Readers Write 1/24/11

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!

Connecting Performance Measurement and Clinical Decision Support to Improve Patient Care
By Gregory Steinberg, MD

In late 2009, the National Quality Forum (NQF) convened a panel of experts from across the health care industry to lay the foundation for promoting clinical decision support (CDS) to enhance performance measurement and help improve patient care. The Health Information Technology for Economic and Clinical Health (HITECH) Act had standardized the information needed for quality measurement.

However, it did not address the lack of standardization when it comes to the information and algorithms for measuring clinical performance, or the importance of linking clinical performance measurement with CDS to help improve it.

Over the past year, a panel of CDS experts, including Dr. Madhavi Vemireddy (our chief medical officer at ActiveHealth), worked to create a “taxonomy,” or classification of the information that connects quality measurement and CDS in clinical information systems. The result – the first step in defining the data sets needed to ultimately drive performance improvement. The panel’s new taxonomy is described in the report Driving Quality and Performance Measurement – A Foundation for Clinical Decision Support, announced this month by the NQF.

This new taxonomy has the potential to significantly improve health care. Today, many health care providers’ and organizations’ systems do not automatically capture the necessary information to drive CDS and performance measurement reporting. Having a common language for CDS and performance measurement is essential to improve quality with every patient.

All too frequently, at the individual practice level, performance measurement data has to be manually collected at the end of each performance year to create static reports that are not linked to CDS. The new CDS taxonomy will not only automate and standardize the data sets within electronic health records (EHRs), but also create the foundation to transform CDS into a dynamic workflow tool that is tightly linked with performance measurement improvement and supports performance measurement reporting as a byproduct of everyday practice. It is this connection that will improve performance and, ultimately, improve patient care and reduce health care costs.

The NQF’s report is only the first step in standardizing CDS datasets and in synergistically linking clinical performance measurement with CDS. Now, it will be up to health care vendors and organizations to begin using the taxonomy, building CDS and performance measurement alignment into their IT infrastructures. The hope is that this alignment will soon become standard practice in hospitals, physician practices, and other provider organizations across the country.

Gregory Steinberg, MD is CEO and president of ActiveHealth Management.

The “One” Thing HIT Vendors Need to Know
By Cynthia Porter

Reading the Web’s recent prognosis for Meditech strongly reinforced this simple truth: the customer is at the heart of the healthcare IT industry. This can sometimes get lost in the marketing, sales, and product development shuffle, with a company none the wiser until a valued client is no longer a returning client.

Recent blogger opinions beg several questions. What can an HIT company do to make sure it holds onto customers? Why is it so hard at times to better understand clients’ needs? It all comes down to the simple skill of listening. HIT vendors need to listen to what their clients are saying — and they’re saying a lot right now, to be sure.

Market research services fill this listening need. The HIT market is now more than ever in need of an unbiased third party to assist them in listening to their customers. Someone that will derive true opinions from a vendor’s clients — so valuable in continuing to meet clients’ needs when considering future product development.

The third-party solution provides an outlet for HIT customers to compliment or vent to. No selling, no marketing — just an ear that cares.

It is this skill of listening that will enable seasoned (some may say complacent) HIT companies like Meditech to survive. Meditech has been the “one” market leader for years – in the 200-bed market. What HIT vendors like Meditech need to realize is that the market is moving beyond the four walls of the hospital. HITECH, HIE, and ACOs are changing the game and expanding the walls.

Vendors need to listen to their customers and better understand the impetus behind their growing need for new HIT solutions. EHR integration, as mentioned in connection with Meditech’s issues, is just one part of this.

As Curly says in the movie City Slickers, there is just “one” thing and that is all there is to know. But the “one” has gotten bigger. One hospital is now one community. One state is now multiple states or regions. One patient is now the e-patient who demands access to his or her data any time, anywhere.

Meditech will need to adapt to this new way of thinking to remain the “one” vendor its customers have traditionally turned to. Luckily, it has one of the best and most active user groups on hand to help navigate this new course.

Cynthia Porter is president of Porter Research.

Steps to Take Against Medical Snooping
By Pete Niner

Medical snooping is in the news again, with the firing of four workers for looking at Congresswoman Giffords’ hospital records after the Jan. 8 shooting. While this instance was swiftly detected and punished, most instances of snooping will not make headlines, and are thus more difficult to detect. 

Few care providers will ever have a patient whose treatment will be front page news (thankfully). But lower-profile patients are victims of snooping as well.  For every case that makes the tabloids, there are doubtless many more cases involving less-newsworthy victims. A concerned father looking at his daughter’s suitor’s records, an irritated neighbor looking for malicious gossip, or a bitter ex-spouse seeking ammunition in a custody battle are much more difficult to catch.

Technology, alas, isn’t too much help here. Information security products have historically been focused on stopping unauthorized access, not the misuse of authorized access. Though there are a few products on the market that purport to detect and stop medical snooping, they are both expensive and cumbersome, beyond the financial and technical resources of many organizations. Those who can’t afford to spend six figures on a sleek, high tech product need to use other means to detect medical snooping.

Assuming your security fundamentals are in place, below are some additional ideas we’ve seen work.

Implement thorough segregation of duties. Many organizations default to an "all access" or an "all clinical access" policy for information. While this aids in staff flexibility, it is worth asking whether all staff need access to all information and judiciously trimming unneeded access.

Periodic review of access entitlements. Most organizations have solid processes to grant access; far fewer have good procedures to modify or remove access once it’s no longer necessary. An annual or bi-annual review of entitlements can clean up obsolete permissions and prevent surprises from lurking in dusty corners.

Spot checks of access, This can be done two ways: patient-centered or personnel-centered. Either review all access used to a particular patient’s records or review all access used by a particular employee. These can be done either randomly or for cause — an employee who steals medication is probably more likely to have misused his access as well.

VIP monitoring. Should a VIP enter your doors, closely monitor who accesses his or her information and why. We know of one organization that, when a VIP checked in, created half-a-dozen null records of non-existent persons with identical demographic and treatment information to that of the real VIP (security types call this a honeypot — stage actors recall 1 Henry IV, Act 5, Scene 3: "The king hath many marching in his coats".) All those who viewed the record of the dummy VIP were terminated.

Once the misuse is detected, of course, there should be clear, HR-approved procedures in place to very publicly discipline the offender.

Medical snooping can be tough to detect, but you’re not helpless. There are steps to take that will increase your ability to detect and deter such misuse.

Pete is a director at Techumen.

CIO Unplugged 1/24/11

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

CIO Unplugged … Unplugged

“Aim high, aim for something that will make a difference, rather than for something that is safe and easy to do.” – Peter Drucker

How are you wired? Have you studied yourself lately, or are you busy dissecting others in order to increase your worth? (Like right now. What are you thinking as you read this blog?)

Experiences give shape to character, meaning experiences bring out what’s already inside — the genuine you. How you and I react to life’s events, both good and bad, determines whether we will find success or failure. You were created to succeed, but have you chosen to be less?

“Leaders are honest, forward-looking, competent, and inspiring.” – James Kouzes

Honest. As a college freshman, I’d hit rock bottom. A 1.6 GPA. A bank account depleted by the party life. Friends? Not sure. Family? Far away. An empty, haunting, painful experience. I saw where I was headed, and I wanted none of it.

With nothing left to lose, I got on my knees and made the decision for the greatest adventure of all — a new life, set free at last. My junior year, the adventure accelerated. I married a woman. Not just any woman. Julie was — and is — valiant, vulnerable, and scandalous, yet she keeps my feet on the ground. We said “no” to the safe life, and our journey continues 26 years and counting.

Say “no” to simply existing. The easy life makes zero difference on humanity. Healthcare IT does not need more technology or more talk about the bits and bytes. We need bold leadership!

Inspiring. A great adventure is full of thrills and danger. Climbing mountains, swimming in oceans, preparing for war, and competing at the highest levels. I’ve done these things, and I’m telling you about it without shame because I worked my butt off to reach each goal. I take roles that stretch me and then ask for more, trembling. Standing up to bullies takes guts, but someone has to do it. I will, and I have. I’ve pushed the guardrails of employers. How else can a company grow?

In June, I will lead an expedition to Kilimanjaro. We’re funding and building a medical clinic. With Tanzanian government collaboration, we will open and operate the clinic. Is this safe? Hell, no. But it’s worth the sweat and sacrifice to help a sick child.

Three times I’ve faced death. Reprimands wait for me around every corner. I’ve questioned myself and my motives. I fail, but I bounce back. I am a target. So why do I keep going? Because I understand who I am, what my purpose is, and why I was created. I take the downside knowing the upside is rewarding. The safe life is not worth living.

My five years of blogging has brought rewards and criticism — not a safe pursuit. Some find my posts offensive, and I do not apologize. While most comment to debate the merits of theories or ideas expressed, which makes us all better, others attack character. I am accused of many things: narcissism, motivational pundit, etc. (I am a work in progress and continuously developing).

Attacks come with the “unsafe” territory I’ve chosen to inhabit. I encourage debate. If you want to attack character, I am open to that as well, but I will only receive it if you engage me personally. Connect with me. Where is the credibility in taking personal shots from afar? Only cowards take the safe route.

Looking forward. My mission is to “Leverage information technology and leadership to improve health of people.” My vision is to “Develop information technology leaders who impact organizations.” Blogging on leadership from the angle of CIO is one strategy to make this mission and vision a reality.

The amount of feedback I have received over the years helps measure this. People send me stories that would make you cry. Others would have you shouting for joy. Stories of readers taking a stand. Stories of readers rising to their potential. Stories from vendor and hospital CEOs, from clinicians to the young and old, the payor, and the provider communities.

Modeling and encouraging leadership influences more people than does commenting on technology. That’s why I do it. I’m wired to lead.

The significant way to transform healthcare is to speak less on technology and instead be a leader with a bias for action. You can learn about cloud, networks, or virtualization in school. Leadership, on the other hand, is caught, not taught. I will not waste energy rehashing Computers 301 when I can challenge and inspire you to be more of who you were created to be. A success!

This blog is me unplugged. This is my background and my motivation. Do you have a defined purpose? How do you measure your results? What motivates you?

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.

Monday Morning Update 1/24/11

From Tom Paine: “Re: reader comments. I appreciate that you don’t seem to censor.” Here’s where I’m torn: all those anti-technology, axe-grinding comments you see posted under a variety of names are coming from the same 1-2 trolls from Pittsburgh hospitals, sometimes posting as a doctor or nurse, who can be counted on like a fine Swiss watch to clog up every post with easily recognizable anti-HIT comments (software is dangerous, experimental, a government conspiracy, etc.) It’s not their argument that I mind, it’s the attempt to make their monotonic mantra look like a populist groundswell by near-constant posting. I resent the dishonesty and I sometimes delete their comments when I’ve had enough, especially when they start pestering Jayne or Inga.

From Linus Pauling: “Re: Epic. Support is going downhill fast with lots of defections and new customers. Look for KLAS scores to be affected. Hospitals are not happy getting a main contact who’s a 21-year-old straight out of college with an economics degree.” Unverified.

From The PACS Designer: “Re: Stage 1 Meaningful Use. CIO John Halamka and Robin Raiford of Allscripts have given us a handy matrix that defines the numerator and denominator required to measure compliance for the rules to achieve the minimum objectives for payment in Meaningful Use Stage 1. Here’s a link to the NIST testing site for MU validation.”

From Ulysses S. Federal Grant: “Re: salespeople on commission. eClinicalWorks does not pay commissions, either.” I like that approach. To do otherwise is to provide incentives for the wrong outcome, like most of medicine in paying for procedures instead of results: commissioned salespeople make more money for enticing someone to sign a deal and then moving quickly on to the next prospect no matter what the outcome. It’s not surprising that salespeople will promise almost anything knowing that they’ll make hundreds of thousands of dollars for getting someone to sign on the line which is dotted, even if it’s not necessarily in that prospect’s best interest to do so.

From Daryle Harmonica: “Re: EMRs. An meta-analysis study in PLOS Medicine (the open-access equivalent of NEJM) comes to the usual conclusions – the evidence of EMR benefits is lacking. Their methods sound pretty rigorous.” For those who don’t know, a meta-analysis is a study of studies, combining their results in a statistical way to reach a broad and possibly new conclusion. This one finds that, despite the theoretical benefits of digital technologies in healthcare, nobody has proven that they are risk free and cost effective, and recommends that technologies should be evaluated against a consistent set of measures throughout their life cycles to make sure they are providing benefit. I like that idea – hospitals rarely evaluate their clinical system projects at all and almost never publish the results when they do, but even if they did, the results wouldn’t be extensible because everybody is measuring differently. Maybe that’s something that ONC or FDA should do – come up with a standard set of clinical system quality metrics (uptime, user satisfaction, system-related clinical errors, etc.) and require annual centralized reporting that’s open for public scrutiny. The study also found that almost all published success came from big academic medical centers, but I would speculate that’s because community hospitals don’t write nearly as many articles as the publish-or-perish ivory tower types living off federal grant money.

From Uncle Fester: “Re: LSS. Lost in the Meditech acquisition news is that LSS’s C/S 5.6 product earned certification.” I didn’t realize that they have the exact same releases as Meditech, so LSS has certification for its MAGIC and C/S lines, with 6.0 next up.

From Buck S. Pearl: “Re: West Virginia Health Information Network. Moving ahead with Thomson Reuters as the prime contractor in their five-year HIE deployment. The company is involved in projects in NC and SC.” Unverified.

From Sgt. Schultz: “Re: Epic. I know nothing more than this except they have a product called SeeMyChart.” Epic files suit against Altos Solutions for trademark infringement. SeeMyChart is a patient portal into the company’s OncoEMR oncology EMR. I don’t know which product came first or who owns which trademark, but if it was Epic’s, I can see why they would claim the potential for market confusion.

From Bill@$200/Hr: “Re: Kettering in Ohio. Rumor is their Epic install is floundering, looking at delaying their second go-live at their largest hospitals. Local talk is there’s a real crisis of leadership, surprising given the sheer number of consultants involved.” Unverified.

I’m a little surprised that 15% of regular HIMSS conference attendees said they won’t attend this year, according to my latest poll. They won’t be offset by the 8% who don’t usually go but who will make the trip to Orlando. If the turnstile count is down, you heard it here first (I’m pretty sure that won’t happen, though). New poll to your right: have you or your employer been affected by a shortage of experienced HIT workers? I’m just checking again.

Welcome to Clairvia, supporting HIStalk as a Platinum Sponsor. The Durham, NC company was built around the concept of Care Value Management, which emphasizes improving patient care, quality, and financial performance by measuring the care needs of individual patients and then assigning those patients the appropriate level of caregiver resources to ensure the best possible outcome. It’s like a 21st century version of traditional patient acuity and staff management systems, with its tools used directly by clinicians instead of bean counters and focusing on the patient instead of rigid, cost-based staffing models. The bottom line is that it helps hospitals tie together care models to outcomes and to the patient experience, ensuring that patients follow an optimal track from admission to discharge with appropriately assigned resources throughout (i.e., get them from the ED to the right unit quickly and have a defined plan to encourage their progress from the expensive ICU to lower acuity units). I interviewed Beth Pickard, the company’s president and CEO, in December, where she explains why prospects are interested: “Almost everyone is looking for ways to ensure that the patient tracks or moves through the organization to the reimbursable plan for cost as well as having a good experience. I would say that it’s not something that we’ve had to sell.” Thanks to Clairvia for supporting HIStalk.

Weird News Andy was sucker for this news. ED doctors treating a woman for a mild stroke and temporary paralysis determine the cause: a hickey that was administered too close to an artery by her overly amorous lover caused a blood clot. She was successfully treated with an anticoagulant. Said one of the doctors with what sounds like a nearly-creepy familiarity with the pathophysiology, “Because it was a love bite, there would be lots of suction.”

I’m always on the lookout for projects that would benefit the little guy in the industry (both providers and vendors). One that came to mind was to develop a freely accessible database of what major systems each hospital uses. Right now, the only folks who know are KLAS and HIMSS Analytics and they aren’t going to tell anyone who isn’t paying big bucks. It would be a pain to collect and update the information, but instead of doing all 6,000 hospitals, I was thinking most people would care only about the 1,200 or so hospitals greater than 200 beds. I have no idea how to go about doing this or whether it’s even something needed, but it seemed like a good idea when it came to me in the middle of the night. I’m open for input.

The Atlanta business paper profiles Digital Assent, which has developed an iPad-based physician office check-in application to replace the much-hated patient clipboard. I didn’t see it mention on the company’s site, but the article says it also displays ads.

Austin, TX-based rehab and hospice operator Harden Healthcare says it will spend $10 million a year over the next several years on IT, including a move to electronic medical records.

The coroner’s office in an Indiana county is taking more than three weeks to issue a death certificate. The culprit: a legally mandated death certificate application that the coroner says is hard to use.

GE’s Q4 numbers: revenue up 1% (the first growth in nine quarters), EPS up 33%. The UK-based GE Healthcare made a billion-dollar profit in Q4, with revenue up 8%. For the year, GE Healthcare took in $16.9 billion and made a profit of $2.7 billion.

A nurse fired by a Florida hospital for looking at the electronic medical records of Tiger Woods is suing the hospital. Health Central says it has evidence proving that the nurse looked at the records three times in 10 minutes, but the nurse says the hospital didn’t secure its computer system, allowing someone else to check out the records when he walked away.

Beth Israel Deaconess Medical Center will buy out the remaining two years of outgoing CEO Paul Levy’s contract, giving him $1.6 million in severance for what continues to be portrayed as a voluntary resignation.

Odd lawsuit: the wife of an Air Force officer files suit against a VA hospital when an Air Force surgeon inserts 270 ml breast implants because the hospital was out of the 300 ml ones she wanted. According to the lawsuit, “Mrs. Haden was extremely disappointed by the size of her breast implants.”

Sponsor Updates

• AHA extends an exclusive endorsement to CareTech Solutions for data center hosting services.
• Overlake Hospital Medical Center (WA) will implement the full Medicity suite, including MediTrust Cloud Services, ProAccess Community, and the Novo Grid.

Epic Sales

Readers sent in quite a few thoughts about the Epic salespeople and sales process. Here are some of those that I found interesting.

• Epic has 6-7 salespeople, all of them women (the reader provided their names).
• Despite company growth, the sales team hasn’t gotten much bigger.
• Almost nobody knows an Epic sales rep, current or former. Even sales recruiters have never spoken to one.
• All salespeople are required to have done installation work at Epic. Epic does not direct hire people into sales.
• Epic does not do traditional marketing. They focus only on a few conferences and don’t run billboards, sponsorships, or ads.
• Salespeople do not earn commissions, although their performance is taken into account at appraisal time for raises and bonuses.
• CEO Judy Faulkner steps in herself for the big prospects or if it looks like Epic will lose the deal.
• Some folks have been forced out. They call it “flying too close to the sun,” with the sun being Judy.
• The job of the salesperson is less about selling and more about managing the process. Epic has separate teams for RFPs and demos, a legal team for negotiations, and budget/pricing teams for managing the implementation timelines and budgets. If sales needs help from anyone in Epic, that person is expect to drop everything and go to a customer meeting or do whatever is needed.
• Those PMs serve as product experts along with clinicians and developers, with much of their role being to demonstrate the philosophy and culture, not to be salespeople with a passing interest in getting a contract signed.
• The entire company makes the sale, not the salesperson. Customers get good implementation support, an individually assigned technical service rep, and a “customer happiness” rep who will escalate any concerns.
• Until 2009, Epic was making just 10-15 new sales a year and many of those were just for ambulatory or inpatient alone, but the percentage of enterprise sales has increased each year. In 2010, they supposedly made around 40 new sales (some of them listed below).

Reader-Reported New Epic Sales for 2010
Johns Hopkins
Catholic Health Services of Long Island
New Hanover Regional Medical Center
Ochsner
Moses Cone
Bronson
St. Joseph Michigan – Lakeland
Martin Memorial
Idaho – St. Luke’s
US Coast Guard
Provena
Aurora
University of Mississippi Medical Center
JPS Health Network
SUNY Upstate Medical University
LSU Health
Rochester General
ProHealth Care
Owensboro
Rockford
Sansum
Access Community Health Network
Bassett Healthcare
Stormont-Vail Health Care
Hurley Medical Center
Temple University Health System
Amphia Hospital (Netherlands)
Memorial Healthcare System
Orange Regional Medical Center
Tampa General Hospital
Wenatchee Valley Medical Center

HIStalkapalooza

The HIStalkapalooza page is live. It works a little differently this year to be fairer to attendees. Your signup gets you on the “I want to come” list. We’ll follow up with an official e-mail invitation to those we can accommodate, assuming there are more people interested than we have capacity (and if not, great, everybody will get an e-mail invitation). Signing up alone doesn’t guarantee a spot, just to be clear. I did it this way to allow a wider variety of people (especially providers in the trenches) to come since some big vendors were having a secretary sign up their entire HIMSS booth team of dozens of people, taking away spots that some poor programmer or nurse who didn’t pounce immediately lost as a result.

HIStalkapalooza is sponsored by Medicomp Systems, makers of such EMR tools as the MEDCIN clinical knowledge engine, the CliniTalk voice-to-data physician documentation system, and a new offering or two that I’ll be talking about later. I’m really impressed with their commitment to providing you with a good time at HIStalkapalooza. They have had first-rate planners (people who have worked on Hollywood award shows!), PR folks, and others who have put a lot of time and energy into making HIStalkapalooza an event that I think will be the talk of HIMSS. They totally get HIStalk and have been phenomenal in running with whatever harebrained ideas I came up with to make it fun and wildly different from the usual marketing-heavy, button-down HIMSS events. Thanks to Medicomp and particularly COO Dave Lareau for supporting the readers of HIStalk by producing HIStalkapalooza.

Just to reflect for a moment, as a hospital employee with limited time and resources, I couldn’t have done any of this without Medicomp (and kudos to event sponsors from prior years as well, Encore Health Resources and Ingenix, who also threw great parties). It’s amazing to see how the event has grown and to see how many companies want to sponsor it, especially since I insist that it be about the attendees and not the sponsors (no commercial pitches, no giant sponsor signs or booths, I control the agenda and approve all decisions, etc.) That’s a pretty big commitment for a company, especially knowing that most of the attendees will probably be from vendors, many of which are their competitors. I truly appreciate the support of both Medicomp and those who attend. For a  guy toiling anonymously and alone on HIStalk the other 364 days a year, it’s a little overwhelming to see it in person.

So what’s happening at HIStalkapalooza? It’s at BB King’s Blues Club at Pointe Orlando, just a few hundred yards up the street from the convention center, on Monday, February 21 from 6:30 until 11:30 p.m. Medicomp has bought out the entire facility (it’s pretty big), so it will just be HIStalkers there. There will be an open bar, IngaTinis, great food, a red carpet entrance, and professional videographers documenting the event so I can run some video here later for those who can’t make it (and stream it live to a huge on-stage screen for folks already in the venue to watch).

This is amazing: Inga and I desperately wanted athenahealth CEO Jonathan Bush to emcee the HISsies awards again (those of you who went last year understand why), but he couldn’t make it because he had scheduled a family vacation around his kids’ school break. Shockingly, he wanted to be with you HIStalk readers so badly that he rescheduled his vacation, so he’ll be chewing the scenery again and I can’t wait to hear what comes out of his mouth. We’ll also have an expanded line of beauty queen sashes since both men and women love wearing them. Inga has twisted my arm to shell out cash for some swell prizes for Best Shoes and HIStalk King and Queen (overall fashion and look, since Inga’s into that sort of thing, and as a guy I’m not entirely against having fashioned-up ladies around). We may have some special recognition for practicing doctors in attendance.

And for your HIStalkapalooza entertainment .. The Insomniacs, the award-winning, crowd-inciting, high-energy Left Coast Blues band from Portland, OR, which Medicomp is bringing all the way down to Orlando just for our event. Sample tunes here. A real band at a real music venue with a real stage and a dance floor … that doesn’t happen often at HIMSS. This is a full-length concert and the bar will be open throughout. I’m pretty sure that’s a formula for a good time to be had by all.

E-mail me.

News 1/21/11

From Leopold Stoch: “Re: Meditech. They finally buy out LSS.” Bill Belichick and other readers tipped us off on January 5 that Meditech would be buying out its ambulatory partner. They were right. Meditech also announces that HCIS version 6.05 has earned certification through Drummond Group, so all three of its platforms (MAGIC, Client/Server, and 6.0) are now certified. Thanks to the several sharp-eyed readers who let us know about the announcements.

From Frank Poggio: “Re: Privacy and Security Tiger Team of the HIT Policy Committee. They’ve started looking at the issue of a unique person / patient identifier, the ultimate US-only conundrum that has been struggled with for decades.”

From Blah: “Re: Verizon hotspot. Tempting, but Verizon’s 3G network won’t allow data and voice at the same time. Will you just miss calls when using the phone as a hotspot?” See tech expert David Letterman’s skewering of Verizon above.

From Doc Martin: “Re: LA County Department of Health Services hospitals. The surgery system install is going badly, with servicers needing to be rebooted several times daily, reports going unwritten, and [vendor name omitted] staff unable to stabilize the system. It has affected OR throughput.” Unverified. Give me something verifiable and I’ll name the vendor.

From Shot Doctor: “Re: Allscripts. I hear they’ll announce a new president of sales next week and it will a big name. I couldn’t get anything more than that.” Hmmm … anybody want to guess who it is?

From Two Down, One to Go: “Re: Cook County seeks to end inpatient care.” The county wants to end inpatient, emergency, and surgical services at Oak Forest Hospital and turn it into an outpatient primary care center.

From Murray the K: “Re: Allscripts. Has brought on a third-party vendor to supply manpower to its remote hosting facilities.” Unverified, but rumor is that ACS is involved in a capacity somewhere between oversight and total outsourcing.

From Guy Who Lives in Midwest: “Re: Rep. Paul Ryan (R-WI). Is he talking about Epic? Starting at 3:10.” He mentions an unnamed, large, privately held, woman-led Wisconsin company with thousand of employees. He says the CEO told him she wants to offer health insurance to her employees, but her two publicly traded competitors have said they’ll dump their employees from insurance and pay the fine instead, saving $15,000 per employee. Since that gives those companies a competitive advantage, she will have to do the same, he reports. I don’t know if it’s Epic, but I’ll say this: the Congressman is a heck of a speaker.

Jobs on the HIStalk Jobs Page: Director of Consulting – Healthcare IT, Epic Credentialed Trainers, Sales Representatives. On Healthcare IT Jobs: Senior Consultant Health IT, Revenue Cycle Project Manager – Arizona, Cerner CareNet and INet Analysts, Clinical Consultants McKesson HPP.

Listening: new from Jamestown Story, because I know the band (indirectly). I predict they’ll be big soon, so check them out and you can brag that you hopped on the bandwagon early. I’m also liking Tennis, summery 60s-sounding garage pop.

Congressman Mike Doyle (D-PA) is fuming because not only did Congress turned down his $500K earmark request to buy an EMR for a local nursing home, the House Speaker says he won’t even allow spending bills on the floor for a vote if they contain earmark appropriations. Says the Congressman, “They were killed by the Senate Republicans. We thought we were going to get an omnibus [spending] bill, but [Senate Minority Leader] Mitch McConnell bowed to the Tea Party.” The nursing home says the EMR is vital and they’ll have to buy it with their own money instead of using federal taxpayer dollars.

Thanks to long-time HIStalk sponsor GetWellNetwork, which is upgrading from Gold to Platinum. The Bethesda, MD company offers TV-based interactive patient care solutions used by 70 hospitals and health systems that provide bedside patient education, entertainment, patient feedback and surveys, care planning, outcomes research, and personalized patient experience driven by integration with HIT systems. Thanks to GetWellNetwork for its ongoing support of HIStalk.

I’d also like to welcome and thank Staffing Angel Software, a new Platinum Sponsor of HIStalk. The company offers one-click, Web-based scheduling and labor management solutions for medical personnel, with specialty applications for nurses, pharmacy, and physician groups. Each application is personalized and can include electronic timesheets, reconciliation, payroll file compilation, and a historic archive. A video demo is here and you can check out the online training videos for more details. Client-reported results include increased employee satisfaction, efficient multi-campus scheduling, improved recruitment and retention, reduced overtime, and better utilization of FTE and PRN resources. The rules-based scheduling allows employees to self-schedule and to be alerted of available shifts. Thanks to Staffing Angel Software for supporting HIStalk.

Inga won’t stop bragging on her perfect score on SRSsoft’s Meaningful Use IQ Test, so I might as well go ahead and acknowledge it publicly and hope she gets over it. Getting a mention on their site got her wound up all over again.

The wacky, anonymous folks behind Extormity (“the electronic health records mega-corporation dedicated to offering highly proprietary, difficult to customize, and prohibitively expensive healthcare IT solutions”) have cranked out a pretty funny video claiming to feature one of its executives testifying before Congress.

Weird News Andy salivates at this story: a suicidal drug user who showed up at a hospital’s ED twice in two days spits in the face of a nurse trying to place him in restraints for his own protection. He is initially charged with attempted murder since he’s infected with hepatitis C, but the charges are reduced to assault.

Thanking you in advance for the following: (a) use the Subscribe to Updates box to your upper right to ensure immediate e-mail notification and triumphant “me first” smugness when I write something new; (b) use that newfangled thing called Facebook to Like HIStalk or Friend Inga, Jayne, and me so we can pretend to me the popular cool kids we always yearned to be instead of HIT nerds; (c) support the companies that support HIStalk by reading over the sponsor ads (to your left) and text ads (to your right) and click excitedly where indicated as acknowledgment that it’s a pretty gutsy move by them considering some of the stuff I write about companies; (d) send in your rumors, news, top secret documents, incriminating photos, or whatever would titillate me using the garish green Rumor Report button to your right (or if you can’t bear to look at it, just e-mail me). Thanks for reading. And for those asking about HIStalkapalooza, the signup sheet should be online and therefore mentionable in my Monday Morning Update (which by some freakish tear in the fabric of time, actually goes out whenever I get it finished after an all-day effort on Saturday while you’re out having fun).

Ad-supported (free) EHR Practice Fusion says it’s the #1 ranked EHR among primary care specialties in Black Book Rankings. 

Meta Healthcare IT Solutions announces MetaCare Event Manager, a clinician task alerting application that works with its EHR, CPOE, and eMAR systems.

A report suggests that the US will continue to lead the world in medical innovation, but will lose some ground to China, India, and Brazil because of expensive FDA compliance requirements and an entrenched healthcare system that favors the old guard.  In a possibly related move, FDA proposes changes it says will streamline medical device approvals.

Sunquest announces a new physician portal for outreach orders and Web results connectivity.

E-mail me.

HERtalk by Inga

From Wowed: “Re: Dr. Monteith’s testimony. Listened to this clip. This  is one of the most eloquent and straightforward comments I have heard that is so dead on that it will probably be dismissed as a ‘naysayer’ or outlier from typical ‘political’ opinion, even though I and probably many others agree completely! Perhaps David Blumenthal and Obama should have heard these intelligent comments!!!” Wowed is referring to Dr. Scott Monteith’s testimony from the HIT Standards Committee Meeting. Link here and cue to 2 hours and 49 minutes.

Cooper Green Mercy Hospital (AL) contracts with Medsphere to implement its OpenVista EHR.

Adreima appoints former Vanguard Health Systems CEO  Ken Howell as COO.

Marin General Hospital (CA) selects ProVation Order Sets as its electronic orders set solution.

The Charlotte Hungerford Hospital (CT) says it has invested over $2.5 million on HIT systems over the last three years and intends to apply for Meaningful Use incentives. The hospital’s  HIT infrastructure includes products from Meditech, Dr. First, Micromedex, Iatric Systems, and Zynx, as well as HIE infrastructure from MobileMD. Future plans include establishing an ACO and clinical decision support system partnerships.

Ingenix forms Ingenix Life Sciences, a newly-organized division that will focus marketing the company’s life science offerings. Meanwhile, Ingenix signs a definitive agreement with  inVentive Health for the sale of Ingenix’s i3 clinical development business. COO Lee Valenta takes over as president of the life sciences unit while Glenn Bilawsky will remain CEO of i3.

The Indiana HIE names Eric Miller VP of information technology and Patricia Ping information security officer. Miller is the former senior director of IT with Ascension Health; Ping previously was the security officer for Wishard Health Services.

HIMSS confirms Surgeon General Regina Benjamin, MD, MBA as a conference speaker. She’ll share updates on her efforts to incorporate the My Family Health Portrait into PHRs and EHRs, and discuss obesity and efforts to improve healthcare delivery for underserved populations. Benjamin intrigues me, given her history as the first woman and/or first African American woman to fill various leadership roles. It’s on my calendar for Wednesday, Feb. 23 from 9:45 to 10:45.

Brooke Army Medical Center (TX) selects Ekahau RTLS to track over 5,000 pieces of mobile equipment throughout its 1.5 million square foot facility.

Lori Evans Bernstein takes over as president of GSI Health, a provider of HIE and management solutions. She’s the former chief executive of provider solutions with ActiveHealth Management and used to be David Brailer’s advisor when he ran ONCHIT.

AHA issues a member-only resource guide that provides a checklist of topics and questions that hospitals should consider when establishing a vendor relationship. The AHA says the guidelines are intended for hospitals running licensed EHR software and related products on their own servers.

This week on HIStalk Practice: Weno Healthcare takes issue with not being named an ONC-ATCB, plus a look at the Weno/Spring Medical press release that inadvertently hit the Web. athenahealth stock hits an all time high after a big sale to Summit Medical Group. For  EHR gurus or guru-wannabes, SRSsoft has developed a tough quiz on the EHR incentive program (I’m happy to report I made a perfect score). Dr. Gregg Alexander provides an update on his EHR hunt. We are still looking for lucky subscriber #1,000, so make sure you sign up for HIStalk Practice e-mail updates.

The Cleveland Medical Mart & Convention Center hosts a ground-breaking ceremony and shares news of its 57 committed tenants and 31 scheduled conventions. It will open in the fall of 2013.

BMC Healthcare (MD) says it has begun implementing various HIT tools and has filed for Meaningful Use incentives. BMC’s IT advancements include CPOE and EHR (Meditech) and PM/EHR (eClinicalWorks) in its physicians offices.

E-mail Inga.

Dear Dr. Jayne,

I admire doctors for what they know and what they do. But I also have to work with them as they learn EMR and have all the understandable reactions to it. I say it’s like telling someone, “OK, now you have to go through life for the next two months doing everything with your non-dominant hand.”

Bignurse

Dear Bignurse,

I absolutely love this analogy and am planning to shamelessly copy it (with the appropriate citation, of course!) There’s a favorite slide I use when talking about EHR implementation that lists the Kubler-Ross stages of grief: denial, anger, bargaining, depression, and acceptance. It seems lately I’m dealing with a lot of bargaining.

I tell them two things. First, CMS doesn’t bargain. Second, you passed biochemistry in medical school (hopefully) and that was a LOT harder than learning to use a clinical system.

There was a lively bit of commenting after one of my posts last week, with a good discussion about the potential limitations of clinical systems and their forcing clinicians to practice cookbook medicine, stifling creativity, etc. Like any piece of software, EHRs are only as good as the programmer and the user (not to mention their sassy CMIO and clinical champions).

I remind my docs when they are implemented that the EHR is not intended to replace their brains or their good judgment. It’s a tool that if misused can be dangerous. Geriatric (and pediatric, for that measure) patients have different needs than typical adult patients. So do transplant patients, immune-suppressed patients, and pregnant patients. And renal patients. And heart failure patients. And on and on.

Systems are limited by the breadth and depth of the order sets, formularies, and protocols that are designed and loaded. If clinicians feel that the systems have order sets that cause harm, likely it’s not entirely the vendor’s issue. If you have an order set that prohibits you from giving an appropriate dose of medication or one that is unsafe, that needs to be addressed. Look behind the curtain to the Committee that specified the order sets and protocols and express your concerns. Or join the Committee and be part of the solution.

Trust me, these things are not easy to design, and if I lock five nephrologists in a room with a patient, I will get seven different treatment plans. If you feel that certain consultants have lost their minds, vote with your mouse or stylus and refer to another group. If there are no alternatives, discuss serious clinical concerns with the appropriate body in your hospital. Sometimes taking the variation out of medicine is good – especially when there are evidence-based, statistically valid treatment approaches that have been proven to have less morbidity and/or mortality than others.

I personally have benefitted from the alerts and limits within the systems I use. Every physician at one time or another has inadvertently prescribed a medication to a patient with a documented allergy. I’d much rather have a system catch that (or warn me that I’m about to dry-clean my patient’s kidneys) than have the pharmacy call me later after they’ve told the patient I missed it, which is still better than harming a patient.

Dr. Jayne

Dear Dr. Jayne

The IT Cowboy

Dear IT Cowboy,

I figured I’d go ahead and tackle this one since I already used the word “evidence-based” entirely too many times. I feel like I’m at a pharmacy and therapeutics committee meeting!

If we’re talking about proving that the use of EHR itself has benefits to morbidity, mortality, patient safety, and other factors, I think the evidence is all over the place. It depends on whose study you look at, on what day, and whether you asked the Magic 8-Ball about it before you started reading.

Bottom line: it depends significantly on the education, training, and proficiency of the users. Many organizations are learning this the hard way as they prepare for Meaningful Use. They have fully capable systems, but staff either doesn’t use them in the way they were designed, or isn’t using them at all. The jury is going to be out for a long time.

On the other hand, sometimes the systems are, for lack of a better word — bad. My first EHR had hard-coded templates whose protocols that were out of date before the software made it out of QA testing. Vendors are getting smarter and are coding to allow rapid update cycles or user configuration on the fly. Still, whatever governance body is responsible for the clinical integrity of the system (and hopefully you have a fun CMIO who shares in that role) has to review it before it goes into production.

In the city where I trained, due to the presence of a certain researcher’s clinical trials, the local standard of care for a condition is significantly higher than the national standard. Woe is the hospital that tries to deploy out of the box. I’ve seen it done and it wasn’t pretty, especially if there wasn’t enough physician involvement. If I wanted to be a consultant, I could fund a shoe habit worthy if Inga with the proceeds of tidying up after the dust settles.

Speaking of shoe habits, barely a month ‘til HIStalkapalooza. I’m getting nervous about my footwear choices and meeting Inga in person, but I’m looking forward to helping with photos of the exhibitors with the best wardrobes.

Dr. Jayne

Have a question about medical informatics, electronic medical records, or that itchy rash that won’t go away? E-mail Dr. Jayne.

HIStalk Interviews Todd Fisher, CEO, MobileMD

Todd Fisher is founder and CEO of MobileMD of Warminster, PA. His blog is here.

Tell me about yourself and about MobileMD.

I graduated a long time ago with a degree in economics and moved to the Army. The Army was kind enough to pay for my education. In return, I repaid the Army by going on active duty as a communications electronics officer for a Special Forces unit. After that, I moved into the private sector and have spent the time since then in health information technology.

In 1997, I came up with an idea as I was working for a pharmaceutical company to Web-enable an electronic medical record. Today that doesn’t sound like a big deal, but in 1996-97, it was a little more progressive. I taught myself how to write software so I could prototype what I was thinking about. I got a contract that was large enough to allow me to go out on my own. I began a company called Intraprise Solutions.

Intraprise Solutions was, and still is to this day, a successful custom software engineering firm that deals in financial services and healthcare. In October 2009, we spun off the MobileMD division — which was the healthcare division of Intraprise Solutions – into its own company. We took in some venture capital and have been growing MobileMD quite rapidly since.

We’ve been in the health information exchange space as MobileMD or as Intraprise Solutions since 2005. That was when we went live with our first client, Centura Health in Colorado. 

We’ve done a very good job at taking our time to learn the special nuances and subtleties that exist between clients as you’re implementing full-service information exchange. We are SaaS platform. In going through that process between 2005 and 2009, we were able to gather a lot of information regarding what’s common and what’s different between every implementation.

In doing that, we were able to develop an understanding of what was productizable and what was something that would have to be franchised as mass customizable to bring us that last mile. It is part of our service offering to ensure that we not drop technology off the doorstep, but that we provide a complete and comprehensive service for our clients. That means everything from providing data analysis on the front end to delivering information directly into an electronic medical record established on the back end, not dropping off the results at the queue for somebody to put it away.

As you can imagine, given the disparity of systems and the myriad of different systems out there in the market, that’s a complicated task. We found we’re very good at franchising that.

How have HIEs changed over the last couple of years? When they first started, they were large-scale, questionably sustainable public utilities looking at very specific entities and a narrow list of exchangeable data elements.

There are certainly still public dollars flowing to help support and fund health information exchanges, but there has been a shift towards enterprise or private health information exchanges. That’s largely the market that we’re in. In fact, that’s almost exclusively the market that we’re in.

We’re finding that health information exchange is best served by serving a specific provider community and providing that community with a competitive advantage through health information exchange. Then, as patients transfer their care, patients become the catalyst to drive cooperation. The goal of the healthcare industry is to care for patients, so as patients move from provider to provider — in my world, from exchange to exchange – the need to cooperate is driven by the market, not driven from the top down through federal grants and funding.

I think the biggest shift has been a move away from RHIOs, a move away from forcing collaborative environments from the top down, and a move towards allowing market forces to generate the collaboration from the bottom up; creating what I would characterize as a network of networks with each little network being the health information exchange in and of itself. Then, connecting to other health information exchanges using some of the standards that have come out relatively recently from the ONC and are continuing to be developed by the ONC, those being an NHIN Direct and Connect.

That translates to much greater adoption. We have 28 production health information exchange instances right now serving 16 distinct clients. That counts Catholic Healthcare West as one client, but we are in 15 of their regions and each region is really its own health system. I will tell you that the private HIE adoption rate has been fantastic. If you compare that to the various state and RHIO-based initiatives that popped up between 2006 and 2009, I’d think you’d see a massive difference in the level of adoption.

You’ll also see a massive difference in the amount of information flow. We do about a million transactions a day through our health information exchange at our data center in Mason, Ohio. Those transactions include everything from ADT transactions to labs, radiology results, discharge summaries, CCDs — you name it. Any transcribed document, any type of clinical documentation, and some peer documentation is sent to our exchange and then distributed out to where it needs to go.

If you’re a hospital, what’s the biggest bang for your interoperability buck?

There’s physician alignment and fee-for-service. There’s a great desire for physician alignment, because if you achieve physician alignment, the physicians are actually your consumers, not really the patients. I say that sadly because the patient should always be the consumer.

But in a fee-for-service environment, the bang for the buck is alignment with the physician community. That is essential. If it’s easier to do business with the provider, then it generates an affinity and additional referrals to that organization. Simply put, you get your information back faster, you get it into your EMR, you get it available via our applications on the Web, whatever the case may be. It’s just easier to do business with that particular provider. It drives revenues.

Ironically, we’re equally effective in an ACO type of an environment where you have a population of patients that have a fixed amount of money that has been set aside, you have a team that is charged with caring for them, and they have a budget cap. They are to care for them in a manner that provides quality, but in a manner that also ensures efficiency. As a health information exchange that is capturing, centralizing, aggregating, and analyzing all of this information, we provide organizations with a great opportunity to launch accountable care initiatives. They are able to mitigate a huge amount of risk because of the sheer volume and accessibility of clinical information that historically hasn’t been available. Historically, the only information that’s been available is an insurance claim, which contains only a tiny portion of the clinical information necessary to make clinical decisions.

Who would you consider to be your most direct competitors and what distinguishes your offering from theirs?

Axolotl and Medicity. Both of them have recently been acquired by payers, as you know. That’s beneficial to us. It has been my experience that a lot of providers are a little concerned about doing business with health information exchanges that are tied at the hip with payers. 

They’re still definitely our biggest competition in the market. That’s the class that I would put us in. In fact, that’s the class that KLAS puts us in – not to do a play on words – and we’ve been very fortunate to have achieved a high ranking in KLAS and continuing to do so. The most recent scores I saw still have us pretty far out in the lead in the private HIE category.

Why do you think insurance companies are interested in HIE technology?

I had the unique opportunity to sit with Aneesh Chopra and Todd Park, the CTO of the United States and the CTO of Health and Human Services, respectively, at a dinner here in San Francisco. Interoperability, the ability to share information and not have that information locked in silos, is really viewed by pretty much everybody in healthcare as the only way we’re ever going to be able to transition the method of payment and the method of reimbursement in this country. 

Interoperability is a cornerstone of many initiatives. It’s the cornerstone of Meaningful Use. It’s a cornerstone of the Affordable Care Act, It’s a cornerstone of accountable care initiatives. It’s even a cornerstone of any kind of physician and patient alignment strategy that a provider may have. So you have interests in health information exchange companies from the outside, from all angles, from insurance companies that may find themselves playing in some way in an accountable care or capitated payment environment.

You also have a great interest in provider-type organizations that are concerned about their ability to share, communicate, aggregate, and analyze information that is available without having to reproduce that information, have duplicative information, inadvertently create duplicative tests and results, etc.

Every segment of the healthcare industry is relying upon not only the digitization of clinical information, but the sharing of that information. It doesn’t do much good if you digitize it if you can’t share it. A lot of it’s been digitized in lab systems and buried in lab systems for years, but it hasn’t been shared very well. It’s shared as faxes. That’s not very useful. Health information exchange is seen as a means to be able to provide that interoperability.

You mentioned Meaningful Use. What has been the impact on both the Meaningful Use requirements and the sometimes overlooked federal HIE grants on health information exchange?

The exchange of information is highly critical. Some of the Meaningful Use criteria includes being able to deliver to patients their protected health information electronically. That clearly is a role that health information exchange, particularly if it has a patient portal on top of it, can serve very nicely. If it doesn’t have a patient portal on top but can feed PHRs offered by WebMD, Google, folks like that, HIEs play a very, very important role in Meaningful Use in that regard.

The other area that I see that may even be more significant is as dollars are being offered as incentives to adopt electronic medical record technology in the ambulatory space, there has been a huge push to create lightweight electronic medical products. We’re proceeding in that directly lately, but that’s a critical component of our comprehensive solution. The reason that is that , even with all of the opportunity to collect funds over the years, there is concern now in the ambulatory space with respect to how EMRs are going to impact the operation of a physician practice, particularly if that physician practice is relatively small — three or four docs, which is the average size practice in the country.

All of the physicians in those  practices are looking for solutions allow them to achieve Meaningful Use, but they’re looking to newer, different solutions that are more cost effective, more rapidly deployable, or are easily supported. That’s where our Software as a Service approach comes in very handy. There’s no hardware, no software required at the site. You leave everything up to us. If you have any questions, you give us a call.

It’s interesting that EMR vendors are creating their own private exchanges among customers of their own systems, and then you as an HIE vendor are creating lightweight electronic medical records. How is that going to play out? Do you see yourself in competition with EMR vendors, or do you see yourself as the network they need to attach to?

You know what? That’s a great question. Let me state without question, we are EMR neutral. We are very good friends with several EMR vendors and we’ve integrated with certain vendors dozens of times. So I really don’t see us competing so much in the EMR space with EMR vendors.

We offer an EMR Lite simply because it makes logical sense. We have a clinician portal, we have a patient portal, we have all of the information for a community. We’re able to create a connected EMR Lite on top of that, if practices choose to go that route. Our EMR Lite will undoubtedly lack some of the sophisticated functionality that some vendors have spent hundreds of millions of dollars building, but it will be easy to use and it will be much more cost effective.

I think we’ll appeal to that segment of the market that has proven over the last 15 years they’re not going to buy an EMR. The EMR penetration is still very low, so I don’t really see us so much as a competitor to the EMR market. As far as their private exchanges competing with us, we haven’t really seen that at all.

Occasionally we are questioned about the community products that are offered by the likes of NextGen and eClinicalWorks and how that plays with our exchange, but they simply end up being a hub to which we exchange information because never — not even at an Epic site — never is 100% of the care community on the same technology, ever.

In fact, one of our clients is a very big Epic shop. We still have a role to play there because they still have large physician group — physician practices that are using other-than-Epic products in the ambulatory setting. They need access to the same information. Epic is listed in KLAS right under us as a private HIE, although it does clearly say Epic and Epic only.

We really don’t find ourselves competing too much with them, either. It really is one of these things where there are some economies that are able to be achieved because we provide one feed to one hub that then provides three instances of NextGen with data, as opposed to us providing three points. I would argue that it simply adds efficiency to the process.

When you think ten years down the road and we’re looking back, what do you think the impact of HIEs on healthcare will have been?

Ten years down the road? That’s a long time. I hate to imply a level of precision I can’t know, but I will say this. I believe that the ONC is starting to move very much in the right direction with regard to policy and guidance that they’re giving with respect to standards and how we’re going to build up a network of networks to exchange data.

I think we will see an environment in which the accessibility of comprehensive clinical information, regardless of where that patient was cared for, is going to be available, and it’s going to be available in one place, and it’s going to be very readily accessible. I believe that will result in significant reduction in unnecessary procedures, a reduction in medical errors, in poorly prescribed medication. 

I think that health information exchanges will be one of the catalysts to help alleviate so many of the problems that are outlined in Shannon Brownlee’s book Overtreated, playing a role in the massive and continuing increase in costs and healthcare simply because we’re making information that is so critical to decision-making accessible.

If you present at a physician’s office and you’re not able to articulate clearly all those things that have been going on with your health, in an environment in which physicians unfortunately have to protect or provide defensive medicine on occasion — without that information, they have to ask for procedures that may not be necessary or may have already been done. With that information they can avoid that and make much smarter decisions. It benefits everyone.

Without the exchange, the information simply sits in silos and we have a bunch of automated providers that don’t talk to each other. It’s like having one fax machine. Metcalfe’s Law, which is more metaphorical than it is actual, says that the value of a network is proportional to the square of the number of participants on it. One fax machine is useless. Two are a little more useful. Three are nine times as useful as one. The same applies here. 

That’s why we stay EMR-neutral. We want people to subscribe to the network. We don’t care why they subscribe, we just want them to subscribe to the network. Because when they subscribe, they’re providing information and they’re getting information, both of which are very necessary to the care for patients, especially in an environment where care is provided often primarily by specialists and not by primary care physicians.

What did being a Green Beret teach you about leadership and business?

I was communications officer in a Special Forces Unit, so I supported the A-Teams as they went out and did their missions by making sure that we communicated all the necessary information they needed to conduct their missions successfully, wherever those missions took them.

Execution is highly critical. That may be obvious, but all too often people don’t actually execute on plans. Execution is very, very important. Planning is very, very important. Quality of service is very, very important.

When you’re a Second Lieutenant and you show up at a Special Forces Unit, it’s made up of hardened senior NCOs. They’ve had every bit of special training that the Army has to offer. If you don’t provide them the best service possible, they will string you up and beat you like a piñata. I learned early on that service is differentiator. Anybody can build anything in this world, but service is the differentiator.

I also learned a great deal about sense of urgency — what’s important and what’s not important — and how to prioritize. In healthcare, when clinical information is flowing, it is important and it is urgent. Rarely does clinical information flow where it’s not important to get from Point A to Point B.

From a leadership perspective, I learned a great deal. My four years on active duty with the Special Forces unit taught me a lot about how to prioritize, how to strategize, how to look at the big picture, and how to marshal resources appropriately to get jobs done. Because at the end of the day, if the information doesn’t get from Point A to Point B, somebody’s going to get hurt, whether that’s in combat, training for combat, or in a care environment.

News 1/19/11

From CONNECT Development Stalls: “Re: ONC. They have apparently decided to retain the CONNECT development contract with CGI. But since ONC is planning for Harris (the incumbent) to re-file its protest, no work will begin for another 3-4 months. The steam continues to escape from the CONNECT program. No word yet on who ONC has selected to replace the prior program leads, Dave Reilly and Vanessa Manchester.” Unverified.

From HITInsider: “Re: tough times in Verona? First, Epic clients complain about problems complying with Meaningful Use reporting requirements. Now I am hearing that during a recent Epic upgrade at Texas Health Resources, the system was down for THREE STRAIGHT DAYS. Recovery from this took an additional four days, with multiple subsystems failures during that time.” The THR problems weren’t related to Epic – it was a simultaneous Citrix upgrade that caused the problem. Epic was fine, according to CIO Ed Marx – users just couldn’t get to it (not that the distinction matters to users, but it probably does to Epic).

From JustWonderin’: “Re: Allscripts. Hearing it will outsource its TSC remote hospital operations. Not clear if it is just legacy Eclipsys or also legacy Allscripts.” Unverified.

From The PACS Designer: “Re: Verizon iPhone 4. InformationWeek provides us with some more aspects of the Verizon iPhone 4 due for release in early February. TPD likes the Wi-Fi mobile hotspot instance that this iPhone generates for five other devices.”

Thanks to Inga and Dr. Jayne for holding down the HIStalk fort during my short break. I am relaxed, sunburned, well romanced, and still picking Mojito mint from my teeth, all obvious markers that I needed and enjoyed some time off. I’m also way behind on e-mail, so I’ll hold the fascinating comments I received about Epic’s sales process until I have more time to assemble them. For those waiting on something from me, I apologize profusely – I’m in a constant state of overwhelmal (if that’s not a word, it should be, and my pipe-smoking doc’s picture should appear with the definition). 

The HISsies voting is closed – thanks to the 988 readers who took part.

I’ve mentioned New Zealand vendor Emendo, which sells the CapPlan capacity planning software for hospitals. The company, whose sales went from $0 to $10 million in its first three years, expects $50 million in revenue in the next three years and will sign deals with additional US partner companies this year.

Former Cerner COO Paul Black is named operating executive of private equity firm Genstar Capital LLC.

Karl Matuszweksi, MS PharmD joins First DataBank as VP of clinical and editorial knowledge base services. He was previously VP and editor-in-chief at competitor Gold Standard/Elsevier.

Weird News Andy has been busy, for sure. He entitles this find as “She must have been a valet girl.” A woman in labor pains drives herself to the hospital ED at 3:00 a.m., where a uniformed valet offers to park her car as she rushes inside. During her admission, she is given bad news: the hospital does not offer valet parking. The car was later recovered, but the grand theft auto suspect has not been. WNA also snorts at this report: cocaine-like designer drugs that are being sold in gas stations labeled as bath salts for $25 per half-gram bottle are causing suicides, poison hotline calls, and hospitalizations, especially in teenagers. Said a hospital’s ED chief, “They will do stuff that they wouldn’t ordinarily do, like dive from a third-story window into a pool.”

HIStalk’s newest Platinum Sponsor is interesting: IRM (Information Resource Management), part of the 34-hospital Inland Northwest Health Services of Spokane, WA. IRM is an informatics solutions service provider (consulting, implementation, management, and outsourcing, with emphasis on Meditech HCIS) and offers hospitals the services of its 300 IT experts, including the Meditech EMR, Bar-Coded Medication Verification Systems, centralized help desk, software development, and Web development via the shared service model, with an average satisfaction score of 4.89 on a five-point scale and a staff satisfaction score of 96%. For physicians, it developed an ASP model for hosting the GE Centricity PM/EMR, secure e-mail, document management, encounter forms, speech recognition, services for faxing and e-prescribing, and interfacing. I’ll make it a point to learn more since I’m interested in what they’re doing. Thanks to IRM and INHS for supporting HIStalk.

Former Cerner analyst Matt Wenzel is promoted from interim CEO to permanent CEO of Hedrick Medical Center (MO). He started with the hospital in 2006 as an IT analyst.

Bill Hamill, formerly of Picis and developer of the VOCEL Pill Phone app for clinical trials data capture, joins PerfectServe as regional sales VP for the western region.

Apple announces amazing Q1 results Tuesday after the market close, with revenue of $26.7 billion, profit of $6 billion, and a staggering 7.3 million iPads ($4.4 billion  worth) sold in the quarter. Apple also moved 14.1 million Macs, 19.5 million iPods (mine being one – love it), and 16.2 million iPhones, even before they were available on Verizon.

East Alabama Medical Center says it will get about $9 million in HITECH money over the next four years, with the first payment expected this year. They’ve spent $78 million to move to electronic systems.

Another Consumer Electronics Show announcement: BL Healthcare shows its remote Healthcare Access Terminal that offers HD-quality videoconference and sharing of medical telemetry data between patients and providers. It runs on the Verizon Wireless 4G LTE Mobile Broadband Network.

Old news that I might have missed: a network administrator at Pardee Hospital (NC) is charged with stealing $615K worth of Cisco equipment. The federal indictment says Joel Kimble filed false warranty claims, had the replacement items sent to his home address, then sold them on the gray market.

Australian HIT vendors had a terrible 2010 caused by delayed e-health projects, global financial woes, and an unfavorable currency exchange. Everybody knows about the hard fall of iSoft, but other companies with negative news are ISCGlobal (sold its claims processing assets for next to nothing), PHR developer Healthe Solutions Australia (went under in 2009), medical information publisher MIMS Australia (losing money, moving offshore), US-based Milliman Care Guidelines and First DataBank (closing down there, with FDB announcing losses), TrakHealth developer InterSystems Australia (borrowing money from parent InterSystems to cover losses), Global Health (reduced revenue), GE Healthcare IT Australia (reduced profit, was considered for shutdown), and Cerner (slim profits). This is an excellent article in AustralianIT.

KLAS announces a new report on clinical decision support, about which I’ll share all I know (which isn’t much: I don’t have the report). Hospitals say order sets deliver the biggest bang for the CDS buck, integration with third-party content doesn’t work very well, and Meaningful Use requirements are hurting CDS development (interesting since MU touts CDS, but apparently has slowed its progress).

HIMSS and Life Sciences Information Technology Global Institute unify (meaning, I assume, that HIMSS bought the San Diego-based organization but didn’t want to sound crass in the announcement by actually saying so). LSIT is developing references and standards for the life sciences market. It sounds ITIL-like.

Pharmacy automation vendor Swisslog buys Charleston, SC-based Sabal Medical, which sells medication software and and the sabalKOW drug dispensing cart for hospitals, for $9 million.

A survey in Japan finds that 10% of that country’s universities use cloud-based e-mail providers such as Google and Yahoo, raising concerns there that those companies don’t reveal where their servers are located, meaning they are likely outside of Japan and therefore not covered by Japanese law in case of privacy issues.

E-mail me.

HERtalk by Inga

Rush University Medical Center (IL) anticipates earning $28 million in federal incentives for its Meaningful Use of its Epic EHR. It went live in 2009 and will have 90% of its office-based physicians up by the end of the year.

DrFirst announces the establishment of its Hospital Services Group that offers consulting services.

Healthcare Information Xchange of New York completes its implementation of InterSystems HealthShare as its core HIE platform.

Michael Gold joins CareCloud as director of product development. He was previously with Sage Healthcare.

ONC awards Accenture a two-year contract to help identify standards and specifications to facilitate clinical data exchange.

More than a few folks have sent me a note asking if they missed the registration link for HIStalkapalooza. To clarify, Mr. H will post all the registration details on the 21st. Meanwhile, I am pleased to report we have lined up celebrity judges for the second annual “Inga Loves My Shoes” contest and the first annual HIStalk King and HIStalk Queen coronation that will be among the festivities there. The latter will recognize the best-dressed attendees, so don’t forget to pack a tux or sparkly dress. Mr. H has agreed to honor winners with amazing prizes, so it just might be worth that extra $25 checked bag fee to bring your party attire.

Speaking of HIMSS events, I was looking through the conference information and a few items caught my eye:

• Over 70 clinical information systems will be connected as part of the Interoperability Showcase. That’s a whole bunch of vendors making clinical data exchange look easy.
• For a mere $23, you can purchase lunch in the exhibit hall, including a drink and dessert. Menus available here. This is the Bistro HIMSS concept we wrote about last year, where companies can rent tables right in the exhibit area and provide food to their guests.
• One month out and so far, 903 companies are registered exhibitors, including 209 first timers. That’s about on par with last year’s numbers. 
• The annual 5K fun run is Tuesday the 22nd at 4:00. Sounds brutal after a day of walking around a huge convention center in heels. No thanks.

Inova Health Systems (VA) selects a suite of Oracle Health Science products for interoperability and analytics.

In yesterday’s HIStalk Practice, I mentioned a bit of juicy testimony from the HIT Standards Committee meeting last week. A reader forwarded this link, with instructions to cue the recording to 2 hours and 49 minutes to hear what Dr. Scott Monteith had to say. It’s worth taking five minutes to hear why he’s not too impressed with the whole Meaningful Use issue.

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

• Texas Children’s Hospital will become the first pediatric hospital in the country to use iPhones with Voalte’s point-of-care communication solution.
• SCI Solutions is providing its access management solutions to NCO Group, a provider of business outsourcing services.
• Sunquest announces its new Sunquest Physician Portal outreach order and results web connectivity solution.
• Grays Harbor Community Hospital (WA) will use Access Intelligent Forms Suite to improve forms barcoding and version control in the ambulatory infusion services (AIS), cardiac rehabilitation, and diabetes education departments.
• T-System appoints Steve Armond as CFO. He most recently served as CFO of American CareSource Holdings.
• Medicity is participating in the IHE North America Connectathon 2011 this week at the Hyatt Regency in Chicago.
• dbMotion will showcase its latest technologies at HIMSS.
• MEDecision publishes an e-book titled Medical Loss Ratios: Important Implications for Care Management.

EPtalk by Dr. Jayne

Dear Dr. Jayne,

Why is it necessary to have a physician at the C-level or vice president level of administration at an academic medical center for informatics? Do the majority of academic medical centers have such a position or are they using a physician champion? What is the reporting relationship between the CMO and CMIO? What are the main job duties of a CMIO?

PeggyBRx

Dear Peggy,

First, let’s talk about the CMIO title. According to CMIO Magazine’s February 2010 issue (which happens to be lounging on my office credenza with the alumni magazines that I leave around because they have awesome cover art) less than two-thirds of us actually have the title. Some of us are Directors of Informatics, Medical Directors, or something else. Being a direct report to the CIO or CMO are each in the 30% range, with around 15% to the CEO.

Now that I’ve fulfilled my physician-esque need to cite data, let’s chat.

In my opinion, what’s more important than the CMIO title is the CMIO role itself. And that can be filled by either a named CMIO or a physician champion with another title, as long as he (or she, even though that same article said that 93% of respondents were men) has a clearly defined role and enough time to get the job done.

Too many organizations try to do the CMIO role on the cheap and add it to a physician with an already full plate, who may or may not know anything about information systems, and may or may not have good peer relationships. The majority of academic medical centers, especially if they are going to be successful, are going to have the CMIO role, whether they call it that or something else. I know of many mid-size hospitals and large medical groups that have also embraced the CMIO.

So what does a CMIO do? (Warning: literature search in progress! You can take the girl out of the medical library, but give her a laptop and a glass of Cab and she’s right back in it.)

According to the September 2006 issue of the Journal of the American Medical Informatics Association, the CMIO leads clinical IT initiatives, engages in strategic planning, participates in vendor selection, manages clinical IT staff, and leads process redesign. I generally agree with those main job duties, but they left out the more glamorous parts of the job:

1. Mediation between primary care disciplines and specialists. Everyone thinks they are the key to patient care. Welcome to the Village, y’all, and stop posturing.
2. Mediation between the Academic faculty and the Community physicians. Some days, you feel like you’re in a bad high school production of West Side Story, complete with Sharks vs. Jets.
3. Hostage negotiator when physician design committees won’t let the facilitators or subject matter experts out of the room even for a bathroom break, because they are too busy haranguing. (Tip: baked goods. Many physicians still bear the psychic scars of “see a donut, eat a donut” from medical school.)
4. Cat herder. Enough said.
5. Last bastion of patient safety. You put on your riot gear and take on the vendor’s CMO, whose code really might kill someone if they don’t fix it. It’s a rare part of the job, requiring confidence and a thick skin. I tend to psych myself up for this by remembering the most hateful attending who ever yelled at me as an intern. Previous military experience is also helpful. Hooah!

I hope this helps. It sounds like you’re on the way to some serious work – best of luck!

Dr. Jayne

Have a question about medical informatics, electronic medical records, or that itchy rash that won’t go away? E-mail Dr. Jayne.

The MU Hearings: DrLyle Goes to Washington 1/18/11

You may have read some stories about the Meaningful Use Hearings this past week. It’s always interesting to read what the regular press picks up on, but I’d thought I’d give you my "on the ground" report as well.

Background: ONCHIT created the Health IT Standards Committee, which is Federal Advisory Committee "charged with making recommendations to the National Coordinator for Health IT on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information." This committee then has five sub-committees or workgroups: Clinical Operations, Clinical Quality, Privacy & Security, Implementation and the Vocabulary Task Force.

Each of these committees is staffed by volunteers from healthcare organizations and various vendors. I give them a lot of credit for spending the time to do this.

The Implementation Committee held a hearing last week on "Early Adoption of Meaningful Use", meaning they wanted to hear from Eligible Providers (EPs) and Hospitals about their early experience in preparing to meet MU requirements for this year. This makes sense. The government is going to potentially spend tens of billions of dollars on MU. It is smart to get a leg up to see if things are going smoothly from the start. And if not, figure out how they can start fine-tuning.

I was asked a few weeks ago to provide some input at this meeting (as an EP). I figured, hey, this is on my bucket list ("give testimony to a federal advisory committee"), so I’ll do it!

My first responsibility was to send in written testimony answering some questions they provided (e.g. tell us about your successes, your challenges, etc.) Next step was to fly to DC to talk to them in person. We would be given five minutes to provide oral testimony, and then there would be Q&A with the committee.

The first day and the start of the second had various HIEs and RECs commenting. Then came the active EMR users who were planning on applying for MU in 2011 (ten representing EPs, another ten representing hospitals). Most were physicians, along with a few CIOs.

While I was hoping to be in some hallowed marble halls, they did have us in a nice large conference room at a local Marriott. The Committee was in a U-shaped formation. Below that was a table where up to five presenters could sit and behind that was general seating for the public.

The following is my summary of the testimony given by these end users, with a slight bias towards the EP testimony. The following were relatively consistent themes, with my comments intermixed:

The good news is that this bill has indeed "stimulated" many organizations to move forward with various upgrades and focus on how to produce quality reports from the data in their EMRs.

But mostly we heard about the challenges.

• This is hard. It’s not impossible, but it’s a higher bar than many had anticipated because the requirements are not simple, nor are they fully explained. Everyone had at least some questions about interpretation. The worrisome thing is that if it gets to the point where users start thinking this is too hard, they won’t even try. I made it clear that I was thankful to be part of a hospital organization which is helping us with this process, but I feel sorry for those EPs who are trying to do it on their own. If you are one of those, make sure you ask your hospital if they can support you in any way and find out if there is a REC in your neighborhood who can help as well.
• There are lots of questions. For example, many wondered whether we could only use the EMR functions the vendor created or whether we could create our own (e.g. do we have to use a vendor’s "Smoking Status" form if we think we can build a better one). One big question I brought up was getting clarity on whether can we use scribes in the exam rooms to help with documentation and orders, as well as use other intermediaries later on to help with data collection (e.g. clerks or nurses to transfer free text into standardized forms).
• Time crunch. There is a very tight timeframe between the release of the requirements, embedding them into EMRs, the "rollout" of the new EMRs, and the updating of workflows and reports to ensure users are actually meeting the MU requirements. The government does not seem to fully appreciate all the steps involved, especially with large vendors who often need 18 months of lead time for making updates and for larger health organizations who then need a lot of time to do system upgrades. Many felt they really need to consider extending the timeframes for future stages, as rushing these upgrades can have some serious risks.
• Resource crunch. This is often a zero-sum game with resources. I was quoted by some media as saying that working on MU meant that our people could not work on other IT projects. That wasn’t exactly what I said, but rather that spending time on MU meant staff had less time to work on ANY other projects. And this can be an issue since the same people who are on MU committees are often also the ones dealing with operations and quality improvement in general.
• We need more flexibility. Not every practice is the same, and requiring 100% mandate of every requirement is not reasonable. My suggestion is that for Stages 2 and 3, they should create a variety of options like the Menu concept in Stage 1. The result should be that every practice could show they are using an EMR meaningfully, but they don’t all have to show they are doing it the same exact way.
• Functionality is not the same as usability. In other words, there is often a large gap between whether something can be done and whether it can be done in a usable manner. A function might meet the requirement’s definition while being very hard to use. An EMR vendor can get MU certification for their functionality whether their usability is great, good, or poor. Fortunately, the government is starting to look into usability requirements for the certification process, so let’s hope they follow through on that sentiment.
• Data sharing alone is never enough. Dr. Reid Coleman from Lifespan had the quote of the day when he said, "Data is like salt water… you need a filter to drink it". I’d also add that it helps to have good plumbing to connect it to the right facilities, and then also to have plenty of glasses available to make it easy for people to get it to the "final foot."
• Standards. There were lots of people saying they would like the government to make standards for a national MPI and for data in general. I loved the line that many people reiterated, saying "We’d rather have one bad standard we can work with than three good ones without a clear winner." On the other hand, we should make it clear we do NOT want the government to make standards about actual functionality – we can and should be creative in that domain.
• The cost of implementing MU may often be more than the actual monies themselves, when you factor in costs for various software upgrades, consultants, and change management. It also sounded like there were vendors charging significant amounts of money for MU upgrades, that consultants were increasing their fees due to demand, and that some RECs are charging doctors even though they are also receiving money from the government to help. One doctor pointed out that the government needs to either make the requirements easier or pay more (and we know they are not going to pay more).
• Certification requirements don’t always exactly match MU process requirements. Someone has to keep a better eye on this.
• Communication with CMS and ONCHIT has not been easy. The Committee pointed out the five different blogs and websites to get information. I’d suggest they consolidate down to one and create a content management system that can expand on the FAQ concept they currently have in place.
• The result of most of the above is that the biggest and the best are struggling with MU… so you have to wonder, how much harder will it be for others? This is an interesting contrast to the recent reports that "many" hospitals and EPs plan to apply for MU dollars based on a recent survey. My hunch is that most hospitals and doctors like to think they will apply for this, but that is altogether different than actually doing it. Considering that less than 25% of EPs even have basic EMRs in place, it will be interesting to see what happens. And in the end, some limited testimony and lightweight surveys will be long forgotten… the proof will be in the pudding.

Finally, it was concerning was that ONCHIT did not even send a representative to the meetings (one of them called in for the morning only). I do believe that the committee will represent us well, so let’s hope ONCHIT is listening to what they say and take serious the fact that there is increasing concern about the scope and timing of these requirements. If their goal is to make it so just 10-20% of the EPs can meet the MU criteria, then the folks from this meeting would say they appear to be doing well. But if their goal is to get over 50%, then they may need to rethink some of the complexity of the requirements and the timing involved in meeting them.

Full details and testimonies of this Committee Meeting are available online.

Lyle Berkowitz, MD is a practicing internal medicine physician, a healthcare IT consultant (www.DrLyle.com) and founder of the Szollosi Healthcare Innovation Program (www.TheSHIPHome.org). He blogs regularly at The Change Doctor (http://drlyle.blogspot.com/).

Readers Write 1/17/11

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!

Remote Access Is Not Mobile Access
By Cameron Powell, MD

Healthcare organizations are quickly learning that both remote and mobile access strategies are required. See Table 1.

Remote access lets providers work in the hospital computing environment when they are not on location. This includes accessing the EMR and clinical applications via a PC or laptop from office or home. Secure the session with something like VPN, add the necessary authentication and encryption, and clinicians can use their Windows desktop and a browser to interact with hospital applications.

Offer mobile access when you need to empower providers to perform specific tasks anytime, anywhere. This would include visual assessment of images and waveforms, checking lab values, reconciling medication lists, checking allergy status – all while on the go. Providers want the data transformed into meaningful chunks; they don’t want to navigate the medical record from their Droid in order to make timely treatment decisions. Mobile data should be provided via native applications, built to run securely on a specific device and operating system.

Some organizations have considered using Citrix to provide interpreted or emulated application access to the EHR or CIS via a mobile device. Accessing patient monitoring data via a non-native solution is discouraged, because visual distortion is almost certain when things like medical aspect ratios cannot be controlled. [1] Further, the FDA is mandated to regulate mobile devices. [2], [3]

Mobile versus Remote Access

References

[1] http://ahealthydoseofmobility.com

[2] http://www.ebglaw.com/showarticle.aspx?Show=12184

[3] http://www.law.uh.edu/healthlaw/perspectives/2010/kumar-fdamobile.pdf.

Cameron Powell, MD is president, chief medical officer, and co-founder of AirStrip Technologies of San Antonio, TX. 

Transcription Today
By Diligent Monk

Transcription is back.

As EMR adoption picks up in response to Meaningful Use, it is worth noting that lurking in the shadows is a familiar enemy to EMR companies: transcription. The age-old practice of dictating for capturing clinical observation is the most efficient, accurate, and preferred method for physicians to document a patient encounter.

Over the past few months, announcements from large organizations have signaled a return to relevancy for the transcription industry. IBM, Nuance, 3M, HealthStory Project, major universities from around the globe, and many other dominant players in the transcription service industry have made significant strides in utilizing technology to create more value from transcripts.

Enter the transcription technology revolution.

Partnering the skilled labor of transcriptionists with technology produces a rich and accurate dataset from a traditional transcript. Whether labeled natural language processing (NLP) or discrete reportable transcription (DRT), the concept is quick, simple to understand, and the value is just now being seen by the industry at large.

Using extensible mark-up language (XML), data is pulled from transcripts and provided in common transport standards (CCR, CCD, CDA) to be used in EMR systems and reports. A physician can dictate his/her notes and collect all of the data required for meeting the objectives and measures for incentive payment per the HITECH Act without purchasing an EMR.

Historically, the EMR sale was built on an ROI derived from transcription savings. Looking at a practice or hospital balance sheet, the transcription bill seemed to be the easiest to pick on, and with the point-and-click interface promoted by EMR vendors, it was a straight replacement for clinical documentation. EMR adoption would eliminate transcription costs. As an industry, the transcript was losing its relevancy in an age of electronic records, but physicians and practices weren’t thrilled with the results. And back to the revolution.

Permitting a physician to dictate in their preferred and normal manner, coupled with the ability to ‘tag’ the data elements of importance from the note, provides the best of both worlds.

Unfortunately, this does nothing to eliminate that pesky transcription charge, which is still the focal point of many EMR pitches. The transcription industry, however, counters that the prevention of productivity loss will more than cover the cost of their services and therefore be a win-win for all involved. As well, the risk of errors in reports is significantly decreased by the medical language specialists that review documents for clinical quality and integrity before submitting back for approval from the physicians.

As crazy as this sounds, and as hard to believe as it may be, transcribing may be the best way for practitioners to achieve Meaningful Use and the most cost-effective for their practice. The technology continues to improve and adoption continues to be strong, so yes, transcription doesn’t appear to be going away, and that may be a good thing.

FDA Comes to HIT… But Through the Back Door
By Frank L. Poggio

For several decades, there has been a raging debate as to whether HIT systems should be regulated by the FDA. A search of HISTalk on ‘FDA’ brings up hundreds of mentions. Some clinicians believe FDA oversight is desperately needed; others feel it would be a major detriment to new development.

Now the debate is over. It came earlier this month through a back door called ONCHIT, probably while you were sleeping.

On January 7, ONCHIT issued the Permanent Certification Program Final Rules PCPFR. These are the rules that will transfer the testing activities from the ‘temporary’ agencies to ‘permanent’ ones as of January 2012. On the surface, you would think these rules would impact only the companies like CCHIT, Drummond, InfoGard, etc. But our creative friends at CMS–ONCHIT went many steps beyond that.

Here are some highlights from a vendor perspective.

A new entity was created called the ONC-AA called the Approved Accreditor agency. The current ATCB will be changed to ACB, or Authorized Certification Body.

In a nutshell, the ACB administers the test and the AA oversees the ACB. Today under the temporary rule, the ATCB does both. What is now a one-step process will become in 2012 a two-step process for software firms seeking certification. The AA will also be the agency that selects and contracts with the ACBs for testing services (such as CCHIT, Drummond, etc.) 

The new ONC-AA is required to insure that the ACBs conduct ‘surveillance’ of certified vendor products. Surveillance is CMS’s way of saying ‘audit’.

Here’s how the surveillance will work. The AA can walk unannounced into an ACB office and review all certification documentation, or can randomly sit in on tests. More importantly, the AA or ACB can audit at will, unannounced, the MU criteria out in the field at the providers shop to ensure the certified system really does what it was certified to do.

And it doesn’t stop there. Similar to the FDA processes, any user of a certified system (provider clients or their employees) can file a complaint directly with the ONC-AA or ACB stating that the vendor’s installed certified system DOES NOT MEET the certification criteria. At that point, the AA will conduct an investigation at the site and make a determination whether the vendor’s certification should be pulled.

If so, as with the FDA, press releases to that effect will be circulated. OUCH! Better start thinking about stronger client support in the future and set up internal channels to catch the gripes before they get so bad a user wants to scream ‘ONCHIT’.

On of my friends called this the ‘HIT Whistle Blower Act’, a good description. It’s just like the FDA: if a device or drug has an unexpected adverse impact, anyone can file a complaint. I hear a train a coming …

Frank L. Poggio is president of The Kelzon Group.

Monday Morning Update 1/17/11

HERtalk by Inga

From: Florence Bascom “Re: Selling for Epic. A rumor I have heard about their sales team is that their sales executives are not commissioned – which in itself would make it an extremely unique model compared to other HCSW orgs.” Mr. H mentioned his desire to talk to a former Epic sales rep (anonymously of course.) Comments like the above add to the intrigue.

From: Lu Wolf “Verizon vs. AT&T. David Letterman’s take on why fewer drop calls isn’t necessarily an improvement.” Very fun. Now that Verizon officially announces wireless service for iPhones as of February 10th, a predicted 26% of iPhone owners will likely switch from AT&T over the next year. I won’t be changing carriers, primarily because I live in a region where AT&T has much wider coverage. But seriously folks: why isn’t there an option that includes easy workflow, a fast network, and no dropped calls?

The SEC settles with Reza Saleh, a Perot Systems employee accused of insider trading when Perot announced its sale to Dell last year. Saleh, a longtime friend of Ross Perot, agreed to return all the money without admitting or denying any allegations. The SEC will also ask the court to impose financial penalties which could be as high as $25.8 million.

The local paper recognizes athenahealth’s $5,000 contribution to the Waldo County YMCA (MA). athenahealth donates a portion of its profits to organizations that enrich community health; what I find particularly cool is that athenahealth allows its employees to vote for which charitable organizations receive contributions.

Nearly one-third of malpractice claims are the result of mistakes that could have been caught by a surgical checklist, according to a new study out of the Netherlands. Researchers linked the reasons for 294 lawsuits with specific items on checklists and found matches in 29% of the cases. Could this be correct: checklists have been found to save lives and now money, yet only 25% of US hospitals use them?

Sage Healthcare will participate in  a series of workshops sponsored by the Florida Medical Association. The workshops, which include 18 sessions across nine cities, will offer guidance to doctors selecting and implementing EHR systems to meet Meaningful Use requirements.

Sierra View District Hospital (CA) initiates its $13 million, four-year  Meditech EHR implementation. The hospital plans to go live on its first phase by November.

I’ve been very unsettled the last few days, after learning my zodiac symbol has changed. Could it be that I am not adventurous, energetic, enthusiastic, confident, quick witted, selfish, quick-tempered, impulsive, and  impatient, but instead, compassionate, romantic, imaginative, intuitive, selfless, secretive, weak-willed, and a compulsive workaholic? In other words, am I no longer a self-centered, life-of-the-party diva,  but instead just a nice person who works too much? Unsettling, indeed.

Coastal Connect HIE plans to go live with patient data exchange by mid-February. The alliance, which is sponsored by the Coastal Carolinas Health Alliance, includes 11 hospitals along the coast of North and South Carolina.

Catholic Health Initiatives (CO) CEO and president Kevin E. Lofton says his organization will invest $1.5 billion in EHRs and other IT systems between 2010 and 2015. Cerner systems are deployed in larger markets and Meditech in smaller facilities.

Clinical integration provider Valence Health hires Dan Iantorno as VP of information technology.

In his last post, Mr. H mentioned that he and Mrs. H were escaping for a much needed getaway. He checked in with me long enough to share this: “We’ve been here barely more than a day and we’re totally relaxed and pampered. I needed a break more than I realized.” He also added that he took my advice and is sampling the beer, which seems to compliment the gourmet grub and ease the pain of his overexposure to sunshine. Sounds perfect.

Thankfully WNA never seems to rest, sharing news of gamers who hacked into the server of a New Hampshire radiology practice. Seems the Scandinavian infiltrators were hunting for more band-width to play Call of Duty: Black Ops. Per WNA, “They never saw it coming.”

Baylor Health Care System announces its intent to register for stimulus funds and demonstrate meaningful use of EHR. Baylor CIO David Muntz says his organization has spent over $250 million implementing EHR over the least 10 years and that five of its hospitals have successfully standardized its “processes and technologies based on a certified electronic health record.”  My translation for that statement is that Baylor has fully implemented EHR (Allscripts Sunrise, I believe) in five (of 26) hospitals. The remaining facilities will continue rolling out EHR over the next two years.

E-mail Inga.

EPtalk by Dr. Jayne

I’m shamelessly pandering to Meaningful Use with EPtalk, since indeed I am an Eligible Provider. It doesn’t have the same catchy ring as HIStalk or HERtalk, though. Like many physicians, I take issue with the term “Provider” in general. If they needed a word or phrase to summarize those of us on the front lines, the least they could have done is make us “Patient Care Jedi.”

To those of you emailed your greetings and warm wishes, thank you! After several years as a HIStalk reader with the occasional comment or rumor sighting, being on the other side of the screen is a bit strange. I feel like I know you all personally. As a physician, I’m deluged with information from all kinds of sources, but other than FDA drug recall notices, HIStalk is the only one I allow to deliver to my inbox rather than routing into a folder for later. Clicking that link and finding my own writing is quite a thrill!

Several of you have asked for additional details about my background, specifically related to HIMSS, memberships, vendors, and conflicts. There seems to be a common theme about objectivity. Like my other HIStalk BFFs, being part of this team gives me the opportunity to speak candidly about the products on the market today. I have hospital privileges at multiple facilities, so my user experiences have been diverse. I’ve seen (and been forced to care for patients with) the good, the bad, the ugly, and the horrific.

In the interests of full disclosure: Like Mr. HIStalk and Inga, I’ll be attending HIMSS as a regular attendee. My “day job” employer pays for an individual HIMSS membership (as well as my specialty society, the local MGMA chapter, and the Southern Medical Association). A previous employer made me a Life Member of the AMA. Although I’m not currently on any national task forces or committees, that doesn’t mean I haven’t been in the past or might not be in the future. I do serve at the state/regional level in advocacy efforts. I’ve not been employed by any software or hardware vendor. I have never been convicted of a felony and my blood type is O positive.

Now that we have that out of the way… I saw an invite to an AMA continuing education seminar called “High-Reliability Safety: Applications to Healthcare” that’s being held on Wednesday the 19^th. More info here.  They’ll be talking about embedding a “safety management system” in the healthcare environment. Unfortunately, I’ll be attending another tres exciting Meaningful Use Committee meeting at my institution, so if any readers happen to attend, email me with the interesting tidbits.

Multiple media outlets have been talking about the CDC report on EHRs in physician offices. National Coordinator for Health Information Technology David Blumenthal featured it under the extremely optimistic headline “EHR Adoption Set to Soar.” American Medical News was a little more restrained with “Physician EMR use passes 50% as incentives outweigh resistance.” Blumenthal goes on to celebrate the 41% of office docs and 81% of hospitals planning to apply for incentives, but goes on to note that many small practices “still need to learn about the opportunity they have.”

My thoughts on it: take it with a grain of salt. There are quite a few of my peers who are blissfully ignorant about this whole issue; maybe that’s not so bad. As for the study itself, the data was gathered via a physician self-reporting mail sample. Those of us that interview patients know what happens when patients self-report health behaviors – they either double it (exercise) or reduce it (alcohol) so that there’s no way of knowing what the patient is really doing. I think there might be a little bit of creative reporting by my peers here.

The survey looked at full vs. basic systems and although the headline “Physician EMR Use Passes 50%” sounds sexy, a closer look at the numbers reveals that 25% have a “basic” system and 10% have a “fully functional” system. The data doesn’t quite capture what portion of physicians have a system with bionic capabilities installed but are only using it to do the IT equivalent of crushing beer cans. (I recently visited a physician who was using her laptop as a base to stabilize an avalanche of journals, mail, and catalogs. She owns a gold-plated system. It was a shame.) If you dig deeper into the features that allowed a system to at least meet “basic” requirements, you could meet that with a word processor and some scanning software.

Bottom line: if a patient-care study had results like this, physicians would be extremely skeptical about its conclusions.

E-mail Dr. Jayne

News 1/14/11

From Just the Fax, Ma’am: “Re: CSC’s healthcare group. From the confidential e-mail, ‘The market conditions in the overall economy have impacted our ability to build pipeline and to close on those opportunities we have been able to identify and pursue. As a result, financial performance is far below our commitments and we have been directed to improve our forecasts by reducing costs.’ The action: non-billable employees and those billable with less than 40% productivity must take 10 days of PTO or unpaid leave between January and April. IMHO – significant cause is inability to staff opportunities due to implementation consultants leaving right and left.” Unverified.

From The PACS Designer: “Re: XR-EXpress. An interesting image and data viewing software app for the iPhone called XR-EXpress has been released by New Mexico Software. You can manage cases, orders, and patient records easily and also check patient’s exam results.”

Listening: brand new rock-punk from Cage the Elephant from Bowling Green, KY. They’re barely old enough to shave, but they sound good, with some rawness that hints of the Strokes or Pixies. 

On the Jobs Page: Senior Project Manager, Director of Consulting – Healthcare IT, Allscripts V11 Implementation Consultants, Sales Representatives. On Healthcare IT Jobs: Epic Program Director, Enterprise Architect, IT Systems Analyst, HPP Functional Analyst.

Some of the nicest people you’d ever want to know are with Encore Health Resources, starting at the top with industry long-timers Ivo Nelson (chairman) and Dana Sellers (CEO). Encore sponsored the great HIStalk HIMSS reception at Max Lager’s in Atlanta last year, with Ivo, Dana, and our pal Amy getting elbow-deep in the minutiae with me to make sure you had a blast (Ivo made the executive decision to go open bar instead of drink tickets, which saved quite a few of you a small fortune on the overage). They now want to support us even more by becoming an HIStalk Platinum Sponsor, which I appreciate. Everybody knows Ivo – he founded Healthlink and sold it to IBM in 2005. I’m pretty sure EHR (get it?) is following Healthlink’s trajectory of unbelievable growth, solid reputation, and happy consultants (the company is already racking up awards for being a great place to work, so check out their job listings). Encore provides services such as strategic planning, system selection, implementation, optimization, health analytics, and project management. I interviewed Ivo a year ago when nobody (including me) had heard of Encore — he provided some surprisingly heartfelt and profound answers that are worth a re-read, which I just did. Thanks to Encore Health Resources for supporting HIStalk.

William Beaumont Hospitals (MI) expects to get $10.3 million in HITECH money.

I thought of something I’d like to write about: what it’s like selling for Epic. Surely there’s a former Epic iron-mover out there who would talk anonymously. The company claims they do no marketing and implies that their sales process is simple, but there must be more to that story given the large number of big deals they’re signing.

I’m whisking Mrs. HIStalk away for short hiatus somewhere warm and sandy this weekend (Inga’s terse but sincere directive: “Don’t drink the water. Do drink the beer.”) Inga and Dr. Jayne will be handling the Monday Morning Update so that I might travel laptop-free, although I’ll have the trusty iPod Touch for sneaking an occasional, furtive glance at e-mail.

I’ll be closing the HISsies voting in a couple of days, so if you got an e-mail link, use it soon. If you weren’t on the HIStalk e-mail subscriber list as of last Saturday, you can’t vote, sorry. Tying the poll to an e-mail address prevents the usual Internet vote fraud since only those I’ve e-mailed can vote (it worked the same way last year). I know that method excludes those who read by RSS reader or who just cruise over whenever they feel like it, but that’s the only way I could come up with to prevent companies from urging candidate-specific company voting and to hopefully block robo-voting scripts.

ONC’s David Blumenthal hits YouTube to pitch EMRs, citing survey results in hopes of eliciting the bandwagon effect among fence-sitters.

WSJ covers the growing number of patients ordering their own lab tests online, with heart-related tests being the most popular. One patient’s seemingly backward approach struck me as funny: “She says she would call her doctor if she got a worrisome test result.” Most states require a physician order, but the lab companies are hiring doctors to sign them after a quick review of the online request. Sometimes you do wonder, though: do certain tests or medical items really require a physician’s supervision for safety, or is that just a way to prop up the price?

Welcome to new HIStalk (and HIStalk Practice) Platinum Sponsor MD-IT. The Boulder, CO company is the leader in medical documentation for physician offices and clinics, offering them an alternative to “EMR interfaces that require you to become data entry clerks” in creating an using electronic clinical notes. The big picture includes the preferred form of data entry, a chart viewer, e-prescribing software, Internet access to patient records, and provider-to-provider messaging. Specific options include dictation transcribed by medical language specialists; front-end speech recognition as a standalone application or Word add-in; a Web-based platform for creating, storing, and sharing clinical notes; and several EMR options (built into its platform, interfaced to an existing EMR, or a package including the Ingenix CareTracker PM/EMR) that it says let doctors “dictate your way to Meaningful Use.” The company offers its services through a nationwide network of regional offices. Thanks to MD-IT for supporting HIStalk and HIStalk Practice.

As I’m prone to do these days, I moseyed to YouTube to see if MD-IT had anything there. Above is a demo of a doctor using its software.

HHS will open the 45-day comment period for potential Stage 2 Meaningful Use objectives next week. The proposed objectives and measures for Stages 2 and 3 are here (warning: PDF).

Randall Stephenson, AT&T chairman and CEO, tells a Brookings Institution panel that robust broadband will change the healthcare model, particularly monitoring and diagnostics. The head of Time Warner went for the funny bone in his assessment of healthcare bandwidth needs: “We’re just thinking about making more doctor shows.”

EHR users speaking at the Implementation Workgroup of the HIT Standards Committee are concerned about meeting Meaningful Use requirements, mostly involving timelines, cost of compliance, and lack of government guidance. Some I found in my skimming:

• RECS don’t have consistent standards.
• Using a computer during a visit requires doctors to develop an entirely new approach to the patient visit and the time required to document it.
• One practice couldn’t pay its owners because of the cost of an unexpected server replacement.
• A hospital system said it couldn’t get straight answers about some of the requirements, spending 15 hours per week and tens of thousands of dollars in attorney fees. They submitted 21 questions to CMS, with 10 marked as solved even though only one was answered. They submitted eight to ONC and got four answers.
• Several hospitals and practices had to develop their own reports even though they are paying the vendor for a certified product. Those reports had to be changed as CMS and ONC clarified the requirements.
• Customers are being forced to buy software they don’t need. Example: a hospital has its own integration with Google Health, but interpretation suggests they’ll have to buy the unneeded product of their vendor since it was used by the vendor to earn Complete EHR certification.
• The same hospital interprets the regs as requiring them to re-certify their own tools, such as file transfers, every time they apply an upgrade to their EHR or interface engine, with a cost of $8,000 to $10,000 each time.
• From a recent clarification, hospitals must own software that can meet all Meaningful Use requirements, even if defers those requirements for Stage 1.
• Intermountain Healthcare says they don’t think they’ll make the Stage 1 deadline in time at all hospitals, saying they have “a huge and seemingly insurmountable challenge in front of us as things stand today.” They’re not getting timely answers to their questions from ONC and CMS.
• One hospital using a certified vendor with certified quality reports says they’ve had to create their own reports anyway, which they called “an onerous, difficult and time consuming process.” They added, “It is our understanding that only one Epic customer has been able to successfully run all of the Eligible Hospital MU reports.” They’re delaying their attestation.
• One group’s pediatric practices have too few Medicaid patients to quality for incentives, so they aren’t really incented to use EHRs.
• A hospital informaticist expressed concern that too many EHRs are earning certification for Stage 1 that may not be around to move to Stages 2 and 3. He also suggested that usability should be incorporated into the certification process.
• The most entertaining comments came from James Fuzy of Mississippi Health Partners. He says EMR interfaces are too expensive and not standardized and suggests giving hospitals money to do the connectivity because they have the expertise. He doesn’t like mandatory statewide HIE participation since they would have to pay for it even though they have their own HIE. He suggests a Meaningful Use Guide for Dummies since doctors don’t know what it means and most don’t think they money will ever be paid anyway. He says that insurance companies buying HIEs is like “the fox now guarding the hen house” to use the information to direct care; he instead suggests that if insurers want patient data, make them pay the providers for it.

A Weird News Andy diversion: a hospital in what sounds like a dangerous part of Chicago has decided it will no longer accept ambulance patients, saying it can save $25 million per year and increase its outpatient business.

A self-serving Council for American Medical Innovation poll finds that 58% of respondents want the federal government to spend more on medical innovation. As Inga would say, the same percentage also like babies, puppies, and world peace. Never ask if people want something, especially if it sounds noble; the real test is to ask them to hand over the cash to pay for it.

Interesting: a woman whose Wii Fit Balance Board shows her leaning to one side gets checked out, resulting in a diagnosis of Parkinson’s disease. She said, “It’s quite amazing that a computer game was able to point out there was a problem.”

GE Healthcare’s CEO says “the US has snapped back” and it can grow profits 10% per year, although the snapping back seems to refer to increased healthcare spending, which is really not much of an accomplishment unless you like to watch a country slowly going broke.

Transcription software and services vendor iMedX, fresh off several acquisitions, raises $2.5 million in equity financing, increasing its total to $17 million.

The federal government sues New York City’s government for running a Medicaid mill, saying it authorized 24-hour home care for patients without obtaining documentation of need and costing federal taxpayers tens of millions of wasted dollars.

Drug shortages are driving hospitals crazy, but it’s not just them: FDA intervenes to help prisons obtain imported sodium thiopental after domestic supplies run short, delaying death row executions. They’re testing new drugs for their people-killing power.

E-mail me.

HERtalk by Inga

From Wilbur: “Re: Arizona shootings. Bad news on top of horrible news from out here in the great Southwest. Dumb, dumber, dumbest.” University Medical Center fires three clinical support staff members for accessing the medical records of victims of last weekend’s shooting. Officials say they are not aware that any confidential information was publicly released. The hospital has a zero-tolerance policy on patient privacy violations (cheers).

From Claude Noel: “Re: Manitoba eHealth. Saw a weird negative post about the project. Actually the project is going extraordinarily well. This is a very cool project that has had surprisingly little problems with implementation thus far.”

From Z-man: “Re: Moses Cone. I hear that as part of their contract with Epic, Moses Cone has to hire 92 FTEs that Epic screens and approves. Crazy, but I think it is a formula that works.”

NorthShore University HealthSystem launches Epic’s MyChart application for the iPhone, iPad, and iTouch.

Ten Sisters of Mercy Health Systems hospitals are targeting to begin their 90-consecutive-day Meaningful Use validation on April 1. Mercy says it has invested more than $450 million for EHR across its 28 hospitals and has the potential to earn $140 million in incentives.

Honolulu physicians practicing near Kapiolani Medical Center at Pali Momi are forming an HIE and will use the Wellogic Community solution to connect with labs, pharmacies, hospitals, and other providers.

Also from the Aloha state: The East Hawaii Region of Hawaii Health System Corp. commits to meeting an end-of-year deadline to implement EMR (Meditech, I believe). East Hawaii Region hospitals are eligible for more than $7 million in stimulus funds.

HP wins a 52-month, $30 million contract to create a statewide Medicaid HIE for Texas. The project includes creating an electronic health history system for all Medicaid patients.

Former Surescripts exec Kate Berry is appointed CEO of National eHealth Collaborative. Interim CEO Aaron Seib will continue with eHealth as a senior leader.

Are you curious how Gastorf Family Clinic (OK) managed to get their $42,500 stimulus check just two days after applying? A big thank you to Practice Manager Darrell Ledbetter for sharing details on HIStalk Practice. Bottom line: they were committed; their vendor (e-MDs) had the software in time; and they had solid assistance from their REC. Ledbetter says this initial payment alone almost covers what the practice paid five years ago for their EHR set-up.

Other goodies on this week on HIStalk Practice: an interview with Practice Fusion CEO and founder Ryan Howard, who shares some details of his company’s unique business model. Primary care docs and specialists have communication problems that aren’t necessarily improved with HIT. Nuesoft introduces its Nuetopia service and publishes another fun video. You know the drill: sign up for e-mail updates while you are over there. We are about to hit 1,000 confirmed subscribers. I promise to give you a free HIStalk Practice subscription if you are lucky subscriber # 1,000.

According to ONC, recent surveys indicate that 81% of hospitals and 41% of office-based physicians intend to seek Meaningful Use stimulus funds. Only 14% of office-based physicians say they are not planning to apply for incentives. David Blumenthal says these numbers indicate that the Meaningful Use process is increasing the willingness of providers to adopt EHR systems and that, “we are seeing the tide turn toward widespread and accelerating adoption and use of health IT.”

At this week’s advisory HIT Standards Committee meeting, several HIT gurus spoke out in support of including medical images in the next stage of Meaningful Use. Blumenthal agrees that it raises a number of questions worth tackling.

Alvarado Hospital (CA) sends layoff notices to 249 employees, or about 25% of its staff. The layoffs, which begin March 13th, affect 91 nurses, 10 pharmacists, and 13 technicians. Sad situation, but at least the financially troubled hospital gave workers 60 days’ notice.

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

• HealthTrust Purchasing Group aligns with 3M Health Information Systems to offer clinical documentation improvement consulting services and software and 3M IC-10 transition planning services to HealthTrust’s network of 1,400 acute care facilities.
• Picis receives certification for its EDIS, perioperative, and critical care products – all are  compliant with Stage 1 Meaningful Use measures.
  Edwards Air Force Base (AFB) replaces its PACS with McKesson’s Medical Imaging PACS under a new contract with the DoD.
• Nuance announces that 100% of ED physicians across St. Anthony’s Hospital Group (Centura Health) are using Dragon Medical to document patients’ medical reports.
• Memorial Hospital and Manor (GA) chooses ImageNow document management, imaging, and workflow from Perceptive Software for its HIM and registration departments, hoping to phase out paper medical records weighing an estimated 830,000 pounds.

CIO Unplugged 1/13/11

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

Crisis Reveals Leadership

I finished my first week as CIO exhilarated. I slipped out early and headed for a haircut (I had hair back then). The grating buzz of the “emergency broadcast system” disrupted WTAM’s sports update. A power outage that began in the Northeast had hit Ohio. This was not a test.

Out the window, I watched traffic come to a halt. Electricity stopped, rendering signals colorless. I called my family and staff, but cell networks were overwhelmed. I returned to the office.

They say nothing in life is certain except death and taxes. I differ. Crisis is a sure thing. By definition, life is a series of crises, and a showcase of our ability to react. Death, sickness, raising teenage daughters….

Life and career choices determine the number and severity of crises you might experience. But one thing remains true: you will have them. Great leadership will minimize the volume of crisis, but every leader will encounter one. Preparation and execution determines how healthily you emerge.

No course, audit, or survey can tell you as much about your leadership than a crisis. If you want a test that shows what you are made of, crisis will reveal your abilities. Those who aspire for greater responsibility must understand that to whom much is given, much is required. The higher your position — be it family, church, community, or work — the higher the probability that you will be leading in crisis. Be prepared.

I have mishandled some crises and led well through others. In each case, I came to terms with my abilities. Failures and successes totaled, here are things I learned. Master these so they become part of your core leadership abilities.

Take Responsibility Immediately

Do not blame a vendor or an employee. You are the CIO. Crisis happened on your watch. Take responsibility and focus on resolution.

Leadership

• Chain of Command. Ensure everyone knows chain of command, especially when multiple teams are involved working on solutions. Given sleep cycles, you do not want lack of clarity to slow progress.
• Battlefield Promotions. Expend your energy working with the motivated, not trying to motivate the worker. Make on-the-spot promotions as needed. Now is not the time for staff development.
• Fit Leader. Sometimes a crisis can span multiple days. You have to be fit to be effective. Don’t argue with me, argue with science. Most can perform well for 24 hours, but notable performance degradation begins thereafter.
• Visibility. You must be on site. Make a point to lead all customer calls (except on sleep rotation) and walk the floors of impacted hospitals. Walking floors is mandatory for all the command center commanders (my directs).
• Deploy Listening Posts. During a crisis, it may appear that the sky is falling. You’ll hear exaggerated reports. Your plans will be incongruent with reality and spread panic and fear. Having your own listening posts will help discern reality and lead to quicker resolution. Another reason why personally walking the floors is critical.
• Ask the Right Questions. We live in an instant society with on-demand entertainment and microwave food. We often don’t have all the pieces necessary to solve a problem that might arise. The delta between the immediate need for an answer and the time it takes to find the right solution frequently generates stress. In this scenario, stress begins to ebb when you finally start asking the right questions and start getting the right answers. And, like any good jigsaw puzzle, the pieces naturally begin to fit together… as they were intended to.

Processes

• Operations. I am most familiar with ITIL. The operational process you choose to leverage is immaterial, but having established and routine processes is a key success factor during a crisis. You do not have time to reinvent the wheel.
• Downtime Procedures. Again, establish and practice.
• Disaster Recovery/Business Continuity. Most organizations have a DR plan, but few have BC drills. Conduct BC drills quarterly. This enables you and your staff to better handle the stress and drama of an actual crisis before it happens.
• System Access. Avoid single points of failure. In an emerging world of ubiquitous electronic health records, you must have devices and systems pre-deployed to ensure access to data in a catastrophe.
• Business Resumption Plan. While key to focus on solutions, you must also direct your staff and customers on business resumption planning well before the solution is in place.

Practical Logistics

• Food. Assign someone to ensure a steady food and coffee supply. Let your key people focus on tasks, not noisy bellies.
• Sleep. Have a rotation for rest, like airline pilots on international flights. Have comfortable places for people to sleep and nap if staying on premise.
• Command Center. Stand up a center within one hour of calling a disaster and staff it 24/7. Should stay open 2x length of actual event. Do not shut down prematurely.
• Assist Customers Impacted. Constantly ask, “How can we serve you? What else can we do?” whether IT related or not. I deployed staff to delivering water supplies and purchasing fans. Double or triple the number of staff on site. Visibility in crisis is crucial. Keep high staffing levels until the customer signals enough. I saw firsthand how our clinicians reacted to seeing a significant presence on the floors with questions like "How is the system working? How can I help?" This reassured our clinicians that we were taking the crisis seriously.
• Communications Plan. Strong communication fills the void that otherwise gets populated with incorrect messages. Helps develop customer allies in solving crises, as opposed to antagonists. Publish your cell phone number. Start all communications by highlighting your organization’s mission. This serves as a common rally point for all involved. Be consistent in your messaging. Key messages might include accountability, transparency, action, calm, and hope. Execute your plan as published. Leverage multiple venues such as conference calls, e-mails, collaboration tools, portals, etc. Embrace corporate communications. They are experts in communications and can help you develop, adjust, and execute your communications plan.

Profit from Crisis

Document throughout, and take history of all actions and issues. This is critical in averting future crises. Resist the pressure to return an organization to status quo so you can profit from the crisis. Not seeking opportunities or pursuing the underlying cause of the crisis might leave your organization open for future conflict.

• Wiki. Open a wiki and encourage staff and customers to post notes real time. Use these for practical insights during the crisis to document key lessons learned.
• Document Lessons Learned. Encourage all customers to take notes during the crisis so they can make adjustments to the processes.
• Downtime Procedures. These may never have been exercised. The best time to make real world adjustments is while downtime procedures are active.

Engage Outside of IT

• External Expertise. It is a sign of strength to reach outside of your organization for help. If I sense the crisis is longer than two hours, I am on the phone calling peers and vendors.
• Guru Council. Set up a council of advisors to make sure your plans are logical and nothing is missing. Council members are not in the heat of the battle and can provide unstressed ideas.
• Vendor Management. Do not hesitate to escalate early and often. You have no time to dally. Let the level of severity determine when to go to the CEO.
• Engage Senior Leadership. Do not hide what is happening. Engage senior leadership immediately and keep them informed. Bring senior leadership directly into the loop with vendor senior management. This ensures your crisis will receive appropriate attention.

Internal

• Take care of your staff. Keep everyone focused on solutions not blame. Share all positive feedback as received.
• Have multiple teams working on multiple solutions. On two occasions, the primary plan failed to bring about resolution. Fortunately, secondary plans already underway saved the day.
• Ask for ideas from staff not associated with the crisis.
• Levity. Despite the crisis, you must work hard to ensure a calm atmosphere. Staff will think more clearly when you de-stress the environment. I recall Day Two of a crisis when someone began playing Christmas music and a sing-along started. It alleviated an otherwise tense situation.

Ending Well

When the crisis is over, the work begins.

• Send a Thank You. Personally acknowledge all those impacted, first your customers and then your staff. These might include nurses, medical staff, and practices.
• Root Cause Analysis (RCA). Figure out what happened and what can be done to avoid this same crisis. Do not skip this. Publish the RCA and include action and mitigation steps. Monitor for execution.
• Assimilate all lessons learned, downtime procedure modifications, etc, into enhanced processes.

We are all healthcare IT leaders, and my hope is that some might profit from the ideas posted. What ideas and tips do you have that I failed to cover? We will send a “crisis agenda” template to all those who post a new idea.

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.

HIStalk Interviews Jennifer Lyle, CEO, Software Testing Solutions

Jennifer Lyle is co-founder and CEO of Software Testing Solutions of Tucson, AZ.

Tell me about yourself and about the company.

I’m co-founder and CEO of Software Testing Solutions. We’ve been around since 1999. We specialize in building technology-based quality assurance solutions to hospitals. We provide an automated testing solution — focused on laboratories and the blood banks to date –– to help them test, re-test, and maintain regulatory compliance throughout those systems in a way that’s much more efficient, much more effective, and with a lot more coverage than was possible manually.

The hospitals I’ve worked at all tried to use off-the-shelf scripting tools to write their own software testing scripts, but all of them abandoned the idea because of some application quirk or Citrix problem. Or, they realized we would never get enough benefit to have been worth the analyst time required. How is your product different?

That’s absolutely true. I think the latest studies show that across all the companies that try, it’s only like a 37% success rate. It’s very difficult to take the tool off the shelf and to take people who are not automation experts and have them develop robust, maintainable, and reusable scripts.

That’s where we are different. My background is as an automation engineer. The other co-founders of the company were a programmer and a med tech. We were able to take our expertise and our years and years of industry experience of how to use that tool and build something that really became an expert in the functionality of the system under test, so it was completely reusable and maintainable for the client.

The other problem with automated testing tools as they come off the shelf is that the average medical person is not an automation engineer. They can’t sit down and figure out exactly how to programmatically get the script to do what they want or set up the variables to do the variations of the testing that they want. 

Our solutions have a very straightforward front end that makes the system look a lot like a Cerner application or a Sunquest application under test. They fill in the blanks and use drop-down boxes to tell the system how and what they want to test. We keep the underpinnings up to date, so as the system under test goes through release after release by the vendor, we maintain it. The user never sees the underlying testing tool. This way, they can use it from the very first time and use it for years and years. We have folks that have been using it for over eight years in testing and validation.

I assume that software vendors use automation for their in-house QA testing. Do they offer similar tools to their customers so they can do their own validation?

Not that we’ve found. The vendors work very hard to do a very good job of testing their application that they’re developing with the data that they have.

As you know, every hospital sets up their catalog and their procedures totally differently than the next hospital. The flags they’re going to use, the warnings they want turned on, and where they want them turned on vary. It’s hard for those application developers to write a scripting tool that’s robust enough to make it productive for the client.

We prefer to not partner too tightly with any one vendor, especially in the world of the laboratory and the blood bank. The regulatory agencies prefer that if you’re getting assistance in your testing that it not be from the vendor who’s providing the solution. They believe that the more eyes that are looking at the system with a different perspective, the better the chances are that you’re going to find errors. If the people who programmed it are the people who are testing it, it’s testing with blinders on.

Your flagship offering is for the Sunquest LIS, but you’re now offering similar products for Allscripts / Eclipsys Sunrise and Epic, right?

Right. We’ve just started a division called Ratio. The focus of that division is on meeting the testing and validation needs of hospitals implementing CPOE systems. We’re going to be in the GE market, the Allscripts / Eclipsys Sunrise market, and Epic and Cerner as well.

It just seems such a like a perfect, natural flow to go from the laboratory and the blood bank now into the CPOE area. We’re having such a massive rollout of CPOE systems that it’s getting very difficult for the hospitals to exhaustively test all the permutations of patients and orders, where warnings should fire, where messages should appear, and where something should be allowed but something else shouldn’t. Automation would serve that industry very, very well right now. We’ve got the technology to do that.

It’s laborious for analysts to have to do all that testing and documentation. But to automate the process, do you need the cooperation of the application vendors?

We make them standalone. We don’t have any tight relationships with the vendors. Our clients are the end-user hospitals. They provide access to the systems to help us develop our testing scripts and to help us understand the sets of conditions that they want to test — what therapeutic duplications they want to test, what allergies, what drug-diagnosis interaction.

That lets us tailor it to how the hospitals want to use it, since again, it varies so much from hospital to hospital of what they need and what they want. We really want to serve the end-user community here. The vendors are doing the absolute best job possible with testing their solutions in-house, but once those systems are out in the field, you have the variety that comes with the unique configuration of every single institution.

Hospitals would ideally test often, every time they or their vendor make a change. Is your product more of a turnkey solution than a toolkit?

It is turnkey. When we provide that the solution to the client, we train them on how to use it. It’s very, very straightforward and simple for them to use.

Maybe you’ve put a new laboratory interface in and you want to make sure your Epic lab orders are crossing correctly over to your downstream and ancillary systems. With a few clicks of the mouse, our solution will extract all of your lab’s procedures out of your Epic database and, with a click of the button, it will place the orders for you. Once the lab has resulted those orders, another button will go in and look them all up and take the screen prints of those transactions coming back. You can do your results review checking at the same time. We provide a basic set of the patient-procedure pairings or patient-medication order pairings that you want to do.

What we’d love to do over time is continue to work with other industry-leading groups to identify the most common serious medication errors out there so we can build an even bigger sampling of prepackaged conditions.  We can quickly tailor those to a site, let them test it that way, and also give them the ability to add their own. Such as, if in my institution, I want to make sure that if a patient comes in with these demographics and these particular drugs are ordered, I want to see this type of warning.

We want to do both. We want to give you that prepackaged capability, right now, right off-the-shelf within an hour’s worth of training … have it be there and be productive for you and have it grow with you as your institution changes.

I would assume the primary return on investment is to free up analyst time, plus the chance to avoid a software-caused medical disaster that could lead to a lawsuit. What ROI parameters do customers consider before purchasing?

You’re definitely looking at the time and labor savings. You’re looking at a much more accurate testing protocol because it is being done by a computer, not by a human. It allows you to thoroughly do regression testing, which is going to get your releases in quicker as well. As you mentioned earlier, that’s a big problem with the vendors coming out with new releases. It takes the client quite a while to be able to implement those and a lot of that piece is in the testing.

The other area we’re seeing more concern about is providing proof of testing and being able to document. There’s a stronger push by the government getting more into Meaningful Use criteria and mandating certain testing. Our tool provides great comprehensive documentation in the form of reports and screen prints that these combinations have been tested and have been exercised. We can repeat this again at any point that the hospital desires: monthly, quarterly, annually, or when they take a new release. Whatever they feel is appropriate for their site.

Who’s your competition?

We’re very innovative in this particular role. In this particular area, I don’t know of anybody who has this style of an automated solution. There are consultants that you can hire to come in and manually exercise your system and check on it. The Leapfrog Group has their great CPOE tool that you can use and take to see how you’re doing on that performance, but that’s a pretty limited scope of combinations that you’re going to be testing. 

I think this is the leading edge. This is the next place where we can take a great step with technology to make CPOE implementations faster, to make them stronger, to get the benefit out of them, and the Meaningful Use that we’re trying to get out there, and show that the patient safety element is still out there as we implement.

As CPOE is implemented properly, it drives the quality of care and efficiency. When it’s flawed, it can lead to more issues. If we’re going to do it, let’s do it right and let’s make sure it’s functioning as we expect.

What are the challenges and rewards of being a small company offering a niche product that is targeted to customers of specific application vendors?

We’re focusing on the key players in the CPOE world. We’ve leveraged off of our installed base from the laboratory and blood bank side, where a lot of those site have Epic and Allscripts / Eclipsys in them. We’re also developing it with another client for GE and for Cerner.

I think when we have those fully out there, that’s a good representative piece of the market. We’ll continue to look forward and build more solutions for other vendors out there as the client need appears.

You’ve been in business for ten years. What skills and characteristics does it take to succeed?

It’s very customer-focused. We need to deliver value to our end user. We have to make a difference in their software quality. They need to be able to see a meaningful return of their investment in the form of time freed up from the analysts. They have to feel that they are catching things that would have gotten into production and caused patient harm, and we need to provide this at a very cost-effective price point.

So far, that’s what we’ve been able to deliver. In the entire history of our business, we’ve offered a full one-year, 100% money-back guarantee to all of our clients. We guarantee to people who have invested in our product that this is going to work for you. If it doesn’t, then we’re going to make sure you have your funds back to go find something that will work for you.

Putting that hospital’s needs first, respecting their business, and earning a seat there and providing value is what’s kept us in business and kept with us very, very loyal customers.

Have customers contacted  you and said, “Wow … this would have been a disaster if your system hadn’t caught this problem.”

Yes. We’ve had a number of those in the blood bank. We’ve had a number of those with implementing CPOE and the results for review crossing back where certain laboratory flags on tests results were not being carried correctly back into the results viewer in the HIS system, so the physicians were not seeing appropriate results. All of which could have caused a lot of harm if they had gotten through.

Where do you see the healthcare IT industry going in the next five to ten years?

I think it’s explosively growing. ARRA and our move toward CPOE is going to give us an unprecedented opportunity to get more technology out there and to drive quality care. It’s going to provide some challenges along the way. I think as long as we keep making sure we’re focusing on solving the little challenges that come up as we implement these great steps, these great strides, we’re going to see a huge benefit going forward.

We just have to make sure that, as we implement it, it really is working correctly. The tolerance for error in our industry is very, very small. But I think we’re going to see care at great new levels and great more efficiency. That’s what we’re really looking for – patient safety and a more efficient use of resources.

News 1/12/11

From Chi-Town Native: “Re: HIMSS. Their swearing off Chicago as a site for the annual conference helped trigger an overhaul of McCormick Place operations. Now they’re returning in future years.” HIMSS scratches its cross-town pal’s back by dragging all of us attendees back to Chicago in the bleak dead of winter (they call it "spring” there once the vernal equinox is past, even during the snow storms) in 2015 and 2019. Being a skeptic, I still fully expect to find overpriced hotels, surly workers, and the bad weather that vendors love since it keeps everyone hanging around the exhibit hall. Still, I found a list of proposed changes that sound good on paper: outsourced convention center management, allowing competing electrical contractors, letting exhibitors do some of their own tasks like sweeping or plugging in a monitor without having team of nasty union workers threatening physical violence, cheaper setup and food services, and free WiFi everywhere.

From Jerry MindMeld: “Re: Detroit Auto Show. The Car of the Year is one nobody you know has driven. What’s the car equivalent of your EMR? Bentley? Produces a cloud of smog like a 1981 Le Car? A souped-up ‘74 Camaro that only one guy can fix?” I told Jerry that some applications are like concept cars: they look good when being showed off by hot models, but when you try to buy one, you find they don’t really exist. I drive a beat-up econobox that’s seven years old, so obviously I’m one of those Point A to Point B types.

From Hello Larry: “Re: eHealth Entitlement in Canada. Despite what Canada Health Infoway has said about speeding up the Manitoba eHealth project, it is essentially dead due to mismanagement, poor planning, and lack of vision. The health minister, in the December announcement that IBM will run the project for $22.5 million, said ‘there has been no progress made, no clinical EMR consultants hired, and once again Canada Health Infoway has dropped the ball on Canadian taxpayers.’” Unverified.

From Longtime Informatics Professional: “Re: stop the presses. ONC clarifies the difference between EMR and EHR.” Their definition is the same as mine: EMRs are electronic versions of paper treatment records, while EHRs focus on the broader health of the patient and extend beyond a single provider’s walls to share information from all clinicians who provide that patient’s care. Where we differ is that ONC seems to believe such an animal exists, so they use the term EHR universally. I believe that’s wishful thinking and therefore EMR is still correct in most cases (certification as an EHR notwithstanding since that implies theoretical product capability, not actual use). I might also quibble that the R in both acronyms suggest the records (database), not the application(s) that created those records, so I stubbornly stick to calling those data-creating applications “clinical systems” on the hospital side, with the collective end result being an EMR (you can buy applications, but not an EMR unless a single product covers every single hospital department, including diagnostic images). I’m open to reader suggestions for better names since I dislike both of these.

Healthcare Management Systems (HMS) hires two execs: Jack Holt (McKesson) as VP of client services and Todd Redmon (Dell) as VP of customer support.

A Computerworld article suggests that FDA may start regulating hospital data networks that connect FDA-approved medical devices. It points out the now-legendary four-day network outage at CareGroup (BIDMC) in 2002 would have been much worse had they not run medical devices on a separate network that stayed up. Said a GE Healthcare systems designer, “I’ve been to meetings of biomedical engineers. If you ask them if there are any cases where IT has disrupted patient care, all their hands go up.” I’ll argue from the IT side, though: some of those so-called biomedical experts, especially on the vendor side, don’t know squat about enterprise networking — they’re used to just happily plugging their stuff into whatever open network jack they can find without letting anyone in IT know, then high-tailing it when the campus network starts crashing. Maybe both observations highlight the need for IT and biomed to be a single organization, perhaps with FDA oversight when medical devices are involved.

Calling all data geeks: Heritage Provider Network is offering a $3 million prize for creating an algorithm that can analyze patient information to predict which ones will need hospitalization six months in advance, which would allow providers to intervene and save the health system billions of dollars. Teams of any composition can pre-register now for the two-year competition. If you’ve ever worked with neural network training, it’s kind of like that: teams get three sets of de-identified patient data containing inpatient and outpatient encounters, medication dispensing, and outpatient lab results. They develop their algorithms using the Training Dataset, which contains a binary flag indicating whether or not the patient was admitted. Once teams have fine-tuned their algorithms, they run them against a Quiz Dataset and submit their results to see how well they predicted admissions. Then comes the grand finale: qualified teams run their algorithms against a Test Dataset to see if their algorithms merely regress well against a known result or whether they are actually predictive (most of the time, perfect regression curves and neural networks turn out to be dumb when fed additional data points).

I hear that National eHealth Collaborative (the former AHIC Successor that supports the Nationwide Health Information Network) will name a CEO in Wednesday.

Thanks to new HIStalk Gold Sponsor Elumin Healthcare Solutions, Inc. The Sammamish, WA company offers management consulting (selection, contracting, implementation, technology, and clinical transformation), consulting services related to products from its vendor partners (Allscripts, Cerner, Epic, and HealthWare Systems), and the MyWay PM/EHR and Payerpath claims management as an Allscripts reseller. They’re an official Epic Consulting Partner, in case you were wondering. CEO Mark Williams has a long industry history, including time spent at Intermountain and Siemens Medical, so you’ve probably run across him at some point. Thanks to Elumin for supporting HIStalk.
 
Google CEO Eric Schmidt says if he wasn’t running Google and if he wanted to get involved in healthcare IT, he would go to the major research universities to find existing software that could be open sourced, concluding that , “My guess is that a platform like that would be remarkably different from the platforms we are using today.”

Thanks to the 692 folks on the HIStalk Update e-mail list who have voted in the HISsies so far. I’ll send a final e-mail reminder Wednesday and we’ll finish it up. As I predicted, a few readers complained as they always do that (a) the nominees were not much different than last year; (b) I must be involved in a romantic relationship with Judy Faulkner since she and Epic were on the ballot a lot; and (c) I must be clueless to have missed some obvious nominees. To reiterate: anyone could nominate and all I did was take the top four vote-getting nominees (or five in one case of a tie) in each category and put them on the ballot.

I’ve also received a few e-mails about HIStalkapalooza. You haven’t missed anything: the online “I want to come” Web page will go up somewhere around January 21 and will be mentioned here. A rather impressive roster of specialists is finalizing details, like how to make an IngaTini and what time the band’s going onstage.

An article by the now-merged Huffington Post Investigative Fund and the Center for Public Integrity questions the digital divide that may be created as providers with affluent patients are able to invest more resources in electronic medical records that those that care for low-income patients (although if I were a wag, I’d say rich organizations may find their higher income and productivity going down if they buy and implement unwisely). I hadn’t heard of this group: National Health IT Collaborative for the Underserved, formed almost three years ago by groups such as HHS’s Office of Minority Health, a big government contractor, and HIMSS.

NCHICA (North Carolina Healthcare Information & Communications Alliance) is soliciting abstracts for its annual conference at the Grove Park Inn in Asheville, NC on September 25-28. The Word application form is here and is due February 1.

Former Eclipsys sales SVP Jay Colfer joins Prognosis Health Information Systems as EVP of client solutions. OpenView Venture Partners made an investment in the company last month.

Butler Health System (PA) says it has personalized patient care by using a location-driven patient flow and communication solution that includes products from Intelligent InSites (RTLS), Ekahau (patient and equipment RFID tags), and Vocera (caregiver voice communications).

The Supreme Court will decide whether states are allowed to ban the sale of prescription data to drug companies. Vermont outlawed the practice, but was sued by data mining companies and drug trade groups because that particular lack of privacy protection makes them billions.

HIStalk links to Epic-related stories provided so many incoming hits to website of The Verona Press that its top stories of 2010 had to be separated into Epic and non-Epic lists. They nicely mentioned HIStalk specifically. Epic articles outdrew other big news stories about deer season, a sausage factory fire, and bear sightings.

E-mail me.

HERtalk by Inga

From Not Sheldon: “Re: Project Shoes. Last night’s Big Bang Theory TV show contained an idea for a smart phone application for a program where you can take pictures of cute shoes, and then learn where to buy them. Of course I thought of you.” I don’t know the TV show, but I love the app! It’s Shazam for Shoes! And speaking of shoes, Mr. H asked me if I wanted Dr. Jayne to provide some surgical shoe covers to help protect my shoe identity at our upcoming sponsor lunch at HIMSS. Of course I turned the idea down flat. I suppose he doesn’t see the sense in lugging a extra pair of shoes to Orlando when the shoes may only be worn an hour. I’m sure plenty of readers understand that sometimes it does make sense to pack six pairs of shoes for three days of travel.

Geisinger Health System (PA) will implement NextGate’s patient indexing software to enhance the sharing of clinical data across the organization.

Northeastern Pennsylvania HIE picks Covisint ExchangeLink to provide clinical messaging support for its participating physicians.

Southern Ohio Medical Center implements MetaCare IntelliDocs clinical documentation solution.

Keystone HIE (PA) and partner GE Healthcare announce plans to expand the region’s HIE to augment its chronic disease management capabilities. Area health case workers will have access to KeyHIE functionality to retrieve cross-team communications and receive auto-generated notifications of patient encounters.

IBM and Complex Medical Information Systems implement HIT solutions built on Lotus Notes Domino in several Russian public hospitals .

Spending for EHR by all providers is expected to grow to approximately $3.8 billion in 2015, with ambulatory EMR making up $1.4  billion of that number. A mere $2 billion was spent on EHR in 2009, including $633.5 million for ambulatory EHRs. That’s an overall compound growth rate of 11.5% and a whopping 14.2% in the ambulatory space. Just in case IDC Health Insights’ numbers are anywhere close to correct, you best hold on tight for the ride.

Michael Critelli, the former CEO of Pitney Bowes, is appointed president and CEO of Dossia, for which he had been serving as board chair.

Staggering: treatment costs for diabetes grew from $18.5 billion in 1996 to $41 billion in 2007. That includes $10 billion for outpatient care and $19 billion for prescription drugs. Nineteen million American adults were treated for diabetes in 2007, twice the number as in 1996.

With the hottie Dr. Jayne now on board, I am am more focused than ever on maintaining my youthful appearance, so this new, free iPhone app has come none too soon  Beverly Hills surgeon Dr. Payman Simoni created it to let users to see how they might look with a bit of enhancing. You can upload a photo of yourself and then play around to create a new nose, face lift, or the like. I went for the eyebrow lift. I think it makes me look more surprised than young, so for now, I’ll continue seeking the fountain of youth.

 E-mail (the un-enhanced) Inga.

Dr. Jayne

By now, you’re wondering, “Is Dr. Jayne really a physician? Does she actually see patients? Does she know what she’s talking about? Does she ever go out for cheeseburgers and beer, or perhaps the amusing house wine?” and other questions. The answer to all these (and many more) is yes! And so, Dear Readers, a bit more information about the newest HIStalk correspondent:

By day, you’ll find me in the CMIO trenches. By night — well, we’ll save that for another time. The life of a CMIO is never dull; there’s always a fire to be put out somewhere, and usually an angry physician behind the scenes holding a lit match.

I can’t blame them, though – they’re faced with tremendous changes that sometimes seem to threaten their core identity. Healthcare delivery didn’t change much for decades, but the past fifteen years have been Mr. Toad’s Wild Ride. Not only in the science behind the practice of medicine, but in how we are compensated, the equipment we must use, and the rules we must follow to care for patients. There are few industries that have gone through this pace of change. Physicians claimed E&M Coding was going to be the ultimate downfall of medicine in America. Meaningful Use makes that look tame by comparison!

My colleagues who view the profession as a calling tend to take this just a little bit personally. Each one of you has worked with these physicians. I spend a good chunk of time with docs like these, doing something between hand-holding and crisis counseling, depending on the person and the situation. Thank goodness for those psychiatry rotations that taught me never to sit between the agitated patient (or colleague) and the door.

When I’m not working directly with physicians, I’m exercising my clinical brain, working on evidence-based order sets, protocols, formularies, clinical reporting, training strategies, and making sure anything new is communicated in duplicate and triplicate for my colleagues who still refuse to read their e-mail (although I bet they use Facebook to see pictures of their grandchildren, but just won’t admit it.)

Speaking of Facebook, a shout-out to my new friends! I have a long way to go to catch up with Mr. H and Inga.

I also see patients, in an old-school, white-coat kind of way. I use the same systems that my colleagues claim I am using to interfere with the practice of medicine, force them into retirement, or otherwise torment them.

When I’m not handing out Kleenex or making sure we are doing quality clinical work, I exercise my technical brain. This is the part of me that loves playing “vendor Jenga” to see if we can actually make diverse clinical systems communicate with each other while using an amount of staff resources equal to half of what we asked for. Pull out the lower blocks and stack them on top – without toppling the tower! Tricky but challenging, and extremely rewarding when it works.

I enjoy working with our analysts and technical teams and helping them understand why (or why not) a particular piece of software is going to be accepted by clinicians or if we need to budget for our Implementation Analysts to start wearing Kevlar. And if they’re nice to me, I write my own SQL queries to get at information I want. And if they’re not nice to me, I might just play the “doctor card” and make sure they have no idea that I even know what Management Studio is. I also work closely with our vendors and doing the odd bit of development work and focus groups.

So, Dear Readers, now you know my skill set. Send me your provider-centric thoughts, questions, and conundrums. These will be answered in our new “Dear Dr. Jayne” feature – although I’ll be responding with a glass of wine in hand and you’re on your own for Kleenex.

E-mail Dr. Jayne.

 Sponsor Updates by DigitalBeanCounter

• Voalte partners with Rauland-Borg Corporation to integrate Rauland-Borg’s Nurse Call with Voalte’s iPhone communications solution.
• MED3OOO’s InteGreat EHR V6.4 earns ONC-ATCB certification through CCHIT. MED3OOO also announces the appointment of Jim Altenbaugh as VP of tech services implementation and training.
• Vocera Communications acquires Wallace Wireless, a developer of software to deliver pages, text messages, and alerts directly to smart phones. The acquisition is Vocera’s fourth since October.
• Lancaster Hospital selects ProVation Order Sets from Wolters Kluwer Health.
• Chadron Community Hospital contracts with Keane Healthcare Solutions for the full suite of Keane Optimum applications, including Optimum Clinicals.
• Geisinger Health System is using Precyse’s NLP coding software and  M*Modal’s NLP voice to text technology to enhance its clinical documentation and coding.
• Vermont Information Technology Leaders (VITL) selects Greenway’s PrimeSUITE EHR to leverage its REC; Colorado Regional Extension Center (CO-REC) does the same.
• Greenway also partners with DiagnosisONE to provide clinical decision support for its EHR deployments.
• NextGen releases v.5.6 SP1, offering several new enhancements such as clinical quality measures for Meaningful Use and 5010 healthcare transaction compliance.
• iMDsoft increases its global presence compliments of its MetaVision Suite, which went live at 45 sites, 11 countries, and in seven languages in 2010.
• OSF St. Joseph Medical Center (IL) renews its multi-year contract with GetWellNetwork and goes live with GetWellNetwork’s system integration for its Epic-based EMR.
• San Luis Valley Regional Medical Center (CO) signs a five-year technology outsourcing contract with CareTech Solutions.
• Holon Solutions will participate on an HIE panel at iHT2 Health Summit in Atlanta.
• CapsuleTech is hosting an enterprise device connectivity  webinar on January 19th.
• Nuesoft announces its Nuetopia service that combines its EHR, billing software, and revenue cycle management services.
• Bridgehead achieves a 40% year-over-year income increase for FY2010 thanks to its focus on the healthcare vertical.

HIStalk Interviews Dewey Howell MD PhD, CEO, Design Clinicals

Dewey Howell MD, PhD is founder and CEO of Design Clinicals of Seattle, WA.

How’s business?

Business is good. We’re seeing more and more interest in med rec and what we’re doing, not only with medication reconciliation, but some of the stuff we’ve added to our platform around Core Measures and a number of modules that extend beyond that med rec fit into organizations’ Meaningful Use plans quite well. Like every vendor in the space, we’re definitely seeing an uptick in business because of all the Meaningful Use discussion.

I think most of the readers know what medication reconciliation means, but in case someone doesn’t, can you give a description?

Medication reconciliation is nothing new. It’s something that doctors, nurses, and pharmacists have been doing for decades. It’s just the process of gathering medications when a patient arrives at your organization, reviewing that list, and making sure it’s accurate. Then every time you write new orders or change a patient’s care, you review that list again and make sure that they aren’t pieces of that list that you need to re-address. Finally, when you send the patient back home, looking over their home medications before they arrived at the organization, making sure the patient knows exactly what you want them to do at home or how you want them to proceed with any instructions around the medications. Again, med school, nursing school, and pharmacy school 101.

When we talked three years ago, you said hospitals were just checking off Joint Commission’s medication reconciliation box but not really improving patient safety because of low compliance with paper-based processes. Is that still the case?

We are primarily still seeing folks doing this on paper. That’s because so many of the vendor systems still haven’t provided electronic solutions and work flow that is manageable in the context of the other systems.

I think the real problem is that we consider med rec a very broad piece that touches nurses, pharmacists, and doctors. In many hospital systems, those functions are very different applications. To really make it work, you need a process that touches all of those users. That’s hard to do in the silo design of a lot of those systems.

Do you think that doctors are adequately involved or it is it just being turfed off to nurses and pharmacists?

I think as a hospital moves to physician order entry, doctors are by necessity involved, because at that point when they’re writing their orders, it’s at those points that the medication reconciliation needs to happen. If the doctors are doing that electronically, it had better be included into their electronic workflow.

A lot of nurses and pharmacists are still carrying the brunt of reconciling. That’s because it has been perceived as an administrative task. Just document it on paper so we can have it on the medical record that we’ve touched these meds and looked at them, as opposed to having it as a real integral part of the clinician’s thought process at the time of ordering.

The rules change as of July 1, right?

Joint Commission surveyed med rec for a few years in 2006. Then in 2009, Joint Commission stopped scoring med rec because hospitals weren’t able to meet the strict language of the mandate. Hospital after hospital was getting cited on their survey, so Joint Commission took a couple years off. 

They just recently announced that coming July 1, they’ll be re-scoring it again. They’ve revised the goal. They put out that goal for public review several months ago. Now it’s been finalized and published for scoring on July 1.

Do you think the nature of medication reconciliation will change with interoperability and HIEs?

I think it will. Medication reconciliation has been put into Meaningful Use. It’s in that discretionary set or menu set for Phase 1, but it’s very clear that it’s going to continue to be an important part of the Meaningful Use standards in Phase 2 and 3.

You mentioned HIEs. I think in an HIE environment, it becomes really critical to have a tool that allows you to reconcile medications across multiple sources. HIEs are great for bringing a wide variety of data, including medications, together from hospital after hospital and a variety of clinics in a connected community. But to make that data usable still requires a human reconciliation process because there’s a limit to what can be reconciled electronically by computer logic.

Compared to either paper or functions that vendors would typically call medication reconciliation, what are the key functionality points of your application and why is it superior?

The first one starts out on intake. We’ve taken a great deal of care to make sure that the medication list that’s gathered by nursing, or if they use pharmacy or pharmacy techs on intake, that the list is as accurate as possible. One of the first challenges with med rec is getting as accurate a list as is possible. There’s a component that is never going to be solved by any solution because patients don’t know what they take.

Whenever possible, if the solution can help with things like common misspellings get translated automatically and ensuring that the doses and the routes and the frequencies are relevant to that med. The idea is that the path of least resistance is medication sentences and orders documented on the med history list that makes sense. You don’t end up with these really dirty lists that the doctors don’t know what to do with and that don’t make clinical sense.

The other two pieces that have become critical are allowing the doctor to review that list at the time of ordering — not as a separate process, but an integral part of the ordering process. Just by doing admission med orders, med rec has been satisfied, as opposed to doing your admission orders, then coming over to a piece of paper or another system or screen and doing med rec. It should be integrated right into the way the doctor orders. That’s how we’ve done since Day One. 

The other really superior piece is translating that intent to the doctor at the reconciliation steps into a very usable, patient-friendly, complete instruction sheet for the patient. It tells the patient in very clear language what to stop, what to continue, and what’s changed. It all gets translated. Even free text stuff that the doctor types gets translated. A lot of folks will say they translate in patient lay language, but there’s a lot of sort of techie challenges around doing that in a practical way. We’ve been doing it that way for four years, so it ends up being really quite complete.

We have support for something we call minimal use workflow. In the new mandate, they call it 24-hour areas or something along those lines. It allows you to designate certain areas of your hospital — whether that’s the ED or day surgery or endoscopy, these outpatient treatment center areas — where you don’t have to do the full-blown reconcile and address every single med, but rather in an abbreviated process that really makes a lot of clinical sense.

You got more live sites then when we talked last time. What are you learning from them?

We have good coverage now around the country. I think what we’re seeing is that, similar to what we saw early on but it’s just been repeated many times now, if you engage your doctors in a process of medication reconciliation that makes sense to them, the process goes a lot better if doctors, nurses, and pharmacists are all engaged, as opposed to saying “this is a nursing problem” or “this is a pharmacy problem”.

You tell the doctors, “We’re not taking something that was previously a clerical job and making them do it. What were doing is enhancing the normal work and thought process that you do anyway, while at the same time, satisfying the med rec mandate.” With that kind of explanation and understanding, I think docs engage.

CIOs are worried about CPOE because it’s hard to implement. What advice would you have for the CPOE designers?

Our application is a great way to start off in CPOE and to meet that CPOE portion of Meaningful Use, because 30% of patients have to have at least med order done electronically. Across all of our sites, the organizations that are using our product meet that level of performance just by doing med rec and admission transfer and discharge. It’s a very easy to meet that part of the mandate.

Really? They meet the new more stringent medication reconciliation criteria plus count as a a CPOE order each time you do it on a patient?

That’s exactly right.

That’s pretty cool.

Yeah, exactly. We have a few of our newer customers and some of our existing clients that are specifically using the use of our product as meeting those two parts of the mandate.

Go ahead, I didn’t mean to interrupt you.

Vendors have struggled with CPOE.  When they put together those systems, they were so focused on medications and medication ordering, and I think it’s a real chilly feel for a lot of CPOE system. There’s a couple of reasons. A lot of CPOE systems were historically started with experience that industry had from pharmacy ordering systems, and doctors aren’t pharmacists, as you know. Taking something from pharmaceuticals and what’s dispensable and what’s on the pharmacy shelf to an order that the doctor expects is a very difficult process.

I think the approach that many vendors have had is that CPOE systems basically spend six to nine months building that abstraction or taking the order from the pharmacy level to the physician level. You end of making a lot of decisions in a conference room with a small group of people. Maybe they’re not all clinically relevant decisions, so you end of doing a whole lot of reiteration and it can be a big mess, depending on the expertise on your team and how much resource you have to build those systems.

We did something very different. We started out with a product from First DataBank called Order View. This was brand new when we started the company. We built our application from scratch around it. It’s a product that was specifically designed for CPOE systems. Going from pharmacy-level data, that First DataBank had been very good at obviously, to physician-level orders. What’s brilliant about the product is you have the ability to present data to the doctors in the way they expect to see it, but at the same time, you can turn that into a pharmacy-fillable order without a lot of effort. It comes out of the box ready to do that.

With CPOE, most of the real patient benefit involves medications. You can’t make a patient better with diagnostic testing or lab tests along and you’re not going to harm a patient in most cases by doing those incorrectly. Without meds, there’s not much of a CPOE patient safety story.

Absolutely right. I think that’s why going with a product like ours — that is really so focused on medications and has spent four and half years getting medication ordering right — as your initial strategy into CPOE makes a lot of sense. It’s where the big bang for the buck is, for two reasons. One, as you mentioned, in patient safety. And two, for physician usability. 

With CPOE systems, it’s an order of magnitude easier to make entering a nursing order or a rad or or diet orders — making that entry process easy for doctors is an order magnitude simpler than making a pharmacy order easy and effective.

If you look down the road, where do you see the company and the medication reconciliation piece going?

I think organizations realize the importance of medication reconciliation. I think as we’ve grown and gotten more market share, people are relaxing that here’s a solution to med rec that works. They don’t have to change their corporate strategy. They don’t’ have to change their HIE or HIS strategy and still implement this third-party vendor. My hope is we’re going to see a lot more traction in helping with that medication ordering space.

We talked about the inpatient all in this interview so far, but we actually have a fair amount of use in outpatient areas as well. Beyond that market penetration for medication reconciliation, we have a couple of development partners that we’ve built this medication reconciliation out to full CPOE. It was a logical next step for us, because as we just talked, we got the medication ordering and that very central portion of CPOE done right and better than most vendors out there have been able to achieve. It made sense to layer in the additional clinical modules to have a complete system.

So you’re now able to operate as an integrated CPOE system?

That’s right. It’s a standalone CPOE system that stands outside of the HIS vendor, but it integrates with the HIE or HIS strategy, sharing data back and forth as needed for effective CPOE. It’s pretty tough to have a fully standalone island CPOE system because there are so many dependencies, but coming in the very first part of Quarter 1, we’re going have our CPOE system up and running.

What kind of customers would be prospects for it?

Since we just have a couple of development partners and are just building out the project, we haven’t done a market analysis. My guess is it’s going to be the small- to medium-sized hospitals, a couple hundred beds and less, that maybe have a system where their docs have tried to do some portions of the order entry and it hasn’t gone very well, so they’ve really struggled to get adoption and they’re not sure how they’re going to get the doctors to become Meaningful Users.

Most organizations are in the very low percentages of adoption. These small organizations, to have a CPOE system that actually promotes physician adoption while at the same time being easy to employ without requiring a big, extensive build and implementation process, is a pretty attractive thing.

Any final thoughts?

We didn’t talk much at the beginning about how the medication reconciliation mandate has changed. I think it is probably pretty important to note that the mandate is a bit different from the original one. It gives organizations a little bit more flexibility. The thing I like the most about the changes to the mandate is it’s less prescriptive. It says that we recognize that med rec isn’t the same everywhere — it’s not even the same within a given organization. This enables organizations to meet the mandate, following the sprit of the mandate as opposed to following the letter of the law without it accomplishing much. That’s what I like most about the changes to the mandate.

Monday Morning Update 1/10/11

From EHR Geek: “Re: Vitalize. Mr. HIStalk, why didn’t you post the Vitalize purchase of Validus on your real page? It’s only on the HIStalk Fan Page of Facebook.” I was torn on that one. I had just blasted out the SIS news and I couldn’t decide if this item was of broad enough interest to justify another e-mail (I don’t want to give readers alert fatigue), so I just posted it as a Facebook status item until the next scheduled post (this one). That’s another good reason to Friend/Like us there since I usually post news blasts there, too. Anyway: Vitalize Consulting Solutions acquires (warning: PDF) Minneapolis-based Validus Consulting, which has around 60 consultants providing strategic advisory and project leadership services. Vitalize, which offers strategy, EHR implementation, revenue cycle, project leadership, and application / technical resources, says it’s now the largest privately owned HIT consulting firm, with more than 450 consultants. I hadn’t realized that former Allina Excellian (Epic) VP Kim Pederson, who I interviewed awhile back, is a Validus principal. I also didn’t realize until Googling something else that industry pioneer Bill Childs, who just won CHIME’s Lifetime Achievement Award, is a Vitalize VP (there might be no HIStalk if Bill hadn’t broken the HIT journalism ground with Healthcare Informatics). I know and like the Vitalize folks and I’m amazed at the company’s growth under CEO Bruce Cerullo, a long-time friend of HIStalk. 

From Jerry MindMeld: “Re: joke of the day. Dr. Blumenthal was at Congress yesterday during the reading of the Constitution. He looks over at the stenographer and realizes they are typing every word spoken for the entire day, every speech and every vote. He leans over to the guy sitting next to him and says, ‘Jeez, I wish we had that in my industry — it would make practicing medicine a lot easier.’" I’m here all week – try the veal.

From The PACS Designer: “Re: Dimdim. Mr. H, since you now can’t use Dimdim collaboration software due to Salesforce.com’s privatizing it, why not go to Yugma, which is another collaboration application on the web?” I will give it a look. The biggest differentiator among the Webinar-type tools is how well they record and archive the session, especially the audio portion. I also liked ReadyTalk. I’m kicking tires because I really like the idea of providing some kind of education at a higher level of quality than you usually see (i.e., less of a commercial pitch).

From Leopold Stoch: “Re: Paul Levy. Stepping down as CEO of Beth Israel Deaconess.” I guess John Halamka’s boss is down to blogging as a job for now, but I’m sure he will have many opportunities.

New HIStalk contributor Jayne (or Dr. Jayne if you or she prefer) introduces herself below. What sold me on her: (a) she writes well and in a non-stuffy HIStalk way; (b) she’s funny; (c) she has a great education and medical experience; (d) she works in an informatics role, but still maintains a medical practice, so she knows a broad swath of the industry; and (e) she’s an HIStalk fan and gets what we do. E-mail her your greetings if you like. We thought a recurring “Ask Dr. Jayne” feature would be fun, so let’s have any questions you’ve always wanted to ask an informatics doc (what does she think of EMRs, how important is usability, how does she interact with the EMR in the exam room, etc.) Her brand new Facebook is looking a bit bare, so I’m sure she could use a friend or two there.

Listening: Young Fresh Fellows, a Seattle-based alt pop band that’s been around for 30 years. I played their 2009 album and immediately bought it for the gym iPod, which almost never happens. Their music is hard to categorize – sometimes its Pixies punkish, sometimes REM jangly, but it’s always fun (extra points for using “bereft” in a lyric and then rhyming with it).  

I’m intrigued by these poll results: 52% of readers plan to keep the same job and employer in 2011, but a full 42% are expecting to land a better job, either with the same employer (18%) or a different one (24%). Only 3% expect to move to a worse job, with about the same percentage saying they’ll retire or quit this year. New poll to your right: what are your plans for the HIMSS conference?

Thanks for your HISsies nominations. I’m e-mailing out survey ballots this weekend, so watch your inbox and please vote. Thanks, too, to readers who nominated Inga and me for several categories even though the instructions said not to.

HIMSS government relations VP Dave Roberts posts the organization’s priorities for the new Congress, the main ones being keep HIT bipartisan and keep the HITECH money flowing despite all the good reasons it shouldn’t. He also lists what he says are the priorities of HIMSS members, such as establishing a Meaningful Use grievance process and spending even more taxpayer dollars, this time on “health IT action zones.”  He asks for feedback.

Say hello to new HIStalk Platinum Sponsor Shareable Ink. The Nashville-based company’s concept should resonate with quite a few hospitals and practices: you shouldn’t have to disrupt clinician workflow to move to electronic health records. Shareable Ink’s enterprise-grade digital pen and paper technology lets clinicians keep documenting the way they like without turning themselves into patient-ignoring keyboard zombies, yet it translates their work into digital, discrete, and shareable EHR data as if they’d labored over a keyboard instead. Anybody can implement it quickly since there’s no software running on site (it’s zero-footprint Saas) and there’s no boondoggle IT project standing in the way of hospitals and practices anxious to move to EHRs and collect their HITECH checks. It integrates (with registration, EHR, CDR, etc), it pre-fills forms from inbound interface data, and it makes paper smart with form-based electronic rules and outbound alerts (e-mail, SMS, page). You don’t have to force behavior change on set-in-their-ways ED docs and anesthesiologists (not to mention that 90% of hospital daily progress notes are, of course, written by hand and that’s a tough battleship to turn). It must be cool since T-System, whose paper forms (T-Sheets) are an ED mainstay, chose Shareable Ink to power its DigitalShare electronic ED encounter documentation system. Shareable Ink also just released an analytics package that lets organizations mine all the handwritten data it converts, so paper documentation from anesthesia, ED, and progress notes can be electronically reviewed for quality and efficiency metrics without chart pulls. Thanks to Shareable Ink for supporting HIStalk.

I turned myself on a little writing about Shareable Ink, so I headed over to YouTube to see if there was a demo. Here’s one from a year ago, as co-founder and CMO Vernon Huang MD (sounds like a fascinating guy: Hopkins biomedical engineering degree and GWU MD, practicing anesthesiologist, worked for Apple, was a Navy flight surgeon) shows how his sloppy doctor handwriting (sorry, Doc) is turned into an electronic record without his doing anything.

The Walgreens drugstore chain, in my mind, leads the way with consumer-friendly mobile apps for their patients / customers (text alerts, patient-scanned barcodes for prescription refills, health risk assessments, kiosks, EMR, e-Prescribing, etc.). The company’s CMO moderated a digital health session at the CES Digital Health Summit. Too bad the rest of healthcare doesn’t have such clearly aligned incentives (invest in technology, sell more stuff as a result, make more money, everybody’s happy).

Drug maker Roche files suit against a software company it bankrolled and intended to acquire. Medical Automation Systems had agreed to be acquired by Roche for $40 million, but then got a better offer from a competitor. Roche sued, saying it has right of first refusal and shouldn’t be required to participate in a bidding war. The company’s RALS software is used in the Accu-Check and CoaguCheck point-of-care monitoring systems to send results to hospital clinical systems. Wish you’d thought of it, right?

The promotional video for the just-announced new version of the Microsoft Surface coffee table thingy shows people collaborating over radiology images and ultrasounds. It reacts to both touch and objects, where it “seamlessly merges the physical and digital worlds.” It works like a massive iPad on four legs, accepting all kinds of gestures and manipulation. I have to say it seems cool and a pretty good deal, with the new version priced at $7,600 compared to the original’s $12,000 price tag. Imagine an EMR built for a screen that size run by touch – docs would love it. It would also be amazing for patient teaching, but you’d have to bring the patient to the Surface instead of vice versa (unless someone invents a SOW – a Surface on Wheels).

Speaking of the Surface, I found this old picture of MEDHOST’s ED dashboard running on it. I found pretty much no information on MEDHOST’s site about it, so I don’t know if they still offer it or if anyone ever bought one. It looks good, though.

Eris Medical Technologies, created in a Youngstown, OH incubator, will provide its erisRX charge capture management software to Florida Hospital Orlando. Founder Jennifer Wexler used to work at FHO as well as Orlando Health, while co-founder Kelly Bucci comes from Deloitte. 

We had a slip-up in Friday’s post due to a bogus news alert (old Web pages sometimes suddenly pop up as news – I’ve been burned by that a couple of times). Mark Briggs is still CEO at HIE solution vendor VisionShare, which he joined in May – the link we ran was to an older (undated) press release from when he took an earlier job.

J.P. Morgan’s healthcare conference runs this week. Ben Rooks wrote about why you should care (or not) in his HIStalk column from a year ago.

e-MDs says CMS’s first HITECH check for a physician practice went to one of its clients just two days after CMS registration opened. Gastorf Family Clinic (OK) got $21,250 each for its two doctors. They told doctors they’d get big checks and that one’s ginormous.

Speaking of HITECH registration, CMS says 4,000 providers registered for EHR incentives in the first four days after its site went live on January 3.

Inga and I have decided that we should have vendor tee shirts made for HIMSS that read, “Want to be profitably acquired? Sponsor HIStalk.” The list of sponsors recently completing successful transactions (these would be listed on the back) includes Medicity, Ingenix, Picis, Sentillion, Eclipsys, eScription, Sunquest, and now SIS. There are plenty more, but those are some of the larger and more recent ones.

Philips buys Pittsburgh-based medSage, developers of an automated telephone-based system for home health patients to reorder supplies. Their executive bios are fun: “Bob is the ‘Old Guy’ on the medSage Team … has been in the healthcare industry for over 30 years (our abacus will not go any higher) … Bob is the ‘Really Big Guy’ on the medSage Team. (If you have met Bob in person, you know what we mean!) For that reason, Bob is to be Mr. October, November, AND December in the 2009 medSage Team promotional calendar.” Let’s hope they keep Bob happy since if they don’t, it sounds like he’s got a couple of potential discrimination suits to choose from.

A judge overturns a community college’s dismissal of four nursing students for posting cell phone pictures of themselves posing with a placenta on Facebook. The instructor of the students told them it was OK to take the picture as long as any identifying information was removed, even though the students told here they planned to post the pictures on Facebook. The student whose case set the precedent for the others is worried about her reputation preceding her for an eventual job. “I am concerned that my name is all over the Internet. All you have to do is Google ‘placenta.’” She’s right – above is my Google News search result, complete with her smiling placenta pose.

E-mail me.

Why Me? 
By Dr. Jayne

Let me just start by saying that I’ve idolized Mr. HIStalk and Inga for quite some time. So when Mr. H posted that he was interested in finding someone to help out, I was tres excited. I put together a few thoughts, crossed my fingers, and clicked “send” with visions of IngaTinis dancing in my head. A few spins of the planet later, here I am, excited to be part of the HIStalk family!

Why did I want to write for HIStalk? First, I wanted to be able to provide a physician perspective on hot topics in healthcare IT. Now that Meaningful Use is finally here, understanding the real impact the new rules are having on patient care is going to be important. Who better to talk about it than someone who is actually seeing and treating patients?

Don’t worry though, I’m a serious IT staffer (also a shoe aficionado, so the chance to work with Inga was a huge part of this, but we’ll save that for later) who lately spends more time talking the IT talk and walking the IT walk than personally caring for patients. But I still see enough patients to be able to regale you with strange-but-true stories about what happens on the other side of the exam room door.

Second, I enjoy expressing my creative side, love writing, and am fluent in a variety of poetic forms. Healthcare IT words are just about as hard to rhyme as medical words; although it might be possible to rhyme “ruptured appendix” with “clustered index” it would have to be a really special poem to make that work so you’ll all just have to keep reading and see what I come up with. (A special shout out will go to the first reader who pulls that one off.)

Third, IT systems and patients are more similar than most people would think. When they’re healthy they’re happy and you enjoy going to work every day, and when they’re “sick” they can drive you mad. I’ve spent the last several years of my career trying to help bridge the gap between “the IT people” and “the clinical people” and being able to do that on a larger scale seemed cool. We all want the same things – and if I can give the “computer guys” and the “doctors that just hate the system” some tips and tricks to better interact with each other, then I’ve helped make all of our lives a tiny bit better.

Finally, a tiny part of me wanted a guaranteed invite to HIStalkapalooza (OK, maybe it was a very big part). Although I suppose as a team member I’m likely excluded from the “Inga Loves My Shoes” and HIStalk Queen contests, I might try anyway, so dust off those shiny taffeta ball gowns and the ruffled tuxedo shirts, and I’ll see you there.

Say hello to Jayne.

Norwest Equity Partners Acquires Surgical Information Systems

Surgical Information Systems announced this morning that private equity firm Norwest Equity Partners has acquired the company from Vista Equity Partners, its owner for the past four years.

“By maintaining our focus on the financial engine of the hospital, SIS has achieved year-over-year growth that significantly exceeds industry averages. We have also enjoyed success in the perioperative area during some of the most challenging economic conditions in memory,” said SIS CEO Ed Daihl. “Demand for perioperative-specific information solutions is rapidly growing, particularly in anesthesia solutions, and our new partnership with NEP represents the continued evolution of the company.”

The 50-year-old Norwest Equity Partners, headquartered in Minneapolis, manages $4.6 billion in capital, focusing on building middle-market companies. Its major limited partner is Wells Fargo & Co. The firm’s other healthcare IT investment is communications vendor Amcom Software. According to the announcement, the SIS executive management team will remain in place.

SIS executives we spoke to said that hospitals are focusing on the perioperative area in preparation for healthcare reform and potentially declining reimbursement since it contributes up to 60% of hospital margins. That makes the OR and anesthesia business of SIS a highly attractive investment, they told us, with anesthesia alone having a 24% annual growth rate.

The Alpharetta, GA company’s growth has been organic, with new customers, exclusive industry endorsements, and expanded technology partnerships. Its perioperative software was recently certified as a modular EHR.

SIS customers were notified by an e-mail today from Ed Daihl, who described the acquisition as “a new phase of growth that will benefit you with the accelerated delivery of new, innovative software solutions that will support your efforts to optimize the delivery of perioperative services.”

News 1/7/11

From Clarence: “Re: HIMSS. Isn’t the conference in Orlando?” Looks like someone copied over last year’s e-mail announcement for this year’s HIMSS Annual Leadership Survey. Doh!

From Lizzy Thin: “Re: GE Healthcare. Rumor is that several workers in Seattle were shown the door today.” Verified, thanks to my GE media contact, who proactively e-mailed me to tell me the following: “As a part of the continuous review of our priorities and opportunities, we’ve eliminated a limited number of positions due to overlapping responsibility. The majority of the impacted roles are based out of our Seattle office. This does not in any way signal a change to the updates that I’ve given you in the past few weeks. Though a difficult decision, we remain committed to the success of our customers and employees.” Condolences to those affected, with my rare positive counsel being that as bleak as it seems when the career rug is pulled out from under you (it’s happened to me), you are likely to eventually end up being glad it did because it forces you to re-evaluate and focus. Kudos to GE Healthcare for at least waiting until after the holidays and for being honest about it.

From John in the UK: “Re: shares in Fletcher-Flora Health Care Systems. Please, could you inform me of their value?” I contacted CEO Neal Flora, who says to e-mail him so he can verify that you are on their list of shareholders. He’ll then provide the information. His contact information is here.

From Student: “Re: Northwestern University. It’s considering changing the format of its online MS in Medical Informatics from live, synchronous meetings (with instant feedback and collaboration) to asynchronous. Students are concerned about the respectability and quality this will provide. What do you and your readers think of an asynchronous format only?” I think it’s fine as long as the pedagogy is made clear to the faculty, i.e. this isn’t just putting lecture notes online and giving online tests, which I’m sure they already know since the program isn’t moving from classroom to online for the first time. Synchronous learning isn’t convenient to students or professors, especially with the considerable number of non-US based students taking HIT-related coursework (the time zone challenge is tough, as are hospital people who don’t work day shift). Technology supports asynchronous learning quite nicely, with podcasts and video lectures being well suited for it. The key is student collaboration and engagement through asynchronous discussion, projects, and learning that supports multiple learning styles (especially tactile/kinesthetic, which in my experience is tougher in an asynchronous environment, but that just means the instructor needs to plan for it). My conclusion: it’s not only OK, it’s a good idea, provided the proper expectations for student engagement are given to instructors. I’ve always thought that synchronous learning was more show than substance, often mandated by highbrow educational institutions that were not only slow to move online, but anxious to show their superiority over competitors who actually make learning accessible. Today’s synchronous is yesterday’s sage-on-the-stage.

The first sizeable acquisition of the new year will be announced Friday, so look for my news blast as soon as I get the green light to send it out. I’m hoping I’m not tied up at work since that’s always my nightmare – I’m stuck in some meeting sitting on hot news that’s congealing while I impatiently check my watch every ten seconds. I’ve also been given a heads up that a consulting company will be making an announcement tomorrow. If you don’t get my e-mail blasts, now’s the time to put your name and e-mail address in the spam-proof Subscribe to Updates box to your upper right. Tomorrow will be another chance to one-up that smart-alecky colleague down the hall.

eHealth Initiative announces its new board members, including new chair William Jessee of MGMA and Micky Tripathi of Massachusetts eHealth Collaborative.

Motion Computing announces the CL900 Windows 7 ruggedized tablet at CES. Available in Q2 starting at under $1,000, Motion says.

This article impacted Weird News Andy, which he titles “You have WHAT in your colon? I don’t even want to think about how it got there.” A woman undergoing a routine colonoscopy for abdominal bloating is found to have a Blatella germanica in her transverse colon. For you lay folks, that means they found a cockroach in her large intestine, presumably accidentally eaten by her in her infested home. I would have included the picture, but I’m sure your mental one is graphic enough.

HISsies nominations will close soon … make your nominations now. Voting will start this weekend if I get time to put the ballot together and e-mail it out to the HIStalk subscriber list.

I was playing around with Webinar tools the other day and liked Dimdim, which has a goofy name but pretty cool technology. I just got an e-mail from my signup that it’s been acquired by Salesforce.com.

Jobs on the sponsor-only job board: VP Sales Central Region, Senior Software Engineer, Software / Implementation Engineer. That reminds me that I need to figure out why people who don’t work with engines are still called engineers. On Healthcare IT Jobs: Project Manager, McKesson HEO Analyst, Assistant Health Services IT Director.

Travis, the tech-savvy doc who writes HIStalk Mobile for me, is putting up some good stories. Up now: hospital support of mobile devices, next generation iPad speculation, Skype for telemedicine, practices offering online appointment scheduling, Sutter and MyChart, IDEAL LIFE’s health tablet, and more. Drop your e-mail in the Subscribe to Updates box on that page to make sure you don’t miss anything, and if you’d like to contribute guest articles, news, how you use your favorite health-related iPhone apps, etc. give Travis a shout. Thanks much to our sponsors there: AT&T, Vocera, Voalte, 3M, Access, Thomson Reuters, and PatientKeeper. Some of the most interesting technology in healthcare involves smart phones, messaging, clinical communication, health management via technology, etc. and we cover it all there.

I’ll have a new HIStalk contributor to announce shortly. She’s a practicing physician and informatics expert who nonetheless described herself in offering her services as a long-time HIStalk fan and “young, blonde, and love shoes, making the perfect bookend for you with Inga.” I knew her lofty credentials, lack of pretension, and obvious sense of humor would raise Inga’s professional jealousy, which they did, as Inga sniffed to me that our new BFF is “too smart and young and cute and perfect.” They are both wonderful, so readers will benefit as we are able to explore even more issues and offer more useful information. She will be contributing to all three sites (HIStalk, HIStalk Mobile, and HIStalk Practice) and will be on the ground with us at HIMSS. Since Inga is often insecure, I should say that I don’t value or love her any less just because we’re getting help to hopefully achieve higher levels of pretty-goodness. I may need your assistance in reassuring her, though.

LifeIMAGE, which offers a medical image sharing platform, finishes its second funding round with $12 million, raising its total to $17 million. I interviewed Hamid Tabatabaie, president and CEO, a few weeks ago.

4Medica’s Inpatient Cloud EHR and integration engine earn CCHIT certification as an EHR module using hospital criteria.

I don’t find this to be true, do you? A reporter claims that Microsoft Making Name in Lucrative Health Care Records Market. The article suggests that HealthVault is profitable, which it isn’t as far as I know. It also touts Amalga HIS, overlooking the fact that the company shut it down not long after it bought it. The sweeping, big-finish conclusion: “Whatever the reason, Microsoft’s strategy seems to be working – it’s making a name for itself in a sleeping giant of a market that’s only now awakening to the power of business technology.” I’m not saying they aren’t doing some interesting things, but I’d hardly say they’re leading a sleeping market, and some of what they are doing is more in life sciences than healthcare. At my hospital, Microsoft means Windows, SQL, Office, and now Sentillion.

Some scumbag steals three Internet Cafe computers from Brockville General Hospital (Ontario) over the holiday, shutting it down and leaving users (some of them palliative care and rehab patients) without. The hospital doesn’t have the money to replace them, but a local travel agency donated one and is challenging other local businesses to do the same.

I still think this software should win awards: still another patient is saved by a kidney transplant made possible by an application that figures out a complex series of transplants that gives the greatest possible number of donor-recipient marches from the available pool.

University of New Mexico Hospital is reviewing its emergency alert system after a gunman fires a shot inside, but the employee text and e-mail alert took 32 minutes to get out after police had showed up en masse. The hospital says their incident people couldn’t get logged into the Web-based alerting system. They also couldn’t get executive approval to blast the message. The hospital says it will  hire a consultant. Something to think about before the reporters show up. I bet employees were already burning up Twitter and Facebook.

The local paper covers IT raises at University of Missouri and the hospital, noting that 52 employees were promoted with raises in December alone. It suggests that a just-opened IBM facility in town may have forced the university to give raises to keep staff.

E-mail me.

HERtalk by Inga

From Joe Walsh: “Re: HISsies. I am aware that the HISsies are just a bit tongue-in-cheek, but how serious is the proposal for a Lifetime Achievement Award?” I’d say all the categories are as serious as readers want them to be, but that one in particular is totally serious. As Mr. H often mentions, 100% of the nominations and final voting come from readers. Many of our past winners have been touched by the recognition. Todd Cozzens, for example, was quite appreciative of Picis’s Best HIT Vendor award a couple of years ago, and even the irreverent Jonathan Bush seemed to love winning HIT Industry Figure of the Year. We also know some organizations stuff the proverbial ballot box in favor of the home team (at least before we starting sending ballots directly to the HIStalk subscriber list last year instead of letting anyone vote), but ever that suggests that folks consider the HISsies an honor. 

From Elmer: “Re: Kudos. Love your blogs. You guys are the glue to what’s going on in HIT.” Thanks, Elmer. As Mr. H will tell you, I’m chronically insecure and need loving encouragement every now and then, so your words are appreciated.

From AA CoolNeal: “Re: A MEDITECH rap song. Funny rap song composed (supposedly) by former MEDITECHers. I worked there for 10 years and the song does hit all the highs and lows.” Very clever. And reminds me of many things I don’t miss about working for a big company.

From Eero Saarinen: “Re: Cerner win. Columbus (IN) Regional Hospital has signed a contract with Cerner. No surprise; they’ve been in negotiations for many weeks. CRH has used Cerner PathNet and Apache for several years but the new deal is a near-total McKesson replacement.” Unverified.

University of Kentucky Healthcare and Central Baptist Hospital are among the first recipients of Meaningful Use incentive checks. Kentucky Medicaid has already issued a $2.8 million check for UK and $1.3 million for Central Baptist. An additional 25 Kentucky providers have begun the application process.

Partners Healthcare is borrowing $420 million for EMR improvements and debt refinancing.

Healthcare represented 17.6% of the US economy in 2009, with total spending of $2.49 trillion (with a “t”). That’s up from 16.6% of GDP in 2008. Reminds me of when I was interviewing for my first job in HIT. I wasn’t sure I wanted to leave my budding career in finance, but my soon-to-be new boss convinced me that the business of healthcare and computers was going to become increasingly important. Obviously he was right.

I see that Bill O’Toole, an occasional HIStalk contributor, is offering a complimentary white paper to providers considering the purchase of an EHR. He’s founder of the O’Toole Law Group, spent 20 years as corporate counsel for MEDITECH, and has a friendly writing style.

Spectrum Health (MI) launches its MySpectrum smart phone app created with the InterSystems Ensemble integration and development platform.

Saint John’s Health System and St. Vincent Jennings Hospitals join more than 80 hospitals as part of the Indiana HIE.

Maricopa Integrated Health System (AZ) renews its agreement with MedAssets for multiple Web-based, revenue cycle tools.

New on HIStalk Practice this week: a peek at Cerner Ambulatory. Hospitals buying up practices. A physician review of the Motion J3500 tablet.  A couple of my New Year’s resolutions. Health reform may boost house calls. HIStalk Practice traffic, by the way, grew 25% in 2010. If you haven’t stopped by yet, it’s time to check out what you have been missing.

Jennie Stuart Medical Center (KY) implements ChartWise:CDI for clinical documentation.

LinkedIn is rumored to be going public this year, making it the first social network to do so. Which reminds me: I am pretty social, so feel free to connect with me on LinkedIn or Facebook. Mr. H is not quite as social as me, but seemingly better connected, so make sure you friend and connect with him as well. And don’t forget to join the HIStalk Fan Club on LinkedIn and to like us on the HIStalk Facebook page.

Cleveland Clinic and MetroHealth Medical Center say they will begin sharing patient records using Epic’s Care Everywhere program.

Dr. Lyle Berkowitz, MD, another occasional HIStalk contributor and medical director of clinical informatics at Northwestern Memorial Physicians Group, asked us to give a plug to HIT X.0 (Beyond the Edge). That’s a new sub-conference that will run during HIMSS and focus on innovation and the future. One session that looks particularly fun is called HIT Geeks Got Talent.  Eight companies will be given 2-5 minutes each to show off their coolest, newest technology. A panel of judges will give feedback, then audience members will have a chance to text their vote for the best product. The call for contestants is still open If you have some bleeding edge technology you’d like to demonstrate. There’s no extra charge for the HIT X.0 sessions, but Dr. Lyle said attendees are advised to pre-register to get a guaranteed seat. Mr. H tells me he’s in and planning to sit on the front row.

A patient drives his Chevy Blazer through the doors of a Kelowna General Hospital (BC) after being told he’d have to wait 45 minutes to see an ER doctor. The hospital estimates damages of $15,000. I wonder if the hospital is now checking into one of those Web-based apps to display ER wait times.

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

• Imprivata OneSign is named a premier solution in SC Magazine’s 2011 Reader Trust Award competition, which honors best-in-class security products and services.
• maxIT Healthcare promotes Mike Sweeney to president, reporting to CEO and Chairman Parker Hinshaw. maxIT also names Reese Gomez executive vice president of solution management.
• McKesson takes top KLAS honors in eight separate categories, including Best in KLAS in Community HIS for its Paragon solution. Horizon Practice Plus also wins Best in KLAS for  Practice Management (26-100 physicians).
• The MED3OOO-owned CPU Medical Management Systems partners with Revenue Advantage to provide hosted interactive voice recognition applications to billing companies and healthcare providers.
• Allina Hospitals & Clinics chooses Greenway’s PrimeSUITE for providers in Minnesota and western Wisconsin largely due to Allina’s Epic-based EMR.
• YouTube Video: Using RXHub and External Med History in eClinicalWorks v 8.0.
• Carefx expands its presence in the UK by partnering with Northgate Managed Service, and agrees to deploy its Fusion healthcare interoperability platform with Cambridge University Hospitals.  Trillium Health Centre (Canada) also goes live with Fusion.
• AT&T includes MedApps as part of their ForHealth telehealth products and solutions.
• maxIT Healthcare appoints Mike Sweeney to President; he will manage day to day operations and will report to Parker Hinshaw (CEO).
• SC Magazine Awards names Imprivata as a finalist in the Best Multifactor Product category for the Reader Trust Award competition.
• CentraState Healthcare System chooses MobileMD for their HIE.
• Frank Stellato is announced as myHealthDirect’s Chief Financial Officer; he’s been with the company since July 2010 and was most recently CFO of MedAssist. Doug Cobb also joins myHealthDirect’s board of directors.
• Ochsner Health System (LA) goes live with Orion Health HIE.
• Lake Medical Group selects GroupOne Health Source to implement eClinicalWorks EMR system for its roughly 50 healthcare providers.
• Nuesoft has a nice entry on their blog asking the question: Are more doctors adopting EHRs?
• CynergisTek CEO Mac McMillian will present at the HIMSS Southern California Chapter meeting on January 13th in Orange, CA.
• North Highland acquires Insight Solutions Group.
• OnePartner selects MobileMD for its HIE.
• Nason Hospital (PA) will use tablet-based e-Forms completion from Access, integrated with MedSeries4 and the Soarian document management application.