new niche systems as long as the major vendors lack the functionality, but I would suggest that most niches have been filled (other than those that don’t have a lot of funding for systems, e.g., home health care and assisted living facilities.)”

From Capezio: “Re: Epic. I recently left Epic. The non-compete prohibits former employees from working with Epic products or competitors for a year. This includes consulting for or working directly with Epic clients as well as for/with clients who use or are implementing Epic’s competing products. Many former Epic employees return to grad school or seek careers entirely different than what Epic offered. After being run into the ground with long hours and hectic travel schedules, the last thing many of us want is more of the same. Epic makes it hard to stay in the game, and hard to want to stay in the game.” Unverified.

From NomsDePlume261: “Re: Super Bowl ED usage.” Interesting – visits dropped to nearly none while the game was on. I’m sure business was good before and after with accidents caused by drinking, spousal beat-downs, heart attacks, and hot wings-induced choking.

Listening: new rootsy soul from Amos Lee with guests that include Lucinda Williams and Willie Nelson.

Humor me, OK? Drop your e-mail address in the no-spam Subscribe to Updates box to your right so I can tell you about stuff. If you’re a early adopter trying out that little site called Facebook, do some Friending of Inga, Jayne, and me and maybe toss in a Like for HIStalk. Click the nausea-inducing green Rumor Report box to your right and securely and anonymously send me news and rumors. And here’s a thought I had on the sponsor ads to your left: they are fun and cool like Twitter because the enforced brevity of the small rectangle tells you everything important in a quick glance, saving you hours of trying to figure it out from their more verbose Web pages, not to mention that those companies follow HIStalk and therefore share something in common with you and me. Thank you for reading.

I sent the e-mail blast about David Blumenthal’s resignation while thinking the obvious question: who’s going to replace him? I bet the snowed-in HIMSS people will be burning the midnight oil to strategize. TPD had interesting conjecture: Blumenthal’s brother Richard is the new Democratic senator from Connecticut (sworn in just four weeks ago) and maybe having a brother running ONC was going to be a political problem for him. Not to mention that the ONC job is a tough one that doesn’t pay a whole lot (despite handing out billions to everybody else) and draws a constant stream of venomous and mostly partisan criticism from politicians.

On the Sponsor Jobs Page: Healthcare Informatics Specialist, Epic Prelude and Resolute HB Consultants, Project Manager – Michigan. On Healthcare IT Jobs: Integration and Support Specialist, Health IT Manager, Application Services Programmer / Analyst, Epic ADT Consultants / Analysts.

Paul Merrywell is named VP/CIO of Mountain States Health Alliance (TN). He was formerly VP of IS of Mercy Health System. 

The HIStalkapalooza invitations haven’t been e-mailed yet, but they will be soon. We had a lot of sign-ups and will invite as many people as we can handle given the venue’s capacity. I always like to scan the job titles, which run something like this: 88 VPs, 72 presidents/CEOs, 26 CMIOs/CMOs, and 19 CIOs.

Speaking of the party, thanks to Medicomp Systems and COO Dave Lareau for not only paying for it, but also sponsoring both HIStalk and HIStalk Practice at the Platinum level. The Chantilly, VA company offers dynamic (non-template based) EMR tools that require minimal clinician training, powered by its MEDCIN clinical data engine, developed by founder Peter S. Goltra going back to the company’s founding in 1978. The company works with academic doctors from big-name hospitals and the DoD to continuously enhance MEDCIN and to develop new EMR offerings. Their product is used by 100,000 clinicians, requires less than four hours of training, handles codes for reimbursement and Meaningful Use, and provides real-time information and clinical decision support. CLINITALK converts voice to data for physician documentation and coding without typing or clicking, using the MEDCIN engine to present and collect patient care information. A new product will be announced sometime before HIMSS. Thanks to Medicomp Systems for sponsoring HIStalkapalooza, HIStalk, and HIStalk Practice. If you come to the event, say hi to Dave and thank him for putting together such a great evening for HIStalk and HIStalk Practice readers.

I said that this week’s statement from eHealth Initiative was predictable in urging House Republicans to not touch HITECH money. eHI sent me a clarification: their concern is that the legislation only goes after Meaningful Use incentive payments since that money isn’t yet committed. Funds for RECs, HIEs, job training, etc. are not being targeted, meaning that the government would have paid for infrastructure without having the carrot needed to get providers to use it for quality improvement.

A reader suggested looking into PCAST documents for evidence that Microsoft Chief Research and Strategy Officer Craig Mundie and other Microsoft-friendly participants may have steered the group to recommendations that favor the company (Amalga, HealthVault). I guess it’s possible, but hard to believe even for a cynic like me. I e-mailed PCAST asking for meeting minutes and got a reply from PCAST Executive Director Deborah Stine, PhD, who sent a link to the webcast page. Those probably won’t help. I don’t have much time or knowledge of government intricacies, so if you do and want to snoop around, let me know.

It always bugs me that the biggest, least-needy hospitals get throngs of deep-pocket donors. The latest example: Stanford Hospital, spending $2 billion for a new Taj Mahospital, gets $150 million from Apple, eBay, HP, Intuit, Intel, and Oracle. Donations always come with strings attached, at least in my hospital experience, so they’ll probably have to buy iPhones to keep Apple happy since Intel wouldn’t like an all-Mac shop. I still argue that since hospitals can’t distribute their big profits to shareholders since they supposedly have neither, their executives build monuments to themselves like Egyptian boy kings.

Mediware’s Q2 numbers: revenue up 22%, EPS $0.21 vs. $0.10 but $0.06 of that was due to a one-time tax benefit.

Healthcare billionaire Patrick Soon-Shiong, MD buys Boston-based Vitality, Inc., which developed the wirelessly enabled GlowCap medication reminder system for drugstore pill vials. I went to the mHealth Summit presentation of Vitality CEO David Rose this past November and was impressed enough to mention it on HIStalk.

Sad: a nursing home is banned by emergency order from accepting diabetic patients after killing a patient with a 100-fold overdose of insulin. Employees admitted that they didn’t have a clue how to manage the patient’s insulin pump, so a one-time IV dose of regular insulin 10 units was ordered. The nurse injected the entire 10 ml vial IV. Employees were even confused when reporting the error to the patient’s doctor, explaining that they had given 100 units of insulin instead of 1,000. You might be surprised that a nurse would not find a 10 ml insulin dose unreasonable, but not if you knew the caliber of nurses LTC facilities get given their low pay and bad working conditions.

E-mail me.

HERtalk by Inga

KLAS takes a look at Meditech consulting firms and finds the highest scores come from maxIT Healthcare customers. ACS ranks a close second, followed by Navin, Haffty & Associates, Dell, and CSC. KLAS also notes that Meditech customers are twice as likely to hire Meditech-focused consulting firms than those that advise on multiple vendor brands.

Also from KLAS: the adoption rate for surgery management solutions in hospitals is almost 90%. Hospitals are expanding their use of these systems beyond basic charting and scheduling and don’t necessarily feel pressed to implement a surgery system from their core EMR vendor. Unibased earned the highest customer ratings, followed by Epic and Meditech.

Ness County Hospital (KS), Tyler-Holmes Memorial Hospital (MS), and Beacham Memorial Hospital (MS) contract for ChartAccess EHR from Prognosis Health Information Systems. Prognosis says its revenues have grown 200% over the last year.

SCIOinspire acquires National Audit, a provider of claims auditing services.

Community Health Network of Central Florida and Parrish Medical Center implement MDI’s Viewpoint Analytics for data warehousing and healthcare analytics.

Parkview Health (IN) will install Zanett’s Clinical Online Delivery System software for order set management.

Chilmark Research investigates the HIE market in a new report, which includes analysis and rankings of 21 HIE vendors. Lead author and HIStalk friend John Moore forecasts more acquisitions in the HIE space over the next couple of years.

Nash Health Care Systems (NC) partners with TeleHealth Services for TeleHealth’s interaction patient education solution.

Nearly 60% of healthcare executives have HIE plans in the works and another 20% are in the pre-planning stage. Other findings from the same Beacon Partners survey: 1) a mere 5% of healthcare organizations say they have not applied for any federal or local grants; 2) over 40% of healthcare organizations plan to enhance their physician and patient portals; and 3) quality reporting is the top concern in hospitals’ efforts to achieve Meaningful Use.

The University of Iowa Hospitals and Clinics fires three employees after investigating the improper access of electronic medical records of 13 UI football players. Two additional employees will receive five-day unpaid suspensions.

AstraZeneca Pharmaceuticals and WellPoint subsidiary HealthCore are collaborating to determine the most effective and economical treatments for chronic diseases. Findings will be based on de-identified patient data collected from EHRs, WellPoint and BCBS insurance claims, and patient surveys.

On HIStalk Practice this week: physician-specific offerings at HIMSS. A low-cost concierge practice that accepts insurance. NCQA issues new PCMH standards that reinforce Meaningful Use incentives. Doctors want to share clinical data electronically with patients. And while you are visiting HIStalk Practice, be like all the cool kids and sign up for e-mail updates.

Starting salaries for female physicians average almost $17,000 less than those for men and the gap cannot be explained by specialty choice, practice setting, work hours, or other characteristics. One theory: women physicians seek greater flexibility and family-friendly benefits at the expense of a lower starting salary. The authors of this Health Affairs study do not rule out other potential explanations, including gender discrimination and that women are not as skilled as men at negotiating salaries.

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

• Billian’s HEALTHDATA launches a new version of its Portal healthcare database that includes over 3,000 data points across more than 40,000 healthcare facilities.
• Design Clinicals releases version 5.0 of MedsTracker, which includes enhanced clinical decision support and meets nearly all Stage 1 criteria for Meaningful Use.
• Microsoft announces new encrypted e-mail functionality that will allow users of the Quest Diagnostic Care360 EHR to transmit clinical information directly to patients. An encrypted copy of a patient’s clinical data is also automatically saved to  patients’ HealthVault account.
• University of Washington Medicine chooses Hayes Management Consulting to provide strategic guidance to the organization.
• Eye Faculty Practice (NY) selects the SRS EHR for its 13-provider practice.
• Orion Health partners with Health Language, Inc. to imbed HLI’s Language Engine into the Orion Health HIE. The combined offering will facilitate data exchange by mapping data from disparate systems to standardized terminologies.
• The West Virginia HIT REC names Sage Healthcare a five-star vendor in its EHR Vendor Recognition Program.
• AT&T & Acuo Technologies announce a strategic alliance to develop vendor-neutral, cloud-based medical imaging storage solutions.
• NextGen announces that Palm Beach Orthopaedic Institute (PBOI) will leverage its revenue cycle management services.
• Charlotte Hungerford Hospital (CHH) selects MobileMD for its HIE and EHR.
• iSirona will participate in the Interoperability Showcase at HIMSS with its software-based medical device integration solution.
• Cooper Green Mercy Hospital (AL) selects Stockell Healthcare’s InsightCS patient access and revenue cycle management software solution

Dr. Gregg Goes to HIMSS
By Gregg Alexander

Reporting – 0, Blogging – 1

I have been given the unique opportunity of being a regular contributor to one of the components of THE industry standard “Healthcare IT News and Opinion” conglomerate, collectively known far and wide in HIT-dom as HIStalk. It is not a responsibility I take lightly.

On HIStalk Practice, the provider-focused offshoot of Big Daddy HIStalk, I have espoused both opinion and news. But to be honest, the news side of my offerings is miniscule in relation to the opinion side. I could never match the skill and wit which Mr. H and Inga bring to reporting healthcare IT news. “Damn it, I’m a doctor, Jim,” not a reporter.

That said, I am preparing to head off to HIMSS with a press pass courtesy of the inimitable Mr. H. Again, this is a responsibility I don’t take lightly. Thus listed with the HIMSS folks as a reporter (he said, using the term ever so lightly), it has been fascinating to see all of the reach-out from industry folks, mostly marketers, trying to get the word out about their product or about their “big announcement” at HIMSS or about their CEO’s scheduled talks, etc. Most have very much the same boilerplate look and feel as the majority of EHR products these days … and are about as inspiring as phlegm.

However, just as with EHRs, a few do stand out as different, as having something special to offer or a unique approach.(Extormity is not included in this assessment.)

One e-mail that particularly caught my eye recently was from a vendor who wrote, “I know you’ve blogged a lot about new EHR demos you’ve seen recently — all the innovations and disappointments, too — so I’ll try to spare you the hype….” Obviously this is someone who has taken the time to do some homework and/or is a regular HIStalk Practice reader. That is one request to which I wrote back immediately. (I hate hype and greatly appreciated the hype-sparing. Plus, I appreciate those who read the HIStalk sites.)

Another was from a “young company with a BIG story” who is taking on IT industry giants – and winning! As a trench grunt, I appreciate the little guy’s approach. They are another I answered quickly and have found very intriguing as I have begun to research their BIG story.

I’ll be providing more on stories that catch my eye or stimulate my curiosity, but please remember I’m from the opinion side; I’m a blogger, and perhaps most importantly, I look with the eyes of an end user. As an end user, I’m looking for that which gets my juices pumping and that which I think will do the same for my fellow providers. I look at the technology, sure, but perhaps just as important to me is the company behind the technology – the people, their philosophy, and how they interact with me and my fellow provider peeps.

I don’t even pretend to be dispassionate about this stuff. If I appear to show favoritism, well, maybe I do some. But, it is never because of kickbacks or payoffs. (Though I sometimes wish it were!) It is because I’ve met people and technologies who inspire my passion and I try to show that in what I write.

So, if while trying to report from HIMSS, my blogger/opinionator nature shows through, please understand. My roots are what they are.

From the trenches…

“Being a reporter is as much a diagnosis as a job description.” – Anna Quindlen

E-mail Gregg.

EPtalk by Dr. Jayne

Dear Dr. Jayne,

We’re a five-physician family practice and my doctors are balking at documenting in the room with the patient. My docs find it distracting and say they have to apologize for using the computer. They also spend too much time at the end of the day trying to finish their notes, or don’t finish them at all, which makes them cranky and causes issues with the revenue cycle.

Sincerely,
Kept Visits Seeking Charges

Dear Seeking,

There is an art to using the computer while seeing the patient. The provider’s ‘style’ of practice pre-EHR needs to be considered as they figure out how they are going to document. And the implementation teams and tech people need to be OK with it if not all providers document in the same way.

I tend to think about it this way: if users previously wrote in the paper chart while in the room, I encourage them to keep this workflow with the computer. They need to know their software well, though. If they are hunting through templates or pecking at the keyboard, it’s not going to flow.

If users didn’t write in the chart before, but instead went out into the hall to dictate, it’s easy to replicate that workflow as well, with workstations in a niche or cubby (provided there’s adequate privacy.) They still need hardware with them in the exam room, though, so they can reference the chart.

Seeing the patient with no computer is not OK. Providers who think they can remember everything about the patient without a chart are kidding themselves.

One exception is a situation where the provider talks to the patient first, then the patient changes clothes and the provider returns to do the exam, then the provider talks to the patient again after he/she dresses. It’s OK for the provider to not have access to the EHR during the exam as long as they have it during the rest of the visit. I provide this example for the non-clinical IT people because I said this once, and had a team member say they had a doctor with “dangerous” habits and this is what it turned out to be.

I do encourage everyone to do as much of their visit in the room with the patient as possible. At a minimum, reviewing the patient’s history and entering any prescriptions and patient assessment / plan information while they are face-to-face with the patient. It’s not just a matter of efficiency – it  also ensures that information is documented so that the patient can leave the office with a printed visit summary for those practices that are working to demonstrate Meaningful Use.

Regardless of the approach, providers need coaching on how to interact with the patient and still maintain eye contact and rapport. During implementation, consider using mock patients (a trainer or a staff member can play the role) and practice how they’re going to sit, how they interact with the computer and the patient, etc.

Finally, a word on typing skills. If your EHR requires providers to free-text, or if your providers plan on using a lot of it because they hate clicking, for everyone’s sanity, please go to Amazon.com and purchase a copy of Mavis Beacon Teaches Typing. The Deluxe edition is $17.95 and eligible for free super-saver shipping, for goodness sake. There are few things more painful than watching someone with a post-graduate degree two-finger type. It’s not confidence-inspiring. And for those providers who say they can’t learn, tell them that if they learned the Krebs Cycle they can learn to type.

Dr. Jayne

Dear Dr. Jayne,

We just signed with a vendor, and my docs are trying to figure out what kind of hardware to select. As pediatricians, is it better to go wireless? Desktops seem cheaper.

Sincerely,
Caring for Kiddos

Dear Kiddo,

When I work with offices that are converting from paper to EHR, I spend a lot of time talking the users through the different hardware options and letting them test drive different configurations whenever possible. Keeping technology from interfering isn’t difficult, but does take some thought.

Practices with “traditional” exam rooms are the most challenging – those where even in the paper world, if the physician tried to use the writing surface, they’d be facing away from the patient. Most of these users held the paper charts in their laps. This becomes hard to do if you’re trying to juggle a laptop or tablet, or … ahem, a paper chart and a computer during conversion.

Practices sometimes cite budget as a reason for not reconfiguring exam rooms, although modifications are probably cheaper than a dropped laptop. Modifying the space is also cheaper than neck pain, carpal tunnel, or other consequences of poor exam room design. I encourage people to think outside the box. Pull-down wall units or pull-out trays in cabinetry work great when tablets or laptops are in use.

When I work with new start-up practices, I try to be involved during the design of the office space so that these issues can be addressed early in the process. Unfortunately, a lot of architects are still cranking out the same tired old layouts and have no idea about wall mounted monitors or pop-up keyboard trays on swing arms.

When practices don’t choose to go wireless, I advocate the smallest hardware possible, mounted under a desk or on a wall so it doesn’t interfere with housekeeping or wind up being interfered with by pediatric patients or children accompanying patients. For monitors, go with the largest size that’s practical and affordable. Patients like looking at lab values or imaging studies and it helps reinforce the idea that they are part of their care.

Make sure your docs understand that whatever they decide, they’ll be using it for several years. This helps them focus on the decision if they are glassy-eyed by this part of the process. It also sets the stage for when you have to come back to them in two or three years and ask for budget for a hardware update.

One more thing: make sure that if they test drive hardware that they do it using EHR software they have selected. Solitaire and word processing look great on everything, but when they figure out the wide-aspect laptop they chose makes their EHR look horrid, you’re going to be the one they call.

Dr. Jayne

Have a question about medical informatics, electronic medical records, or what reflector thingies were actually used for? E-mail Dr. Jayne.

CIO Unplugged 2/2/11

The Lost Art of Mentoring

Who taught you life skills? Did anyone coach you in the ways of culture and values? An uncle? Your grandma? The television?

The movie Gran Torino with Clint Eastwood gives a genuine, raw portrayal of mentoring. In a nutshell, Eastwood attempts to teach the immigrant neighbor boy how to be a man. He starts by teaching Thao the skill of carpentry: how to hold a hammer and which tools to always have on hand.

Then he comically endeavors to educate the kid on manly talk and how to act like a man. Eastwood verbalizes it, then demonstrates it, and finally observes Thao doing what he’s learned. The mission took time, money, energy, and the forging of a relationship, but it was worth it.

Some of us wish we had an Eastwood-like character in our lives. Speaking from experience, we all need mentors. When I became CIO of a large, prestigious organization in my mid 30s, I was both elated and scared. Mostly scared. What gave me comfort and accelerated my success were my mentors. Even today, despite the 10 years’ of experience under my belt, I can’t grow without a mentor.

Dictionary.com defines mentoring as an ongoing, planned partnership that focuses on helping a person reach specific goals over a period of time. Unfortunately, the art of mentoring has rarely caught on in the business world, healthcare included. We see this reflected specifically in the graying of existing leadership and the lack of succession planning.

This type of one-on-one interaction — lost somewhere after the apprenticeships of the pre-industrial age — has been replaced with short-term, focused leadership programs. These programs attempt to turbo-charge management education by cramming years of collective wisdom into a one-week synopsis. For example, the College of Healthcare Information Management Executives (CHIME) offers an excellent leadership development program entitled “The CIO Boot Camp” that cannot keep up with the demand for enrollment. Why is it so popular? It fills the mentoring void in today’s organizations.

Is mentoring beneficial in healthcare? Yes, when done right. Committing to mentor another person is an investment in the long-term success of an organization, a selfless act of service for the sake of the profession and the future of healthcare.

This type of partnering also offers something a person might not get directly from their supervisor: broader experience, organizational perspective, and new skills. Let the CFO or CNO mentor an IT professional. If the CNO teaches the info specialist leadership skills, that will broaden the mentee’s ability and understanding.

Determining the appropriate mentor. Examine your strengths and weaknesses. Match up a clinician with a CFO in order to gain key insights into the healthcare financial world. Cross-pollination does wonders to promote teamwork and connectedness. (Mentors from outside of the organization or healthcare might offer a level of anonymity and broad perspective, but they would lack the context for key elements of discussions.)

Mentoring programs and recruiting. Job candidates respond favorably when they understand that the organization cares for their professional development and will enable them to achieve career success. Over time, as the mentoring program becomes a major differentiator in recruitment efforts, your organization will become an employer of choice. Gallop has statistically demonstrated that an organization with a high level of engaged employees significantly outperforms non-engaged workforces in areas including customer satisfaction and financial results –  both employee and employer win. Clearly, such programs lead to improved health in the corporate setting.

Partnering exposes you to new insights and understanding. One academic medical center I know sends its IT leaders on annual short-term mentoring assignments to all of its clinical departments. The CIO began routine rounds with physicians and residents. In each case, the mentor allowed the IT leader to experience the specific clinical care setting, answered questions, and discussed the critical intersection of IT and quality patient care. Each IT leader came back with a new sense of purpose and motivation. They in turn made immediate changes to IT systems and support to help ensure a higher quality of care.

Mentoring develops future IT leaders. Given the limited pool of emerging leaders, mentoring is more critical than ever. Identifying and growing talent within our organizations is imperative. Our leadership effectiveness is not so much based on formal education and rigorous reading, but in real-life, on-the-job experiences.

Restoring the lost art. We are the sum of our collective inputs. I credit my success to my mentors. I have been deliberate in this process. On even years, I mentor someone. On odd years, I am mentored. I require each of my direct reports to do the same. I’ve been formally mentored by health system CEOs, COOs, CFOs, CMOs and hospital presidents. I have mentored many who have since moved into positions of authority. Check out the many resources available on establishing quality mentoring programs.

A personal board of directors. At this stage of my career, I have had so many mentors that I consider them my board of directors. In fact, just today, I needed help in specific situation, so I called up a former mentor and met him for lunch. I left that meeting ready to conquer the world — or at least my personal struggle.

Resources. Anyone who posts a comment, I will send to you a simple one-page mentoring contract you can use to facilitate your own relationships. I will also send to you a list of “golden nuggets,” the bits of wisdom I have learned from being both a mentee and mentor.

Update 2/8/11

Thank you for the many responses. By now, everyone who posted should have received the Mentoring Contract and the mentoring Golden Nuggets.

Quick answers to some of the questions.

I do not recommend mentoring any person in your chain of command. That is one reason for mentoring across disciplines. This is hard to avoid at the most senior levels, but can be accomplished by having a mentor outside of your organization.

Your chances of landing a willing mentor are exponentially increased if you disarm them first by telling them it is for a fixed period of time at regular intervals not to exceed one year, that you will handle all logistics and work around their schedule, that the relationship will be confidential, and you have a contract where you will define objectives. Genuine flattery helps — I have never been turned down.

Don’t wait on your organization or be a part of a weak mentoring system. Do what I call grassroots mentoring. Find someone who would make a strong mentor and ask them. But how do you identify a mentor? Observation. Look around you. Who do you admire or look up to? What disciplines do you need help in? Who inspires you? Who are you attracted to?

Finally, while I believe in diversity, I choose only males to mentor and mentee. Personal preference.

On the vendor side, those were some tough questions. To the extent possible, carve out the time for mentoring and make it untouchable. Because I often mentor with executives, I normally pick a breakfast slot. One, breaking bread is intimate. Two, you are less likely to have interruptions and tardiness. Three, everyone has to eat.

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

News 2/2/11

From Former CIO: “Re: PCAST report. It seems the PCAST report has been glossed over or dismissed as a bunch of government mumbo jumbo. The HIMSS response is once again laden with not-so-hidden vendor protection. This blog note hits the nail on the head.” Vince Kuraitis describes the organizational reaction to the PCAST report, which basically says we’re going in the wrong direction with today’s HIT systems. Those criticizing its conclusions include the usual turf-protectors: HIMSS, EHRA, AHA, FAH, RSNA/ACR, and IHE. I realized that I hadn’t provided highlights of the PCAST report, so scroll down for my summary and you’ll see why those groups don’t care much for the recommendations.

From AZ: “Re: MyChart. Tucson Medical Center has launched it for Saguaro Physicians along with Epic’s MyChart Mobile App.” Unverified.

From Dolphins Fan: “Re: Epic. There aren’t many spinoffs in the Madison area. Either they retain top talent, people leave Madison to start their businesses, or they have one hell of a non-compete.”

Speaking of unsurprising reaction to political events, eHealth Initiative releases a statement (I don’t have a link) urging that House Republicans keep the HITECH feed trough full instead of exercising fiscal responsibility. “We realize that the Spending Reduction Act represents a principled stand against government spending, but we would encourage Members of Congress to not use the HITECH Act or any of its provisions as a target, as that will only create further uncertainty in the health care sector. Any attempt to repeal funding for health information technology would have severely negative effects on public and private progress now and in coming years.”

Management changes at enterprise visibility vendor Intelligent InSites: president and CEO Mark Rheault resigns and the majority owner, an investment company, puts one of its people in the interim role until a successor is found. That guy is Doug Burgum, who took over Great Plains Software years ago and arranged its acquisition by Microsoft.

Thanks to Iatric Systems of Boxford, MA, joining HIStalk as a Gold Sponsor. The 20-year-old company has provided applications, interfaces and reporting solutions to over 900 hospitals (especially Meditech), has been recognized as one of the country’s fastest-growing companies, and has been named one of the top 100 businesses in the Boston area. Check out their YouTube channel, which features an interview with Denni McColm, CIO of Citizens Memorial Hospital (Stage 7 EMRAM, putting the tiny hospital in elite company), which used Iatric to integrate their Meditech systems with Google Health and a patient portal. They’ll be at HIMSS talking about interoperability, so plan to drop by, say hi, and thank them for supporting HIStalk. And of course for doing the cool HITECH Train parody video.

McKesson announces Q3 numbers: revenue flat, EPS $0.60 vs. $1.19. The company set aside $0.52 per share as a one-time expense for its continuing fight against drug Average Wholesale Price lawsuits that have already cost it a fortune. Without that charge, earnings would have been down but would have hit estimates and the company raised guidance for the fiscal year. Technology Solutions revenue was up 2%, but software revenue was down 2%. Still, that division made $106 million. It had $1.3 billion in unrecognized revenue, which could be great (lots of money coming) or terrible (it hasn’t been recognized because customer contract terms haven’t been met).

The McKesson conference transcript is here. John Hammergren says he doesn’t think ARRA money will be pulled out even if healthcare reform is successfully challenged, but that it doesn’t really matter at this point since customers are already committed.

HIMSS announces the recipients of its clinician IT leadership awards: Liz Johnson RN, VP of applied clinical informatics at Tenet (the announcement calls it “Tenant”) and Michael Zaroukian MD PhD, CMIO at Michigan State University. 

A hospital in Australia doubles its eye tissue donations by monitoring the outbound ADT messages of hospitals to see if any designated donors have died, allowing tissue banks to be immediately notified. The application was built using InterSystems Ensemble.

We sometimes do interviews on HIStech Report when companies want to use the final product in handouts or downloads. I recently interviewed Mitchell Goldburgh from image management vendor InSite One, just acquired by Dell.

Weird News Andy fingers those Down Under: an upcoming journal article finds that Australian medical students are performing exams (genital, rectal, and breast) on unconscious hospitalized patients who have not been asked for consent.

Open source EMR vendor Tolven gets profiled in an article covering venture capital in California. British publisher Elsevier gave the company $3.6 million from its venture fund. The article says the company had $1 million in sales in 2010 and expects $2.5 million this year.

The regular company e-mail from Kaiser Permanente CEO George Halvorson has some interesting 2010 numbers: members logged in to its site 62 million times to get information, patients viewed 25 million lab tests online, doctors conducted 10 million secure message based e-visits, patients had 8 million electronic prescription refills, and 2 million visits were scheduled electronically. He concludes that people want online convenience instead of driving and telephone.

Wolters Kluwers Health is supporting HIStalk as a Platinum Sponsor, so thanks very much to them. The company has quite a lineup of clinician-familiar names: Facts & Comparisons and Medi-Span (drug references and databases); the ProVation ClinicNote custom content and documentation solution for EMR vendors; ProVation EHR for ambulatory surgery centers; ProVation MD for clinician procedure documentation; ProVation Multicaregiver perioperative documentation system with monitor interfaces; ProVation Order Sets, powered by UpToDate Decision Support for CPOE and paper order sets; and the fabulous UpToDate evidence-based clinical decision support system. Clinical content and order sets are important for improving outcomes and meeting Meaningful Use EMR requirements, so give them a look. Thanks to Wolters Kluwer Health for supporting HIStalk. 

This happens all the time: a treatment assistant making $62,000 per year racks up $1 million in overtime pay over 12 years, making the state employee eligible for a pension (if you don’t work for government, you’ll probably have to look up the definition of that word) that will pay 50% more per year than he makes working. 

E-mail me.

PCAST Report Summary

This report was commissioned by the President and created by his Council of Advisors on Science and Technology (real scientists, not vendor people, HIMSS puppets, or the usual talking heads).

Healthcare IT’s potential:

• Integrate technology into practice without forcing doctors to perform data entry
• Provide clinicians with complete information at the time of decision making
• Get patients involved in their care
• Enable public health monitoring
• Speed up clinical trials
• Reduce administrative overhead
• Create jobs
• Support healthcare reform

But it isn’t working:

• 80% of physicians in practice still don’t us even a primitive EMR and interoperability is poor
• Need to take advantage of the network effect, which would require universal data exchange standards
• As a result, the market for new HIT-based products and services is underdeveloped
• Systems are proprietary, don’t work well with physician workflow, and weren’t built to exchange data in non-proprietary formats
• EHR users see their systems as purely internal – they have no incentive to open them up to patients, competing providers, or research organizations
• Privacy concerns are common
• Incentives are misaligned, so the only good reason to invest in HIT is if it improves administrative efficiency

Conclusions:

• Goals can’t be met with the modest interoperability requirements of HITCH and certification
• Putting more non-interoperable EMRs out there via HITECH will just make the problem worse
• Need a universal exchange language – tagged data elements (similar to XML – CDA is an example).
• Cost to develop the universal exchange language would be $20 to $40 million and the cost to vendors would either be a  5-10% increase in EHR cost or a one-time expense of $5-$20 million per vendor
• ONC and CMS need to step up the interoperability game for the 2013 and 2015 Meaningful Use requirements
• Services should be created to send and receive tagged data elements, which would eliminate the need to repose data in a national database
• The universal exchange language would open up markets for new tools and services, improve privacy, eliminate the need for a national patient identifier, and facilitate public health
• HIT is a mix of "the good, the bad, and the ugly"

Also:

• CMS itself has outdated systems and lack of internal knowledge about information exchange and replacement system proposals are just as inflexible (doctors have to submit data twice, for example, once to get paid and once for quality incentives)
• HIE progress is being slowed down by the complexity of developing their member agreements, the lack of financial incentive to improve outcomes, and their unclear capability to scale
• HIEs are "ill-suited as the basis for a national health information architecture" and only a handful have gone beyond the pilot stage once their initial grant money was spent
• Middleware that can extract information from proprietary EHR databases can help (dbMotion, ICA CareAlign, Medicity MediTrust, Microsoft Amalga, Oracle HTB, Orion Health)
• Examples of successful EHR adoption are VA and Kaiser, but even they can’t exchange information outside their organizations and since they are closed systems, they don’t create a market for innovation
• The problem with today’s EHRs: they don’t make the physician’s job easier and force doctors to type in their own information
• EHRs were built to look like electronic versions of paper forms without the involvement of usability experts, so they don’t provide much decision support
• Errors in diagnosis may be far more common than errors in treatment and EHRs don’t help much with that
• Quality measures are too specific and focus on medicine’s traditional emphasis on treating illness rather than coordinating care and maintaining health
• EHRs were built around billing codes, which don’t provide a patient-centered and historical view

Recommendations:

• Federal CTO Aneesh Chopra should within 12 months produce metrics to measure progress toward a national healthcare infrastructure, including pilots, and assess yearly
• ONC should require metadata-tagged data elements to meet 2013 MU requirements, publish standards for services that can access patient data, and work with the Small Business Administration to develop companies that could offer cloud-based services to small physician practices, LTFs, and hospitals
• CMS should move away from collecting data relating to lists of health measures and move toward higher levels of information exchange and clinical decision support
• AHRQ should be given funding to develop a test network for comparative effectiveness research and give medical researchers access to de-identified, near real-time data using data element access services
  

HERtalk by Inga

From Sales Professional: “Re: commissions. Every HIS vendor I’ve worked for (SMS, Data General, TSI, IMS, Eclipsys, HMS, McKesson, AGFA, and Keane) had commission plans that tied payments divided just as the license fees, i.e. you get your money when the client pays his bill. Albeit ‘golden handcuffs’ for the rep, this did link incentives for the rep to selling business that the company could install and get paid for. SMS, I believe, started this in the early ‘80s after a few reps got paid huge commissions and SMS could not deliver. After Sarbanes-Oxley, a lot of the bigger companies claim they need payment terms that the GAAP accounting rules can recognize, and most claim that a ‘holdback’ for post-live payments is NOT a bookable revenue item for them.”

DiagnosisOne appoints Kenneth W. Kizer, MD, MPH to its board of directors. He is former president and CEO of Medsphere Systems, the founding president and CEO of the National Quality Forum, and a former Under Secretary for Health for the VA.

Mediware Information Systems posts its Q2 numbers: net income of $1.73 million, compared to last year’s $783K; revenue of $13.2 million versus $10.8 million.

The board of directors of Harrison Medical Center (WA) approves a $7.6 million, 10,000 square foot data center to support the medical center’s new EMR (Allscripts Sunrise, I believe).

Venture capital investment for medical software and information services grew from $387.5 million in 2009 to $460 million in 2010. That’s a 19% increase.

NCH Healthcare System (FL) anticipates earning $11 million for its meaningful use of (Cerner’s) EHR.

Awarepoint says that 91 hospital sites contracted for Awarepoint’s RTLS products in 2010, a 30% increase over 2009. In addition, annual revenue growth exceeded 100%.

Newark Beth Israel Medical Center (NJ) licenses Meta Health Technology’s electronic clinical documentation improvement software.

The University of Texas MD Anderson Cancer Center purchases Carestream Health’s RIS system.

Streamline Health Solutions appoints Robert Watson as president and CEO, replacing founder and president/CEO J. Brian Patsy. Patsy retired at the request of the board and also resigned as a company director. Watson is the former president and CEO of DocuSys.

CareFusion names Kieran T. Gallahue chairman and CEO, replacing the retiring David L. Schlotterbeck. Gallahue was most recently president and CEO of ResMed.

Harold J. Apple takes over as CEO and president of the Indiana HIE. The HIE’s founding president and CEO J. Marc Overhage will remain on board as chief strategic office and national policy advisor. Apple is the former majority owner, CEO, and president of Vector Technologies.

Fifteen California hospitals adopt InQuickER, which facilities patient appointment scheduling for emergency rooms. Patients wanting to reserve a time in the ER typically pay a $15 to $25 premium for the service. At Lakewood Regional, the hospital pays $3,000 for the InQuick ER  service and charges patients $15 to schedule an appointment. Lakewood’s ER sets aside only one appointment per hour and patients must reserve their spot at least two hours in advance.

Speaking of ERs: between 2003 and 2008, the rate of ER visits in the US exceeded rates in both England and Canada.

OMG. It’s February and I am leaving for Orlando in 19 days. So much to do beforehand! I shared with Mr. H (who couldn’t even feign excitement) that I bought a new dress for HIStalkapalooza, but am still pondering over the shoe selection. Truth be told, I am afraid I’ll be “outed” if I were to were the fab shoes that would really make the ensemble. I am hoping that others attending will take their fashion selections as seriously as I am, especially since this year there are prizes involved. So ladies, find your best shoes and a sassy cocktail dress. And guys: women drool over men in tuxes, especially when the IngaTinis are flowing. And, keep in mind that it’s hard to look hot when you are wearing a shirt that screams your company’s name. Just sayin’.

Versus Technology introduces Enterprise View Mobile for use on the iPhone, iPod Touch, and iPad. The free application gives users access to patient, staff, and equipment locations on mobile devices.

Former Cerner COO Paul Black joins the board of Netsmart Technologies.

Poudre Valley Health System CIO Russ Branzell tells the local press that PVHS will spend between $30 and $40 million on its EHR investment (Meditech). He also admits that their EHR stimulus reimbursement will be “nowhere close to the investment we put in.”

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

• Denver Health engages MEDSEEK to develop and deploy its new patient portal.
• T-Systems and Medicity separately announce the successful validation of their interoperability expertise at the recent North America Connectathon.
• DIVURGENT managing partner Colin Konschak co-authored the recently published book, Accountable Care Organizations: A Roadmap for Success. Guidance on First Steps.
• CynergisTek announces that its revenues grew 33% in 2010, which included a 10% jump in existing client revenues. New client revenues accounted for 48% of 2010 revenue growth and technology partner solutions revenues grew 265% over 2009 performance, accounting for 50% of total revenues.
• Janet Dillione, EVP & General Manager of Nuance Communication’s Health Care Divison, is featured in this week’s Forbes technology section.
• Several EHR vendors, including NextGen and eClinicalWorks, are mentioned in an Information Week healthcare article titled How 7 Vendors of EHR Systems Measure Up.
• Design Clinicals announces its contract with St. Patrick Hospital and Health Sciences Center (MT), where it will implement MedsTracker for medication reconciliation.
• Florida Hospital Celebration Health chooses the interactive patient care solution of GetWellNetwork.
• API Healthcare announces the release of API Healthcare Syngergy, a workforce management solution.
• Forest Park Medical Center (TX) chooses Access Intelligent Forms Suite to replace pre-printed forms with on-demand e-forms that include printed and barcoded Meditech data.
• St. Joseph Medical Center (MD) selects Provation MD for gastroenterology procedure documentation and coding.
• Florida Academy of Family Physicians recommends Ingenix CareTracker to its members.
• MEDSEEK will develop and deploy Denver health’s new patient portal.

EPtalk by Dr. Jayne

What a difference a year makes! This week, I spent time with a family member in a hospital across town, which incidentally has a large integrated clinical system different from my own. I was last there with another family member about a year ago, not long after the hospital went live.

At that point, the staff was still fairly hostile and frustrated, having just come off of weeks of training and feeling very stressed. Knowing that I work for a competitor hospital, and knowing what I do, many of them went out of their way last year to tell me how much they hated the system. This week was the completely opposite side of the pendulum. No one was saying anything about the system. I was puzzled: could it really be that good? Or had they just all been assimilated?

Being the investigator I am (probably watched too many episodes of “Quincy, M.E.” as a kid) I “accidentally” left my name badge from Enemy Hospital on my collar the next day, to see if anyone took the bait. Nothing. Finally, I asked the nursing staff what they thought. Had they reached Nirvana? Had all the issues been fixed?

The answers I received were what could only be described as a completely mixed bag. Although some of them feel that the system has changed for the better, others still perceive it to be largely the same as it was a year ago, but they’ve learned to use it as a patient care tool like any other. One self-aware nurse commented that she didn’t really hate the system at first, it was just the idea of it, and it wasn’t worth the energy to keep complaining about it.

That’s the central challenge of most of us that are in the implementation and support business have to figure out – how to determine which users are going to be like that nurse gradually accepting the system vs. which users are going to rage against it regardless. This is the magic of figuring out which of the 20% of users will ultimately need 80% of your attention, and finding a way to help them adjust.

One thing I found interesting about the experience was that only the health system-owned primary care practices are on the system, and they have no health information exchange with their community and subspecialty docs. The specialty physician caring for my relative walked in with a (gasp!) paper chart from his office, after walking it out the door and across the campus, sans audit trail, sans security, and with wild abandon.

After I recovered from the delirious thought that it would probably spend the night in the trunk of his car, mingling with other deviant charts, I asked him why he was still on paper and whether they planned to switch any time soon. It turns out they are, having finally succumbed to being purchased by the health system after a protracted battle with one of their major insurers.

It will be interesting to see how much difference the next year makes for them. They are not only losing their autonomy to a major health system (and boy, do I wish my system had snapped them up instead — his group is incredibly fun at parties) but also giving up their paper. Theirs is just one of thousands of practices that will go through one or both of those transitions in the next several years as Meaningful Use unfolds. I’m sure I’ll be offering them a shoulder to cry on at some point.

Speaking of crying, those were tears of joy as I responded to a deluge of Facebook friend requests last week. I was starting to have a bit of the winter hum-drums, but my new BFFs seem to be extremely entertaining. I also heard from the team at NextGen, vendor of the system used by my not-so-secret crush, Dr. Robert Murry. They’ve offered to put us in touch. Do I sense an interview in my future?

I’ve received several great “Dear Dr. Jayne” questions this week, but I am holding out for something sassy, so feel free to send those deep, dark questions my way!

Have a question about medical informatics, electronic medical records, or whether nurses ever yell at doctors? E-mail Dr. Jayne.

HIStalk Interviews Jonathan Bush, CEO, athenahealth

Jonathan Bush is CEO, president, and chairman of athenahealth of Watertown, MA.

We’re into the nuts and bolts phase of HITECH and the checks are going out. How are your customers responding to it, what are your opinions of it so far, and where do you think it’s going?

Well, you know, they’re doing their thing. I guess there’s a lens of how is Nation doing. Does Nation like it? My sense is that Nation got a little something that Nation didn’t want, which is that Nation didn’t want vertical integration and more pricing power as the cost of healthcare goes up. You know they wanted more buying power, not less.

So Nation might not be psyched about that, but the vendor world, whether they live in the cloud or don’t, are happy at the stir and the flurry of energy and excitement around information technology. When someone’s whipping you from behind, you might not make the coolest, smoothest, most permanent of decisions. There’s going to be a lot do-over. I see grounds for a lot of do-over right now, which is, I think, exciting. Unfortunate, but exciting. 

For example, at the JP Morgan conference, the most interesting data point I heard in the entire conference … they had a not-for-profit hospital track and the JP Morgan guy who runs the desk that floats the bonds that hospitals use to finance their activities — these not-for-profit hospitals, you know, they depend on good bond ratings  — he said that between 30% and 45% of all the bonds he’s floated in 2010 are underwritten by software, but the life of those bonds, the payback period, is between 10 and 15 years. I don’t know. Do you, Mr. HIStalk, have any 10- to 15-year-old applications running on your D: drive there?

What I see is the perfect sub-prime mortgage crisis type in store. It’s just the beginning. It’s just the drop in barometric pressure that’s causing the weather systems to move. You know, the birds are still flapping their wings, the fish are still jumping, Clooney isn’t being turned upside down in his boat yet. But it’s a perfect set-up. 

These physician subsidy deals will certainly not last at current levels. The difference between those physician subsidy deals this time around and the time around before – which ended around ’95 – is that this time, significant system investments are being layered on top to fuel the marriage. I expect those kids to be orphaned. That’s wonderful for athena at some level because all the Athena clients aren’t putting out any capex on these things and none of their bonds have IT inside of them. They will be in a very good place to acquire or pick up off the ground the systems that overextend in this way.

That’s the result of this rush to hit these deadlines. Now, maybe that’s OK. Maybe these mostly weaker, more isolated not-for-profit hospitals are being pushed off a cliff that they were already on the edge of. I don’t know. I don’t have the judgment on that.

Most of our big enterprise clients are for-profit. They were the first ones to find the cloud and value that freedom of the balance sheet that we offer. They had the least problem with the idea of laying off large numbers of billers and medical records clerks, so they represent a large portion of our base. They’re obviously in a position to expand dramatically for the first time in a while as these independent, not-for-profit, more urban systems get strapped.

Hospitals live day-to-day by their capital spending, which is a problem in itself, but they money they’re spending on buildings, electronic medical records, and practices comes as margins are about to get thinner. When you see Loma Linda’s bond ratings slip, you know something has to give. Are hospitals not being prudent or are they overreacting to what they think healthcare reform will be?

Well, you have an interesting confluence. Obama’s policies have been interesting in this way. There’s so much to gain by rallying behind the ACO banner in the form of non-ACO, short-term gain. “This is my chance to lock down my catchment area,” you know. “Inside the ACO, all my Stark rules are relaxed.” It spooked the doctors where they’re ready to reconsider the whole idea of being independent. It works from a pure “driving up referrals” perspective. 

I think all of them have obviously the very best of intentions on building the ability to coordinate care more effectively. I don’t think there are any evil … all of the evil that I’ve seen done in healthcare in my 13 years has been done by really good people. That’s one of the great ironies and excitement of healthcare. 

I don’t think it’s malicious, but I do think it’s attractive and it caused a free agent season. The rush caused the price at which a physician would switch to full employment to go higher than the physician could ever actually pay back in the form of admissions. I don’t know these numbers cold, but looking at our claims and referrals traffic, I would say that the best primary care doc could do in terms of admissions to a hospital, you know, if you imagine a doc who does zero admissions with Hospital X, and then Hospital X acquires the practice and is now subsidizing the doc. The doc goes to 100% admissions to Hospital X, right? So that’s the best-case scenario.

The most that doc can bring in in admissions – not the most, but you know, a good number for that guy to bring in — would be about a million bucks’ worth of admissions per year. The hospital’s got a 3% margin. You’re talking about $30,000 in contribution to the bottom line, assuming 100% of the admissions are new that they weren’t getting already. Well, the average subsidy is over $100,000 for a primary care doc in this current season, these new compensation deals. So that’s a negative $70,000 deal for the hospital annually, and that’s before the IT investment.

And that’s before the doctor’s schedule tends to, as we’ve seen before … I love docs, I represent them, I’d take a bullet for most docs … and the calendar does tend to lighten up with somebody’s who’s got a rock-solid floor on their salary. I don’t know what it is. It’s just quality, quality. “Don’t ask me to see more patients — what about quality?” Quality suddenly becomes capitalized, italicized. 

So, anyway, those are some of the things that I haven’t seen people write about that are going on. Obviously the energy level, the excitement, the interest in ambulatory care by hospitals and by really everyone in healthcare, government … the payers space is an interesting space where payers did not do a very good job in all the healthcare reform debate of putting forward their own solution. We’ve calmed society down and lost a lot of ground now. As they see the hospitals vertically integrate and further erode their own pricing power, their own buying power, we’re seeing a real spike in really serious pay-for-performance where the payer’s saying, “No, no, I’ll be the ACO. I’ll coordinate all that. I’ll pay the bonuses and you can still be independent because I really want you to feel just as good sending the patient to a non-hospital based surgery center as you would to a much more expensive hospital-based surgery center.” 

The payers are late for the game, but certainly the most provider-side oriented payers like Humana are now fully headlong into the ambulatory care space. In fact, I think the most interesting announcement of all – unfortunately it was not during 2010, but they must have been working on it – was when Humana bought Concentra. So Humana now is full-on, back to the future, employing 800 docs. The athena deal was a 2010 deal, where they are talking about paying 25% more to primary care doc that remain independent and stay on Humana-sponsored systems like athenaNet versus the hospital sponsor’s system. Very interesting.

What about the insurance companies buying the HIE platforms like Medicity and…?

Ah, another good example. Not sure what they’re going to do with that bad boy, but I’m not very close to either one of those companies. I really like the leadership. I love Ron Williams and I really like Kipp Lassetter a lot, so – I don’t know the new guy at Aetna at all though – so they must have a good idea there. Clearly it had something to do with making patients able to leave the borg. There’s the cloud and there’s the borg. Most HIT investments have been on the borg side of things. Mostly $100 million, “everything is included as long as you stay inside the biosphere” IT systems are not good for buying power. They’re not good for patient power. They’re good for the traditional, more paternalistic approach that most of society is still very interested in.

Do you think that there’s any chance that ARRA will be repealed or that HITECH will be de-funded?

Oh, no, no, no… No, no, they’re going to do their ritualistic dance and then they’re going to begin … this is the first beating. Then there’ll be other beatings. Then the lights will be on at night and then the dog barking and then the waterboarding. These guys know how to do this.

This is the first of many major congressional movements to chip away at and personalize and just whittle down the more Malthusian forces that have been in government since 2008. Basically, it’s not that there’ll be any … unfortunately I wish there’d been more reasoned argument against the more micro-managerial approach and for a more… but instead they’ll just be random beatings of these well-meaning Malthusians, you know, until they just get tired and go back and take a nice job on the other side of the revolving door for a while, if only to rest.

We’ve seen it before. I mean, the Republicans had it in a mid-term and Clinton had it after his mid-term. You know, it’s just one of those things that people do. It’s funny because it will certainly make the Republicans look ridiculous and probably get Obama his seat back if they’re as aggressive as I imagine they will be, which is ironic of course, but the way things work, you know.

It doesn’t seems that EMR certification was as much as a barrier as people said because it seems like every system I’ve never heard of suddenly keeps becoming certified. Do you think the bar has been set too low or does certification maybe measure the wrong thing since it doesn’t seem to really distinguish between no-name products and ones that are household names?

This again is the problem with the Malthusian approach, where you get all these detailed things that you’re going to make people do, and then no one does them. Now what do you do? My three-dimensional model of the universe that I so carefully and lovingly built actually doesn’t work because no one is doing it.

In this case, the specific problem was this was part of the ARRA. This was supposed to be a set of shovel-ready projects. The mandate is to spend the money. It’s not to incent people who cross a bar, which would be a very cost-effective program because they could set the bar where it really ought to be and no one would pass, and we’d really separate the wheat from the chaff.

But that’s the rubric this program was authorized under. This was, “Get the $30 billion in the economy.” What has been going on since the original ARRA bill passed was the bar has been lowered and lowered and lowered until Oompa Loompa could jump it, so that it could be jumped by everybody, right? And that was their mandate. 

In the very end, you’ve got this bar laying on the ground with this doctor who’s got … you can imagine the guy who qualifies for the ARRA and how much work he’s done and what he looks like. The guy who came in last place that still passed. You know, you can do that cartoon at HIMSS [laughing]. He’s got a copy of Microsoft Word, you know, and the password feature turned on, you know… a couple of little whizbangies and he’s wearing a Sony Walkman with the Dolby button turned on. I can see this guy. He’s like [laughing], and he’s like, “What? What, I’m fine! I’m totally Meaningful-Use certified. Yeah, absolutely!

But what are you going to do? Their job was to get the money out the door. Now they’re saying, “Next time around, the bar is going to be much higher. This 2011 thing was just a shot across the bow. Wait until you see what we’re going to do in 2012. Oops, no, we’re not going to do anything in 2012. Wait until you see what we do, God damn it, it’s going to be amazing in 2013. The bar’s going to be sky-high! No, you’re going to need a pole vault to get over the bar in 2013.” And so the guy’s, “Sure. Maybe.” 

In fact, if other forces are in play and people get much more able to engage in the verb “health information exchange,” I fully believe that they will end up with a more aggressive set of rules. The nice thing about all of it is they … it is a rule-making rather than a Congressional act, literally an act of Congress to the get these things moved around. So if society somehow gets all online, then sure, they’ll try to move the bar up. But remember, society’s buying mostly legacy IT, which does not exchange information outside of the server. It’s unlikely the bar will be terribly much higher in 2013 than it is today unless athena Community works or some of these other more social network type concepts take hold.

Even with what limited work is required to meet the first Meaningful Use stages, there’s already is the first pushback that says, “Hey, it’s too hard, it’s too fast, I’m not ready.”

Can you believe that? I mean, can you believe that? This is the greatest argument against public schools. That’s been going on for decades in our public school system. “Really? You can’t pass that one, Jimmy? That’s one crab and there’s two crabs in the basket. There’s one crab and the … now how many crabs are in the basket?”

The whole premise is to get people hooked with the easy money and then move them up. But what happens if everybody opts out even on the easy money?

I think there’s that, but more importantly, if you latch people into easy money by getting them to blow their wad, financial and operational, on offline technology, you know, non-exchange technology, they are interoper-able, but not interoperating with anyone. There’s one argument that says that no breath is lot better than bad breath, that if you actually put everybody on static systems that are attached with the obvious motive of keeping people stuck inside that system environment – keeping patients inside that system and referral environment – you run the risk that it will be very hard to then wake that system up and get them to make that system talk to others.

This magical talk that you hear Halamka going on about middleware is … you know, this is the guy who manages to be on giant billboards but can’t exchange information with the hospital across the street that teaches with the same medical school and the same doctors for 100 years. I love the guy and I’m sure he’s got perfectly good reasons why literally one side of the street can only exchange information via paper airplane. But you know, it’s pretty amazing. 

Fundamentally, if you’re not in the cloud, if you aren’t in a system, and… the cloud I think is a business model as well, it’s not just if the technology uses browsers or whatever else is… It’s the underlying incentives to everyone who plays ball, mitigate, correlate profit with exchange to give in more exchange. The doctor makes more money in an exchange setting if they do more exchanges. If the hospital makes more money in exchange setting, they’re going to do more exchange, right? The IT vendor or the cloud and service vendor make more money with successful exchanges. Are you going to be more successful with exchange? It’s that simple. Certainly that’s the intention of the government is to create that, but right now, in a way, one very much seems to be oriented in an exchange prevention initiative. Everybody’s got to be inside my biosphere.

Vendors are using this opportunity to rebrand themselves. Allscripts claims it’s an open system. Every vendor who used to be SaaS now says they’re cloud-based because it sounds cooler. Now vendors are saying that private interoperability among their own customers is exactly what the market needs, that you don’t need all this outside stuff, just let Epic hook everybody up …

Yeah, yeah — private interoperability. That was like the guy I watched, the CEO of Kaiser, and the panelist says, “Now that you know about the cloud, are you sure you would have spent that money on Epic?” And he said, “Oh, we have our own cloud.” I mean, you can’t have your own cloud. The whole point of a cloud is that it’s part of the universe, it’s not a thing that you … can you see him there, like with a smoke machine from the disco room? You know, “It’s my cloud!” It’s just so perfect.

I don’t know if he doesn’t get it or just it was so embarrassing in front of a thousand people, but you’re right, I mean, what’s he – and you know, it’s been very hard for athena because we work for our customers, and it’s our customers… as the employer, if our docs are actually not organized as independent groups, our job is to work for that hospital, to make that hospital successful. Now, I believe — and our hospital clients believe — that the slightly passive-aggressive strategy of making it technically impossible for a patient to go where they want is not the long-term winning strategy. Being the lower-cost hospital with better coordination, whether the person is inside your biosphere or not, is a long-term winning strategy and the guys that we serve …

I was talking to someone from one of our big enterprise clients. He is so for the open system it’s unbelievable. He can’t wait. He said, “I need to get every low-rent colonoscopy center off the Interstate connected to my hospital because I want to go after every bankrupt union and state employee health insurance fund and take that stuff over at seventy cents on the dollar. But I can’t do that if everything is adding to my fixed cost base.” This is a really brilliant visionary. He’s been around for a while and he’s talking about eviscerating his costs, turning his hospitals into variable costs. That’s a guy who’s going to win.

The HIMSS boat show is coming up. Are you mellower about it now that athena has exhibited there for a few years?

We are bringing down a ladder where you’ll be able to climb up and if you take off your shoes, we will show you our new thrusters. You’ll climb up the ladder, you’ll take off your shoes, you’ll step in, and you’ll go below decks, and there’s going to be our thrusters there. I recommend your readers come and the new athena bow-thrusters will be on display. They are turbo, and they are cloud-based thrusters.

You met Judy Faulkner last year at the HIStalk reception. How was it?

It was your event. Actually, it’s been hard to talk trash about Epic ever since, because I actually think she’s lovely. I think she’s a really inspired person. It pains me. It’s like Old Yeller. It’s a beautiful, beautiful thing she’s built that now has to walk quietly over the hill.

At least it’s cooler than many.

Well, yeah, I know the rest of it’s like making burgers for McDonald’s – no issue with the other animals in going over the hill, you know, moving through rapidly and quickly; hang them on the racks, move them through the line …

With all these changes to healthcare, do you think consumers are gaining control or losing it?

Losing right now. But you know, they’ll be back. We will bankrupt any all-you-can-eat buffet. The food goes. In healthcare, we’ve been figuring new things to put on the all-you-can-eat buffet for 15 years. More — 20 years, 25. Once we neutered the payer – see, we don’t like all this “mean payer beating people up” thing – then the payers stopped and they figured out … first of all, they did a lot of mergers and acquisitions, so they were getting a lot of return on that.

But then also they figured out that now that there are very few in every market, as long as they just pass the full cost increase right through, they actually make more money in the medium and long term as rates go up. So there is the obvious disincentive. When you see an obvious incentive … if you’re one of many sellers, you can’t control — you know, there’s no oligopoly — you want to be the lowest cost player, right? But if you can actually wink or rub your eyebrow or just let the world know that you’re going to just let costs go up. There’s not that many players left to see your body language, and everybody gets into the habit of letting costs go up? Everybody wins. All the different sellers win. That’s exactly what has been going on since Barbara Walters threw a cranky fit from Humana’s headquarters on 60 Minutes in 1994.

This industry doesn’t even need collusion.

There’s not enough players for  collusion. You just start moving and you’re so big, “I think I’m going to go to the bathroom now!” And you get your big ass up and start heading down the hall. Everybody knows what’s going to happen next. Nobody has to spy on the stall, you know? 

We need more new entrants in healthcare. We need more crazy ones …um, not that I’m crazy, of course, that’s not what I mean, although it’s possible. That consumer power, I imagine, will drive the crazy human ones into the marketplace. Crazy sellers, vending to consumers, as soon as we run over all of the money we’ve newly allocated to healthcare in this last buying spree. Eventually there will be a market, whether it’s a radical reform of the existing market, or whether it’s a market that forms on top of the benefits provided by the health insurance market, like our private school market or the health insurance market in India or UK, where you have a fully functioning, consumer-centric market for a smaller portion of the population that sits on top of the nationalized healthcare system beneath, but acts as a sentinel. It creates the new innovative products, that then pull down through the public school system of healthcare.

That’s what they have in the UK, where they also have the NPfIT implosion, which may be another aspect that we’re headed toward. Do do you think there are enough lessons learned?

We are headed towards a … and it’s a beautiful… What UK healthcare system is is just a really big IDN. What we’re doing is we are blow-by-blow copying the IDN-IT implosion that they did, only they’ve got much more of a European comfort with discomfort that we don’t have. They could stick it patients and put them in queues and stuff like that in ways to make things pencil out in the short term that we can’t do, or won’t do, I don’t think. But you’re absolutely right. That is the playbook for what’s happening right now. The giant RFP …  just like the same vendors, same deal, right? The giant purchase, the giant multi-years long implementation and then the wheels coming off the cart.

Athena was the disruptive cool innovator a few years ago. That’s always a tough label to keep. Do you think it’s still athena and what other companies do you think are doing something interesting in healthcare IT?

Gosh, I should know the answer to that. OK, here’s an interesting thing that I’m seeing in terms of new innovators. It’s not vendors of IT, but actual vendors of healthcare services that are the disruptive innovators now. They pay for or build their own IT as part of the offering. There’s this incredible company, OneHealth I think it’s called, based in San Francisco. Incredible, no-wait, concierge private clinic for the masses.

The entire company is built on proprietary IT that looks a lot like athena, but they don’t view that as a thing that you buy and set up with your CIO and send them to him. They actually built the company around that technology. They’ve been iterating their version of athenaNet. It’s going to be a hell of a sell for me to get in there, because they really view themselves as fundamentally a deliverer of a service and the service is fundamentally leveraged by proprietary technology.

That’s an example where the technology is not the product. Technology enables the product. athena figured out a long time ago that we don’t sell IT. These guys figured out that what they’re selling is patient care. They’ve actually got technology as an ingredient to that. We have luckily gotten a bunch of these new kinds of VC-backed, aggressive, disruptive type companies to go to market on the athenaNet backbone in order to better accomplish this open exchange of patients.

So you look at MinuteClinic. MinuteClinic’s accumulating primary care patients much more quickly than those newly subsidized, newly acquired primary care docs at the hospital. They’re advertising. They’re putting their places where people actually are. They’re aggressively going after patients. What they’re going to do is have athena move them into the hospital only when they actually need to go to the hospital; so they’re going to be a non-hospital ACO. They’re going to be an ACO for whom … I mean, I don’t know what their plans are, but I’m seeing this happen. They’re emerging as a really compelling champion of the patient.

Healthcare is one of few industries where there is not a competitive differentiator because everybody uses the same software. Nobody wants to build it, they just want to buy it. But if everybody’s got Epic, then you’re down to nuances of how you use it. Travelocity didn’t go out and say, “I’m going to find some travel reservation software.”

Oh, but didn’t they build a lot of technology on top? Like Kayak. Isn’t that fundamentally different at the DNA level?

I think, though, that the more interesting stuff is the littler companies whose names are escaping me. The general feeling I had, both times, both of the two last Health 2.0s is, we need an ecosystem. We need a place where any little company with a great idea but who could never raise enough money to go and find doctors and sell to them and get them to buy, especially now that they’re of aggregating; to come and sell their wares. Can sell them at the doc level even if docs are employed by larger systems. Whether it’s an iPhone-based EMR that only works for anesthesiologists or a patient-centered pain monitor rap that can be routed into any EMR, or a lot of this homecare stuff that Alere is looking at where you pee in your cup at home and your EMR gets an update and your doctor reads the abnormals and the patient has never shown up at the doctor’s office.

Those are all kinds … another company like this is … what is his name? Roy Schoenberg. American Well. A huge investment in technology, but what they’re selling is, they’re selling extra billing opportunities in the cracks to docs, and they’re selling instant access to a doc over the cloud to patients. So this idea of convergence where we’re selling the ones and zeroes on a disk; or even renting the ones and zeroes over the Internet, is no longer the product — it’s some larger value-added service which is necessarily enabled. The technology almost becomes the store into which you walk to buy the thing, and the thing is the service.

What are your top goals for the company for the next five years?

Form the first hardcore business-to-business social network. I want any doctor on athenaNet to be able to friend any other doctor in the country and be able to execute referrals and authorization. I want to be able to execute the referral and authorization work so that they can move patients back and forth anywhere they want to move with a click and have all the crap-work go away.

How do you do that? Are you building that now?

Yeah, athena Community. We’re actually starting mostly with hospitals, because hospitals are the people that are most interested in fomenting connection with docs. But it works doc-to-doc just as easily as doc-to-hospital. And as hospitals become large acquirers of docs, they become the first eager occupants of this new, cloud-based supply chain. We piloted it, we did an alpha test in 2010, and we intend to do 15 markets in 2011 if we’re lucky. Probably won’t get there, but that’s my goal.

Everybody sees the great parts about being Jonathan Bush: smart, rich, famous. What sucks about being you?

I disappoint everyone I love. I want everybody … I want things to work so badly that I… and I’ve got the false power and then you know, the electrical energy that comes with the title and the brand that it isn’t really me. So I let them believe all the greatness that could be around the corner, and then when it isn’t, it’s like they say about me, “Shit, I really believed that loser.” 

I hate disappointing. I hate disappointing my kids. I hate disappointing my wife. I hate disappointing my ex-wife. I hate disappointing my team. And I disappoint them all, all the time, because I dream too far ahead of the curve. It’s exhausting.

But companies like Apple have someone at the top who’s a visionary and is somewhat merciless to their direct reports to make things happen, even though it may not be the most fun place to work if you happen to be one of those direct reports.

Well, yeah. I just personally can’t stand letting people down. When you have to tell someone it wasn’t enough, or you have to miss dinner, it’s just torture for me, I just can’t stand it.

Anything else you wanted to talk about?

No, I’m a big fan. I changed my kids’ vacation with my ex-wife so I can be at the HISsies.

I appreciate that. I didn’t really expect that, so that’s definitely a plus. It wouldn’t have been the same without you, I’ll say that.

It is the single thing about HIMSS that I most look forward to. It’s really fun and I can’t believe you’ve pulled off such a happening after all your .. well, I can believe that it, makes total sense, but it took huge balls and I’m glad you did it.

Monday Morning Update 1/31/11

From Expandable Beltway: “Re: VA. Opens a solicitation for VistA.” I skimmed the document – the VA is looking for help to define an open source structure to support VistA modernization. I don’t know if they’ve ditched their previous plans to buy commercial systems like Cerner’s LIS.

From Epic Employee: “Re: Epic. If you’re a star, you’ll go far. If you’re not a star, you won’t. It’s like a professional sports team – you grab the best college recruits and some work out, some get cut. You are compensated based on your talent, so your subordinates may out-earn you if they’re better at what they do than you are at what you do. You don’t have to be CxO to be financially set. If you need a manager to succeed, you won’t like it here.”

From Merger Pain: “Re: Allscripts. Over 30 sales reps let go this week.” Unverified.

From Philly BlackBerry: “Re: widespread e-mail outage Saturday morning. RIM is not commenting.”

From Lupus: “Re: sponsors. Why do you have so many?” I freely admit that I’m an incompetent, unmotivated, and staggeringly lucky accidental businessperson who just wanted to write work-related stuff for fun back in 2003. I expend zero effort to solicit sponsors. I’ll reply tersely to e-mail inquiries from vendors and the always-nice ad agency and marketing people, but replying to the e-mails is all I’ll do. Every other HIT-related blog you read is written by someone trying to sell something – consulting services, EMRs, conferences, speaking engagements, etc. I’m a money-indifferent guy who’s happy working full time for a non-profit hospital. If I get sponsors, great, I get paid for the endless hours I spend on HIStalk. If not, that’s fine since that was the case for much of HIStalk’s eight-year existence and my hospital job ensures that I won’t starve anyway. I like staying anonymous because it keeps me honest: you can’t get too full of yourself if nobody knows who you are. My About page explains everything.

From The PACS Designer: “Re: cloud basics. FedEx CIO Rob Carter explains cloud basics and how FedEx deploys a private cloud solution to run the giant package distribution system. He explains the cost advantage of private clouds this way: ‘What’s happening, and this is such a big deal in our world, is that for the first time ever, you can make investments in a whole new class of technology for about the same price of just maintaining the base.’ This cost advantage is something to think about in the effort to employ cloud solutions in healthcare settings.”

Thanks to everyone who signed up for the “I want to come” list for HIStalkapalooza. The page has been turned off since it was scheduled to run for a week. I haven’t checked the count to see if we can accommodate everyone, but I’m hoping we can, and anyone we can’t will go on the waitlist in case someone cancels. We’ll be sending out e-mail invitations soon. It’s only three weeks away, as I just now realized in near-panic as I think about all the HIMSS-related stuff Inga and I have to do between now and then. I should take a week off from work just to catch up.

Here’s the HIStalkapalooza agenda for those who need to plan their existence down to the minute. Doors will open at 6:30, starting with red carpet interviews streamed to a big screen on stage (it’s a “big entrance” kind of thing that I thought would be fun, but you can bypass straight to the bar if you’d rather). Eating and drinking commences, with IngaTinis in abundance and beauty queen sashes strutted by a chosen few. The video and photo crews will be plying their trade and I’ll have a roving reporter inside BB King’s covering the event for summarization in HIStalk afterward. The official welcome comes at 8:00, followed by Jonathan Bush and the HISsies awards (special guests are always possible, but I usually get a polite “no thanks” when I ask, so don’t count on it). We’ll have a short HIStalk Queen and King contest with voting by applause (like high school, winners will be chosen based on fashion, poise, and willingness to pander shamelessly to the audience). Inga’s BFFs will choose the “Inga Loves My Shoes” winners while most of the men head off for another beer. Our super sponsor, Medicomp, will offer up some doctor recognition at 9:00. At 9:10, the Insomniacs concert starts, running until 11:30, with food and drink available most of the evening if I remember correctly. Dancing will be encouraged by our HIStalk ambassadors, the band, and the open bar. Inga, Dr. Jayne, and I will probably be in anonymous attendance, overwhelmed and schizophrenic (am I me or Mr. H?) Everybody who works hard all year deserves a little bit of silliness and entertainment and that’s what we’re offering (but I bet that as in past years, important contacts will be made and deals will be struck by high-powered attendees hammered on IngaTinis).

A Weird News Andy graphic moment, in the form of a patient instructions handout.

Listening: Tiamat, because sometimes you need a little depressing Swedish doom metal (Pink Floyd meets Metallica) to brighten up your day. It’s good.

A reader tells me those Extormity EHR parody people will be unveiling themselves at HIMSS, revealing themselves to be sellers of some flavor of PM/EMR. I’d scoop them by announcing it here except I have no idea who they are.

These poll results confirm what people are telling me (not that I didn’t already know since recruiters are burning up my phone and e-mail at the hospital): it’s getting tough to find experienced HIT people. New poll to your right: how many hours per week do you work? I’m curious since the comments from Epic’s employees seemed to raise some curiosity. The poll accepts comments, so add yours if you like. 

Quality Systems, Inc. (the NextGen people) turns in record Q3 numbers: revenue up 23% to $91.9 million, EPS $0.60 vs. $0.46, expectations beaten, dividend raised. Board chair, founder, and former CEO Sheldon Razin holds almost $400 million worth of shares. He started the company in his garage in 1973 with $2,000 in capital and took it public in 1982. Its market cap is now over $2 billion.

I’m happy to announce Symantec as a new Platinum Sponsor of HIStalk. Everybody knows Symantec for their security products (Norton, Ghost, pcAnywhere, Veritas, etc.) but I’ll call your attention to Symantec Health. They offer Symantec Health Safe, a medical image archiving and sharing service designed to complement existing medical imaging infrastructure. Per-TB Storage costs are reduced since you pay for only the capacity you use with no upfront capital expense or data center operating expenses, lowering the total cost of image archiving by 25 to 50%  or even more. Images can be retrieved directly to PACS and shared securely online with any other provider. The trusted leader in online security is offering a free cost savings analysis. Thanks to Symantec for supporting HIStalk.

If you’re interested in more than my brief explanation of Symantec Health Safe, I found the above video on YouTube.

David Darnell, a 39-year-old VP with healthcare data analytics vendor MDI Holdings of Ponte Vedra, FL, died Thursday in car accident. He is survived by his wife and four children ages 1 to 7. Condolences.

UPMC’s insurance division forms a joint venture with UK company Ultrasis to create a US version of that company’s Beating the Blues online CBT (Cognitive Behavioral Therapy) patient tool for treating depression.

University of Iowa Hospitals opens an investigation after determining that the electronic medical records of 13 University of Iowa football players may have been inappropriately accessed. The hospitalized players have been diagnosed with rhabdomyolysis, a kidney-damaging condition caused by damaged muscle and sometimes by nutritional supplements. The university has also launched a separate investigation into the football program’s off-season workouts, which started last week.

The Methodist Hospital (TX) opens a 35,000 square foot simulation-based surgical training center that will teach physicians to use technology such as image-guided procedures and robotic surgery. One tool uses a thermal camera to determine a student’s surgical expertise.

An interventional radiologist who patented the idea behind drug-eluting stents while a medical resident in 1993 is awarded $482 million in his suit claiming that Cordis stole his idea and made $13 billion from it. Bruce Saffran, MD PhD had already settled with Boston Scientific for $50 million after winning a $431 million judgment against that company three years ago.

Mobile drug reference vendor Epocrates plans an IPO next week valued at around $50 million.

I appreciate and acknowledge the support of Perceptive Software of Shawnee, KS, a new HIStalk Platinum Sponsor. The company offers the ImageNow document management, imaging, and workflow solution that ties unstructured documents to the EMR and streamlines paper processes and workflow. The benefit: a comprehensive, hybrid patient record that improves care by offering immediate access to content, provides secure access, reduces the cost and space requirements inherent with paper, and quick implementation. It integrates with any HIT system including those from Meditech, Epic, Cerner, Allscripts / Eclipsys, Lawson, and Oracle. There’s an overview demo series here and they’ll send you a copy of The Top 10 Things You’ll Save with ECM if you mention HIStalk (or if you don’t, for that matter, but maybe I’ll score points with them if you do). Thanks to Perceptive Software for supporting what I do.

Above is video I found on Perceptive Software’s healthcare solutions. It’s just some real-life customers (North Kansas City Hospital, Asante Health System, Citizens Memorial Health) talking in a seemingly unscripted way about how they’re using the ImageNow solution.

Digital Prospectors Corp. of Exeter, NH is supporting HIStalk as a Gold Sponsor and we appreciate that very much. DPC is a fast-growing boutique consulting firm whose healthcare division provides consultants and direct-hire candidates for all areas of HIT, including experts in Cerner, Allscripts / Eclipsys, Epic, McKesson, Lawson, and Quovadx. The company has won several awards (Inc. 5000, top woman-owned business, best places to work) since its founding in 1999. I found a nice profile of the company in a local publication here and also its Facebook page. You can also check out their open positions. Thanks to Digital Prospectors Corp. for supporting HIStalk.

Awarepoint’s 2010 results include 91 hospitals contracted for its RTLS solutions (up 30%) and revenue up over 100% for the third straight year.

Bizarre: a pregnant woman that her husband has impregnated his mistress as well. She decides to kill the mistress’s baby, forging a doctor’s prescription for Cytotec, an ulcer drug that also causes abortions, and calls the woman pretending to be the doctor’s employee and tells her take the medication to protect the unborn baby against Down syndrome. The mistress takes the Cytotec, sending her into immediate labor, but the baby survives in the hospital. The wife then sends a male friend to the hospital with two bottles of poisoned baby milk, which suspicious staff refuse to pass along. Somewhere along the way, the wife pretends to be a hospital executive in an attempt to get the baby’s ventilator turned off. Says her lawyer, “My client was in the last trimester of her pregnancy and was acting irrationally.” The jury didn’t buy it: she’s going to prison for four years. I’m sure she’ll make a stellar mom.

E-mail me.

News 1/28/11

From Whillikers: “Re: vendor receiving a percentage of a hospital’s stimulus money. I don’t see this as necessarily wrong. We don’t know how the contract was worded – perhaps the vendor is sharing risk and reduced license and support fees in return for helping the hospital earn the incentive money, or maybe even faced penalties if they didn’t achieve Meaningful Use.”

From Arliss: “Re: managers not knowing what their employees make. I’ve worked in several large companies over many years and rarely knew what my reports made. Does it really make a difference? Middle management is middle management, sometimes just to manage process that happen to include certain assets called people.” I don’t know if it’s necessary to know, but you’d need a much better appraisal / rating system than places I’ve worked to take that out of the hands of managers. Epic supposedly fires the bottom 25% of its staff each year according to some of the comments I’ve seen, so I’m sure they do have such a rigorous rating system.

From Sporting Group: “Re: mobile app that rocks. Very cool development for first responders. I remember when this was an idea … how to locate AEDs and identify those with CPR training when someone drops with an MI.” The iPhone app, called Fire Department, asks when you first launch it if you’re trained in CPR and would be willing to help a stranger in need. When 911 gets an emergency call, the operator can send a push notification to those volunteers who are near the location, also telling them where the nearest automated defibrillator is. That’s brilliant if you ask me. As screwed up as America seems to be at times, its citizens will usually do anything they can to help someone in need.

From 70HourWeek: “Re: Epic work week. The long hours aren’t unique to Epic. I work 50 hours on a slow week. That doesn’t mean I like it, but our systems are constantly changing and our facilities are 24×7. Where we could improve is to recognize what we do and adopt truly alternative schedules and options to work from home. We all work long hours and are lucky if enlightened managers recognize the need for work-life balance. Epic does have a reputation for favoring young employees, which saddens me both that it exploits new hires right out of college as that it will eventually catch up with Epic.” I don’t disagree, except I’m always skeptical when someone claims consensual exploitation.

From InDenial: “Re: Epic. I keep reading that they set their price and don’t negotiate, but that’s not entirely accurate. I was previously with a large health system and Epic was definitely negotiating with us against their competitors. They didn’t get down the level of discount the others were offering, but they did make an aggressive offer that was much different from their initial proposal.” Unverified.

From Nasty Parts: “Re: eCW not paying commissions. Not true. HIStalk has a responsibility to publish facts and retract inaccuracies.” That statement, just like yours, came from a reader. I don’t claim that reader comments that I run, including yours, are 100% accurate, although they often are. In this case, Inga had confirmed with eCW, who told her that they do indeed not pay commissions, so I ran the item without tagging it as unverified. Several readers sent details indicating otherwise (such as precise commission percentages and specific salesperson income). Inga forwarded that to eCW, who then amended their previous statement to say that the company does indeed pay a few salespeople commissions (I didn’t understand or really care from their explanation which ones get commissions and which ones don’t). I believe I met the test of prudence in obtaining verification, even though it turned out to be incorrect.

From Natty Boh: “Re: Epic employee comments about hours, management, obsolete technologies, and lack of credentials to work elsewhere. How funny – this is EXACTLY what Cerner associates say as well, all except the ‘experienced Cerner resources are hard to find due to selling more big sites’ part).” I tried not to conclude from all the complaining that the upcoming generation of US workers are the marginally motivated, Facebook-obsessed, self-absorbed children of excessive privilege, instead choosing to believe that they’re doing exactly what I and everybody else should have done decades ago in refusing to sell one’s soul to an employer who sneers at paying 40 hours’ worth of salary for 40 hours’ worth of work. Sometimes all of that extra effort pays off, but generally you’re going to end up bitter after being stabbed in the back by someone with better connections, passed over in favor of a co-worker with less distaste for shameless up-sucking, or clueless management. Like the old saying goes, nobody’s epitaph brags on how many hours they spent at work.

Want to come to the HIStalk reception (aka HIStalkapalooza) at the HIMSS conference? Sign up now on the “I want to come” page since it will be turned off in a couple of days. People e-mail me every year after the fact claiming they didn’t know about the sign-up, which tells me right away they don’t really read HIStalk very carefully since I make a big deal out of it for precisely that reason. I can only reiterate: if you want to come, sign up right now, please. I’m especially reaching out to providers, who often get lost in the shuffle among all the vendors who attend – if you are a doctor, nurse, CIO, programmer, help desk tech, field support analyst, professor, or whatever you do for a hospital, clinic, practice, university, or agency, I will do everything I can to get you an invitation, which is why I changed the sign-up process. I’m not prone to hyperbole, so believe it when I tell you that it’s going to be the talk of HIMSS.

Listening: new from The Script, Ireland-based alt-pop. You’ve heard them but just don’t know it: play Breakeven on their MySpace page. It’s a little soft for me, but it’s pretty good and the new album is better.

CareTech Solutions opens a new $5 million, 30,000 square foot operations center and technology hub in Troy, MI to handle its growing business. The company has 1,100 employees, hired 200 in 2010, says it will hire more than that in 2011, serves 155 hospital customers, and expects to quadruple its business in the next three years.

EXR, the enterprise EHR from Reliance Software Systems (aka RelWare), is certified as a complete inpatient EHR and a module outpatient EHR by InfoGard. I don’t have a link, but friend of HIStalk Dann Lemerand sent over the press release. Dann started the HIStalk Fan Club on LinkedIn that’s now up to 1,328 members. I’m slightly embarrassed by having a fan club, but I can tell you without hesitation that it provides a psychological boost when I’m having a crappy day (which is thankfully rare since I have perpetually low expectations). I also admit that when someone wants a favor from me while claiming undying devotion, I often make less of an effort if they aren’t members.

Among the listings on the HIStalk Jobs Page: VP of Sales Central Region, Vendor Partner Product Executive, RVP Sales – Southeast Territory, Meditech ADM B/AR Sr. Consultant. On Healthcare ITJobs: Epic Cadence Application Coordinator, Pharmacy Informatics Specialist, Clinical Data Analyst, Epic ADT Consultants / Analysts. Lots of good jobs there from Vitalize, Marshfield Clinic, Joint Commission, Olympus, Ivesia, and other companies.

Ryann Winn, former IT director at Munson Health (MI), is named VP/CIO of MidMichigan Health.

CPSI’s Q4 numbers: revenue up 28%, EPS $0.61 vs $0.33, beating the bejesus out of consensus estimates of $0.43. The company also declared a dividend, although one might argue that in the rapidly growing HIT sector they might have been better off using the money to grow or acquire instead of sending out tiny checks that non-grandmotherly shareholders don’t usually care about.

The Methodist Hospitals (IN) is suing consulting firms FTI Cambio and HealthNET as well as Meditech for convincing the hospital to abandon its in-progress, $26 million Epic implementation and instead spend $16 million to replace it with Meditech to save money. Methodist wasn’t meeting its bond covenants, so it hired Cambio and subcontractor HealthNET to evaluate its Epic project. The two firms said it would cost $25 million more to install Epic, although the hospital says the real number was closer to $11 million. Methodist also claims that the consulting firms advised them to dial back their security protection, which led to a widespread virus infection. The hospital says it gave up on the Meditech implementation in 2009 after finding that data wasn’t being updated properly, which had forced employees to go back to charting on paper. Interestingly, the hospital claims its own CEO, CFO, and COO were also responsible because they were all Cambio employees. Methodist wants out of its Meditech contract and is asking for $16 million in damages. I guess the lawyers have to get involved when a tanking hospital has spent $42 million on two abandoned IT projects and is still stuck on paper, but I’ll also be interested to hear the other side of the story, which is probably just as believable despite being the opposite of this version. As for saving money with Meditech, I don’t doubt it a bit – I bet if you compared annual maintenance between Epic and Meditech it wouldn’t have taken long to cover that extra $5 million to switch.

The new 289-bed, $1.6 billion UCSF Medical Center at Mission Bay (that’s  $5.5 million per bed, $1,800 per square foot) requires an $80 million contract for wiring alone. It will have a wireless Distributed Antenna System to feed EMR access to touch-screen systems at each bed. The announcement says the new hospital will be a showcase for best practices, presumably not among them being building an affordable structure that won’t require the hospital to milk the healthcare system for generations to pay off the debt. I just don’t get why we need Taj Mahospitals when healthcare costs are already making the country non-competitive globally. I’ll bet money that their Edifice Complex doesn’t improve their patient outcomes a bit (and you don’t even need an EMR-type study to easily find that out).

I’m not going to harp on this, but it’s odd: the rags that e-mail out healthcare IT related news blasts don’t seem to have a clue which press releases they use as sources really relate to HIT. Case in point: Cisco is buying Pari Networks, which offers network management tools. So why is one networking company buying another hot healthcare IT news worthy of an e-mail? Those updates always have unrelated junk about some non-healthcare arm of Siemens, a non-HIT related acquisition by a vendor for whom healthcare is a small vertical (like Cisco), or some pharma executive’s promotion. If you get those updates (and actually read them), I bet you’ll find at least one “why should I care” story written up in breathy excitement in every one of them. If I’m wrong, tell me.

A string of medication errors at Seattle Children’s Hospital, two of which occurred in babies who died, cause the hospital to scramble to regain its credibility. Hiring the Institute for Safe Medication Practices to review their processes isn’t going to do it for them, as ISMP finds many problems, including a “culture of intimidation” in which doctors belittle nurses and senior doctors and nurses alike bully their junior peers. The day before the report was announced, the Department of Health found that the hospital may have killed a baby being transferred by regularly allowing transport nurses to give meds without a doctor’s order.

The former ophthalmology chair of Temple University School of Medicine is charged with insurance fraud by the Department of Justice, which claims he submitted more than $3 million in false charges for patients he didn’t actually see. DOJ says the doctor told employees to bring him the charts of patients seen by other doctors, which he would then alter to indicate that he had evaluated the patients.

E-mail me.

HERtalk by Inga

Mississippi Medicaid contracts with ACS for use of its State Level Registry solution to manage EHR incentive payment applications, including verification of qualified applicants and certified EHR use.

Telehealth provider Teladoc Medical Services secures a $4 million investment from Cardinal Partners and HLM Venture Partners.

Dana-Farber Cancer Institute (MA) selects Versus Advantages RTLS for patient tracking, room utilization, workflow optimization, and reporting. The system will be deployed at Dana-Farber’s new Yawkey Center for Cancer Care.

Three hospital companies and two hospital systems invest in the Heritage Healthcare Innovation Fund, a venture fund targeting healthcare services and HIT. The fund says it can place up to $10 million in early- and growth-stage healthcare businesses.

AirStrip Technologies appoints Alan W. Portela to its board of directors and to serve as the company’s senior strategic advisor. He’s the founder and CEO of Hybrid Clinical Transformation and the former president and current board member of CliniComp.

New from KLAS: providers are planning to purchase more diagnostic imaging equipment in 2011. Radiology departments anticipate spending about $200 million on equipment this year, 10% more than last year. Siemens and GE are the most-considered vendors in the space, but competition continues to grow. MRIs are the most discussed purchase, followed by CTs, ultrasounds, digital X-rays, and digital mammography.

Swedish Medical Center (WA) experiences a four-hour shutdown of its Epic EMR, forcing providers to use pen and paper to document. The system automatically turned itself off upon noticing an error that could have potentially corrupted data. During the outage, users across all Swedish’s campuses could see data, but not add or change anything. The health system is now exploring “more sophisticated levels of backup,” which might include a giant server in a different geographic location.

Laurens County Health Care System (SC) chooses Summit Healthcare’s Summit Scripting Toolkit to automate billing and administrative workflow within its CPSI system.

I’ve enjoyed the dialog this week about HIT salespeople and commissions. I think Mr. H had it wrong, as many pointed out. Most companies don’t pay 100% of the commissions when the sale is made, and thus are highly motivated to make sure an implementation is successful. Car salespeople probably get paid 100% up front, but HIT is a different beast. Salespeople who are in it for the long haul will sell clean and earnestly work to make sure their solution fits their clients’ needs. Those that sell a “bad” deal and leave it to others to clean up lose credibility within their organization and find it difficult to get assistance on the next deal. Customers remember the sales rep who did them wrong and happily share their woeful story with potential customers. Other vendors also learn the names of “sleazy” sales reps and have no interest in hiring them after they’re fired from the  original company. Of course there are a few bad eggs in the business, but, I believe there’s honor in being a commission-based salesperson in HIT.  Every successful salesperson I’ve ever met works 50-60-70 hour weeks, which means they miss miss out on soccer games, birthday parties, and bunco (!) Base pay ranges from 40K to 120K (if you are a superstar.) That means that if you aren’t closing business, you’re not exactly making the big bucks. A big deal may pay a big commission check, but you may only close one or two big deals a year. In the ambulatory world deals are smaller, so a salesperson must close multiple sales a month. To be successful, a sales rep must effectively manage time and resources. If you are a sales rep working on commission, I salute you for your hard work and believe you when you say you’re committed to your customers’ success.

Hill-Rom posts 77% growth in its first quarter earnings and a five percent increase in revenue to $374 million. Revenue from the company’s North America Acute Care segment grew 6 percent to $218 million. Capital sales rose 12%, led by a 22% jump in sales for patient support systems.

Communicating via social networking leads to faster hook-ups, according to a new survey. To test the theory or to just make us feel desired, you can friend Mr. H, Dr. Jayne, or Inga on Facebook; additional foreplay opportunities are available by liking HIStalk. Find us on LinkedIn as well.

This week on HIStalk Practice: pay for performance programs don’t improve outcomes. Dow Jones files suit to allow open access of Medicare records containing provider payment details. Louisiana Medicaid issues the nation’s first EHR stimulus for an FQHC. Dr. Alexander says finding an EHR ain’t easy. Dan Nelson, a practice administrator for a family practice group, discusses his testimony before the HIT Standards Committee’s Implementation Workgroup.

Dr. David Blumenthal posts a new note on ONC site, noting plans to increase REC funding to $32 million and to award $16 million in new Challenge Grants to encourage HIE innovation.

I can’t believe WNA didn’t send us this story. The Florida Supreme court refuses to overturn a slander award against a hospital executive in favor of a surgeon. The surgeon had been denied surgery privileges at the hospital’s open heart institute. The hospital executive, in describing the surgeon’s skill level to another surgeon, said, “I would not send my dog to him for surgery.” A jury awarded the surgeon $5 million in punitive damages.

E-mail Inga.

Sponsor Updates

• St. Patrick Hospital and Health Sciences Center (MT) contracts for the Meds Tracker medication reconciliation system from Design Clinicals.
• Kansas Health Information Network chooses the CareAlign solution from Informatics Corporation of America for all of Kansas and parts of Missouri. It provides a provider and patient portal, secure clinical communication, interoperability, EHR Lite, population management tools, and a patient health record.
• McKesson declares a shareholder dividend of 18 cents. Shares are trading near their 52-week high and are almost back to their pre-HBOC meltdown levels of 1998.
• GetWellNetwork is named among Washington DC’s fastest-growing companies.
• F.F. Thompson Hospital (NY) will replace its existing hospital information system with McKesson’s Paragon HIS.
• Voalté releases a white paper called The Smartphone Tsunami – Will Your Hospital Sink or Swim?

EPtalk by Dr. Jayne

I’ve enjoyed reading some of the testimony from last week’s HIT Standards Committee Implementation Workgroup. My new crush is Robert Murry, MD, PhD, medical director of informatics at Hunterdon Medical Center (NJ). His testimony has given me a host of phrases I’ll be stealing when I next speak with hospital executives who continually expect their IT resources to deliver the impossible again and again. Among my favorites: doing an EHR upgrade in a large organization is like “upgrading the engines on an airplane while it is flying.”

Murry also goes on to say that by interfering with the go-live schedule and causing resource strain, “meaningful use has slowed down our implementation schedule, perversely having the opposite of the intended effect of rapidly rolling out robust EHR technology in our enterprise.” He lobbies for more clinical informaticists to “speak the language of physicians, understand their time pressure, perfectionism, and medico-legal stresses, but also able to understand IT, prioritize development and implementation resources, and construct the amalgam of workflow and software changes that is acceptable efficient in practice.”

CIOs and IT purists, take heed — you need someone like this in your organization, whether you call him/her a CMIO or not. You’re not just slapping a system in a doctor’s office, you’re potentially imploding their entire workflow. The last word: “EHR implementations fail when they became IT projects, as opposed to clinical projects involving technology.”

Dr. Murry, if you’re out there, I hope to see you at HIStalkapalooza. I’m still working my way through a lot of the testimony, so if readers have other favorites, e-mail me and I’ll bump them to the top of my reading list.

Several people have written to follow up on my PQRI to PQRS comments, particularly on how the new acronym can be pronounced. Some of the suggestions are downright hilarious, but I’m too much of a lady to quote them, so feel free to comment below with your thoughts.

I’ve had a pretty harsh week at work, which has led to the need for an unusual amount of vegetative Netflix, Facebook and YouTube activities. I’m a big fan of www.xtranormal.com so thanks to Betty for brightening my day with this one (and yes, I think I did see this patient the last time I had office hours.)

Speaking of Facebook, I just passed the 50-friend mark. Not anywhere near Inga-like status, but it’s helping me feel part of the HIStalk universe. The friend suggestions I’m receiving look like fun people, so don’t be surprised if I start randomly friending you.

Have a question about medical informatics, electronic medical records, or how many pre-meds cheat on their chemistry labs? E-mail Dr. Jayne.

HIStalk Interviews Jeff Surges, CEO, Merge Healthcare

Jeff Surges is CEO of Merge Healthcare of Chicago, IL.

Tell me about yourself and about Merge Healthcare.

Merge Healthcare is a leading provider of imaging information systems. Over time, it has consolidated a number of acquisitions in the imaging space, neutral archives, PACS, and branched that out to any provider looking for solutions that an image would follow in the –ology or –ography space. Publicly traded on the NASDAQ, 730 employees, and aspiring for the future of interoperability and connecting to electronic health records.

I’ve been in healthcare IT on the vendor/provider side since 1995. I’ve been with a number of companies on the management team. Built, taken public, sold to HBOC back in the day, funded my own company called ECIN, which was a start-up that helped case management and discharge planning, ultimately sold that business to Allscripts in 2007, was on the senior leadership team for Allscripts during their acquisitions of Misys and most recently Eclipsys. I joined the board of directors of Merge back in June of 2010 and joined the company as chief executive officer on November 9, 2010.

You ran sales at Allscripts and Michael Ferro said you were chosen for the Merge CEO job with one of your responsibilities being to build a similar sales organization. What’s involved with that and what’s the desired result?

I think that what we find similar in my past and the opportunity here at Merge is solution selling, consultative selling, and relationship-building. Those are the three primary objectives if you want to gain the trust of CIOs, COOs, CEOs, and CFOs. Having experience in this business is important.

A key ingredient in both my Allscripts days and here at Merge is successful products, successful teams, and building great relationships with clients and partners and your employees so that the word trust is what ultimately binds everybody together.

Merge’s portfolio creates that opportunity on the back side. Bringing in and complementing the existing team with industry people throughout that have similar qualities that we look for will help Merge with that message as we educate people about the new Merge in the coming years.

You mentioned in the recent earnings conference call that Merge is a well-kept secret, but a lot of the news about it has involved fluctuating share price, executive turnover, and boardroom drama. As you’re trying to get the word to the two publics that you sell to — the IT departments and the radiology decision-makers — what message do you take to them?

I think what has always worked for me in the past and the companies that I’ve worked with is to prioritize your clients as the top of the food chain and talk about your value proposition — the problems you solve, the return on investment you create, how your systems compliment their existing strategies as they lay out five-year plans and strategies for their own businesses. We have to position ourselves to help them be successful, because inherently their success becomes the company’s success.

A lot of the historical perspective on Merge is good reading for the weekend, but it doesn’t solve client problems and it doesn’t return value to the customer who bought the application. I think if we follow suit, which I’ve been able to do in the past, the DNA of the company is really client-driven on solutions.

One urgency is that PACS has become a price-sensitive market, almost a commodity, and big companies that sell other products can lowball their PACS price and make it up someplace else. Is that part of what needs to change about the business, or do you have a different strategy to compete in that environment?

Merge looks at the opportunity two-fold. One is to re-establish the value of the existing PACS system. Rip and replace sounds exciting, but is heavy lifting and requires a lot of money when dollars are tight.

The second piece then is to show how that investment can be re-traded to other value propositions and interoperability. Moving images across the continuum of care to vendor-neutral archives and moving that image to the electronic health record becomes a great complement with not a lot of investment. We can capitalize on what’s already a sunk cost and show value that way.

Imaging is on the upswing again, with people talking about sharing images beyond just looking at them for diagnosis. Do you see a fundamental change that’s a second wave of digital images?

I think the affect of ARRA and this Meaningful Use driver has asked people to not only implement electronic health records — and those winners are going to be decided in time — but then find the credible assets to add to the electronic health record. While interfacing flat-file data is going to be important to round out the view, nothing is going to be more important than the image. It’s one of the first things everybody asks to see. It’s one of the first things people want to get their hands on.

Yet inherently, prior to PACS, neutral archiving, and images being in an interoperable state, it was heavy lifting. You needed big pipes to move the data. I think what we’re seeing with cloud computing, hosted PACS, as well as Web access, you’ll see that images can move real time to accommodate the schedules of physicians every day.

I was interested that the company has said that more than 90% of the data that providers generate is in the form of images, which really makes them a key component of electronic health records. Do you think that Meaningful Use emphasizes images enough, or do you think that providers already know that and it doesn’t further emphasis?

I think Meaningful Use has provided radiologists and the whole industry with two opportunities. One is they can qualify for Meaningful Use on their own by getting to a certified EHR that has and meets the criteria. 30,000 radiologists in the country have a $44,000 opportunity each, which creates over a billion dollars of market opportunity to qualify.

Secondarily — and maybe more important to community healthcare, to accountable care, and this bundled payment story — is the interoperability of the image. For Stage 2 and Stage 3 funding, we are seeing the importance of the image being attached to that record. Whether it’s from the American College of Radiology, whether it’s from RSNA, or the eCoalition of imaging, we’re finding third-party constituents really rising up right now and talking about not only Meaningful Use for the radiologist’s practice, but for the image being a critical part of Stage 2 and Stage 3.

The early challenge was capturing and storing images, but now it seems it has advanced to the point that metadata is being used in different ways, where the image is more than a picture that you just go look at by clicking a link in the EMR. Where do you see the use of images in the EHR going?

We really have seen two focuses there. One is the general availability, which I would call, “How do I get access to the image?” Second, which is really the more important question, is, “What’s the quality of the view of that image — is it 3-D, is it a zero-client view, can I move it from a mobility or a cloud standpoint so that it’s a value-add to the decision that either a radiologist has to make on that study or that the physician has to make when making a care plan decision?” 

Early on, people want to review the investment on the PACS, but there wasn’t a quick way to do that. Starting to see the cloud, starting to see an iConnect share model allows you to move studies within your continuum of care and within your community. Whether that be called interoperability or intraoperability, you’re starting to see that. That will ultimately reduce exams, duplicative exams are what a lot of our clients call convenience exams — that is, “I don’t have my X-ray with me.” “Oh, that’s OK, let’s take another one.”

We want to help the efficiency model by moving that through the connection, as well as starting to track radiation dosage. If every time it was convenient just to go in for one more scan, you’re actually putting more radiation in somebody. California back in November made a law on tracking radiation dosage, we start to think about that for overall consumerism and patient health.

I wanted to ask you about interoperability and connectivity because I know it’s been prominently mentioned lately, especially with the iConnect suite that was pieced together from some of the acquisitions. How does connectivity fit in with where you want to take the company?

I think the ability to move the image and the ability to share the image — not only within a health system that wants to be efficient for their own owned entities, but then as you collaborate your care model in a community where you’re working with affiliate organizations — you have to be able to show up with a model that says, “Not only can I move the records, but I can also move the image.”

iConnect in the value proposition suggests that you can move it from within the system and outside of the system by connecting it to the interoperability standards, connecting it to our third-party partners, and connecting it to government or federal-type opportunities where for Medicare and Medicaid, the uninsured scans are some of the most expensive ones out there today. It’s an efficiency play, and it’s the ability to really complete the record for 70 to 80% of those records that require the image to be present.

If you look at your competition, what advantages does iConnect give you?

Most importantly is that it’s available today. We have customers that are using it. We’re moving images electronically in the operable state. 

What we continue to see is people wanting to know what it’s going to be like and what they’re planning to build. We have existing customers – 1,500 hospitals, 6,000 imaging centers — that today say, “I need to move those images now. How do I get started with my connectivity story?” We can actually start implementing that.

There are existing community models out there, whether it’s with our partners on the electronic health record side or new name partners that want to collaborate to move the image. You have to be able to show up under this time-sensitive trail of Meaningful Use and say you have it, you have it available, and you can meet the project plan. 

Years ago, without a Meaningful Use carrot and stick, you had a lot of people saying, “Well, we’ll delay. We’ll go live next year. We’ll go live next year.” I think the sense of urgency to capture the reimbursement is really the call to action to get people excited, but I think the end-state of a complete record has the radiology industry excited and the overall connectivity play.

The sense of urgency must include HITECH and the potential for Accountable Care Organizations, where images may need to be shared with folks who haven’t been shared in real time before. Is that what your customers are telling you is most important to them right now?

Yes. Back in November at the RSNA show here in Chicago, one of the recurring themes we heard loud and clear from not only OEM partners, customers, and prospects was that this time is now. We have to move now, because of the sensitivity of not only meeting the standards, but the timeline. The larger hospitals and health systems have longer plans, but they have to start now.

Some of the other radiology centers are just learning about this, so there’s almost a catch-up mentality going on in this industry that wasn’t present in my last industries where Meaningful Use and EHR was front and center. This one here is catching up. I think Merge has an opportunity, as does the whole industry, to quickly educate and facilitate this transition.

How have mobile devices impacted your business and the industry in general?

We continue to think of mobile devices and mobile computing as an ongoing opportunity. I think Merge, like everybody, saw the iPad and the iPhone and the Droid as something that they quickly had to showcase, but then practically had to figure out what the longevity, what the real value was.

On the imaging front, you have to be able to have a quality image that somebody can read real time to make an informed decision. So not only is the end-state of the device important, but the quality of that image, the way to move that image, and to do in seconds and not minutes becomes the priority. Having the end-state solved looks good. It is all the work that the client expects to be able to move that image quickly when time is of the essence, so, we see a lot of focus on the speed and the cloud, more so than the device right now. That seems to be solved.

It appears that Merge has multiple PACS and archiving products that overlap. Are there plans to change the product line?

Most of our focus in on, not only the current client and the retention on their investment, but really focused on the next generation. That kaleidoscope, so to speak, allows us to take existing functionality from only a couple of systems and bring it forward, partner with our advisory groups and our clients, and build a next generation of PACS or next generation of neutral archive. 

iConnect is already bringing that to bear. We’re showing those results. We’ll continue to capitalize on the iConnect investment that sits on top of, in many cases, the current customer’s opportunity, and then can also show an upgrade methodology for some of the systems that are maybe longer in the tooth that need reinvestment because the customer strategy has changed.

But you have no immediate plans to retire or sunset any products?

Most of our announcements that we’ve made around products were made at each of those acquisitions to those clients. We have not come out recently our plan to announce any big sunsets. We have a user group for over 600 client attendees coming in the late spring-early summer and our teams will be hard at work, working with clients on showing them how to upgrade, how to move for Meaningful Use to qualify, and how to get ready for interoperability and iConnect.

It’s been almost a year since the AMICAS acquisition. How would you say that’s gone?

If I were to qualify and judge that by the client attrition, I would say it’s an A-plus. The client base within AMICAS has been impressive in terms of their utilization and impressive in terms of how they extract value from that investment.

I think the uncertainty around “who’s on first, what’s on second, I don’t know’s on third” has presented Merge with a great branding opportunity to showcase where we are today, where we we’re going, and why that client base is so important to Merge, and again, focusing on the client. The back half of FY10 and all of FY11 will be really focused on our customer base, which is large and growing and valuable to the company.

In that regard, are you generally happy with the KLAS ratings and the trend within those for your product line?

Again, I want to reiterate that so much of our acquisition strategy over the last 24 months — it started with the end in mind, which is as we saw interoperability and we saw Meaningful Use coming, we had this asset called the image. Strategically, each one of our acquisitions that we’ve made all have a similar theme. They’re complementary to the overall image and its importance to the record, and it stayed in the interoperable world. I just wanted to make sure that that was clarified. That’s an important base.

Yes, I actually am very pleased with not only many of our KLAS ratings, but the amount of people that are filling out the surveys. Because what you ultimately want is feedback to improve. As I deep-dive into the KLAS surveys, as long as we’re getting feedback, we’re getting told where we’re strong and where we can improve and again, having some history with KLAS in my past, I’m pleased with where we start from here. 

In the state of an acquisition, it’s always an anxiety state for clients, but to be in some of those ratings, I feel that’s a place that we can improve on and it’s a goal. It’s the feedback loop that KLAS actually gets for you that you have to have as a trusted resource. That’s one of the ways I view it.

The company has, seemingly to me, pretty quietly moved into software clinical trials, laboratory information system, and anesthesia via acquisition. What was the attractiveness of those markets and how do those products fit in?

Each of them has a unique component to the story. The acquisition of the AIMS Anesthesia System starts to bring us into a perioperative state, starts to lean into the view of surgery and where there’s images. That documentation and that certification is an important asset to have. It also gets us connections to devices, which in many cases as you know, to complete a record, you have to have device connectivity.

On the clinical trials front, we have long seen a growing interest in imaging. As our portfolio stack has the image as its interoperable value point, the portal to clinical trials allows all radiologists that are looking at studies from around the word to view into clinical trials and to take full advantage of any trial opportunity that can lead to an opportunity for enhanced care. The etrials acquisition years ago was a thought-provoking one that recently has started to grow in our own portfolio. The interest level for radiologists to view and search for clinical trials within the portal gives us a great opportunity.

The last you asked about, lab, was really an opportunity for us to get data in a quantitative state so that we could link it to images, pull it through the devices, and start to really connect lab and lab information to the image. We think that’s important. We also looked out a little bit and see the digital pathology, digital oncology, and if you take the blood tests alone which are all on film and convert that to digital, you can quickly see the size and the capture rate of what would need to change in those business models. The laboratory information system is a way for us to walk into that industry, learn about the industry, and pull the image into that model.

If you look down the road three to five years, what, where do you hope the company goes or what changes would you like to have made by that time?

I said on the first day I started that I thought Merge had a head start over all of its competitors in the imaging space because of the acquisition and the strategic acquisitions it took on. I think there’s a billion-dollar opportunity here.

I’ve been part of two different companies as a part of a key leadership team to grow businesses. I think Merge has the culture, the portfolio, and with the stimulus reimbursement, interoperability, and connectivity, I think a marketplace has been created. Typically you can plan for two of those, but you need a third market to suggest that itself is available. That’s what I think we found in the connectivity play and the interoperable space. 

I continue to not only see Merge leading on the radiology and information technology side, but I also think you’re going to see much more consumer advocacy around health records, wanting their image locally or resident to their personal record. I think this radiation dosage is going to be a call to action on consumer activism. I think Merge is going to look at over millions of images being scanned and taking place a day as an opportunity to participate in a leading capacity in this industry.

Any final thoughts?

We continue to look at the current landscape in healthcare, healthcare IT, and look forward to not only this coming HIMSS, but also the next pronouncements on Meaningful Use Stage 2, Stage 3, the importance of the image. As we’re seeing not only on behalf of our clients, but on behalf of the marketplace, people are starting to realize that the most important piece of a record is the image. It’s the picture, it’s the view, and it tells a lot of the story that’s important to have if you’re going to set up a care plan or a treatment plan.

News 1/26/11

From Mandrake: “Re: HITECH. I heard from someone that [vendor name omitted] is writing into their hospital contracts that if the hospital gets stimulus money, the vendor receives 10% of it. I thought these dollars were for hospitals, doctors, and patients, not IT vendors. I hope this is wrong, because it definitely isn’t right.” I e-mailed the vendor in question, which has not replied so far.

From Bobby Orr: “Re: HIMSS. Not only for vendors. Here’s an interview with a community hospital CIO who’s also a HIMSS board member.” Mass High Tech interviews Scott MacLean, CIO at Newton Wellesley Hospital (MA). It’s part of the Partners system, but he says neither his administration nor his docs view IT as anything more than a support function.

From QPFC: “Re: Epic. On Glassdoor.com, ex-employees have some very interesting things to say about Epic. Judy only gets a 58% rating.” Those things are fun to read, but most of the posters have a company axe to grind (and 140 comments out of an always-churning several thousand employees isn’t a large sample). A common thread is that the new grads Judy hires resent the work hours, the not particularly talented middle management, the obsolete technologies used there, and the fact that they leave Epic unqualified to work anywhere else. It might be worrisome that turnover is mentioned often, not a good thing when experienced Epic resources are hard to find and they keep selling more big sites, but all Epic really need is an endless supply of fresh, naive liberal arts grads and three months to train them. Candidates with those minimal credentials aren’t hard to find in this economy.

From IT Director/Informatics Professor: “Re: HIStalk. I really enjoy your blog (it’s the only one I read) and believe you provide a wonderful service to the industry, provide thoughtful guidance on an array of issues, and do so with humor, integrity, and grace. Great job!” Thanks. I need a little encouragement now and then and I appreciate yours.

From Unicorn Rider: “Re: Norton. Partnering with Humana to build one of the four ACO partner sites. They are also a ‘future’ Epic site, which must mean they’re getting ready to start their build.”

Sign-up for the HIStalkapalooza “I want to come” list continues. A few folks reported an error when they clicked the Submit button, so here’s my suggestion: go ahead and sign up again, even if you already did. We’ll de-dupe the list later. I’d rather spend the time cleaning up the list later than have someone miss out because of a technical problem (maybe we overloaded the site or something since lots of sign-ups went through just fine). Response has been, shall we say, brisk. Sign-ups will end shortly (maybe by Friday), so do it now. I always get e-mails right up until HIMSS from readers who claim they scrutinized HIStalk carefully, yet somehow missed the multi-paragraph announcement (with pictures and video, no less) that the sign-up was open. And just to be clear, you will not get an e-mail invitation directly just because you came last year – you still need to sign up.

Huguley Memorial Medical Center (TX) goes live on the Shareable Ink Anesthesia Record, the first of 34 hospitals served by NorthStar Anesthesia to implement the digital pen and paper solution. The company’s technology also powers the T-System DigitalShare ED solution, for which I found the new video above.

The Iatric Systems folks did a really good video parody of Ozzy Osbourne’s “Crazy Train” called “HITECH Train.” They asked my  permission a few weeks back to use HIStalk in the video and lyrics, so you’ll find it there. “I’ve read the objectives, I’ve read all the rules, all eight hundred pages, of Meaningful Use, I’ve read HIStalk, listened to Blumenthal, will we get incentives,  or nothing at all?” The HIStalk part is at 3:03 (the timer counts down instead of up). It may be a 30-year-old song, but I’m still air guitaring to it right now, and parody or not, Iatric’s version rocks.

Yet another study finds that evidence is lacking that EHRs improve outpatient care quality. The definition of “quality” is as slippery as always, in this case tied to simple indicator measures like documenting smoking cessation counseling and routine blood pressure monitoring. The EHR cheerleaders are crying foul since the data set was from 2005-2007, but it’s hard to believe that systems have really gotten hugely better since then (the better argument would be that the indicators themselves weren’t as well accepted that far back). Still, if EHRs can’t move the needle on simple, well-accepted quality measures, they aren’t likely to do much else, either. They’ll get credit down the road, though, since pay for performance will improve those measures coincident with increased EMR adoption (since government incentives simultaneously encourage both). My interpretation is that this study, among the majority of others that try to tie EHR adoption to outcomes, failed to find a correlation, but that doesn’t mean there wasn’t one, just that one wasn’t found using the measures identified. That would be slightly bad news for those with skin in the EHR game, but it’s pretty terrible news considering the billions of taxpayer dollars being spent without rock-solid evidence that patient care will improve in return. But hey, it’s stimulus money, and nobody’s holding anybody very accountable for how it’s being spent.

The Australian profiles New Zealand-based healthcare IT vendor Orion Health, which us running 22 major projects in 12 countries, including a big one in Singapore. The article has a tiny mention at the end that Orion partner Allscripts is vendor of choice for an 80-hospital state EHR project, announced in November. That’s a huge Sunrise deal.

Some updates / corrections to the unnamed reader’s list of new Epic sites sold in 2010. Johns Hopkins is evaluating, but has not committed. More reader-reported recent sales: Kadlec Medical, Resurrection Health – Chicago, Providence Oregon, Providence Washington, Owensboro, and Yale New Haven.

A few more Epic tidbits. The ones I can share, anyway (others I was sent are proprietary and I know Epic would not be happy to have them divulged):

• Epic managers are not allowed to know what their own employees are paid. Epic frowns heavily on sharing salary information.
• Epic does not negotiate price with prospects, but may consider looking at terms in some circumstances. You pay what they say, and even the method of setting the price (volume, whatever the market will bear, etc.) is secret.
• A new sale is celebrated by playing wedding music over the PA and customers are encouraged to send in a video skit or to be played at the monthly staff meetings.
• Epic will not budge on its principles even if a sale is threatened.
• Sales demos are exactly what you’d be buying – they do not demo future releases or vaporware. Demo people are key people with deep clinical experience and product knowledge, but the salesperson disappears as soon as the contract is signed and you get turned over to a project director.
• Epic employee churn is picking up, but technical support continues to be the best of any vendor (this comes from a large site).

EMR vendor gloStream offers practices a full refund on software and services if physicians aren’t back up to their usual full patient load within 15 days of the implementation completion. Sounds good, although I’d want to take a careful look at the wording of the agreement since I’m sure the company has to protect itself against lack of customer initiative.

eCareSoft, a Texas-based company affiliated with Mexico’s largest EHR distributor, launches its certified, SaaS-based inpatient EHR for small to medium hospitals. Details are skimpy (like exactly which modules are being offered), so it’s hard to say if it’s worth a look.

I can’t decide what to make of the response by HIMSS to the PCAST report. This part seems unusually frank for an organization mostly known for exuberant vendor cheerleading: “Most health IT systems are proprietary, do not adapt well to workflow changes, and have difficulty supporting interoperable exchange.” There’s a lot of technical discussion of meta-tagging data. HIMSS also expresses concern that PCAST pitches the idea that we don’t need a universal patient identified given all the pieces of information that can collectively identify a patient positively, but HIMSS says it’s not that easy (citing the fact that the only big EHR implementations in the country all have identifiers – VA, Kaiser, etc.) HIMSS also warns that tagging individual data elements isn’t the right answer, that you need the context contained in the original document. I wasn’t interested enough to scour the response in detail, but I found myself agreeing with the HIMSS position most of the time.

David Brailer will speak at a Brookings Institution discussion on personalized medicine and HIT in Washington, DC this Friday.

Quantros will implement its patient safety and compliance solutions at Oasis Hospital in the UAE.

The Burlington, VT paper profiles PKC Corp. the local 25-researcher company formed in 1991 by Dr. Lawrence Weed. His “Problem-Knowledge Couplers” match patient information to a medical database to generate diagnosis and treatment suggestions. IDX co-founder Rich Tarrant sits on its board.

Philips turns in weak Q4 numbers, mostly due to weak TV sales. Healthcare did OK, with earnings beating estimates slightly and up 15.5% from a year ago.

I ran across LifeBot, which offers telehealth and EMS applications, including its DREAMS ambulance telemedicine system developed with the US military, Texas A&M, and UTHealth (the program is led by world famous trauma surgeon Dr. Red Duke).

In Victoria, Australia, the overdue and over-budget HealthSMART project, which offers Cerner Millennium as its cornerstone clinical system, is rumored to be facing cancellation.

E-mail me.

HERtalk by Inga

From Evan Steele: “Re: Meaningful Use IQ Quiz. I thought you would find these stats on the quiz interesting. Before Mr. H mentioned the quiz on HIStalk January 21st, 692 people had taken it and the average score was 56.9%. After the mention, we had a surge of 164 quiz takers and the average score was 57.3%. Most of my blog readers are from the ambulatory side and I’d imagine that HIStalk readers are more from the hospital / CIO side. The conclusion is that the meaningful use knowledge of the ambulatory and acute folks is about the same.” Quiz here, if you haven’t seen it. If you care to annoy Mr. H, ask him to share my my MU IQ score.

From Svelte Dude”: “Re: Phreesia. Will name a longtime Allscripts/Misys director as VP of sales to run its patient check-in business.”

Clairvia says numerous academic medical centers have recently selected its Physician Scheduler, including Children’s Hospital of Philadelphia, the University of California Health System, and University of Utah Health Care.

UMass Memorial Health Care deploys Merge’s iConnect Access imaging distribution solution, giving affiliated physicians the ability to view medical images from their EHR.

Vermont Blueprint for Health signs an agreement with Covisint for its DocSite solution. Meanwhile, the Greater Tulsa Health Access Network selects Covisint’s ExchangeLink for its HIE infrastructure.

DiagnosisOne partners with ACS to deliver clinical decision support and lab data management solutions to ACS’ pharmacy benefits management and HIE solutions.

TeleHealth Services names Joel Harris VP of corporate development, tasked with identifying and evaluating potential M&A targets and managing product strategy. He’s a former senior director for Pfizer and spent eight years as TeleHealth’s VP of operations.

CCHIT grants ONC-ATCB 2011/2012 to Beth Israel Deaconess Medical Center (MA) under CCHIT’s new EHR Alternative Certification for Hospitals (EACH) program. The EACH program provides testing and certification for hospitals with self-developed software.

St. Joseph Medical Center (MD) selects ProVation MD software for gastroenterology procedure documentation and coding.

MedVentive president Nancy J. Ham joins the board of directors of NxStage Medical, a manufacturer of dialysis products.

Saint Francis Medical Center (NE) implements Interbit Data’s NetDelivery Integration Module, giving it the ability to transfer Meditech lab results to physicians’ EMRs.

The University of Louisville Physicians (KY) will roll out EHR to over 500 healthcare professionals as of February 1. Allscripts, I believe.

By February, all ER physicians at DePaul Health Center (MO) will be using scribes for electronic medical documentation. Administrators hope to improve staff productivity as well as patient satisfaction. Apparently patients were “annoyed” that doctors were sharing their attention with a computer.

Doctors Hospital of Sarasota (FL) chooses EXTENSION’s Cisco and smart phone-integrated healthcare team communications solution.

The US Information Systems Engineering Command awards Harris Corporation a one-year, $10.6 million contract to upgrade the communications and IT networks at 23 US Army Medical Treatment facilities.

HHS Secretary Kathleen Sebelius reports that last year, the government’s healthcare fraud prevention and enforcement efforts led to the recovery of more than $4 billion. In addition, the government filed criminal charges in 488 cases involving 931 defendants, 726 of which were convicted.

Sebelius also announces that an unspecified amount of new grants will be available to help states implement health insurance exchanges.

United Memorial Medical Center (NY) will replace its legacy document management system with Perceptive Software’s ImageNow ECM solution.

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

• OCHIN, an REC and non-profit provider of HIT systems and services to community based clinics, announces plans to resell Allscripts EHR and PM to Oregon physicians.
• Orion Health names Christopher Ward SVP of global marketing. He’s the former chief marketing officer for GE’s Healthcare IT business.
• Greenville Hospital System University Medical Center (SC) goes live on Holon’s Central Order Entry Pharmacy medication order management solution, which will integrate with the hospital’s existing Siemen’s Med Administration Check system.
• South Florida Health Information Technology Regional Extension Center (SFREC) selects Greenway’s PrimeSUITE EHR.
• GetWellNetwork announces its 4th annual user conference, GetConnected2011, which will be held at the Gaylord National Hotel & Convention Center in National Harbor, MD.
• Dr. Cynthia Taylor, an affiliate with Norman Regional Health System, credits eClinicalWorks after being recognized as the first in the nation to receive a reimbursement check from CMS for demonstrating meaningful use.
• Divurgent is co-hosting a cocktail networking event with VAHIMSS during HIMSS in Orlando.
• NextGen partners with Allina Hospitals & Clinics to improve care coordination for physician practices in Minnesota and western Wisconsin.
• Speaking of NextGen, here’s a cool YouTube video highlighting knowledge-base management (KBM) and meaningful use (MU).
• Nuesoft unveils its new logo.
• Nuance introduces Swype and also Dragon Medical 11.
• Imprivata reports 38% growth in its total bookings compared to the same quarter last year, citing demand for its single sign-on and access management solutions.
• PatientKeeper 7.0 earns ONC-ATCB certification as an EHR Module for CPOE, privacy, and security criteria.
• Sunquest is demonstrating its ICE solution (Integrated Clinical Environment) and the new CoPath Plus anatomic pathology specimen labeling and tracking solution at the Arab Health Exhibition & Congress in Dubai this week. The company also announces that its LIS has earned ONC-ATCB certification as an EHR Module.
• AirStrip has a demo of its cardiology app running on an iPad.

EPtalk by Dr. Jayne

The January/February issue of Family Practice Management arrived to a multitude of inboxes last week. It’s time for their annual “Survey of User Satisfaction with EHR Systems” feature. I encourage my physician readers who are members of the American Academy of Family Physicians to complete the survey. Those of you who work with real, live family physicians, please encourage your physicians to do this. It runs through March 31 and can be completed online, or alternatively, they will accept it by fax.

Historically the EHR I use in practice hasn’t done very well on this survey, but the number of respondents for the vendor has been low. Hopefully more people will participate this year. I do think it’s a good system and I’m tired of certain cranky physicians citing the results with their miniscule “n” number as the holy grail of EHR satisfaction data. Besides, they’re giving away an iPad and some other goodies, so it’s worth the five minutes it takes for family docs to register their opinions.

The same issue also has a timely (and physician-friendly) article, “Should Your Practice Participate in a Quality-Reporting Program?” This is a nice summary of how practices are handling four available quality reporting programs (including PQRI, now known as PQRS – what is up with that anyway? Did we not have enough acronyms? Or were they tired of people calling it PICK-ree?)

It looks at the costs of these programs, including staffing, data mining, etc. It should be required reading for anyone in healthcare that thinks Meaningful Use and other programs are just giving away free money. The data is surprising — several of the programs had potential costs that outweighed the financial incentives. Costs per full-time provider ranged from $133 to $11,100 during implementation. (Yes, that’s eleven thousand.)

Thanks to my FP buddies who always make sure I see these articles. I’m always interested in these types of articles in other specialty journals, so feel free to send them my way.

Dear Dr. Jayne,

What is most interesting to me is your IT education… or are you one of those quick learners who likes IT and learned on the job?

The IT Cowboy

Dear IT Cowboy (and I do love cowboys),

Like many other CMIOs, I fall into the quick learner category. Many of us who have been in this role for a while fell into it gradually rather than having a formal education. My medical school had a top-notch informatics expert who was a major influence. Plus, he had a really fun fourth-year elective that didn’t involve actual patient care, which was good for those of us who needed a break from the pleasures of the local psychiatric hospital and being tormented by burned-out residents.

My knowledge of non-clinical IT systems stems from an apparent affinity for “IT guys.” This is how badly medical training warps you — your life is so chaotic that you think someone who does critical systems support has a normal lifestyle. I’m probably the only physician you know who has ever been to the NOC on a date or been out with someone who was wearing more pagers than she was. (Thank goodness for the BlackBerry – so much more chic than the whole Batman Utility Belt pager ensemble.)

Like Anakin Skywalker, I was slowly drawn to the Dark Side. I decided I needed additional education if I was going to live up to the “I” in the title, and after thinking about how much medical knowledge I received in school vs. “the trenches”, I decided to take the hands-on route. I’ve bought many a beer while slowly extracting mounds of knowledge from IT staffers late into the night. I’ve bribed analysts to help me understand what’s going on in the code. I read scads of articles and IT publications and frankly, some of the words that come out of my mouth these days scare me. I’m talking things of the four-letter variety: DHCP, ODBC, ISDN, VLAN, CCOW, LEAP, and many more.

I’ve also learned a lot from vendors, especially working with development teams on creating clinical content. It’s given me a peek under the hood to better understand the limitations of the software so that I can better help my physicians prepare for impacts on patient care as well as to give useful real-world feedback to the vendor. Understanding the underbelly of EHRs gives me more credibility with vendor teams – I’m not just another doc crying wolf, I’m someone they can partner with to fix the issue. (Running my own mini-development shop for certain applications is also helpful — I understand the constraints of release cycles, testing, packaging, distribution, etc.)

There you have it, my IT education in a nutshell. I do hope we’ll be seeing you at HIMSS. Maybe I should ask Inga if she’d be offended if I had a “Dr. Jayne Loves My Boots” award. Wranglers optional, but preferred.

Dr. Jayne

Have a question about medical informatics, electronic medical records, or which specialists are the nastiest? E-mail Dr. Jayne.