HIStalk Interviews Jennifer Bordenick, CEO, eHealth Initiative

Jennifer Covich Bordenick is CEO of eHealth Initiative and the eHealth Initiative Foundation of Washington, DC.

Tell me about yourself and eHealth Initiative.

I’ve been working in health care quality technology for about 18 years. I started out working at a hospital. I worked with health plans and did QA for a number of years along with technology organizations. I started at eHealth Initiative about eight years ago and was appointed as CEO last January.

We are a non-profit, non-partisan membership organization. Our mission is to drive improvement in health care through the use of health IT. We educate, research, and advocate for the use of health IT to improve quality of care.

We’ve got about 210 corporate members. Some of them are influential groups in HIT. We are multi-stakeholder, so we’ve got clinicians, labs, vendors, and hospitals. Everybody is on board. We’re not really beholden to anybody, which makes it nice. We’ve got a nice multi-stakeholder consensus when we are advocating for a position.

I should probably also mention we’ve got the Connecting Communities Coalition, which is a group of about 260 regional, state, and local initiatives that work on health information exchange.

eHealth Initiative had a big part in getting healthcare IT into the stimulus bill.  I noticed that not many more than half of your 2010 follow-up survey respondents said care delivery had improved as a result. Is this going to be like England’s NPfIT or will taxpayers and patients eventually see a return on investment for all these billions?

Gosh, I hope not. I mean, it’s incredible that the federal government made this significant investment. It would be to all of our benefit for this to work, so I certainly hope this works. I think a good number of things are going to come out of it. So what’s the question exactly?

For folks who aren’t seeing the quality improvement, how do we know we’ll see it at some point?

I think the one thing you can say is that we’re going to start measuring it. We haven’t measured it before. If there are improvements, we’re going to see if there are. If there aren’t improvements, we’ll see that there aren’t any improvements. One of the things you can’t do is you can’t improve if you can’t measure it. So I think that’s the first thing — that we’re going to start doing that.

In terms of the money hitting the system and when we’re going to see the improvements from the federal investment, I would imagine that’s going to be two years down the line because the money hasn’t come out yet. But I do think that the market has already started to move significantly and it’s significantly accelerated the adoption of technology.

People are talking about it. When I started doing this 15 years ago, it was not cool. Nobody new what health IT was or HIT. Now there’s a sense out there that is important, and not just that this needs to happen, but that it has to happen.

A couple of years ago we were really fighting and advocating and trying to prove to Congress and to the market why you should do this, why you should invest in this. Now we actually have the investment. So now it’s kind of, how do we do this to make sure that it works?

Most of the poster children for health IT have been organizations that already did it without having the government help pay for it, bigger organizations like Kaiser. Is there concern that maybe this doesn’t scale down to the vast majority of providers that aren’t as big or as savvy as a Kaiser?

I think that’s a valid concern. I mean, the folks that have been successful in the past are the names that we’ve all heard of. But it’s like any new field or industry. You always have those early adapters.

I think that we’ve seen just in our survey of Health Information Exchange over the last seven years … we’ve seen the numbers grow and grow. Especially in and industry that is growing and learning from itself. I think you’re going to see more names up there. There’s definitely more technology out there now and more successes stories then there were eight years ago.

A lot of the incentives encourage people to buy systems that are already out there that they had already passed on. Is there a concern that all of this came about before the whole concept of health care reform? We’re putting out a lot of automation just as we’re changing the goals as we realign care in a different direction around Accountable Care Organizations or whatever the next attempt to make it better will be.

Well, actually, if you look at the legislation and you look at what’s really happening, it’s complimentary, because you can’t move to Accountable Care Organizations unless you have an infrastructure that supports data and technology. I mean, you just can’t get there. You can’t coordinate care unless you can connect those organizations and identify those patients. You can’t do any of that without the electronic infrastructure. So you really need one to get to the other.

I think HITECH and the stimulus package create a foundation to build these changes on and the payment adjustments and the bundling and all that’s going to come about because of health care reform. If you look at the timing as well, the health IT changes should start to kick in before the ACOP. In theory, they should compliment each other.

A survey came out recently suggesting that hospital CIOs are less optimistic that they’ll be able to meet the Meaningful Use requirements. Are you worried that there may be enough skeptical providers out there that the incentives won’t be enough?

Yes, I am. I think the timing on this is quite aggressive. I think there are a number of folks that aren’t going to attempt this in 2011. I think there will be a number of folks that will just wait and hang on. I think we’re going to see a bigger number of folks for this in 2012 once the ground has cleared.

So yes, I don’t think anybody can look at this program and say it’s not aggressive. It’s incredibly aggressive. The timelines are aggressive. Everybody’s concerned about resources, money, and time.

You mentioned HIEs. It seems that there are still questions about if they’ve really found a business model that will work once the grant money runs out. What’s your thought on how HIEs fit into the picture?

My thought is that health information change initiatives have been around for a number of years. I mean, we’ve been tracking them for eight years. This program, the state-designated entity, just started this year. You’ve got 56 new state-designated entities that we’re just starting to track now. But even before they existed, there were groups out there doing this. I don’t think one is reliant on the other.

Your point as far as sustainable business model is incredibly valid. This has been the number one challenge every year when we survey folks — getting the model. The issue with health information exchange it’s a public utility and it helps everybody. So who pays? It’s a really difficult thing to figure out. What’s the right business model for that?

EMR vendors have been successful in basically having their products mandated, without any penalty or downside for them except having to pay for certification. Will they see any negative impact from the movement as opposed to all the positive impact they’ve seen so far?

It’s like any other product. People are going to buy it or they’re not going to buy it. If it’s certified or not, if the customer feels that it’s meeting their needs, if the physicians feel it’s the right product, they’re going to continue to buy it.

Despite the fact there’s a mandate, there’s a lot of competition out there and there’s a lot of vendors to choose from. Hopefully like anything else it will just move the way the market is supposed to move and people will compete.

The investment timeline is short. Does it inhibit competition and innovation by encouraging the purchase of systems that were build long before HITECH, possibly eating up provider budget money that could have been spent on more innovative systems that might not even be on the market yet?

I think there’s a fine line between standardization and innovation. We have to deal with it throughout this program…I will say there’s dozens and dozens of products that have been certified. So I think that there are a number of groups out there. There’s all the old favorites that we’ve all heard of but, there’s also a lot of new ones there. It might not create completely level playing field, but I do think there’s still opportunities for innovation.

What does it mean that we now have two big insurance companies that have bought HIE technology vendors?

I think they realized the need for an infrastructure for data and quality. They maybe positioning themselves for the ACOP piece, which is coming up. I think there’s a real recognition right now that people need to invest in data and quality. You can’t do a lot of the stuff without the data. I can’t comment too much on that because I don’t too much about the specifics. I just know probably what you know.

The issue about the data is who’s controlling it and with what kind of privacy and security. We know that some vendors have decided it’s OK for them to sell de-identified patient data without individual patient approval. We’re also trying to build a national framework around a set of individual state laws. 

I think what you’re getting at is the privacy and information sharing issues, which is of great concern to patients, providers, and everybody. Who owns the information? Who can you share it with? Who can look at my information? That’s a really valid issue and I think that’s important.

As far as whose technology creates the infrastructure … just because a road is built by a certain company, does that mean you’re not going to want to drive down that road? Probably not. We’re talking about HIEs, the infrastructure or the wires that are going to connect all these different pieces together. What’s going to be most important is the laws and regulations around privacy information sharing and not who owns it. Who created the technology, not whose application it is.

But when people start talking about technology, they’re all for it until they start talking about healthcare privacy, which brings out a lot of emotion. Will we ever figure how to ease the fears of patients about their medical data?

I think that we overcame it with banking. People exchange all kinds of information on the Internet right now, especially if you look at the younger generations. People put all kinds of stuff out there on Facebook and Twitter. I think there’s a different set of concerns growing up with each generation. I think that we are going to be able to adjust to privacy issues.

I think that the other thing is that people want mobility and convenience. Everybody wants the app on their iPhone that allows them to refill their prescription with the press of a button. People want that convenience, and I think at some point that’s going to override some of the other issues.

HITECH is mostly about making providers more efficient or more effective. Do we have a vision of population health, things like obesity, personal choices, chronic disease management, and lack of access to care that has nothing to do with making doctor encounters more efficient?

This is really the golden opportunity. This is the stuff that really excites me. Having the data to find a cure for cancer. It’s all about population health. And once we have the identified data where we can actually look at what works and what doesn’t work, I mean, it’s going to be incredibly valuable to all of us. I think everybody kind of understands that’s going to be good thing.

Part of the problem is that we really need to drive the agenda and the message and win the communication battle that’s going on here. We really need to be able to explain to patients and help patients understand health IT and how it’s a good investment and a smart investment. It’s going to make your care better. It’s going to help us find cures for diseases. This is a good thing. I think that’s the battle that everybody’s engaged in right now with a lot of this.

Do you think consumers are interested in that discussion?

I think that there are consumers that are interested. Like anything else, it’s the people that have the most interaction with the system. If you have a chronic care condition or if you have a lot of doctor’s appointments or you have children like I do, you’re always at the doctor’s office. You know there are convenience issues. There are real issues about your care. The more interaction that you have with the health care system, then the more screwed up you realize it is. I mean, let’s be honest.

So I think that, yes, we can explain this to people. I think it makes sense to people once they understand the issues. There’s always going to be privacy concerns. There are always going to be privacy advocates that say, “You shouldn’t do this.” There’s still people that say, “You shouldn’t do banking online” or “You shouldn’t use Amazon.com because somebody might get your credit card information.” There’s always going to be that element and that group that’s concerned about it. But we can’t let that … we have to deal with the issues and figure out what the policies are going to be surrounding that. Then we have to move forward.

You said something I agree with, that the value of HITECH is to get providers on the data grid so really useful things can be done with population data analysis, which is happening with Kaiser. Do you think the idea has been sold well that the HITECH benefits may be more societal than individual?

No, I don’t think it’s been sold well at all. I think that the message has not been clear. I think it hasn’t been loud. I think that we can all do a better job with that.

There aren’t enough examples out there for people to say, “Oh, I get it” or say, “I understand now — you need my information so you can figure out that this medicine works really well for people with my condition.” You know there’s not a lot. We don’t talk about that. 

That’s so important. There’s not a lot of people unless you interact with the health care system a lot who realize that, “Oh, OK, this is why my doctor’s EHR needs to talk to my specialist EHR — so I don’t have to lug my images across town to the radiologist. So they can get them and look at them and shoot back the results to me.” People either have to have a close interaction with the health care system or they have to have a more profound idea of why this is needed for the greater good. We haven’t done a good job of that.

I would think you are encouraged by what Kaiser has done, making it a cornerstone of their strategy and communicating in clear terms what they’re doing and why.

Yes, I think they’ve done some good pieces. I think United has done a couple of good commercials. There are definitely groups that are trying to do that. But more of us need to do that. It has to get down to the doctor’s level. The doctor has to understand why this important and be able to explain it the patient while they’re in their office.

What do we follow HITECH with?

What comes next? [laughs]. I think the data will reveal a lot. If we can figure out how we’re doing out there, that will lead us in the direction we need to go in. We’ll be able to see where we can improve, make care better, see where care is bad, see who’s doing it right and who’s doing it wrong. I think that’s really important.

I also think healthcare reform and the payment structure … that’s really the bottom line. If we can’t figure those out, we’re all going to be stuck in this hole for a long time. We’ve got to get to that point, and I don’t think we can without data. It’s going to be hard to argue why it’s needed unless we have clear-cut data. Payment reform is important and data is important.  

The one time that was tried with mammography, there was an uproar by patients who felt they were entitled to mammograms and providers whose income was threatened even though the information was scientifically valid. Can we ever separate politics from healthcare enough that all this data can be used to make objective decisions?

Gosh, we have to. People don’t want politicians in their bedrooms and they shouldn’t want them in their exam rooms, either. I think it’s really important that we find a way to keep politics out of it. HITECH was bipartisan. Republicans and Democrats agreed on this health IT stuff. For us to all of a sudden disagree on that – that would be really sad because I think both sides see the need for it. I hope we’ll be able to get through this.

News 1/5/11

From Stan: “Re: article in Applied Clinical Informatics on why people discount personal experiences with HIT. I think your readers might find the free download worth reading. Best regards from Switzerland.” The author, Jon D. Patrick from the University of Sydney, Australia, took heat for publishing user reports of ED system problems. His editorial says the problem reports of experienced system users are dismissed as unscientific anecdotes to protect IT interests, the organization’s investment, or its executives from criticism instead of treating those reports as an early warning system. While I don’t buy the idea that user IT perceptions should always be taken at face value, he’s right about the weird dynamic: the IT department and all the suits who signed off on the deal shoot the messenger because they are emotionally invested in it. They honestly believe that complaining users are troublemakers or fools who aren’t blessed with their big-picture vision (specific, serious IT problems are often dismissed on the basis of the greater good, of course). That’s like blaming a patient for daring to develop a post-surgical infection since it makes the surgeons look bad (which wouldn’t surprise me either).

From The PACS Designer: “Re: iPad 2. Sometime later this month, we’ll be seeing Apple’s next version of the iPad, being called the iPad 2 or 2nd Generation. Business Insider gives us an early look on what might be in the iPad 2 and what will probably be done to  the current iPad price. Sources in Japan are reporting that early production models seem to indicate that the iPad 2 will have two cameras, with the rear camera having the ability to record a movie when needed by users.”

From Healthcare Idiot Savant: “Re: Missouri State Senator Brad Lager from North Missouri (R-12). Recently started a new job — wait for it — in Government Affairs for Neal Patterson’s Cerner Corporation. Certainly there can’t be any conflict of interest there, right?” According to a bio in the KC business magazine, A bit of advice if you want to reach Missouri state Sen. Brad Lager: Try to give his e-mail inbox a break. ‘Between my Senate e-mail and my e-mail at Cerner, it’s about 1,000 messages a week,’ says the time-starved 34-year-old. As a measure of Cerner’s good corporate citizenship, the Northland medical software giant makes concessions to allow Lager the four-day legislative schedule he keeps from January through May. He’s back in the office at Cerner on Fridays as a senior strategic analyst in the Health-e Services group. I found some old documents that said Neal’s wife Jeanne donated $25,000 to his 2008 campaign for state treasurer.

From DigDug: “Re: taxes. We are hearing a rumor about tax changes for consultants who pay their own travel costs up front and are reimbursed by the client. There should be no tax implication, as the consultant is not claiming any deduction or tax relief for the travel, but we are hearing that the government now considers these reimbursements as taxable. Any insights?” I’ll use a reader lifeline here since I don’t know. Anyone?

From Lori: “Re: HIStalk. I’m writing to express how much I love and enjoy reading HIStalk! I stumbled upon it on Facebook and have been on it ever since! I enjoy looking at the industry as it continues to unfold. I’m able to do that now with HIStalk! Thanks again!” Thanks.

From NoName: “Re: evidence of an EMR implementation improving patient safety.” An article from East Carolina University and academic medical center Pitt County Memorial Hospital (NC) in Journal of Antimicrobial Chemotherapy finds that its inpatient Epic EMR implementation was accompanied by a 29% reduction in antimicrobial use. Clostridium-caused nosocomial infections dropped by 19% and MRSA infections went down 45%. The EMR doesn’t get all the credit, though: the article suggests that better pharmacist oversight of antibiotic usage, made possible by having immediate electronic access to patient information and orders, allowed them to intervene more effectively. However, order sets built into Epic did reduce the ordering of excessively high antibiotic doses. The good news is that all EMRs can support these efforts if hospitals use them appropriately, so not having Epic isn’t an excuse.

From Roy G. Biv: “Re: weird interview questions. One from Deloitte: how many ridges are there on the edge of a quarter? From my own experience, I’d say that’s about right as far as the average Deloitte consultant’s contact with reality is concerned.”

Listening: The Jessica Prouty Band, which I’m giving special attention since I know her mom, who spent time in HIT. This is a teen band, but you’d never know it since they play hard-rocking prog-metal (to my ear, anyway – think Within Temptation or Evanescence). They’ve toured, won a bunch of contests, and are playing Downtown Disney in California on January 15. I like their sound a lot.

I’m really excited to introduce a new HIStalker, DigitalBeanCounter. DBC e-mailed after seeing my cry for HIStalk help and will be doing some interesting things with us, starting with collecting and writing up sponsor news items in the Sponsor Update section. He’s got a ton of energy and a great attitude (the opposite of me, in other words). It’s great to have DigitalBeanCounter on our little team. I’ll hook him up with an e-mail address soon, but he was anxious to jump right in.

Speaking of which, thanks to the amazing people who e-mailed offering to help out. I’m still sorting through them, but as Inga told me, they’re all so good we want to work with every single one of them (seriously). My several hundred daily e-mail count has swelled lately to the point that I’m behind even after working through the holiday. Any perceived slight is unintentional – I just don’t have a lot of time left between my full-time jobs (hospital and HIStalk).

Former A.D.A.M. CTO Keith Cox is named (warning: PDF) CEO of the Health Information Partnership for Tennessee, which is using a $11.6 million federal grant to connect Tennessee’s RHIOs. 

Advocate Lutheran General Hospital becomes the second Advocate hospital to sign up for PerfectServe’s clinical communications system.

Reminder: HISsies nominations are open, so let’s have yours, please. Every year someone squawks when the final ballot comes out, claiming that I was clueless in omitting some obvious nominee for Best CEO or some other category. I remind them readers do the nominating – I just choose the most-nominated items for the ballot. For example, only one person has nominated Neal Patterson for the “Pie in the Face” award so far, so either Neal has changed considerably in your mind from his unbroken streak of past wins or everybody’s assuming someone else will keep the wheels of democracy turning.

I mentioned a new story about new Cerner contracts in tiny Idaho hospitals. Vince Ciotti of H.I.S. Professionals e-mailed me some thoughts and agreed to let me run them here.

Your Web site is so good and read so much, please don’t take this as a criticism, but as an attempt to set the record straight for your many thousands of readers…

Regarding your piece on Cerner’s $1.3M "deal" for a hospital in Idaho, I’ll bet that is capital (one-time) costs, which are rather low with Cerner’s "remote hosting" approach. This would include primarily implementation fees, and maybe some on-site hardware (e.g: med scanners).

Operating costs are another matter, since remote hosting (also known as ASP or SaaS) usually has a hefty fee per month for processing and storing data at one of Cerner’s two data centers in KC. It is probably six figures per year, and could approach seven figures depending on how many apps were purchased..

So, the TCO (total cost of ownership) over five years should be right up there with the fees most other large vendors charge (e.g.: Meditech, McKesson’s Paragon, Siemens Medseries 4, etc.) for a 14-bed hospital. The best bargains for such a small site are the "Big 3" in the small hospital market: CPSI, Healthland, and HMS. Their TCO over five years should be far less than Cerner, Meditech, McKesson, etc.

In addition, these small-hospital vendors have all apps a small hospital needs, including ERP, which Cerner usually turns to someone like Lawson or Microsoft, increasing their TCO even more. CPSI can even include an integrated PACS and Time & Attendance system, all extra with the "high-end" vendors like Cerner, Siemens, McKesson, etc.

Are the "high-end" EMRs any better? That answer could be a PhD thesis of 10 pages, but the bottom line is: one can achieve Meaningful Use with any one of them! Yes, Cerner probably has far more features than CPSI, but can a 14-bed hospital ever afford the IT and clinical staff to implement them? I doubt it…

This is not to knock Cerner. Millennium is an excellent clinical system, a worthy competitor to Epic in the large and Medietch in the mid-size hospital markets. But for a 14-bed facility, it’s like a newlywed couple starting out with a BMW. They’d be much better off with a Honda, and spend the difference on their kids (patients)!

Former Parkland Hospital SVP/CIO Jack Kowitt is named EVP of outsourcing vendor PHNS.

I mentioned a while back that I was surprised by a British survey that found that 84% of people there use their smart phones as alarm clocks. I bet they’re sorry now: a New Year’s-related software bug causes iPhone alarms to stop working at midnight, causing people to oversleep. At least most of them were off Saturday, I assume.

German mega-vendor CompuGroup acquires Belgian practice software vendor Belgiedata, continuing its worldwide expansion.

Care Innovations, a telehealth and independent living joint venture of GE and Intel, is operational with management in place.

Cleveland, desperate to replace lost manufacturing jobs, kicks off construction this month on the $465 million Medical Mart & Convention Center, hoping it can ride the coattails of Cleveland Clinic to bring high-paying jobs there (like every other city wants to do, but this one’s backed by clinic CEO Toby Cosgrove). Locals get stuck with the tab in the form of a quarter-penny bump in the sales tax. The project, which has yet to sign any tenants, will cost taxpayers up to $840 million over 20 years and competes with a similar project in Nashville that already has landed HIMSS as a renter.

Open source integrator EHR Doctors, which holds a contract to provide the Social Security Administration with its HIE platform for exchanging disability claims documents, says the agency has approved its C32 Continuity of Care Document.

AliveCor’s iPhone ECG is a snap-on back for the iPhone 4 that turns it into an ECG machine. Amazing, but not yet FDA approved. 

E-mail me.

HERtalk by Inga

From Bill Belichick: “Re: Meditech. They will be buying out ambulatory partner LSS and will oversee future product development and business planning. I believe it will most likely be announced by Meditech following their next board meeting this month. This will get Meditech right into the ambulatory market and add much credibility to the product line with the new Meditech branding. It will likely offer customers much more competitive pricing.” Unverified, that but sounds like a good strategic move.

Vitality’s GlowCaps are made available for $10 a cap on Amazon. The AT&T wirelessly-connected GlowCaps are intelligent pill vial caps that use light and sound as patient reminders. Adherence data is recorded each time the pill bottle is opened, then compiled as periodic compliance reports.

Telecare, a provider of wireless communication tools for chronically ill patients and their physicians, secures $4.46 million in a mixed securities offering. The company is headed by CEO and founder Jonathan Javitt, who has a pretty good track record of aligning with and/or building growing companies. Some of his previous enterprises include CodeRyte and Clinitek (now Siemens). He was also the founding national medical director and SVP for the United Healthcare division that is now Ingenix.

Imaging outsourcing firm Foundation Radiology Group raises $3.5 million, bringing its 2010 fundraising efforts to $9.5 million. The new funds come from Chrysalis Ventures and Health Evolutions and will be used for unspecified growth.

I’ve been amused and confused by all the responses to the Epic interview question about the cost of a pear. Mr. H and others used their programming logic to calculate the cost, based on the known prices for an apple, orange, and grapefruit. I would have replied totally differently, I guess, since I  have a much simpler sales brain and an IQ that’s a good 30 points lower than Mr H’s.  Anyway, I would have said that we don’t have pricing for the pear, then pose the question, “How much do you think the pear is worth?” Or perhaps, “If you are willing to buy all the fruit today, I am sure we can come up with a package price that would be acceptable.” Incidentally the question was originally posed to a project management prospect and not for programming or sales job. Maybe a PM would do a SWOT analysis on the pear to develop the right answer.

MEDHOST says that 12 facilities have now purchased OpCenter, the company’s executive decision support solution that was introduced a year ago.

CHIME and HIMSS name Charles E. Christian the winner of their 2010 John E. Gall Jr. CIO of the Year Award. Chuck is CIO at Good Samaritan Hospital (IN).

Texas Health Resources acquires the 420-physician MedicalEdge Healthcare Group, which marks the second-largest purchase of an independent physician practice in the US. THR can now boast more physicians than its chief rival, Baylor Health Care System (620 versus 500). THR is where HIStalk contributor Ed Marx serves as CIO.

Patient flow software provider Central Logic hires Jeff Porcaro as VP of engineering and technical services. He previously served in senior management for Symantec and Novell.

I sent an e-mail over the weekend about the HIStalk-hosted, sponsor-only lunch at HIMSS and another just now about our other activities during the conference. If the e-mails did not find their way to the correct contact, let me know. And if you aren’t a sponsor, I bet you’re wishing you were because you just know that what we’re planning is bound to be fun.

ONC issues a final rule to establish the permanent certification program for HIT. For the permanent program, organizations must be accredited and authorized by the National Coordinator and must conduct post-certification surveillance. I didn’t look into all the nitty gritty details, but you can find more specifics here.

Four nursing students are expelled from Johnson County Community College (KS) after photographing themselves with a human placenta and posting the picture on Facebook. The school’s director of nursing said the students’ “demeanor and lack of professional behavior surrounding this event was considered a disruption to the learning environment and did not exemplify the professional behavior that we expect in the nursing program.” One of the students is now fighting back in federal court, seeking an injunction against the school. The 22-year-old claims her future earnings from her chosen profession are at stake because of a “momentary lack in judgment.” As one who committed a least a minute’s worth of judgment errors at that age, I hope she is allowed to finish her degree.

In an another Facebook-related story, a thief displays more than a momentary lack in judgment by stealing a flat-screen TV from a gas station’s restroom (I will refrain from making comments about the stupidity of having a TV in a gas station restroom). A customer uses his credit card to pay for gas, then hides the TV under his shirt and takes off. The gas station manager uses the credit card information to look up the thief in Facebook and sends him a friend request. Thief accepts request, despite not knowing manager (clearly not the brightest bulb on the tree). Manager tells thief that if he returns the TV, he won’t call the police. Thief ignores the request and before long ends up in jail.

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

• Informatics Corporation of America is named a Top Healthcare VAR by Everything Channel’s CRN Magazine.
• Cancer Centers of North Carolina – Ashville implements iKnowMed EMR. iKnowMed is a division of US Oncology, which is now a division of McKesson.
• CynergisTek CEO Mac McMillan is presenting at the upcoming Security/HITECH conference sponsored by the SoCal HIMSS chapter. January 13th in Orange, CA, if you are in the area.
• MED3OOO announces a strategic partnership to form the Jersey Health Alliance. The Alliance, which includes a network of physicians and hospitals from Hudson County, NJ, will utilize MED3OOO software, consulting, and services.
• Cool video: Allscripts Android Patient File Overview.
• Sentry will attend the seventh annual 340B Coalition Winter Conference in San Diego.
• NTT DATA completes its acquisition of Keane.
• Aetna completes its acquisition of Medicity.
• Vermont Information Technology Leaders selects Greenway’s PrimeSuite as a preferred EHR partner.
• Michigan Health Connect (MHC) chooses Medicity to carry out its HIE.
• Nuance announces its Dragon Dictation voice technology is the secret sauce behind the LG Voice-to-Text app; offered free via the Windows Phone Marketplace.
• AT&T ramps its their presence in the HIT space.
• Payment Processing, Inc. partners with AdvancedMD, citing integration and security advantages.

HIStalk Interviews Beth Raucher MD, Chief Medical Officer, Lutheran HealthCare

Beth Raucher, MD is executive vice president and chief medical officer of Lutheran HealthCare, Brooklyn, NY.

Tell me about yourself and about the hospital.

I am a physician with training in internal medicine and infectious diseases. I’m the chief medical officer here. You can think of me as the doctor who represents both the medical staff, all the doctors in the hospital, and the administration. I have one foot in each door. I help the medical staff come to the hospital and move their way so they can do their patient care. I help the administration work with the doctors to meet their needs.

My role in the electronic health record was the lead physician on the project. I helped make some of the design decisions and work flow decisions, things that would work best for the hospital. I had previous experience doing that in another job before I came to Lutheran four and half years ago.

Yours is the largest hospital I’ve heard of that has implemented Medsphere’s OpenVista. You’re a teaching hospital, too. What parts of the system are you live on and how has it gone?

The part that we are on live now is order entry. All the providers — the doctors, the nurse practitioners, the PAs, the CRNAs, and anyone that’s allowed to write an order — put the order electronically into the system. The nurses pick up the order and the pharmacies pick up the orders through the system. Orders also go to the laboratory, radiology, dietary, and other ancillary services.

The other thing we’re doing now is that the nursing assistants are putting vital signs into the system. The doctors are seeing that in the system. That’s the patient’s temperature, pulse, blood pressure, and heart rate.

That’s a pretty impressive accomplishment going right up with full CPOE and closed loop to pharmacy. Most people struggle with those and save them until last. How did this project compare to the one you did previously at the other hospital and what did you learn from that?

What I learned there was that was a multi-hospital system. It was a little different because that project required us to get consensus in a couple of different hospital systems before we could go out there and train and implement it. But we used a lot of trainers and people who were on the floors super users and other people to help the doctors and the nurses at go-live.

We took that model that I had used successfully elsewhere and brought it here. We had a lot of super users, mostly from our own nursing staff. We had a few physicians.

In addition, we hired a bunch of super users from a training company who did the classroom training a couple months ahead of go-live. They were here at go-live and out on the floor, super users and the employees from the company, all wearing yellow vests. If you needed help, all you needed to do was look for someone wearing a yellow vest and you knew you had some help. They were there 24 hours a day, seven days a week for a full two weeks.

That’s an interesting approach. A lot of hospitals don’t understand that implementation is a hump that you need to get through, but then your labor needs go back down. Was using an outside company something you’d heard of elsewhere?

When we hired this company at my previous job, it was a relatively new company. I think that the chief medical information officer who I worked with at that implementation had done some implementations before using a lot of super users and possibly an outside company. I’m not sure. But he was very clear that you needed to have elbow-to-elbow support for the providers when we went live.

Between him and the leadership of the company, we figured out ratios of numbers of people we needed on each unit and super users. I was able to make a recommendation to do a similar type of thing here. It didn’t really matter to me what company, just that we had enough people. Go-live to me is the big show. You’re either going to make it or break it at go-live.

Did you replace other systems when you implemented OpenVista or was it purely paper to electronic at that point?

In the inpatient unit, it was paper to electronic. In the emergency room, we replaced their electronic system with this one.

What have you learned or what advice would you have for someone else trying to follow your footsteps in the CPOE journey?

You have to have great communication with your clinical staff. This was a long time in coming. From the time we signed the contract until we built everything and started training and implemented it, was about three years.

Medsphere was a young company. We were trying to figure out exactly what we needed to do when, so it took time. But you get the physicians on board in physician advisory committees. You get the nurses on board with nursing advisory committees. You keep them up to date.

This was probably a good time to do something like this because there’s no physician — unless they have their head in the sand — who would not know about electronic health records and Meaningful Use and the importance to the Obama Administration. In addition, a number of our bigger groups have already put these into their offices. It’s not like ten years ago when the physicians at Stanford said, “We’re not doing this.” That just wasn’t going to happen because timing is everything. This was the right time to do this. There’s no question about it.

We made it easier for the physicians. We gave the physicians three options for training. We didn’t put any pressure on them. We told them, “You decide what your skill level is and do what’s best for you.” We offered them Web-based training. We offered them classroom training with a proctor. We offered them true classroom training, where they went in sync with an instructor for four hours. They had their choice. 

All of them at the end of their training had to do a validation test. About a half hour or 45-minute test where they had to go through some exercises and show an instructor in the classroom — even if they had done the Web-based training in their office or at home — that they could do the basic things, like log on, find a patient, make some orders, and things like that.

But we knew that the hard stuff — like some of the harder orders, like complex orders like IVs with additives in them, or insulin sliding scales — that was going to come with practice. That was something that the super users and other folks on the floor were able to guide them through the first time they did those things.

When you choose OpenVista, what other systems did you consider? What led you to make the decision that you made?

I wasn’t here then. I had just come when the final decision was being made. But I know that they did go to other hospitals that had rolled out some of the bigger programs like Cerner, Epic, Eclipsys, and Mediware. I think they did do their due diligence in the two years before that with all those companies.

OpenVista was a funny story. The CIO apparently learned about VistA through some technology newsletter that he got and realized that you could download it free of charge. I think you could buy it for $17 or something like that because it was in the public domain. He downloaded it and realized we couldn’t do a thing with it [laughs]. It was too complicated. Then I guess Medsphere got out there and started to advertise. They met with them and decided to go with it.

Eclipsys and Epic all of those are probably, I don’t know, three or four more times expensive then what we’re paying for OpenVista because it is open source. What we’re really paying for is the support, the interfaces, and obviously the hardware we would have had to pay with any system. The training cost we would have paid no matter what system. It was something we could afford.

What parts of it do you plan to implement?

We’re going to implement all of it. We’re likely to go to medication bar coding next. Then, to full documentation, clindoc, with notes from the doctors and the nurses. The ED already is everything. They have clindoc and they have order entry. They replaced their system in full. Otherwise, it would have been taking a step back for them. That’s the likely scenario, but it’s not in stone yet.

Are there other key clinical systems that you use outside of OpenVista?

We went with their radiology system. Right now, we’re still using our interface to our laboratory system, which is Sunquest. We’re using their pharmacy system.

I think the reason we didn’t go with the laboratory system was because our system actually was more sophisticated and better then the one that the VA had. Theirs was sunsetting and they were going to be moving to one of the commercial laboratory systems anyway.

Do you have physicians who learned VistA at the VA and are happy to have a system that they already know how to use?

There were a couple of residents that rotated through the VAs as medical students when we announced that we were going to be using OpenVista. A couple of people had used or had read about it and heard that it was a great system. So that was very positive. There’s been a lot of national press about the VA’s system.

You mentioned Meaningful Use earlier. What are the hospital’s plans for it and how are you doing?

Just by going live the way we did, we basically have completed the option of CPOE. That’s one indicator we don’t have to worry about. On Day One, we were at 93% acceptance by the physicians. The other seven percent was only because there are physician extenders that enter their orders and it’s only measured by physicians. But in reality, 100% of our orders are being entered into the OpenVista system now.

The other parts of Meaningful Use – we’re looking into the software and we’re working with the company. Medshpere expects to be certified for Meaningful Use sometime in January, I believe. A lot of the validation for Meaningful Use for us will be in the clindoc part of the system. That’s where we’ll be able to get the data from to show Meaningful Use. We have some of it now, but we still have to go into that phase to be able to show the first stage of Meaningful Use. We’re hoping to do that before the end of 2011.

Many hospitals are concerned about their ambulatory strategy and exchanging information with employed or affiliated practices. What are you doing along those lines?

Our ambulatory practices were already up on another health record called eClinicalWorks. Our strategy now is to try to interface both systems so that we can share basic information like medications, allergies, previous visits, and those types of things. Which you know is very doable, and that’s working well. But they were way out ahead. They did a project with the City of New York and so they’re using that software very successfully.

What about interoperability? Are you working on projects involving health information exchange or any data sharing with outside facilities?

Yes, we’re working with a couple of other Brooklyn facilities on RHIOs and health information exchanges both. We’re working with a visiting nurse service and a number of the local community-based health programs. So yes, we’re actively involved in that.

Organizations will need data to prepare for Accountable Care Organizations and other reimbursement plans. What thoughts do you have about that?

You’re absolutely right. It’s going to be critical. We’re looking at everything that we build to make sure it’s discrete data and we’ll be able to get it out in a usable form. We have been doing chart review for some of the indicators that we have to do for CMS core measures for care of patients with heart attack, heart failure, and pneumonia. There are a bunch of indicators they look at to see what kind of care you’re giving and they publicly report those indicators.

Up to this point, it was chart review and we did that by hand. Now we’re trying to figure out how to use the electronic health record. As we build our screens, notes, and templates, we’re making sure we can get that information out in an electronic way and hopefully make life much easier for the data abstractors.

Any final thoughts?

So far, so good. I was very proud of our staff here. I really was. They just took it all in stride. We went live late on a Saturday. Those who came in on Sunday thought it was great. The masses came in on Monday and it was just a regular day. Challenging for everybody, but nobody stormed my office. It was great.

Monday Morning Update 1/3/11

From Mighty Mite: “Re: HISsies Lifetime Achievement Award. I like that proposed category. The name that comes to mind is Rob Kolodner, MD for his incredibly important work at the VA, his ONC work when Bush gave him a mission and no money, and his open source work, where he’s trying to build systems for poor countries that can’t afford $100 million systems (can we either, really?)” I can’t quibble with your pick. In the interest of offering choices, other names that come to mind are Octo Barnett, Neal Pappalardo, Paul Egerman, John Glaser, Bill Childs, and many more from the provider side, although their work maybe hasn’t been quite as non-commercial as that of your nominee. I’ll be interested to see who readers suggest. The HIT industry has finally been around long enough to have a history worth recognizing.

Nearly 2/3 of my survey respondents say their software vendors focus on releasing enhancements that help sales instead of current users (we could have another debate about why those desires differ). New poll to your right: what employment changes do you see for yourself for 2011? The poll takes comments, so leave yours if you want. My vote: same employer, same job. I get recruiter calls all the time like everybody else, but I’m really happy at the hospital where I work.

It’s hard to believe it’s 2011. It’s comforting that the person I kissed as the ball dropped was the same as last year and presumably will be the same next year (I like romantic predictability). I lost Internet connectivity for nearly a day starting Friday afternoon, but the broadband company was good enough to send a tech out on New Year’s Day to replace my modem while I was making chili and whipping up killer guacamole (probably because I have business class service paid for by the hospital). I was lucky during that Netflix-free period to accidentally spot an IFC marathon of the funniest TV show in history, The Larry Sanders Show, which is being DVR’ed as we speak. Hey now!

You know what 2011 means: it’s HISsies time. Nominations are open here. In a week or so, I’ll use the nominations to create the final voting ballot, which I’ll send to HIStalk e-mail subscribers only to prevent ballot box stuffing. I’ve deleted some tired categories and added some fun new ones. Winners will be announced at HIStalkapalooza and I always invite some of the big category winners to say a few words there (they usually pass since they don’t get the HIStalk thing, but what the heck – at least I offered).

Inga e-mailed sponsors about our little appreciation lunch at HIMSS and is sending out RSVP information this week. If we missed you somehow, contact Inga.

I need your advice as readers for my New Year’s resolution. I’m fortunate to not need to make a living from HIStalk since I work full time and have little interest in money, which gives me the freedom to do work that’s not necessarily commercial in nature (or even projects that cost me money, if I think they are useful to the industry as a whole, especially the provider-siders). What projects should I be working on? Education, sharing of best practices, innovation, social networking, charitable work, etc. purely for the benefit of hospitals, practices, and patients? I have limited time, but I do have connections and resources that could be put into play for the right initiatives. I need your help in identifying those possibilities. E-mail me if you have suggestions.

Cerner must be throwing out some low prices lately, even based on per-bed license charges. This article on Idaho hospital EMR projects describes Cerner, being implemented at North Canyon Medical Center for $2 million, as “an economical system that works well for smaller rural hospitals.” Syringa Hospital (a strangely satisfying hospital name) paid $1.3 million.

A reader mentioned not being able to find a 990 form (the IRS tax form for for non-profits) on the Patient Privacy Rights Web site. I asked Deborah Peel, MD and she says they’re putting it up, but she sent over a copy anyway. I’ve given it my usual look-over and there are no secrets: income and expense of around $200K, it pays one relatively modest salary to a full-time executive director, and Deborah Peel takes no salary, In fact, she’s the organization’s biggest individual donor, so it’s costing her money, not to mention time. I’m disappointed that HIMSS didn’t invite her to speak at the conference this year. I don’t necessarily agree with her in every case and sometimes she provides more emotion than hard data, but I’m glad she crusades for privacy and security since without her there might be no rational compromise. She’ll be the keynote speaker at the Computers, Privacy , and Data Protection conference in Brussels, Belgium (January 25-27). I spent time with her at HIMSS last year and she’s a hoot, not just smart and sincere, but cynically funny in an HIStalk-approved way.

New announcements from Medicity: (a) Children’s Dayton chooses Medicity’s Novo Grid to connect with its partners and affiliated physicians, sending out results, reports, and face sheets from Epic clinicals and McKesson patient accounting and receiving back lab and rad orders; (b) CHRISTUS Health will expand its use of Novo Grid to include ProAccess Community, MediTrust Cloud services, ambulatory orders initiation, referrals, and CCD exchange, all across seven states and extending to an additional 900 physicians; (c) Hoag Memorial Presbyterian Hospital (CA) announces that it connected 250 providers to its HIE in five months using Novo Grid; and (d) Medicity’s iNexx platform has been certified as a modular EHR by Drummond Group, qualifying its users for Meaningful Use.

Hospitals always announced their first baby of the new year, so I’ll proudly flash the picture of the first new HIStalk Platinum Sponsor of 2011: Marietta, GA-based Nuesoft (not to mention that they’re also supporting HIStalk Practice at the Platinum level, too). You saw their fun Lady Gaga parody video and the pic of their booth people dressed in hideous 70s fashions, but that’s not all they do. Their offerings include NueMD PM and billing software; NueMD EHR (CCHIT certified); Nuesoft Express management software for college health clinics; Nuevita student health clinic management and EHR; RCM and billing services for college health; and the Nuetopia medical billing service in which the company provides an EHR, PM, billing, EDI, clearinghouse, and services. NueMD, they note on their site, is Internet based, not just browser based. Thanks to Nuesoft for its support of HIStalk and HIStalk Practice.

Speaking of Nuesoft, they’re darned good at making videos. I ran across the one above on YouTube. If you’ve seen other fun, HIT-related videos, let me know.

A job site’s annual list of weird interview questions that gets picked up by newspapers everywhere includes one from Epic: “An apple costs 20 cents, an orange costs 40 cents, and a grapefruit costs 60 cents, how much is a pear?” You figure it must have something to do with logic and formulas since it’s a programmer test. Nothing related to word length or consonant count makes sense (since the first two fruits have the same number of each but different prices), but the formula of (vowels-1) x 20 works, which would price a pear at 20 cents. I’m lazy and immature, but the college tested my IQ as 162 back in the day, which offers no real benefit except I can answer questions like this.

A hospital in England starts conducting patient satisfaction surveys via iPads.

MedTech Publishing, which publishes Healthcare IT News in a business relationship with HIMSS (and also Healthcare Finance News), takes over the HIMSS-acquired Government Health IT. I wouldn’t consider that good news since I’m a semi-fan of the latter but not at all of the former (even though I don’t read either, so I probably shouldn’t have an opinion at all). HIMSS will continue running the Government Health IT Conference and Exhibition. Also part of the deal: MedTech will take over the dead tree publications related to the HIMSS conference that it has previously printed under contract (those papers that are always being thrust at you by cute girls in ball caps every 15 feet as you try to traverse the convention center, necessitating hilarious evasive maneuvers). Neil Rouda, MedTech founder and chairman, is being replaced, and rather vague wording suggests that HIMSS is buying a majority interest in the company. It’s not like they were running a lot of hard-hitting, industry-unfriendly stories anyway.

E-mail me.

News 12/31/10

From HISJunkie: “Re: SureScripts as an ATCB just for e-prescribing. How an e-prescribing clearinghouse be an objective judge about a vendor’s functionality? If I don’t use their clearinghouse, where does that put me? I think the certification process is going to get much stranger in the new year.”

From Athenahealth Win: “Re: win. They just took out a huge Allscripts/GE-IDX install. Should be announced soon.” Unverified.

From Limber Lob: “Re: Maryland Board of Physicians newsletter article on e-prescribing of controlled substances. I really enjoyed the first two and last two sentences. Another EHR skeptic!” It reads: “The health care community has lived through the initiation of electronic health records. They will, we are told, save time and money and reduce medical errors … Use of the term ‘interim final’ by the DEA suggests that this field, and the concomitant federal records, are evolving. For more information, go to the Internet.”

From Promises Promises: “Re: gag clauses. None here.” This document lists Allina’s terms and conditions for practices that want to use its Excellian (Epic) system. It says Excellian isn’t a substitute for human thinking and requires practices that want to use it remotely to: (a) verify its behavior; (b) don’t rely on it for anything critical – ask the patient instead; (c) don’t use it to communicate any important results; (d) look out for programming errors; (e) test it before letting users on; and (f) don’t disclose Epic’s trade secrets. You’d think they didn’t have much confidence in their $250 million implementation from all the disclaimers, but I’m sure that’s just the Allina and Epic lawyers expensively talking.

Listening: new from Ryan Adams (just to be clear, not Bryan Adams – this one’s from North Carolina instead of Canada and is married to Mandy Moore). Actually, the new double album consists of three-year-old tracks that had been gathering dust until he started his own record label and released the 80s-theme concept album a couple of weeks ago. Sometimes it sounds like U2, sometimes like Tom Petty, sometimes like The Cars or Spandau Ballet. I guess those are the 80s musical references at work. And Watching: Doc Martin on Netflix, which is a very nice British dramedy. If it’s realistic, the Brit GPs store paper medical record folded into a little 5×7 or so envelope, so they must not churn out the insurance- and lawsuit-required documentation like here. I could spend hours looking at and listening to Louisa (Caroline Catz).

I have Uri Geller sitting right here beside me and he’s telekinetically moving your fingers to the Subscribe to Updates box to your upper right, forcing you to type in your e-mail address and name so that you might live a fuller life in HIStalk one-ness. You will receive no spam since I don’t care about money enough to sell or rent the subscriber list to the many companies that keep asking. You will, however, get everything important in HIT as soon as Uri or I push the “send” button.

A family member got an iPad. I played around with it for a few minutes and liked it a lot (amazing display), although I think smaller tablets sold by competitors might be more my speed. It was nice to have a display larger than that of my iPod Touch but a bit much to haul around. I like the idea that you can get a no-contract AT&T data plan for it for $25 per month for 2GB (cheaper than an Aircard, but that’s in addition to your smart phone plan, unfortunately). I’m really happy with my iPod Touch despite still not having played any MP3s or videos on it (I take a second-generation Nano to the gym since I’m rough on stuff there). It is amazingly handy to grab the Touch from the nightstand and be checking e-mail or Web browsing at WiFi speeds within five seconds of having the urge to do so. Mrs. HIStalk probably hates it since on those rare occasions I watch TV with her, I constantly pounce on the Touch to recite trivia from IMDB about whatever she’s trying to watch or do the “alive or dead” quiz about some actor on the screen. The shows she watches aren’t very cerebral, so I think I may be more fascinating anyway, although I don’t have the nerve to ask if she agrees.

Ed Marx has updated his Why I Fired and Rehired Myself post, which he’s good about doing in response to your comments (even the nasty ones).

Here’s a shout-out for HIStalk pal Michael Christopher and CarePrecise, which offers a variety of ways to access the federal government’s healthcare provider database with data points on three million providers that include UPINS, Medicare IDs, state license numbers, phone numbers, separate tables of newly added and newly dropped providers, etc. They also have medical marketing tools for you vendor types. Michael’s a genius, so you get to talk to him if you buy something (I talked to him once as Real Me and not Mr. H and was mightily impressed, which doesn’t happen too often).

I wasn’t quite prepared for the immediate response to my casual blurb about maybe needing to hire someone to help Inga and me out. I expected to get an e-mail or two, but not from household name type people (VPs, retired CIOs, people who have published or edited magazines, etc.) Let’s just say I’m honored that folks at that level read HIStalk, much less want to help with it, and I want to hire every one of them because they all sound great. It’s a low-rent operation here, so we’ll see how it turns out (I’m behind on responses, but I’ll get there). Several did the same as Inga when she first contacted me years ago: listed 10 sassy, cynical, funny reasons I should hire them. Here are some of the ones I liked as showing a deep understanding of the HIStalk (anti) corporate culture:

1. I am considered a pain in the ass by 95% (or more) of people who know me.
2. I know the industry, the jargon, and where some of the bodies are buried.
3. I really, really want a cool avatar like Inga has, although I firmly insist on a bit of virtual Botox.
4. Smart-ass, I am (much more fun if you say it like Yoda). Above all, this is the personality trait that appears to be the key to the HIStalk inner sanctum.
5. I am certain that you’ll get more impressive volunteers to write for you than me. That being said, you shouldn’t pick them because they’re too busy and they suck in their own perceptions of HIT.
6. My husband says, “I’d hire you. You are smart and cute.”
7. But enough about me, let’s talk more about me.
8. I am a passionate sports fan, mainly that of European soccer. I will defend to the end the reason for soccer not blossoming in America is that our social fabric is built on competition, not community, and therefore we cannot support soccer on a national or regional scale. It has nothing to do with boredom or slow-moving play, as we support baseball and American football, which border on tedium with the amount of time-outs, commercials, and gratuitous jock-adjusting. Soccer is like the ballet — no matter how much you hate it, you know it will end at a reasonable hour.
9. Actually, in all candor, my experience makes me a perfect fit for this role, not OJ and the leather glove, but an honest-to-goodness Isotoner glove-type fit.
10. I always attend HIStalk events at HIMSS!

I think I’d need one of my attorney readers to help decipher the legalese, but it sounds to me like Cerner and Mayo Clinic prevailed in an intellectual property lawsuit they brought against a former Mayo physician. Mayo said he took his knowledge of a natural language processing application that Mayo was commercializing to Merck, which may or may not have planned to commercialize NLP software (depending on who you believe). Cerner apparently licensed the software from Mayo and sells it as Discern nCode. He wrote it in MUMPS for you haters out there. I lost interest at this point (earlier, actually), but if you didn’t, here you go.

Wolters Kluwer Health buys EMR training software developed by a research team at University of Tennessee. Its intended audience is schools of nursing for training students on EMRs. UT gets a cut of sales. The iCare web page is here.

Geisinger Health System (PA) notifies 3,000 patients of a data breach that occurred when a former doctor at one of its hospitals e-mailed information about his patients to his home e-mail account. Geisinger says it notified patients because the information wasn’t encrypted even though it’s almost certain that nobody else saw it. So there’s your first HITECH-related action and one that doesn’t involve EMR bribes – it requires providers to send breach notices to affected patients.

Thirty-six top-earning executives at the University of California are threatening lawsuits against the UC system if it doesn’t increase their retirement payouts. The university is changing its pensions (most of us would need a dictionary to know what those are) since they were underfunded by $20 billion by the perpetually fiscally irresponsible state. Among those signing the demand: UCSF CIO Larry Lotenero (paid $377K) and UCLA health system CIO Virginia McFerran ($477K), along with mostly hospital and investment management people. The bank bailout is going to look like a child’s allowance as states start going broke over wildly generous salaries and pension plans, loading their payrolls with double-dipping “retirees” and employees jockeying their positions for their last year before retirement since guaranteed lifetime payments are based on final salary.

Strange lawsuit: a mentally ill patient who had spent years in a psychiatric facility sues its operator, the State of New York, for nearly letting him die with an untreated infection. He wins, but the state asks the judge to give it his $1.7 million award in return for treating him without payment for 10 years. The judge agreed, so the patient got nothing.

Happy New Year!

E-mail me.

HERtalk by Inga

ONC names Surescripts its sixth Authorized Temporary Certification Body, but only for e-prescribing and privacy and security.

Central Florida RHIO names Jeanette Schreiber its new chair. She’s associate dean and chief legal officer for the UCF College of Medicine.

One week after hitting a last-minute snag, McKesson completes its acquisition of US Oncology.

I am back at home after a week of holiday merriment in the land of No Internet. I had intended to make it a working vacation, but underestimated how very slow my connection would be. After two days of pulling my hair out each time the connection dropped, I finally had to fess up to Mr. H that my escape from civilization was not going as planned and that, alas, HIStalk Practice would have to skip a day. Now, as I sit at my desk using lightning-fast Internet, I must say that I am surprisingly happy to back at work. I promise that my renewed attitude has nothing to do with the Help Wanted sign Mr. H posted during my absence, nor the fact that two dozen people more qualified than me are vying to become Mr. H’s new BFF. Actually I am pleased that so many people “get” how fun this job can be and I am hoping it will give both Mr. H and me more time to work on some other fun projects.

Speaking of fun projects: the upcoming HIStalkapalooza event during HIMSS. Mr. H spilled the beans on a few details and I must also make a couple of comments. First, I have high expectations for contestants in the “Inga Loves My Shoes” contest. It’s quite easy to participate – just pick out the most fabulous pair of shoes from your closet and wear them to the party. A trusted Inga stand-in will eye your feet and select the winning footwear. If shoes aren’t your thing but you want to impress the HIStalkapalooza universe (and definitely me), dress your very best and you will automatically be in the running for HIStalk King or Queen. Here is a tip for the soon-to-be-legendary King and Queen contest: if you are wearing a straight-from-the-booth vendor tee shirt,  you will not win this incredible honor. Those wearing tuxedos and chiffon will automatically make the semi-finals. Wearing pirate costumes or pink pants may only get you a Mr. or Ms. Congeniality award. I am trying to convince Mr. H that we need some amazing prizes for our lucky recipients, but no decisions yet. Meanwhile, I am dreaming of IngaTinis, red carpets, and dancing the night away.

An Ohio surgeon is sentenced to a year in prison for having his office manager pose as a doctor while he was out of the office. The office manager for Dr. Charles C. Njoku had previously been sentenced to three years of probation, including one year of home confinement. The two also must pay restitution of $131,000 for billing Medicare and Medicaid as if the office manager were the doctor seeing patients.

I would love to know which EMR this doctor uses. An internist treating a complicated patient complains that her EMR will not allow her to write an evaluation exceeding 1,000 characters. When the physician calls the EMR help desk for assistance, the tech replies, “Well, we can’t have the doctors rambling on forever.” And the industry wonders why doctors resist EMR adoption.

The mHealth market continues to boom, with over 200 million apps now in use. About 70% of people worldwide are interested in owning at least one mHealth application and are willing to pay for it. Countries with large populations and limited healthcare options, such as India and South Africa, are the most interested in mHealth. Look for the number of mHealth apps to triple by 2012.

Puget Sound Blood Center (WA) is launching the GCI ConnectMD private medical network to connect with Swedish Medical Center, Cherry Hill Campus.

Government auditors report that the CDC lost or misplaced more than $8 million in property in 2007, including a $1.8 million hard drive and a $978,000 video conferencing system. Whoops. The CDC says it has now instituted better controls and that 99% of its property was accounted for in 2009.

A computer tech in Michigan is arrested for allegedly violating state hacking laws and gaining access to his then-wife’s e-mails to confirm his suspicions that she was having an affair. Turns out she was, with her ex-husband. The wife (who is now actually the alleged hacker’s ex-wife) realized the computer had been hacked when personal e-mails showed up in a child custody pleading involving her first husband (hacker was husband number three). Computer geeks, lots of husbands, and adultery – it just doesn’t get much juicier than that.

Sponsor Updates

• Greenway Medical Technologies announces a new web site covering EHR adoption incentive programs.
• PatientKeeper is moving to new headquarters in Waltham, Massachusetts in a building adjacent to the Massachusetts Medical Society and the New England Journal of Medicine.

E-mail Inga.

Readers Write 12/29/10

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

The Role of Automation in Reconciling Patient Records
By Beth Just

Duplicate patient records have long been a serious problem for hospitals, creating the potential for missing or inaccurate patient information that can lead to life-threatening care situations. They are also a substantial drain on financial, health information management (HIM), and IT resources.

Industry estimates are that 3-15 percent of patient records at a typical hospital are duplicates. That number skyrockets to 30 percent or higher for facilities that have been acquired or merged or are part of an integrated network. Exacerbating the sense of urgency surrounding the elimination of duplicates is the impact they can have on a hospital’s ability to qualify for incentive payments under HITECH. In particular, duplicates artificially inflate the number of unique patient records, which are the basis for several Stage One criteria.

That is why eliminating existing duplicates and preventing the creation of new ones must be an integral part of any facility’s data management strategy. In addition to easing the burden of achieving Meaningful Use, doing so also eliminates significant cost drain. One three-hospital system determined that the duplicate volume for its health system was more than 17,000 records.

The estimated annual cost of those duplicates? Anywhere from $554,000 to more than $1.2 million for repeated tests and treatment delays, as well as incremental costs related to longer registration times and correcting duplicate records.

The challenge is that reconciling and eliminating duplicates is a cumbersome, manual process that requires staffing resources most hospitals cannot spare. What’s more, these processes do nothing to prevent future issues.

Traditionally, the reconciliation process is executed entirely on paper. Potential duplicate records are identified as patient charts are pulled. They are then assigned to the HIM staff, which must analyze previous charts and other information to verify whether they are actual duplicates before they can be eliminated.

Even if a hospital’s information system provides reports of duplicate records, the data they contain typically is limited to key identifiers, such as name and date of birth. More research is generally required once potential duplicates are identified.

Progress on reconciliations is also typically tracked on paper, leaving room for error and duplication of work.

By automating portions of the reconciliation workflow, hospitals are able to quickly and efficiently weed out existing duplicates and prevent new ones. By allowing multiple duplicates to be reviewed in a single view, automated processes also heighten user control over the merge process, lessen the time required to complete the process and enable more effective quality assurance before records are merged. High-level process will also support merging records in downstream systems while reducing manual steps and associated costs.

Automation can also reduce the time and resources required for reconciliation. The best systems will also automatically document decision validity, track productivity and generate comprehensive, user-friendly reports that provide a complete view of efforts and insights into problem origination points.

After six months of manually analyzing duplicates records, the previously mentioned hospital system chose to leverage the efficiencies of an automated reconciliation process to eliminate duplicates prior to its transition to a new clinical information system. Today, it relies on the software to maintain clean, high-quality patient records. The automated solution resolves upwards of 500 duplicate records monthly at each of its three hospitals – and it does so with fewer resources than had previously been dedicated to the process.

Beth Just is CEO and president of Just Associates.

How Healthcare Is Different
By Rambling Man

Healthcare is unlike any other industry for a ton of reasons, a few I found the time to ruminate upon this morning.

What industry does not know its costs? There are examples of providers performing this analysis, but most community hospitals, ambulatory care centers, and primary physician offices operate from ignorance of this information. How can providers negotiate payer contracts without this knowledge?  This information will become increasingly important as the industry evolves from traditional payment models with ones based on quality of care and outcomes. This begs the question: how will we measure quality care and outcomes? The answer will inevitably involve more consumer involvement.  

How will the industry respond to the increasing demands upon the primary physician? Today’s reimbursement models force physicians to fit more patients into their daily routine, while still making the same amount of income. This model will eventually change the face of healthcare, and perhaps for the better. Demands on physicians to stay current with new clinical data, juggle a schedule of seeing 36 patients a day, and “practicing the art” seems super-human and may be outdated. 

These demands, combined with an alarming decrease in physician ranks, will create a new layer between the patient and the science. This new layer may be satisfied with Nurse Practitioners or Physician Assistants, or a skill-set not yet defined that focuses on data gathering and psychological insight.

How can patients do to better the system? Medicine addresses our physical vulnerability and fear of death, which are the darkest of human emotions. Physicians must have a serious sensitivity towards the emotional needs of patients, and one could argue society’s reaction towards death has worsened in the last fifty years. 

For many, years of pain or confinement to bed are better alternatives to accepting the inevitable. We expect our physicians to be the best scientist and psychologist all wrapped up into one package, but how have we changed as consumers? We need to bear a larger portion in the direction of medical care, and the systems that provide medical information to the consumers must be simplified for all. Health data banks, where consumers store health information and pay for data analysis, will emerge and become the centers of our data. 

And finally, and arguably more difficult, is that we require a change in attitude regarding death. Fear of death is the motivation behind the largest portion of healthcare expenditures. Has our consumer psychology foregone quality of life in favor of quantity? Changing these attitudes will not happen overnight and will not be easy.  Each of us facing our ultimate demise need to do so with dignity and faith that death is a beginning to a larger chapter in our existence.

As I Stand With Nozzle In Hand
By Mr. HIStalk

Pumping gas is boring. There’s nothing you can except fidget and enjoy the fumes (which I do). The high point for me is spotting a squeegee in a nicely full container so I can at least pretend that my windshield is dirty and entertain myself for a few seconds by cleaning it (or curse the lazy clerks who’ve left the squeegee in a desert-dry container because they just don’t care).

Sometimes I read the stickers on the pump, like the last inspection date or how to find the emergency shut-off valve (daydreaming of heroically saving an entire neighborhood by stopping a spreading ocean of flame as I sprint confidently to shut down the pumps like John Wayne in Hellfighters). While scanning for those exciting tidbits the other day when I was in another state, a sticker on the pump caught my attention. Under a picture of a scowling, R. Lee Ermey-lookalike state trooper, it said Drive Off, Lose Your License.

I marveled at the political clout of the gas station owners. Shoplifting, walking out on a restaurant tab, or any kind of petty theft are all subject to a ponderous legal system with generally light penalties for first-time offenders. The punishment, if it ever comes, is generic and disjointed from the crime. But somehow the gas guys used their political grease to get politicians to approve a very specific (and severe) penalty for a specific type of theft affecting only them.

Obviously the R. Lee sticker was designed to get your attention. The Lose Your License part is a lot more dramatic than, Drive Off, You Will Probably Not Be Arrested and At Worst Will Get a Slap On the Wrist Months From Now Even If You Are Arrested, and That’s Assuming the Unmotivated Dry-Squeegee Clerk Cares Enough to Chase You Down the Street To Get Your License Number.

I was appalled. What does skipping out on a gas station tab have to do with the privilege of driving? That makes about as much sense as … uh oh … penalizing doctors for not using electronic medical records.

Gas stations could have eliminated their problem without judicial favoritism by simply requiring cash customers (are there really any left?) to pay before pumping. Just like EMR vendors could have boosted use of their products beyond the pathetically tiny percentage of busy, pre-HITECH doctors willing to use them by making them easier to use and designing them to increase doctor efficiency rather than accumulating interesting but not always clinically helpful data for insurance companies and the increasingly intrusive Uncle Sam to poke around in to find reasons not to pay for services already rendered.

Even though I’d paid at the pump, I decided to go into the C-store for a soda and some nutritionally devastating snacks (anybody for an jelly orange slice or a pack of those mini-donuts slathered with coconut gunk?) On the wall beside the “deli” (where the commissary-made sandwiches encased in their nitrogen-filled coffins are moved from totes to the refrigerator in a form of “cooking”) was the C-store’s health inspection sign.

I read those. If I’m going to a strange restaurant (especially if it’s Asian or Mexican), I’m going to seek it out right away to make sure the cooks at least occasionally wash their hands and don’t store the goat carcass designated for employee lunches in the same refrigerator as the desserts, at least during the inspector’s surprise visit. (As a second-level review, I always check out the customer restrooms since whatever disgusting state those are in is ten times cleaner than the areas customers can’t see, like the kitchen).

I want to see those health inspection signs on hospital and practice doors. Give me a letter or number score of how well they adhere to quality measures, as measured by a totally independent and fear-inspiring government bureaucracy (not the chummy Joint Commission, which has given hospitals glowing scores right before the state inspectors came down on them like the wrath of God for running shockingly lax operations). I would turn tail just as quickly from an impressively ornate medical provider’s facility with a C-minus score as I would from a $5.39 all-day Chinese buffet restaurant that doesn’t even own a trash can (but with illegal immigrant employees who probably wash their hands more than the average doc even though they’re deboning chicken thighs instead of probing people).

So thumbs-down for making up new penalties to encourage whatever behaviors the politicians and those who influence them have decided are desirable. Thumbs-up for letting businesses run their own affairs, but with mandatory full disclosure to their customers. Let the market decide whether and EMR-wielding C-minus practice is preferable to an A-grade practice using an IBM Selectric and one of those, “Sara, this is Sheriff Taylor” telephones that look like the far end of a clarinet.

But in the mean time, I’m thinking about applying a for a few paltry million of the HITECH bonanza to create an EMR awareness program for the paper-clinging providers. I’m calling up R. Lee Ermey, posing him in a government-looking suit and power tie, and putting him on stickers for manila folders that read Write Order? Lose Income.

News 12/29/10

From BeKind: “Re: Texas patient privacy breaches. Mentioned in this article.” It also mentions that JPS Health Network is spending $94 million on its Epic implementation.

From Jennifer: “Re: QuadraMed QCPR. Now fully certified!” CCHIT certified QCPR as a hospital EHR on December 23.

From Skinny Minnie: “Re: vendor gag clauses. A billing vendor’s new customer did a YouTube testimonial about why they switched from their previous vendor (service and cost). The previous vendor told the customer they were violating the terms of their contract, which says they can’t ‘disparage or denigrate’ them, and insisted they make their new vendor take the video down.” No link was provided, but I found a YouTube video featuring a customer of the same ‘new’ vendor explaining why they replaced the same ‘old’ vendor, specifically mentioning the monthly cost of each. Either the ‘old’ vendor missed this one or it didn’t get taken down after all.

From Alfonso: “Re: healthcare IT tools for Accountable Care Organizations. I ran across an article touting two companies that are attracting VC and private equity interest – MedVentive and AmalgaMed. Investors are looking at the next two years as being critical for capturing market share as payment reform in the form of ACOs restructures healthcare delivery.” AmalgaMed is a new startup founded by a couple of entrepreneurs with benefits management experience.

Genesis HealthCare System (OH) sells $20 million worth of buildings to pay for an EMR system, freeing up cash flow to fund mission-critical projects.

TPD has updated his list of iPhone apps.

Who knew that Tom Selleck was a cheesy-mustached technology thought leader way back in 1993? Or at least he sounded that way as he read the script that AT&T gave him for these old commercials. I ran across a mention of this compilation video on something called Dvice, from Syfy.

Inga and I have been swamped lately, with a ton of new sponsors, interviews, HIMSS planning, etc. I’m thinking I need to hire someone part-time to help out. I could use someone who knows the industry, writes really well, and enjoys dealing with cool people like our sponsors and contributors by e-mail and telephone. Pay won’t be impressive, but it’s a good chance to learn and to get your name out there. Those interested should do like Inga did years ago: e-mail me and tell me why I should hire you since my natural inclination is to just suck it up and work more hours myself.

Registration for CMS’s Medicare and Medicaid EHR incentive programs starts next week. Instructions and the link to the registration page (when it’s turned on) are available here. You can register now even if you haven’t implemented anything yet.

Weird News Andy notes that of the 20 least-efficient charities in the country, only one relates to healthcare: Charleston Area Medical Center Foundation (WV), which runs an administrative expense ratio of 49% and earns one star from CharityNavigator. In comparison from the most-efficient list, Brother’s Brother Foundation, which includes medical supply donation among its projects, runs an expense ratio of 0.0% and has earned a four-star rating from CharityNavigator (which is where I always look first before donating). I have to be honest: having worked for hospitals nearly all of my life, they’d be last on my list of organizations to which I’d donate. Charity is big business at that level, with highly paid foundation employees, lots of private club donor schmoozing, and constant trading of favors (like donors making their contributions contingent on hiring their company as a vendor or giving their worthless kids phony jobs). Not to mention that I would never fund a charitable cause that pays executives $1 million or more like many hospitals.

Cerner shares are continuing their generally upward trend, closing Tuesday at $96.01. You could have bought shares for $72 in September (or $16 in 2003).

India-based NIIT Technologies Limited acquires the Preferr patient referral system, developed by Visions@Work of Clermont, FL.

E-mail me.

HERtalk by Inga

Manatee Health System (FL) will spend $2.5 million to implement Cerner, with Manatee Memorial Hospital and Lakewood Ranch Medical Center making the switch in August.

St. Joseph’s Hospital Health Center (NY) will hire at least 25 people "with considerable information-technology (IT) experience, preferably in the health-care field." The additions will double the size of the existing IT department.

UPMC introduces a mobile version of MyHealth Connect, giving users smart phone access to UPMC Health Plan information. The initial phase includes details on UPMC’s provider directory. Future versions will include a virtual ID card and access to members’ PHRs.

US Oncology names Karen Gibson SVP and CIO of its technology services, reporting to EVP Asif Ahmad. She was previously CIO of Life Technologies and of GE Healthcare Information Technologies.

Sponsor Updates

• Cumberland Consulting Group promotes Mary Francis Shaw, Dao Dang, and Chris Wolfert to executive consultant.
• Allscripts CEO Glen Tullman will join the founders of Wikipedia and eMedicine to discuss the impact of the Internet on healthcare on January 6 at the University of South Florida Alumni Center in Tampa.
• CareTech Solutions offers a money-back guarantee to hospitals that try its Solution Found service desk offering.
• Picis will incorporate the AORN Syntegrity framework into its perioperative suite.

E-mail Inga.

CIO Unplugged 12/27/10

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

Why I Fired and Then Rehired Myself

The capstone of holiday seasons past has been The Plunge: leaping into the icy waters of Lake Erie wearing nothing but swim trunks. Each New Year’s Day, we Cleveland Triathlon Club members gingerly — if not insanely — worked our way across the snow and ice then charged into the lake. Once we reached waist-high water, we crowned our feat with a head-first dive. Like an arctic baptism, the Plunge symbolically washed away the old and welcomed the new.

A few years back, I used this event as the demarcation point for firing and rehiring myself. I plan to do the same as we head into 2011. I think we all should give ourselves the pink slip.

A few years ago, Intel was losing market share and profitability. Consequently, the company floundered. Knowing it was a matter of time before the Board would take mending actions, the leadership (Grove, Moore) discussed a particular phenomenon they’d observed. Nearly every time a company or division installed new leadership or brought in consultants, their outcomes improved.

Their conclusion: the new leader came in energized and with a fresh pair of eyes. Knowing they were being evaluated, he or she took their responsibility more seriously than the former, uninspired leader.

Subsequently, Intel’s old leadership had a brainstorm. Why not fire themselves and come back to the job as the new leaders? They said:

If existing management want to keep their jobs when the basics of the business are undergoing profound change, they must adopt an outsider’s intellectual objectivity.

They fired themselves over a weekend. After shifting markets (from memory chips to microprocessors), Intel became the clear leader in a very competitive market.

At that time, I worked for University Hospital. Although neither the hospital nor IT were in dire circumstances as Intel was, we needed to guard against complacency. I challenged my leaders to follow my example and take time over the holidays to reflect. Pondering how you would approach your position as a new employee is a healthy and worthy assignment.

Look at yourself as a potential candidate for your position. How will you evaluate the talent, change processes, and adjust the service mix? Should you alter your interactions with customers, your personal engagement, or your attitude? Will you embrace ideas you formerly rejected or feared? What strategies and tactics will you deploy to ensure business and clinical convergence with the health system? Do you have the fortitude to remove employees who add no value? Are you stretching the boundaries of innovation? Do you demonstrate courage despite resistance? How will you be a better servant…? The variations are endless.

To survive, you probably won’t need to change anything you’re doing. But to thrive means constantly reinventing yourself and operating differently. As a team, we embraced change, adopted an innovation-oriented culture, and began to walk in the fullness of our authority. What Got You Here Won’t Get You There.

Several other UH leaders fired and rehired themselves that New Year’s Day of 2007. The result? We experienced a dramatic shift moving from transactional to transformational services that had a net impact on our business and clinical operations. Our business, quality, and service metrics shot up to new heights. I experienced exponential growth, both personally and professionally.

Since I no longer live by the Great Lakes, I have to find a new point of demarcation. By the time you read this, I will have hang glided over the Swiss Alps (JungFrau). At the moment I leap off the mountain into the alpine chill, I will fire myself as CIO. An internal shakeup. I’ll let the present perceptions of my role plummet to the icy depths.

By the dawn of the New Year, I’ll find innovative eyes to view the future. Only then will I rehire myself.

Are you willing to give yourself the pink slip?

Update 12/30/10

Thank you for the comments, both positive and negative. I really liked the idea about being re-interviewed by your staff in this sort of process…have to incorporate that somehow going forward. Clearly I can’t respond to every comment, but as always, readers are welcome to contact me directly where we could further exchange ideas. Happy New Year!

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 12/27/10

From The PACS Designer: “Re: Flock. As the number of social web sites continues to increase, it becomes a challenge to keep up with all the goings-on amongst your web friends. Now you can have all your social web sites in one browser with Flock. You can view HIStalk’s Facebook and Twitter sites in one place to keep your browsing activity from consuming too much of your time. TPD hopes everyone had a Merry Christmas and wishes all a Happy New Year!”

From Nicole: “Re: Merry Christmas. My kids like reading HIStalk with me and often ask me to read them the news clips. My son (the oldest) likes the business news, my daughter liked the story about Zsa Zsa’s husband.” That’s fun. I’m hoping HIStalk isn’t your story of choice because it puts them to sleep faster at bedtime. I’m a fan of  “out of the mouth of babes” wisdom, so I’m picturing them at HIMSS passing judgment on speakers and booths. I bet they would have priceless observations.

From FamilyPhysician: “Re: instant messaging. Doximity lets you find any healthcare provider in the US (not just your hospital system) and communicate via text securely if they agree. I use it from my iPhone, but you can also use it from the web. Hospitalist groups in my area are using it as well as outpatient docs like me.” This isn’t quite the objective testimonial it seems since it came from a Doximity co-founder, but I’ll allow it since the product seems pretty cool. You can only give it a test drive if you’re a doc since the sign-up form checks your name against a list of licensed physicians.

From ChiefCookandBottleWasher: “Re: Jim Stalder. You interviewed him a few years ago. He has joined Cook Children’s Health care System in Fort Worth as their new VP/CTO. They’ve gone through a number of IT leadership changes over the years.” Verified, according to his LinkedIn profile. I assume he replaces Tracy Waller, who left in August to work for an oil company services company as an IT consultant. Jim was CIO of Mercy Health Services (MD) when I interviewed him three years ago.

I expected readers to vote their preferred form of FDA regulation of clinical systems in order of least- to most-comprehensive. That wasn’t how it played out, although survey topics stirring up more emotion seem to generate less reliable results. For whatever reason, the most-restrictive choice (vendors must prove safety and effectiveness the same as drug makers) was the #1 choice. New poll to your right, for providers: is your software vendors’ enhancement road map more focused on making new sales than meeting the needs of existing customers? You are welcome to leave comments.

Listening: Patto, described by the reader who suggested it as “raw, bluesy rock n’ roll with a jazz twist.” The band was obscure even its 1970-73 lifespan and tracks are hard to find on the Web, but it still sounds good (to me, it’s UFO meets Steppenwolf). Check out the guitar solo on this one. The namesake founder, who also started up Boxer, died in 1979 at 36.

John Stone is named CIO at Fairmont General Hospital (WV). 

It’s eight weeks until the HIMSS conference, just so you know. I’ll be starting up the HISsies in the next couple of days. Below are the results from last year. I’ve already decided to add two new categories, Most Fun Vendor and Best Informatics Professional, but the floor is open for your ideas of additional categories. I like to change them up a little each year. I’m thinking about adding a Lifetime Achievement Award as a serious award.

2010 HISsies Winners

Smartest vendor strategic move
athenahealth guarantees Meaningful Use

Stupidest vendor strategic move
GE Healthcare loses enterprise clients

Best healthcare IT vendor
Epic

Worst healthcare IT vendor
GE Healthcare

Best CEO of a vendor or consulting firm
Jonathan Bush, athenahealth

Best provider healthcare IT organization
Cleveland Clinic

Provider or vendor organization you would most like to work for if salary, benefits, and job title were not factors
Epic

HIS-related company in which you’d love to be given $100,000 in stock options that can’t be cashed in for 10 years
Epic

Most promising technology development
Smart phone apps

Most overrated technology
Speech recognition

Biggest HIS-related news story of the year
ARRA/Meaningful Use

Most overused buzzword
Meaningful Use

When _____ talks, people listen
David Blumenthal

Most effective CIO in a healthcare provider organization
John Glaser, Partners

HIS industry figure with whom you’d most like to have a few beers
Judy Faulkner, Epic

HIS industry figure in whose face you’d most like to throw a pie
Neal Patterson, Cerner

HIStalk Healthcare IT Industry Figure of the Year
David Blumenthal

Each year right about now, I start getting more e-mails asking about the HIStalk event at HIMSS. We plan to have the sign-up page live by January 15 or so. I can tell you this one’s going to be memorable – the sponsor, [name coming soon], is going crazy with super-fun ideas that the 500 or so lucky attendees will enjoy (Inga and I keep trying to probe their upper limits: How about we shine a giant HIStalk logo on the outside of the building? Done. Say, wouldn’t it be cool to bring in a professional video crew so I can run party video on HIStalk afterward? You got it, Mr. H.) So for you as a prospective attendee: Did you ever want to feel like a celebrity on Oscar night, making a dramatic entrance on the red carpet while sipping an IngaTini and being interviewed on live camera? Do you like great food and an open bar? Do you like the idea of a full-length concert at HIMSS with a real band playing on a real music hall stage? Did you enjoy the “Inga likes my shoes” contest last year, all the other fun beauty queen sashes, the HISsies, and surprise guests? Would you enjoy special recognition for physicians in the audience, beautiful ladies in their best party fashions as orchestrated by Inga, and maybe even a King and Queen winner just like at your prom? It’s so big and crazy that the sponsor convinced me to use the name to which I was jokingly referring to it as our plans got more ambitious: HIStalkapalooza, sponsored by [name coming soon]. So there you have it: HIStalkapalooza, Monday, February 21, 2011, 6:30 until 11:30 p.m. Eastern at BB King’s Blues Club in Orlando. Thanks very much to [name coming soon] for helping me honor HIStalk’s sponsors and readers in a soon-to-be-legendary way.

Weird News Andy’s radar picks up this story: Beth Israel Deaconess Medical Center (MA) admits that its surgeons miscounted vertebrae in three surgeries in the past three months despite taking the usual precautions, causing them to operate on the wrong part of the spine. The hospital says human error was involved and it can’t find a connection, although two of the three surgeries were performed by the same surgeon. The hospital also admits that it is working to fix problems found by inspectors, including using a checklist developed by another hospital to help surgeons mark their site correctly.

RAND had glowing things to say about CPOE in its 2005 study paid for by Cerner and other HIT vendor. Its new analysis, sponsored by a non-vendor group, finds that healthcare IT hasn’t generally improved the Core Measures scores of hospitals using it. However, the conclusion of the study’s lead author isn’t that HIT isn’t effective, but rather that outcomes measures are too broad to show HIT-related improvements. It was the usual drawing room type study that linked readily available but questionably useful information together to draw new conclusions: the HIMSS Analytics database, the AHA survey, and Core Measures numbers. It would be great if the effects of HIT were so dramatic that overall outcomes improved (not just Core Measures ones), but that’s probably not realistic, especially over a short timeframe. You’d have the same problem trying to make a quality case for almost anything: management changes, process redesign, policy changes in the use of drugs or devices, or better credentialing of staff. Measuring quality isn’t as easy as measure drug safety and effectiveness, where it’s not that hard to set up control groups, measure specific and immediate physiologic changes of effectiveness in patients, and monitor for easily recognized adverse reactions.

Thanks to Imprivata for its support of HIStalk, joining us as a Platinum Sponsor. I think you may infer from the above that the Lexington, MA company is justifiably proud of its #1 rating in KLAS’s Single Sign-On category. The company offers the OneSign single sign-on suite (say that three times …), OneSign authentication management, and the Imprivata PrivacyAlert system that detects and audits EMR snooping. Resources: a OneSign webinar, an overview of OneSign VDA for virtual desktops, and a data sheet covering PrivacyAlert and its out-of-the-box data support for Millennium, Sunrise, Meditech, and other healthcare apps. You might also want to check out Identity 360, the company blog. I don’t recall if I mentioned this, but OneSign Secure Walk-Away won the Security Innovation of the Year award from the British Computer Society two weeks ago. It uses a webcam to detect when a clinician walks away from their logged-in workstation, forcing a new user log in with their own credentials to improve security and avoid medical mistakes. I interviewed CMO Barry Chaiken just a few months ago.  Thanks to Imprivata for keeping the HIStalk wheels turning.

Strange lawsuit: a neuroradiologist and an endocrinologist playing a round of golf take their second shots of the first hole and head off to find their balls. The endocrinologist finds his and takes his shot, shanking the ball into the head of the neuroradiologist, blinding him. The neuroradiologist sues the endocrinologist, saying he should have yelled “Fore!” The appeals court throws out the case as had two previous courts, saying that the neuroradiologist was standing 15-20 feet from the endocrinologist at a 50-80 degree angle, making it unreasonable to expect the other golfer to yell “Fore!” before swinging since nobody was even close to his expected line of fire. The neuroradiologist’s attorney probably did little to elicit sympathy for his client, who has been unable to practice full time since the original 2002 incident, by claiming his eight-year lost income is “more than you and I will ever make in a lifetime.”

Canada-based healthcare document management solutions vendor Accentus acquires two transcription companies: ZyloMed (FL) and Transolutions (IL).

Virtual Radiologic completes its all-cash, $170 million acquisition of Nighthawk Radiology, paying a 100% premium to the market closing price of NHWK when the deal was announced in September.

A gastroenterologist’s editorial in the Cleveland Plain Dealer says EMR should stand for End of Medical Rapport, an unwelcome technological intrusion into the doctor-patient relationship being pushed by insurance companies, the government, and EMR vendors. I don’t buy this a bit since my doc is a big EMR user and, if anything, it makes our time together more valuable to me. As in most of life, it’s not what you have, but how you use it. His method: (a) we chat for a couple of minutes before he even looks at the screen since the assistant or nurse has already entered my vitals and chief complaint; (b) the monitor is placed on the desk beside the patient chair, so we’re still sitting close to each other and the monitor is to our side instead of between us; (c) he quickly looks up the information he needs, then turns back to me for the rest of our session; (d) he doesn’t type while we’re talking and generally hardly at all while I’m in the room; (e) if we’re talking about something, like my lab values, he pulls them up on the screen and we go over them together. Now my doc is great overall: he doesn’t wear a white coat because he thinks it’s too authoritarian, he always leads off with a friendly handshake and some chit-chat, and he is highly supportive of helping patients find their own healthcare answers, so it could be that his patient style is just so good that the EMR can’t overcome it. Maybe someone should write a how-to guide for docs on how to minimize EMR disruption since I’m pretty sure it can be done.

I don’t think I’ve ever watched a soap opera even once (being a non-viewer of Unemployment TV, I didn’t even know they were still on), but apparently on All My Children last week, someone named Greenlee got into a hospital’s computer using a stolen password to find out that someone was pregnant. Scenery-chewing overacting and hammy dramatic gestures ensued, I’m certain.

E-mail me.

News 12/24/10

From Donde Esta: “Re: hands-free interface. Interesting.” A group in Switzerland uses Microsoft’s Xbox Kinect 3D motion controller to enable voice and gesture commands with PACS.

From Woody the Wabbit: “Re: Allscripts. As positions EMR and PM positions open in Raleigh, they will be moved to India.” Unverified.

From AccidentalCIO: “Re: Meditech. On a conference call last week, they said customers will need to purchase their data repository to meet the requirement for electronic capture of quality measures. Nothing on their site, no press release. No other customers that I know have been made aware.” Unverified. I e-mailed the Meditech press contact, but haven’t heard back.

From Vanilla Ice: “Re: GE Centricity Enterprise. I hear they’ve told customers it’s going into maintenance mode.” Not exactly, according to my GE contact who tracked down “conversations” the company is having with customers (I’m quoting that since I don’t know exactly what it means, so I’ll use their word). GE says that, to demonstrate their commitment to the success of existing customers, priorities have been changed to help them rather than going after new sales. Not many were buying anyway, of course, and I can’t imagine there are more than a few dozen existing customers left, but GE is at least promising to support them in their quest for HITECH money and other benefits.

Testing 1-2-3 … can you hear me? OK, maybe we were silly to post the day before what is a holiday for most folks. But Inga and I are hard-working, salt-of-the-earth types who don’t want to let our equally dedicated readers down just because most people are sleeping late, shopping, and preparing to overeat. We’ll keep it short, but we’ll make sure to include something useful or entertaining that the less industrious will miss.

A CEO sent me this today, wanting to renew their HIStalk sponsorship: “We absolutely want to continue our support and participation with HIStalk. In fact, I personally believe it’s the most valuable marketing dollar we spend.” Nice! I appreciate that very much. And from another CEO, “Thank you again for all you do. I do not know of anyone who does more to keep everyone honest in this less-than-honest business of healthcare.” I know it’s like a tiresome grandparent whipping out endless pictures of a shriveled, newborn grandchild while everybody rolls their eyes, but I promise to brag only infrequently.

The VA finds that employees are using Web-based applications to store patient information, which CIO Roger Baker says is both a security challenge and a call for the VA to offer something similar. They discovered residents and employees using a Yahoo calendar and Google Docs to store patient information, going back to 2007. Apparently it was a primitive interoperability project: the residents covered multiple hospitals and needed to see VA patient information while off campus. The VA blocked access and sent letters to those whose information was stored there, even though it was secured.

Weird News Andy offers this Christmas gift to all. A woman sues her surgeon, who she claims was negligent in performing her hemorrhoidectomy. The gas she passed during the procedure was ignited by the surgeon’s electrosurgery pen, setting her genitals on fire. She lost the case.

Pinnacle Health (PA) reports exposure of patient information when its contracted transcription vendor inadvertently opens up its server to the Internet.

Verizon provides a $100,000 grant to UMDNJ-University Hospital for the STAT-MI system, which allows ambulances to send ECGs directly to a hospital cardiologist’s smart phone so that patients having a heart attack can be transported directly to the cath lab.  

Jobs on the Sponsor Job Board: Senior Software Engineer, VP of Sales, Application Consultant. On Healthcare IT Jobs: RN Clinical Informatics Transformation Leader, Senior Clinical Analyst, Enterprise Integration Architect, Meditech EDM Consultant.

CCHIT certifies Ingenix CareTracker as a Complete EHR.

Just a suggestion: sometimes I use the HIStalk mailing list to offer benefits to those readers on it (first notice of stuff, HISsies voting privileges). If you haven’t signed up, that “Subscribe to Updates” box to your upper right is your ticket to paradise.

The news that Dell is acquiring InSite One caught me by surprise since I had just finished interviewing the company’s CEO. I’ll have it up soon.

Strange: Zsa Zsa Gabor’s husband (her eighth) is admitted to the hospital after he apparently mistakes Zsa Zsa’s nail glue for his eye drops and seals his eye shut. I figured he might be a bit old to be taking care of himself since she’s 93, but he’s only 66 and planned to run for Governor of California this year until Zsa Zsa’s health became an issue.

Vermont’s REC adds Greenway’s PrimeSUITE to its list of preferred EHR partners.

A hospital in Canada loses $1.5 million to a minimally supervised accounts receivable clerk responsible for loading its ATM machine with cash. The $40K per year employee treated nine friends to a trip to Hawaii and had blown $400K on slot machine gambling at a local casino.

I hope your Christmas is just peachy and that Santa brings you whatever you want. All is right with the world when the marathon of A Christmas Story is on, gift wrap is strewn everywhere, and the smell of turkey or beef or tofu or whatever traditional food you cook is wafting over the Cowboys on the big screen. Once the holidays are behind us, HIMSS looms, so you know it’s going to be a whirlwind (for me, anyway). Thank you for being involved with HIStalk in whatever fashion. I’ll be here with the usual Monday Morning Update, which probably means working Christmas Day, so don’t forget to come back.

E-mail me.

HERtalk by Inga

From Zebedee: “Re: St. Joseph’s. Merry Christmas, Inga, thanks for an educational year. I heard this story on NPR this morning.” The Catholic church strips St. Joseph’s Hospital and Medical Center (AZ) of its religious affiliation after providers terminate a pregnancy. Hospital officials insist the surgery was in line with Catholic teachings and was performed to save the mother’s life; the local bishop disagrees and severs the church’s tie with the hospital (facility excommunication?) St. Joseph administrators insist the move will have little effect on its ongoing operations or hurt donor contributions.

From Sam the Snowman: “Merry Christmas, Inga. You never seem to age in your pictures. Keep it up.” Thanks for noticing, Sam. Clean living.

Florida’s Agency for Health Care Administration awards Harris Corporation a four-year, $19 million contract to implement a statewide HIE infrastructure.

Also from Florida: Good Samaritan Medical Center and West Boca Medical Center are using the RF Surgical Detection System to prevent and detect foreign items inadvertently left inside patients during surgery.

Let the registration begin. Beginning January 3rd, eligible providers and hospitals can apply for participation in the Medicare EHR incentive program. Eleven states will open Medicaid registration the same day; other states will begin accepting Medicaid applications in coming months. David Blumenthal says, “It’s time to get connected,” which is kind of a hokey statement at this point in the game. But heck, maybe he is just in the holiday spirit.

Rhode Island MSO Polaris Medical Management selects DiagnosisONE as its exclusive provider of clinical decision support for EHR deployments.

McKesson wins anti-trust approval to complete its $2.16 billion purchase of US Oncology on Tuesday, the same day an interim court order stalls the acquisition. The Supreme Court of the State of NY puts the purchase on hold, based on a case filed against McKesson by the Cancer Clinics of Excellence. The network of oncology practices claims the deal breaches an existing contract it has with McKesson.

In India, seven health department employees are suspended after allegedly organizing a “vulgar dance” program at work. I bet Mr. H’s holiday party outlook would be greatly improved if his hospital hosted a similar program. He might even wear a Santa hat to show his support.

From Luke O’Cyte: “Re: Santa and shoes. We know that’s not you sitting in Santa’s lap because the real Inga would never have posted a photo that didn’t show her fancy shoes!  Obviously this photo was one of a woman wearing inappropriate shoes, which necessitated the cropping of the photo, lest it clue viewers in that this wasn’t the ‘real’ Inga! Here’s hoping that Santa brings you lots of fancy footwear for under the tree, and with that note, I give you The 12 Shoes of Christmas:

On the twelfth shoe of Christmas,
my true love sent to me
Twelve sandals peeking,
Eleven flip-flops flopping,
Ten pumps a-pumping,
Nine loafers dancing,
Eight moccasins a-walking,
Seven slippers slipping,
Six golf shoes putting,
Five golden boots,
Four peep toes,
Three Mary Janes,
Two canvas runners,
And a high heel in a shoe tree!”

Brilliant. Thank you, Luke, my newest BFF. Wishing all readers a lovely holiday!

E-mail Inga.

HIStalk Interviews Beth Pickard, President and CEO, Clairvia

Beth Pickard is president and CEO of Clairvia of Durham, NC.

Tell me about yourself and about Clairvia.

I’ve been in the staff management business for health care organizations my entire career, going on 25-plus years, implementing software solutions to improve the staffing and hospital organization. Clairvia is the second company that I’ve managed in staffing. We’re seeing staffing management being transformed into new staffing practices. This company is focused on the patient experience and the value that staffing brings to that patient experience.

Give me the elevator speech definition of Care Value Management.

Care Value Management is a transformational solution that bridges the gap by linking workforce management to the patient experience. It integrates the patient’s condition to the care levels that are required to move each patient through the hospital organization to the best possible outcomes.

In the old days, resource allocation or staff management meant a rigid model based on acuity or historical trends. How is real-time staff resource allocation different?

The biggest difference is that the data is real time now. Historically, it was retrospective or just looking at the next shift.

All of our solution sets are utilized by clinicians at the bedside. That’s a core strength of our technologies as well.

The third piece is that we never linked the value those resources brought to improving the patient’s movement through the organization. In other words, we always predicted or planned for the next shift, but what we hadn’t done is look at, “Are these staffing levels actually making the patient better quicker or moving them through the organization with a better experience?” It was more in terms of looking at what staff we needed versus were those staff members really impacting the patient’s care.

Success used to be measured by simply getting through the shift with the predicted low staffing number, regardless of the clinical result.

What’s really changed is the value-based proposition. We have to start looking at what improves quality and cost, and obviously staff resources. We have to start looking at what care models do improve quality or how they impact cost or the patient experience.

How is your system used in the management of a typical nurse shift? 

A patient comes into an organization. We immediately put them on a plan of care based off of their reimbursable working DRG. At all points in time of rounding and working with that patient, we know in our minds what that patient’s planned movement through the organization is.

It changes as their condition changes. At all times, the collaborative team is working towards whether or not that patient is moving to expected outcomes and moving to their expected discharge date in the system.

Think of it as managing to a flow and ensuring that the resources are available at all points in time so that that flow is complete or as it’s happening or occurring as planned. As charge nurses and caregivers are planning for those patient needs, they do interdisciplinary rounds. They’re managing to that expected progress as well as assigning caregivers who will actually provide the care for those expected events.

Are your prospective customers already doing that process of managing to an expected outcome and discharge date, or is that a concept you have to sell them on?

Absolutely. I would say that the technology enables the process. Typically we find that the planned discharge dates are managed in silos of organizations or departments within the hospital. The technology enables everyone to have more of a collaborative approach. That’s one of the transformational processes that occurs.

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. I think we are one of the few systems out there that as we’re tracking to the length of stay, we’ve linked the staffing component to that management. They are fully integrated and affect each other. You have to have the resources available and working to impact the length of stay management. 

We have both of those pieces. It is the key and the value of the system. You’ll find people that have one or the other, but there hasn’t been another technology that has linked the two together.

Hospitals are always transferring patients for many reasons, not all of which are clinical in nature, without really considering the skills and staffing levels on the receiving unit. Can your system help make the transfer process more efficient?

Absolutely. One of the first things it does is to get patients in the correct location. We’re very much linked into capacity management. As you’re looking for available beds, you’re also checking to be sure that — based on their progression of care and their planned care – patients are being placed in the right area.

That’s the number one most expensive error that organizations make: getting them from the ER to the correct care area. Then once they’re in that care area, we obviously have already assigned and have waiting the correct resources to provide that care. 

If you’re moving them from the ER to the ICU, we start looking at well how’s that patient been tracking through the ICU to ensure that they also move in a timely manner from the ICU, which is a high-resource cost, to routine care. But most importantly, that their outcomes are also good and their condition is also what we would consider ready to move to that next level of care.

A lot of hospitals have bought bed-tracking type applications. Do you see this as the level above those systems?

Patient flow is one piece. But with patient flow, you have to see whether the staffing is available to move that patient where they need to go. Is the unit staffed to transfer them from one area to the other? Without the complete staffing area, you’re missing a key piece.

But the second most important piece that I remind people about is that this is an outcomes system. That’s where our success is really driven. We’re tracking which patients are moving to the best outcome, because at the end of the day, it’s not always a good idea to move people faster through an organization. 

We talk more about optimizing. What’s most important is that at each point in time of their stay, they’re achieving the desired level of wellness or the desired outcome. I think that’s a key and critical component in a value-based organization or an accountable care organization.

You just landed a large customer in Sutter. What are their plans for your products?

The key to their implementation was to leverage existing clinical data. When people ask me why didn’t we do this 25 years ago like I wish we did, I say we really didn’t have the clinical data available to track whether or not the patients’ progression or health-wellness was improving. 

The key for Sutter was that it managed and evaluated the outcomes of each of their patients and ensured that the resources were available for safe, effective care. Very key to the implementation is the clinical integration and leveraging the rich clinical data that they’re getting through their Epic implementation.

What kind of success metrics do they have?

At each of point along the way, we’ll look at total resource cost, length of stay or patient cost by DRG, NDNQI outcomes, employee satisfaction, position satisfaction, and patient satisfaction outcomes. With all of our implementations, we benchmark those indicators and then track them post-implementation to assure that our clients really get the results that they technology should provide them.

States like California where Sutter is located is have mandated nurse staffing levels. Do you think those requirements do enough to ensure that patients have access to the care they need?

States like California have mandated staffing levels are because there’s never been a way to measure whether or not staffing levels really affected patient care. In California, what we’ll be able to do is see which staffing levels have the associated better outcome.

We’ll get past strict ratio staffing, which basically says that since we don’t know what staffing levels produce the best outcomes, we’re going to mandate them. We’ll collect data that will show which models of care or which ratios provide the best patient experience or best patient’s stay or quality by patient population.

You can imagine the data that we now have by patient population and staffing ratios is going to provide us the evidence for new models of care and staffing. That’s how we’re going to get better. We’re not going to get better with just looking at whether or not we’re using outside agency use or overtime costs.

Most hospitals have already done what I call the “squeezing” in their staff resources. We must look at are the staffing levels that actually making most patients get better. That’s where our technology solutions are going to help move organizations. California is a very good area for needing the technology.

Other than the technology readiness that enabled the real-time use of data, how do you think the political and the healthcare delivery climate is to come up with a potential way to introduce new models?

I think they’re going to have to. Very little is written about how hospitals are going to save dollars or show efficiencies.

With 60- 70% of their cost being staffing, they’re going to have to look at new ways of doing things to get better. Not only for efficiency of the care, but to retain and attract the best talent. Hospitals that are providing and managing their patients to good quality outcomes will attract the best talent — not only nurses and caregivers, but physicians.

Those are the hospitals that are going to be ready for what we know already to be an acute shortage of talent over the next several years. I see it as a way of retaining and tracking the best talent, as well as providing the good patient experience.

One solution companies came up with was the shift-bidding model to use your own experienced employees who wanted to work extra shifts. How are hospitals using your shift-bidding application?

It’s absolutely popular. It’s used by 100% of our clients. Employee self-service eliminates the paper in the scheduling and staffing process because you close the loop between signing up and posting shifts. It absolutely has enabled our clients to move from a paper-intensive process to paperless. 

A second benefit is that it definitely improved employee satisfaction. Staff love it. Employees, especially new nurses, want to work for organizations that allows that communication and transparency in the scheduling and staffing process. Employee satisfaction and moving to a paperless process have been enabled through those types of technologies.

I’ve not seen a time where so many people at the top are saying that nurses should have a voice on determining how healthcare delivery should change. As a nurse, what do you think of that?

In my entire career, it’s the most exciting work that I’ve been involved with. We’re finally focused on what brings value to the patient’s care or the patient’s experience. We know patient care brings value, including both the medical and nursing or caregiver care. 

To finally be in a place where we have data available to affect and make those decisions to improve patient care is a good time. It has been extremely rewarding to work with the clients we’re implementing.

Dell To Acquire InSite One

Dell announced this morning that it will acquire InSite One. The Wallingford, CT company offers cloud-based, vendor-neutral medical image storage and archiving, with 800 clinical sites as customers. Its InDex enterprise architecture is based on the IHE framework and supports recovery and migration services.

Dell says the company’s technology will extend Dell’s Unified Clinical Archive solution.

Berk Smith, Dell’s vice president over healthcare and life sciences, said, “As the first company to bring cloud technology to the medical archive space, InSite One will help Dell’s healthcare customers take advantage of the economics and scalability of the cloud for medical archiving and retention. And looking beyond archiving, the cloud will also be a valuable tool for information exchange which is foundational to the transformation of healthcare.”

Terms of the acquisition were not announced.

News 12/22/10

From Vendor Prez: “Re: RFID tagging of HIMSS conference attendees. I think this is appalling. As an exhibitor, the last thing I want is for the attendees to feel more ‘targeted’ that they already do. Frankly, if exhibitors can’t get attendees in their booth on their own merit, they don’t deserve to capture key information from drive-bys. This is pitiful and my company will not be participating. We will however, proudly display the HIStalk Sponsor poster that you always drop by!” Above is the end result of tracking us attendees like stray cattle via the RFID chip tucked away in our badges. Vendors pay $3,000 for the basic package up to more than $20,000 for a turnkey tracking service. You can opt out on your conference registration like I did. And thanks to Vendor Prez for displaying our amateurishly made “We Power HIStalk” signs in their booth. I know it’s hokey, but we are really proud that many HIStalk sponsors participate because they want to support what we do. As you might imagine, I really appreciate that.

Speaking of which, you would think the stray cattle tracking company could at least spell the name of its excessively vendor-friendly partner correctly.

From Chatty Cathy: “Re: instant messaging. Do nurses typically use it in hospitals to communicate with each other and with doctors? Just curious.” In mine, the PCs are theoretically locked down and IM clients aren’t allowed, although I’m sure someone has figured out a way to bypass that (like using an online chat client like Meebo or the ones built into Yahoo or Google). I like the question, though, and would appreciate comments. It’s a pager-driven world in many hospitals, made kind of IM-ey with Amcom’s Web-based paging app that lets people chat primitively back and forth. Staff could also use SMS messages or specific VoIP apps. They could even use FaceTime video calling if they have iPhones or iPads.

From IT Begins: “Re: Ingenix. Appears to be the first steps of unveiling strategy around the recent acquisitions.” Inga covers it below, but Bethesda Healthcare System (FL) chooses Ingenix to manage the revenue cycle of both the hospital and its outpatient services. Ingenix will provide its Electronic Financial Record, coding solutions, patient financial counseling, an ED information system (since it bought Picis and can offer ED PulseCheck), and full-time employees in scheduling, registration, HIM, PFS, and decision support. It sounds like a great business move, although odd that a hospital would hire a company owned by an insurer to manage its revenue cycle, most of which involves dealing with insurance companies. Who better, right?

From Epic User: “Re: FDA oversight of EHRs. Epic’s ‘fear of stifling innovation’ doesn’t resonate with this long-time user of their applications. They routinely fail to prioritize making simple changes to their system (icons, language on screens, similar functions in different applications) that are consistent and would reduce user confusion / error. They also fail to prioritize making enhancements to their systems requested by customers year after year (apart from the annual voting, which is application-based and not focused on consistency across applications), and instead focus on new features that help sell the systems (e.g. focus on ‘what sells’ vs. ‘what’s useful’. If FDA oversight stifles their innovation and helps make their systems more consistent from application to application in terms of functionality, user experience, etc. then that’s a good thing.” Here’s who I blame for that: customers and prospects, since most vendors work pretty much the same as you describe, i.e. creating what the market demands. If customers don’t like their apps or feel they endanger patients, then it’s their fault for writing that check anyway. I’m growing weary of hearing how big, bad vendors prey on helpless health systems and their excessively paid C-level leadership who can’t be bothered to understand exactly what they are getting in return for their many, many millions of dollars or creating a vision of how it could be better. I’d like to see better applications, but those voting with their dollars are saying otherwise – guess whose vote counts? If there’s a demand for iffy software applications, unhealthy Big Macs, or illegal drugs, economics assures that someone will meet that demand.

This is sobering, but not surprising: Fitch Ratings downgrades the bonds of Lima Linda University Medical Center (CA) BBB with a negative outlook due to poor liquidity and inconsistent financial results (54 days days cash on hand). Once concern is the $1.4 billion it will need in capital over the next 10 years, mostly for seismic compliance requirements (which management has already said they can’t possibly meet) and implementation of electronic medical records.

The chief nursing officer of Capsule, Susan Niemeier, receives a slew of social media awards for her work under the pseudonym Nurse Sue.

KLAS releases a report covering single sign-on, concluding that high customer expectations aren’t always met, but that they are generally glad they implemented it. Imprivata edged out Microsoft (Sentillion) for the top ranking.

This sounds like something I’d come up with: UMass Memorial Health care allegedly hires hot models for $75 per hour to approach mall shoppers and football game attendees and ask them to give cheek swab DNA samples for its bone marrow registry. Those agreeing were told that their insurance would pay the $100 charge, only to find that their EOBs showed charges of $8,400, not to mention that many of them may not have been made aware that they were obligating themselves to donate marrow if they matched. A hospital worker supposedly told the models, for which the hospital paid up to $4 million, to wear short black skirts, heels, a white lab coat, and colorful wigs.

Good news: today is the shortest day of the year, meaning it can only get better when it comes to driving home from work in the dark.

The guy who robbed and shot Wheaton Franciscan Healthcare IT VP Tim Belec in WFH’s parking lot three year ago is finally sentenced to 12 years in prison after pleading guilty to a single charge of attempted intentional homicide. I never heard how Tim did after taking two bullets in the chest, but I Googled his name and articles I ran across indicate that he’s back on the job at WFH.

A Dean Health System (WI) doctor breaks hospital rules by storing patient information on her laptop, which was then stolen. The hospital sends the usual “so sorry, how about some free credit protection?” letters to 3,000 surgery patients. And in Virginia, Centra notifies 14,000 patients that their billing information was exposed when an employee atttending a Georgia conference has her laptop stolen from her rental car.

Cerner opens a Collaboration Center in its London offices. I’m not clear on what its point is, but the Cerner UK GM says it will help clients “identify their respective organisational imperatives, such as financial savings or patient safety initiatives, and align them with the capabilities of Cerner Millennium.” I guess it’s like a Vision Center for existing customers.

David Brailer’s Health Evolution Partners launches Halcyon Home Health, which he says will “redefine how home care is delivered” through clinical excellence and IT. Its Web site (above) isn’t quite ready.

The government of Hong Kong starts the next phase of its EHR project, soliciting proposals for pilot projects and interface work that involve patient-facing health applications and standard terminology. Proposals are due by January 31.

Healthland’s inpatient EHR earns CCHIT certification as a Complete EHR.

I happened to drive by one of those consumer lab store fronts the other day and noticed a somewhat fun sign in their window pitching their lab tests: “Sex, Drugs, and Cholesterol.”

iSoft finds a new source of revenue: offering another company’s technology that will extract information from its EMR and de-identify it for researchers (hopefully not selling it outright). The Cliniworks platform sounds kind of cool, actually.

The GAO says HHS missed the 2007 date set by Congress to develop a plan for an electronic system to support sharing of information in public health emergencies. I guess they aren’t Meaningful Users.

Clinical trials software vendor DrugLogic files suit against Oracle, claiming patent violations related to two life sciences software companies that Oracle acquired, Relsys and Phase Forward. In the mean time, Oracle turned in killer Q2 numbers, with revenues up 47% to $8.6 billion and profit up 28% to $1.9 billion.

The local Massachusetts paper runs an interview with eClinicalWorks CEO Girish Kumar Navani, focusing on the company’s local economic impact and impending move to bigger quarters. Tidbits: eCW will be hiring 100-200 people in 2011, it has more than 1,300 employees, its new building will cost $18 million, 2010 revenues are expected to be $130-$150 million, and its five-year goal is to have 100,000 providers and 100 million patients.

We’re having the usual semi-lame holiday events at work this week (you can’t say Christmas, of course, since somebody’s lawyer would show up before you finished the sentence). There are always a few really disturbing souls wearing Santa hats in an unwelcome public display of carefully orchestrated holiday exuberance (especially since they are usually the really obnoxious people or oddballs who haven’t said a peep since last Christmas). There’s the white elephant gift exchange, which everybody hates because it comes with pages of rules and the person who organizes it always seems to parlay their knowledge into ending up with the only good gift. There’s the door decorating contest, where hastily covering a door with old gift wrap and cut-out occupant pictures is considered extraordinary effort worthy of a noble prize, like a free frozen yogurt in the cafeteria. Leftover celebration food is dumped unceremoniously and anonymously on break room tables, fallen upon instantly and ravenously by beaming IT geeks who should be applying some of their vaunted analytical skills into questioning whether it’s a good idea to eat something that’s been standing at room temperature in a different conference room or office until everyone got tired of looking at it and decided to deposit it in the collective food trough rather than throw it out (hey look, everybody, there’s deviled eggs in the break room!) Guys wear hideous light-up Santa ties and ladies show up in Christmas sweaters smelling of mothballs from their once-yearly exposure to air (the sweaters, not the ladies). But the worst thing is that it will be over in a week, leaving a long stretch of no holidays as the serious work restarts. I’m going to study this holiday phenomenon once I finish my current observational research that questions why a large percentage of men puzzlingly spit in the urinal before or after using it for its intended purpose.

E-mail me.

HERtalk by Inga

A Puget Sound-based public radio station compiles a list of the 86 “top-earners” from area hospitals, including 15 executives who earned over $1 million in 2008. On top: former Swedish CEO Richard Peterson, whose total package exceeded $8 million.

The 600 physician member Morris-Somerset IPA (NJ) contracts with eCast Corporation for its ACO-Care HIE product.

Essent Healthcare (TN) selects ProVation Order Sets  from Wolters Kluwer Health as its electronic order set solution. Essent operates five hospitals across four states.

Billings Clinic (MT) signs a multi-year agreement with Craneware for five charge process applications and implementation services.

Child Health Corporation of American will offer LodgeNet Healthcare’s eSuite interactive television solutions to its owned hospitals.

More than a quarter of doctors in the Czech Republic have declared their intention to resign and emigrate to a better-paying country if their government can’t address pay concerns, long hours, and poor working conditions. The starting base salary for a Czech physician is about $11,000 year. In nearby Germany, pay is about $96,000 a year.  Government officials claim the current financial crisis prevents them from increasing doctor pay.

Vista Health System IPA and Central Jersey Physician Network IPA form a new accountable care organization, Optimus Healthcare Partners LLC. The organization will initially include 650 physician members.

HIT consulting firm PHNS realigns its management team following its acquisition by the ConJoin Group. PHNS founder Richard S. Garnick will remain as CEO.

The Texas Organization of Rural & Community Hospitals Foundation is offering QuadraMed’s ICD-10 Countdown Program and Readiness Assessment Services to its 150 member hospitals. Almost 70 hospitals have already contracted for the program.

mdi Consultants will be the anchor tenant for the Nashville Medical Trade Center, according to the center’s management company. Market Center Management Company also announced the creation of a Global Business Development Center to be located within the center. The 1.5 million square foot development is scheduled to open in 2013 and expected to attract 160,000 visitors a year.

Sponsor Updates

• Wishard Health Services (IN) expands its use of Surgical Information Systems (SIS) products to include SIS Anesthesia, SIS Analytics, and SIS Com.
• Ochsner Health System (LA) goes live on Orion Health HIE.
• CDW and Greenway Medical Technologies announce a partnership to offer a practice EMR package that includes PrimeSUITE 2011, technology, and services.
• BayCare Health System (FL) partners with MEDSEEK to develop and deploy an integrated eHealth solution for consumers, patients, clinicians, and employees.
• Bethesda Healthcare System (FL) picks Ingenix to manage RCM functions for its hospitals and outpatient facilities. Ingenix will deploy its Electronic Financial Record technology as well as provide full-time onsite staff to manage RCM functions.
• Momentum Billing LLC (CA) chooses Advanced MD’s medical management software for its medical practice operations and RCM business.
• McKesson says that Community Hospitals and Wellness Centers (OH) is the 100th hospital to go live on its Paragon HIS.
• Cumberland Consulting Group has been honored as a Patriotic Employer for supporting employees who serve in the National Guard and Reserve. The company was nominated by Major John Gobel, one of its consultants who served 20 years in the Guard, stayed on in the Reserves, and served in Iraq.

I stepped away from my HIStalk duties yesterday and met with The Jolly Guy. I shared with him my special request for fabulous boots. Santa said, “maybe.” True story: he asked me to leave out a glass of vino on Christmas Eve, in lieu of milk and cookies. My kind of Santa.

Send holiday greetings to Inga.

HIStalk Interviews John Glaser, CEO Health Services Business, Siemens Healthcare

John Glaser is CEO of the Health Services Business of Siemens Healthcare.

I’m not clear on your exact title and the scope of your job. Maybe you could explain that to me.

The exact title is CEO, Health Services Business of Siemens Healthcare. I’m responsible for, across the globe, the healthcare IT business. This is and Soarian, Invision, MedSeries4. Not only the products, but also the services that go with them … the hosting, managed services, implementation services. That is the pretty typical portfolio that I’m responsible for.

Almost never do provider CIOs become vendor CEOs. What motivated Siemens to pick you for the job and for you to take it?

Their motives were a couple. One is that having lived like I have for two decades on the customer side of it, I would bring an orientation to know what it’s like to go through CPOE implementations to what it’s like to sit in front of the board and request a capital budget. And that perspective would be helpful and useful in the course of the normal discussions one would have with a vendor.

I suspect that the other thing that was attractive to them was the demonstrated ability to lead and manage a complex organization, so there’s a high likelihood that I could actually get something done. Partners HealthCare isn’t the same as Siemens, but nonetheless, Partners HealthCare is a large, complex, highly matrixed organization.

I think the third is that I have a knowledge base of this industry, from CHIME circles or having spent time at ONC or to HIMSS or a variety of Institute of Medicine committees. There’s an understanding of the range of healthcare at the government level, but also because a number of these groups are part of our multi-stakeholders. How to plan things.

That’s probably a series of reasons – the customer orientation, the leadership ability, and the sheer knowledge that comes if you spend a lot of time in this industry.

The reason for me is that I spent 22 years at Partners, both 15 years at Partners itself and seven years at the Brigham and Women’s prior to that. I think we did some pretty good work and we have a lot to be proud of in that. But it can happen to anybody, if you get an itch, to try something different. That itch initially led me to spend some time with ONC and that itch continued.

When Siemens called and said, “Janet Dillione has moved on. Would you be interested in the CEO position?” I thought, well this would be … I’d learn a lot by sitting on this other side of the industry that I know and have been part of for quite some time.

It may sound corny in a way, but I believe deeply in the fact that the technology can improve care. I’m going to give every waking breath I have to that. I thought, I can have an impact – different, but a significant impact – by sitting on the vendor side of this. I have impacted Partners, but you can have a different impact. It was new, it was interesting, it had a wide streak of altruistic ability or potential there. That was the reason I decided to do that.

It’s a bold pick for them, not because you’re not qualified, but companies at that size that are conglomerates with international spans usually have someone they’ve groomed internally or they pick some interchangeable business leader that really doesn’t, in their minds, even need domain-specific knowledge. Is that an indication that Siemens is changing, or has it always been brave enough to say, “We don’t follow the mold and groom people by moving them from manufacturing nuclear weapons and sticking them in healthcare?”

I think it has learned, particularly under Peter Loscher, the new CEO – and I had an interview with him – that they believe you have to be careful in the idea of the interchangeable CEO. There really is deep domain knowledge that comes with it, and a series of relationships that can be very important. They are increasingly picking people that come from an industry who know that industry well and hence are likely to be much more effective at developing strategies and knowing what will work and what will not work.

Obviously you’re complemented by all kinds of people who know how do to the finance stuff that goes in the vendor community and the sales and marketing that goes with that. There’s a lot of corporate talent that can be applied. So I think they’re careful with the interchangeability idea. Sometimes that works, but sometimes it doesn’t.

I also think that they understood that here you’re putting someone who’s the CEO of a large business unit who you haven’t seen demonstrating their stuff for some period of time. They probably thought that on that, while I’m unproven in our situation or context, there is proof elsewhere. One of your earlier questions about having customer perspective and stuff like that, he brings that to the table.

I think it was a bold move on their part, a smart move on their part. It’s certainly not a typical move.

The most important question – is your office nicer than what you had at Partners?

[Laughs] It is truly bigger. I’d be comfortable living in a trailer for the rest of my life. You know, seriously, I don’t need that much. I’m a pretty simple guy in a lot of ways. It’s certainly bigger with a couch and whole bunch of tables and you could put a bowling alley in there if you wanted to. You have to plan on three minutes extra just to go from one end to the other. So it’s nice. It’s a nice place. That’s cool. That’s kind of neat. I don’t need all that space, but I’m certainly not going to start walling it off and living in something the size of a phone booth.

It seems like the hardest thing to get used to would be the incredible span of control that you now have. It was big at Partners, but it was somewhat localized and now it’s international. Has that been a struggle to understand, much less to change to how you want it run?

At Partners, I had 1,500 staff. At that point, you don’t know who most of the folks are. You don’t know all the things that are going on or that are being done. You can know that when your staff is 100, but you cannot know that when it’s 1,500.

One of the challenges of going from a staff of 100 to 1,500 is that your efficiency becomes more abstract and you’re more removed from the daily reality of stuff. So that I’ve gotten used to years ago and just realize that you’re very dependent on the folks who report to you and you trust them and they do good work and every now and then there’s an issue and you have to handle it.

When you come to Siemens, which has a staff of 4,800, it’s the same phenomenon. I don’t really know who all these people are or what they’re all doing or exactly what’s going on here or there. But you’ve got a team that is much closer to you to help you.

The thing that’s been a really steep learning curve is that this is a complex, large organization. It’s matrixed. I’ve been trying to figure out who does what. If you want to float an idea, how exactly does that work? Not only the formal way that it would work, but if you really want to vet an idea and build an alliance, who are you building an alliance with? That has been navigation in a complex organization both politically and formally how you get things done. It’s something you have to learn and I think it will take a while to learn.

Because it is global, you realize that the healthcare system in Japan is different and the healthcare system in Germany is different. These differences are real. It can be cultural differences in addition to the fact that Japan has 9,000 hospitals. Golly, that’s almost twice the number in the US. Average length of stay is almost three weeks. It’s just a different healthcare system, and hence you have to understand that and how systems work and that the role of the physician and the nurse can be different. In the US, things that the nurse does, in other countries, the doctor does that. Documentation is not the same as it is in the US. You have to understand that and appreciate all of those kinds of differences so that you can be effective.

The other is that there’s so much going on. There’s 1,000 customers and we’re in on the order of 20 different countries here. At any given moment, there’s some issue somewhere or something not working like you’d like it to work. You have to triage and knowing what to pay attention to and what not to. That takes a little bit of an experiential gain and refinement of antennae. The analogy that I use sometimes is that when you have your first kid and they cry, you’re all over it, but by the time you have your third, you can distinguish a cry that matters from one that doesn’t.

It’s been a steep learning curve in lots of different ways: complex organization, different countries, really learning about products and what they do and the services and where they’re strong and where they’re not so strong. I’ve been making a boatload of visits out to customer sites, who are they and what are they doing and what are the issues? It’s really neat if you want to be in a mode where you’re learning a lot all the time. Man, this is terrific.

It must be easier for you since you know a lot of the CIOs out there.

I think that’s true. When you’re sitting across from a CIO colleague, you know exactly what their life is like – the issues they face and the things that are hard for them. I get to meet with a lot of CEOs and a couple of times I met with board members. Shoot, I remember sitting across from the CEO of Partners and the CEO of the Brigham and Mass General and what they worry about and how they think.

Certainly a lot of the CIOs I know by name. You can be in these meetings and think, golly, I remember exactly what things were like. And it wasn’t that long ago that I had conversations about capital budgets and strategic direction and what should we do about Meaningful Use and personal health records, all that stuff. It is a very familiar territory.

When you entered discussions with Siemens about the job, was there an agenda on their part about wanting change, or was there an allowance that you’re going to want to make changes?

As you know, they went through some tough years when Soarian first came out. In the last couple of years, it’s been a nice recovery. I don’t think it’s complete, but a nice recovery. You see that KLAS score, you see that in sales, etc. It’s a nice recovery.

The basic directive is to continue the recovery. Let’s see what we can do here, let’s make it as good as it can possibly be.

Within that direction, I got a chance to look at the team, at the budget. Basically the FY11 budget was nailed down, but in a couple of areas we’ve got to add some investment if we really want to do this well. I was able to re-open the budget and insert some things along those lines.

The team had gone through a set of changes over the summer. Tom Miller, who was in the interim role, was orchestrating that. He and I talked all the time about who to put in what chair and what chairs to leave open for when I arrived. There was a real willingness to let me put an imprint on it, both people and roles, but also what is the agenda and what does the budget look like?

Soarian was a punchline for a number of years, but it’s suddenly the overnight success. With the recent KLAS recognition, it’s real. Obviously it was on that trajectory before you got there unless you’re a true miracle worker, but what’s changed and where does it go from here?

I’ve got to give Janet Dillione and Tom Miller a lot of credit for orchestrating that. To your point, coming in with a KLAS score of #3 overall – terrific, golly, that’s not where it was a couple of years ago. It was a lot of focus. There’s no substitute for saying, “We’ve got trouble with quality of software here. We’ve gotta focus.”

That’s not something you turn around in a week. That takes months and can take years. Plus you’ve got to put up with a customer base that’s saying, “Oh my God, I got trouble in River City here” and to help make sure that they don’t wind up in a bad place and stay the course, etc.

In the times I got into trouble with Partners, it was when systems were not behaving like they ought to. There is no substitute for just focusing and putting the best talent you’ve got on it. It’s like a form of guerilla warfare – day in and day out, week in and week out. You get enough small and medium-sized victories and you’ll get through it. In the meantime, you provide air cover for the team, trying to keep the distractions or whatever away. There was a lot of focus getting into that, focus on product, focus on service. It sounds simple, but man, that’s not an easy journey to go through.

So I think that’s a credit to the folks who were there and to Janet and Tom who preceded me. Where to from here? We’re entering a decade of healthcare which will be one of the most profound we’ve seen in 40 years. You’d probably have to go back to the Medicare and Medicaid act to see something as substantive as this. Healthcare is a payment system. When you change that, you change the industry in a very big way.

The Affordable Care Act and the financial changes and the private sector response moving to bundles and episodes and prove your quality and we’re going to pay you in a holistic sense, which is managing a diabetic over the course of a year or managing a total hip surgery through the rehab phase as a single payment, and by the way, prove quality to get your money.

That will be a big change. The level of financial risk will be a lot higher. There will be lots of experiments and Congress will futz with it, but hardly likely to materially change it in the near term. It was not lost on the Republicans that we’ve got a problem here in healthcare cost and quality. So that will be a hell of a time. It will be a hell of a time for providers – doctors, hospitals, health systems – but it will also be for those of us who serve them through products and services.

To be specific about it, if you look at the stuff we have, we’ve gotta have a stronger ambulatory-based story offering. We’ll continue to work with NextGen, but you’ve gotta have that integrated suite. I think Epic and Cerner have shown the value of that in the market.

We have to have much stronger analytics than we currently have, because you’re going to want to know if a diminished quality score’s going to cost you a lot of money or it’s not. We have to have better interoperability offerings that go with this. We’re going to grow the services base that we have because people put out a lot of money on this stuff and they go through this tough exercise of getting it in and now the stakes are higher and they want to make sure that they get yield. I think we’ve got some strong stuff.

I think the Soarian inpatient clinicals are strong, revenue cycle is strong, but you’ve got to round out ambulatory, round out analytics, round out the interoperability and the services base.

I can see partnering or acquiring on the analytics side, but there’s only so many ways to skin the ambulatory cat. What can you do there?

We’re looking at that now. We’ve got a couple of ideas on the table. Obviously we’ve got a relationship with NextGen, so we’re engaging them in the conversation about how they might help with that.

In a way, what an EHR does is pretty well understood. You have to write prescriptions and record a problem list and things like that. That doesn’t diminish the challenge, but in some ways there’s not a lot of mystery here. These things have been around for several decades.

I’m going to fast-forward five years from now, in which there’s a big shift in payment and you’re responsible for cohorts, for population management. You’re going to get paid by bundles and episodes. What exactly does that do to the ambulatory record? How different is it? That’s the analysis that’s underway – how different is that?

In a way, you can bring in consultants and smart people to help you take you through it, but if you look around the country, there are risk arrangements in place now. There are people doing population management now. You can learn a lot from them. So we’re plotting out the specifics of that. I think we need to get a little crisper, frankly, in our own assessment.

You mentioned Epic and Cerner. In all but the smallest hospitals, that’s where all the action is, with maybe Allscripts becoming a player, although two of those three weren’t very strong on the ambulatory side and had to become that. Can you gear up in time as people make their decisions now?

I think that’s fair. I think obviously the faster we get this done, the better, but we’re not going to have it done by the end of this calendar year, that’s for sure.

There’s a normal replacement pattern that goes on in this industry. At any given time, there’s enough people who have said, for whatever reason — my incumbent vendor, I’ve had it. There’s a normal churn you can arrive at. I don’t believe that you get to the year 2015 that nobody buys any more for a period of time. Even through the Meaningful Use ebb and flow, there’s a normal churn that goes on.

An unknown at this point is whether there is a second wave coming. There’s a first wave that was Meaningful Use induced. People scrambled to round out their portfolio to get their payment. There’s a second wave probable. The second wave has two things that will drive it. One is a whole bunch of people got to Meaningful Use by cobbling things together. By hook or by crook, they assembled this piece and that piece and they jury-rigged this and jury-rigged that and by golly, they’re going to get it done in 2011 and 2012 to get their payment. But they know that this is not a long-term answer. They’re here for the couple of years until they get to Meaningful Use payment, then you go into this couple of year window before the penalties start kicking in and they may say let’s do it for real at that point.

That will be one phenomenon, because not everybody did a wholesale replacement. I may not have the capital, I’ve got other commitments, so I’m just going to cross the finish line in whatever fashion, but not a long-term fashion by any stretch.

The second is the read, and it’s hard to know, whether the payment reform stuff will cause hospitals to say, hey listen, we made a commitment a couple of years ago, but boy, given what is coming down the pike here, this just isn’t keeping up with what we’ve gotta do. Is it an EHR or ambulatory? Sure, but it’s different enough that we need a different set of capabilities to complement the normal core set.

I think we’ll see both play on top of the normal churn that goes on. Obviously I’d rather have it sooner than later, but I don’t believe that if you’re not there at a particular point in time there won’t be a shot.

You mentioned Soarian, which is clearly the new star. What happens with Invision and MedSeries4? Will those customers be encouraged to move to Soarian, which doesn’t seem like a good fit?

We’ve got some work to do on Soarian before you could legitimately turn to an Invision or MS4 customer and say, listen, the things that you like about MS4 and Invision, not just the feature function, but the cost of it, that we can get you that in Soarian, too. So we have some work to do to fill out some Soarian gaps. There’s still development engine that has to go on for a couple of years.

We’re increasingly hosting it and using the cloud techniques of virtualization so you can drop the cost of hosting it down to what it would cost you to today to host MS4. In addition, there’s been some really nice progress on getting the time required to do an implementation down and the variability of implementation down such that the conversion process is relatively inexpensive and relatively quick. We still have some work to do there.

We won’t move anybody unless they want to until we’re in a good position to say, you’ll not only be equivalent, you’ll be better off, and they’ll have the same price points and the same brief, straightforward implementation that they’ve seen before. The timetable is slightly fuzzy around the edges, but some people are moving now. I think it will be a couple of years before we’re in a great position to really tell the rest of the base that it’s in your interest to move rather than stay where you are.

You’re making a lot of changes and you had to start there almost immediately by overseeing layoffs. How is employee morale?

I think it’s pretty good. Obviously as you know and you cover, we’re moving 475 jobs offshore. It seems high, but we’re adding about 600-700 positions in other areas. It’s a combination of working with the folks who are affected over a two-year period of time and saying, hey, we’ve got this role over here and happy to fit you in there and retrain you if you’d like to do that and make sure that we do all that we can so that you land well. The other part of it is making sure that we reduce as much as we possibly can the people who wind up out of a job.

We have to make sure people understand what’s going to happen in the provider community. The financial pressures will become significant. I mean scary significant. They will be turning to us and saying, “You’ve got to reduce your costs.” Then it won’t be the normal arm-wrestling with a vendor that goes on – that will be real. What we cannot do is be in a position where they cannot afford us. If that is the case, we will have failed them. And what we cannot do is fail those who, day in and day out, deliver care. That is just not why we’re here.

Whether it is hosting costs will be reduced or implementation costs being reduced or support costs being reduced, we have got to reduce the cost, because they are in a position where they will need that if we are to serve them and serve them well. I remind them, not that they need much reminding, that at the end of the day, there are real physicians and real nurses taking care of real people who are just like us and the people that we love and our job is to serve them. That’s fundamentally why we’re here and we’ll fail to serve them if we become increasingly out of cost reach.

That obviously, to your point, had a morale plunge. I think overall morale is pretty darned good, because what people see, as in earlier this week, Number 3, that’s pretty darned good given where we were. Man, we’re getting’ our mojo back. We have some work to do, but golly, all that hard work over the last couple of years, that’s starting to pay off. And then they hear from customers who are live with CPOE and are pleased with that.

I think the net of it is the feeling that after a struggle, they’re back and they’re where they want to be, mindful of all the work still to be done. By and large, it’s pretty high. The morale is pretty darned good, mindful of all the challenges we face and some of the tough choices we will continue to have to make.

If companies have a personality, and I tend to think they do based on their corporate culture, Siemens always to me seemed really rigid and conservative and quite cold. It just never seemed like it was a very fun, creative, and hip kind of company based on the Web site and the marketing materials. Do you think that’s accurate and do you think that needs to or will change?

I don’t know that it’s accurate. It’s an engineering company at its core. It’s a 76 billion euro company, 420,000 people and all the stuff they do. They do fast trains, they do windmills, they do water purification plants, they do MRIs. They’re an engineering company.

One of the things that comes with an engineering company is a drier appearance. They’re not inherently marketeers. They believe if you engineer a perfect product, people will realize the spec and they’ll buy it. Sometimes I think the coldness is really engineers. They’re not cold, they just don’t understand the need for sizzle and pizazz and that kind of activity.

There’s a need to change that. They understand that it’s not inherent in their DNA that they know how to be more flashy. I don’t know that it’s cold, it’s just engineering-like, for lack of a better word.

I think we have to, and part of the things I got more money for, be more effective and out there in marketing and methods and stuff like that. It matters. People won’t inherently buy from the spec sheet. They’ll need certain messages and understanding and a sense, particularly, of the human-ness that comes with healthcare, and that we’re part of that. That we’re trying to change. It won’t always be easy because at their core, they’re engineers.

Do they get your sense of humor?

[Laughs]. Frankly, the real reason for leaving Partners is that I’d used up all my jokes. I had to find a brand new audience. They were going, “Uh no, not again, not that one, I’ve heard that 26 times.” You can’t help be in certain meetings and not come out with this, that, or another, so I think they appreciate it. At times, I have to use my judgment about which ones to use internally versus which ones I can use in a public setting. So far, they’ve shown me they’ve got a sense of humor and they’re quality individuals.

Your stint with ONC probably changed your perspective. We’ve talked about this before. How do you feel about the time you spent there in advising the government and what’s your feeling about how it all turned out?

I thought that was one of the most extraordinary years that I’ve ever had. There you are, in the middle of them, where you’ve got legislative language that says, we need this definition of Meaningful Use and we need it fundamentally by Labor Day of last year, and you realize that Blumenthal didn’t show up until the last week of April. You’ve got three months to get this thing because then it’s got to go into the rule-making process and all that other stuff.

Listening to all these ideas, and they came from all over kingdom come, from small physician practices, public health people, patient advocates, Web 2.0. There were a lot of ideas, but we can’t crush the clinical community, either. We’ve got to narrow this thing down and that’s your job, to come up with a definition of Meaningful Use that’s a good balance that pushes the envelope, but that’s also in reach.

That’s just a really interesting, cool conversation to be in the middle of that and realize it’s not only complicated and hard to figure out, but whatever you do figure out has a phenomenal impact on the industry. You better be darned careful and thoughtful about it. It was just really neat to be in the middle of a very formative time, Meaningful Use and Regional Extension Center grants, all that kind of stuff.

As I mentioned in one of the things I sent you, I came out of there with an extraordinary respect for the government. Whether it’s Blumenthal or all the people who work at ONC, but also the folks that work for CMS and the Office of Management and Budget – they were smart people who worked their butts off and wanted to get this right and very receptive to feedback from people who were out in the community. This was a terrific set of characters and human beings and professionals.

I think what they did in an amazingly short period of time is extraordinary. There are clearly things you might have done a little bit differently, but jeez, when you look at how well the Meaningful Use definition was done and the various grants they had to get out the door and the standards they did … give a lot of credit to the Policy and Standards Committees and all the time spent there … that was just really remarkable. I think it was remarkable for me. It was an extraordinary piece of work done by all those folks in an amazingly short period of time.

One of the things you come out of that with was an appreciation of the challenge of how diverse this country is. There were conversations about Meaningful Use where it was said that this has to work at Mass General, big old academic medical center, but also it also has to work at Seward Community Hospital in Alaska. Three beds, average occupancy 0.8. I though, 0.8? You’ve gotta be kidding me. If you were at Partners and said 0.8 occupancy, people would say you’re off by two orders of magnitude. But it has to work there to make all that happen.

I also have an appreciation for policy. What we did in these meetings at Siemens is think about how far down in bed size can you move. You say, if we did this, if we did that, we could get to 50. Actually, because of the way healthcare works in this country, you’ve gotta get even further south than that, because from a policy perspective, what you can’t do is strand the 20-bed community hospital. You can’t strand the solo practitioner, because that is so much of the care in this country. It’s interesting to me that the policy angle factors into business decisions because business decisions, if they are done well, also help support a broader national policy.

If we look back in two years and we’re doing your report card of how you’ve done at Siemens, how will we know you did a good job?

I’ve been asked a couple of times by people at Siemens the same question. I say, I’ll know we’ve done a good job if those who are our customers say to us, “Our care is better. It’s safer, higher quality, more efficient. We run a more effective operation and we do all the things we wanted to do as a provider and our strategy and our goals and our plan, because of the work we did with you, because of the products you have and the services.” If they say that, and uniformly or 90-odd percent, then we will have done well.

Obviously there’s numbers that you’ve gotta meet and this that and the other, and I’m not naïve about the need to do that, but that won’t be the success metric. Whether we’re 3, 2, or 1 on a KLAS score here, there, or in between – those would be great, but that will be the real – that you walk into one of these places and the CEO shakes your hand and says, “Working with you guys has been terrific, in fact it’s been essential for doing all the things we’ve done.” Then we’ll know that we’ve done a good job and I’ve done a good job and we can be pretty darned pleased with all the time, effort, money, and anxiety that we’ve put into this.

Any final thoughts?

You’ve got good questions, as you always do. I’m having a great time. I think we’ll do some good. I think we have done some good.

I came out of 22 years at Partners believing deeply in the mission of what they do. That is so part of my fiber that it’s kind of scary … sounds a little nauseating, frankly, at times, almost too much of a Boy Scout. But I believe it.

What I think we’re going to be able to do is we’re going to help those places do that. I honestly feel really good about that, that whenever I punch out of my time on this planet, if I can say that we helped a whole bunch of people do good things and care better … not a bad run. I’ll be OK with that.

Monday Morning Update 12/20/10

From The PACS Designer: “Re: ResMD from Calgary Scientific. ResMD has been mentioned on HIStalk Mobile several times as an up-and-coming mobile solution for referrers only, since FDA approval is still pending for radiology use of the iPhone. Now that ResMD image viewing software has been adapted for the iPhone, referrers can get very good image quality and navigation when viewing images of their patients.”

From Digital Bean Counter: “Re: Alere Health. The EVP/CIO was finally let go. It was a longstanding belief held by many that he was single-handedly responsible for the demise of Alere’s poorly implemented Pega-based clinical health management system.” Unverified – he’s still on their Web page. I couldn’t place the company name, so I Googled to find that it offers online wellness programs, a PHR, and a health portal.

Listening: reader-recommended and Minneapolis-based catchy power pop from Sing It Loud. Sounds kind of Gin Blossomy or Weezerish to me in places, although I could have done without their note-for-note cover of Get Down Tonight. I’ve listened to stuff from the two albums on Rhapsody and I kind of like it – it would make nice driving music. They’re recently defunct, apparently parting ways just three months after releasing a new album. The reader’s family member produced the album and used his Hammond B3 organ on it, which is always a plus.

It’s been a great weekend so far as I write this Saturday evening. I worked ten hours at the hospital Friday, came home and worked another eight hours on HIStalk stuff, including doing a cool interview that I’ll run Monday (although I took a break to escort Mrs. HIStalk to our favorite sexy Asian bistro for some fine pad kee mao), worked on the HIT course I teach, got up way before dawn and worked another several hours on HIStalk, ran eight sweaty miles on the gym’s treadmill while blasting Metallica and REM into my skull and trying to impress the lithe young females running effortlessly just as fast as me while reading their Kindles and chatting on the phone, had some private time with Mrs. HIStalk sitting in front of the fireplace (which might have been triggered by my fighting off leg cramps from my just-finished run since she may have thought that I was performing a mating ritual with all my spastic leg-flexing and prancing around that threatened to topple the Christmas tree), planned our upcoming out-of-the-country beach break, and am now settled in for a few more hours of HIStalk work with college football on. It doesn’t take much to make me happy, which is probably why I rarely think it sucks to be me even when it might.

Athenahealth warns that FY2011 earnings won’t meet expectations, expecting $0.68-$0.78 vs. expectations of $0.85. Shares dropped around 10% on the news, but started a move back up Friday. As the graph above shows, the last trade was at $40.99, vs. a 52-week high of $47.82.

A Huffington Post Investigative Fund article covers the IOM’s just-begun study of the safety of electronic medical records systems. An interesting quote from Peter Pronovost, one of the most influential patient safety experts in the country: “There is a need for the basic science of safety of HIT. There is still a lot of basic knowledge we don’t have.” During the IOM’s two-day meeting last week, Epic’s representative repeated the mantra of boss Carl Dvorak, urging that any recommendations not stifle innovation. Human-computer interface expert Ben Shneiderman said, “Until we have a more public data collection, we will not have quality.” IOM hasn’t posted the minutes from Wednesday’s meeting that I can find. I think the writing is on the wall: FDA’s going to get involved in clinical systems oversight, in the form of a vendor registry and voluntary surveillance program if I had to bet.

HIMSS and RSNA incorporate IHE USA. HIMSS VP Joyce Sensmeier will be its president.

Weird News Andy knows how to repurpose an old joke. Q: How do you get from the pancreas to the uvula? A: Practice, practice, practice. He’s referring to Google’s just-announced Body Browser.

We missed mentioning another sponsor KLAS win. GetWellNetwork was the category leader in Interactive Patient Systems, with a 100% “would buy again” score. It’s amazing to me how many HIStalk sponsors lead their markets, although not as amazing as how many have been successfully acquired in the past couple of years (I’m resisting the urge to claim that as a sponsor benefit).

India is moving to what it calls Telemedicine 2.0, going beyond videoconferencing to live streaming of data and images to mobile phones. A pilot project involves detection of retinopathy in premature babies, offsetting a shortage of specialists.

Thanks to new HIStalk Platinum Sponsor Vocera, providers of instant voice communication systems that enhance staff efficiency and improve patient flow for more than 650 hospitals and 450,000 daily users. It runs on voice-powered communication badges and smart phones, connecting healthcare workers to each other and to alarm and alert systems, and is exclusively endorsed by the American Hospital Association. The company just made some nice acquisitions that bring in products for managing patient hand-offs. The San Jose, CA company announced Q3 numbers that include a 39% year-over-year growth rate, 22 new customers, and 31 new employees. They not only now support HIStalk, they were an original Founding Sponsor of HIStalk Mobile. Thanks to Vocera for their support.

Jack Janoso, originally hired by Sharon Regional Health System (PA) as CIO, is named acting CEO after the incumbent is fired.

My e-mailed copy of December’s Microsoft HUG Connection (which I can’t find online) says that HIMSS is canning its Users Group Alliance Program and turning the Microsoft Health Users Group over to Microsoft. I could never figure out how HIMSS could justify running vendor-specific user groups in the first place, so I can’t say I’m crushed that they’ve flip-flopped. I don’t know what happens to their Cisco group, Community for Connected Health, the only other one. The same, I’d guess.

HIMSS Analytics names Marc Holland as VP of market research. He previously ran System Research Services, an HIT market research and competitive intelligence firm.

About half of provider readers say would be less likely to participate in an HIE if its technology was owned by an insurance company, with most of the other half saying that wouldn’t matter to them. New poll to your right: if some level of FDA oversight of clinical HIT is required, which options do you like? You can choose multiple items and click the Comments link to elaborate.

Nine employees of St. Joseph’s/Candler Health System (GA) are disciplined for uploading a cell phone photo taken of an x-ray of “a male patient’s pelvic region” to Facebook. The hospital says the information wasn’t identifiable, so the employees broke hospital policies but didn’t violate HIPAA. An investigation found that a radiology employee left their workstation logged in while doing a procedure in another room, allowing someone to access the image twice in that time. The hospital fired three employees, disciplined three, and suspended three without pay.

More WikiLeaks stuff, this time an embassy report on Cuban healthcare. It claims hospitals are infecting patients with Hepatitis C, providers administer chemo and radiation treatments without meds to treat symptoms and side effects, the government jails homosexuals with HIV/AIDS, one doctor works 14-hour days and then hitchhikes home because low salaries preclude buying a car, providers aren’t allowed to access the Internet or attend conferences, rich foreigners get first crack at the best medical facilities, and government officials seek their care from other countries. Most interesting: the government supposedly banned Michael Moore’s movie Sicko, which criticized the US health system and lauded Cuba’s, for fear that Cubans would immediately recognize the movie as bogus since they have no such access to the excellent care the movie claims (Moore made a statement saying the US government made that up to discredit him).

I like to cruise the Web sites of sponsors every couple of months just to see what’s new. Here’s what I found:

• FormFast is offering a January 20 Webinar on lean healthcare strategies, featuring the well-known author of book on that topic.
• I’ve been following the Facebook posts of Cumberland Consulting Group, which instead of being dry and infrequent corporate drivel, are regular, cute profiles of its people and their goings-on.
• Lindsey Jarrell and Colin Konschak of DIVURGENT Healthcare Advisors have their book, Consumer Centric Healthcare: Opportunities and Challenges for Providers, published by ACHE. It’s available for $67.50.
• “Local” consulting form North Highland opened a new office in Jacksonville, FL.
• Orchestrate Healthcare and its partner Vangent won a $3.3 million contract to support a Meaningful Use HIE deployment for the Indian Health Service.
• IntraNexus ran a case study of Oswego Hospital, which uses its Sapphire browser-based hospital information system that includes CPOE, results reporting, a clinical repository, barcoding, documentation, and other applications.
• ZirMed released a free iPad app for its patient kiosk, which lets patients check in at doctors’ offices and send their information to its system. Future plans include real-time insurance verification and handling of co-pays.
• Informatics Corporation of America won the attendee-chosen Best in Show from a field of 38 vendors at a November payer and provider summit.
• Philips has started an Innovations in Radiology group on LinkedIn.
• Stockell Healthcare Systems offers a webcast on its InsightCS revenue cycle system.
• SCI Solutions has a good list of archived webinars, some created by hospitals, including How Can I Make My Customers LOVE Accessing My Hospital and Recipe for Success: How to Sweeten Physician and Patient Relationships.
• Orion Health had several announcements last week: its Rhapsody integration engine was chosen my Genesis Health System, the company was chosen as the primary technical provider for Alaska’s HIE, it announced an enhanced release of Orion Health EHR, and it just released GA of Version 4.1 of its Rhapsody integration engine.
• MedVentive’s founder and CMO Jonathan Niloff did a best practices Webinar called ACOs: Old Concept, New Name – Tales from the Field in late November. It’s available on their site through February.
• maxIT Healthcare has tagline I hadn’t seen, “Meaningful Use Requires Meaningful Assistance”, highlighting its 400 clients and their 350-consultant average experience of 19 years.
• Carefx will be at January’s eHealth Initiative Annual Conference in Washington and the 2011 Military Health System Conference the week after that.
• MyHealth DIRECT is growing and has openings for several client services positions.
• CynergisTek CEO Mac McMillan’s article (warning: PDF), Make Meaningful Sense of Meaningful Use: What to Do Right Now, is featured in the December issue of New Perspectives from the Association of Healthcare Internal Auditors.
• Cyndi Cahill of Vitalize Consulting Solutions was elected to the CHIME Foundation’s board of trustees. The company was just named #4 on KLAS’s list of professional services providers, landing in the top ten for clinical implementation, staff augmentation, and technical services.
• Mary Carr RN of iSirona just ran Part 3 of her series on steps to medical device integration success.
• Sentry Data Systems demonstrated its drug tracking, 340B, and business intelligence solutions at the ASHP Midyear a couple of weeks ago.
• MobileMD’s 4DX HIE scored (warning: PDF) 93.64 on its most recent KLAS report, with an all-green report card and all-green trending.
• AdvancedMD is offering white papers for practices that include Medical Practice Optimization and A Prescription for e-Prescribing: How to Make It Work for Your Practice.
• BridgeHead Software CEO Tony Cotterill was interviewed on the topic of protecting healthcare data, covering archiving, storage management, and data migration.
• Culbert Healthcare Solutions is offering consultant positions.
• Software Testing Solutions offers an analysis of how its solution can help Sunquest LIS users meet CAP requirements.
• Holon exhibited at the ASHP Midyear this month, with one of its offerings being Virtual Central Order Entry Pharmacy, its Web-based solution to distribute order entry workloads using custom rules to allow pharmacists to manage physician orders from any location.
• Virtelligence participated in the HIMSS Southern California meeting this month.
• Renaissance Resource Associates has a number of open consulting positions (Epic, GE, and all major vendor systems).
• EHRScope’s frequent blog postings cover industry news and product information.
• Salar has posted a demo of TeamNotes, its clinical documentation system recently selected by PinnacleHealth (along with its charge capture system).
• PatientKeeper offers a number of archived Webinars, including ones on physician adoption, CPOE, and physician portals.
• We ran an interview with MedAptus CMO David Delaney, MD on the subject of revenue cycle management tools a couple of weeks ago.
• NPC Creative Services highlights some of it public relations and press release work on its site. I believe Inga told me they were instrumental in steering a couple of new sponsors to HIStalk, which I appreciate.
• Keane Optimum has earned Complete EHR certification.
• An Intellect Resources blog entry covers how to choose your professional references.
• Enterprise Software Deployment posts its holiday card online, complete with staff pictures (who doesn’t like looking at people pictures?)
• Diligence Analytics offers its cost-effective, professionally conducted research and analysis services to HIT vendors.
• A2M posted a list of of some of its big-name consulting clients.
• MED3OOO just announced a strategic partnership with Emergency Reporting in which it integrated that company’s Web-based fire/EMS system with MED3OOO’s EMS billing and recovery services.
• Daniela Mahoney RN, president and CEO of Healthcare Innovative Solutions, will present Co-Pilots to your CPOE Success – Clinical and IT Collaboration and other CPOE-related sessions at the Ohio Hospital Association CPOE meeting in Dublin on January 18. She will also present several sessions at the South Carolina Hospital Association’s STEEEP Summit the following week.
• Anson Group posted its well-written review of last month’s mHealth Summit, comparing the rise in mHealth to that of Facebook.
• Capsule is running a “Wish I Had Time To … “ story contest for nurses. The entry deadline is March 31 and the submissions will be published as an interactive storybook on their site. Winners will be chosen by Facebook Likes.

I know many readers will be bugging out for the holidays this week. My wish for you is joy, peace, and unconditional love. Enjoy the break, then get right back here afterward because HIMSS will be just a few weeks away and it’s going to get crazy around here.

E-mail me.

News 12/17/10

From Wireless Observer: “Re: InnerWireless. They’ve raised at least $75M in VC cash. Their VCs are just flushing their investment — there is no way they will ever recover what they put in. A transaction amount will never be mentioned because it will be embarrassingly low. This company has been a bit of a financial horror show. Not only did they burn tons of cash, don’t forget that IW bought what was left of Pango Networks (billed as a ‘merger’)and killed that company. And if anyone remembers, they developed the SPOT RTLS solution to the tune of $6-8M and killed that one, too. Not a good track record, to say the least.”

From HIPAA Hound: “Re: Hans Rosling BBC video lecture on the statistics of national wealth and health in the last 200 years. Pretty interesting in a geeky way.” It is pretty cool, not just for the information it conveys about countries advancing in income and health, but in the graphical way the information was presented. It also supports something I find myself saying a lot: public and global health is not all that related to healthcare services delivery. Only in some countries are hospital and insurance considered synonymous with health.

From Orion’s Belt: “Re: JPS. Not only is their new CIO’s background light when it comes to hospitals, they’ve chosen a consulting partner, Accenture, with very limited EMR experience, especially with Epic. I’d keep an eye on them if I were in your business :).”

From Laddie: “Re: Texas Health Resources. Dealing with a severe outage of their Epic EMR caused by a Citrix upgrade that coincided with the 09 upgrade.” Verified. CIO Ed Marx says he’d love to blame a vendor, but the buck stops with him and it was a leadership failure in his mind. To Ed’s credit, I’ve heard CIOs say  lot of surprising things, but that’s the first time I’ve heard that. Many of those I’ve known would have been making excuses left and right and looking for an IT director to fire as a sacrificial lamb. I can say from first-hand experience that when you have Citrix problems, things get very exciting – lots of systems go dark since it’s a single point of failure for all the major apps of many hospitals (although it has to be a big failure since it’s not hard to work around a failed server in the Citrix farm).

From CYAO: “Re: University Health Care System (GA). Appointed an ED physician as CMIO to lead their EMR implementation.” Shannon Stinson, MD is named VP/CMIO. The announcement took a little shot at McKesson, which is egressing as Epic is ingressing. Said the CEO, “For many years, University and McKesson successfully partnered on clinical and financial information system projects. However, recent experience with McKesson has not been as successful.” You know the relationship had to have soured if it warranted a CEO dig in a press release.

From The PACS Designer: “Re: Opera 11 browser beta. TPD is experimenting with Opera 11 after being a Firefox advocate for a long time. Some recent Firefox changes result in numerous hiccups that make the Firefox browser less attractive for use.” I like Opera myself, although I rarely use it except when I’m testing some Web change I’ve made to make sure I didn’t screw it up. I use Chrome 90% of the time, with Firefox making up the rest (but it’s noticeably slower). Opera feels very lightweight and fast to me and it just seems smoother (and extra points for working a Spinal Tap reference into the page’s description, shown above from a Google search). I know I’d rather have a root canal than use IE.

I’ll be beaming these instructions to you telepathically when you least expect it, so do these things now and I’ll stop: (a) put your e-mail address in the spam-proof Subscribe to Updates box to your right, ensuring that 6,490 more ambitious souls aren’t the first to know that your company has been sold or your 1998 arrest record has been unsealed and printed verbatim here; (b) check out HIStalk Practice and HIStalk Mobile; (c) Friend (Inga or me) or Like (HIStalk) on Facebook to help that nice Zuckerberg boy dominate the world; (d) show some sponsor love by perusing their ads and clicking reflexively at the many interesting ones so those companies won’t crush my ego by abandoning me; (e) instantly find mentions about a company or person by dropping their name in the search box to your right, which digs through all three sites at your command; and (f) tell your friends and enemies to read HIStalk, but don’t get their hopes up by laying it on too thick. Thanks for reading, commenting, writing, rumor-reporting, and e-mailing. And be nice to Inga since she’s fragile.

The very nice Sunquest folks sent us a copy of a letter from President and CEO Richard Atkin that was e-mailed to customers Thursday afternoon, with the explanation that they know we’ve already written about their new investor (on December 3), but that they can comment now that the deal’s done (I really was touched a little that they remembered us, to be honest, but then again I’m easily won over with flattery). As we wrote earlier, an investor consortium led by Huntsman Gay Global Capital has taken a substantial equity position in Sunquest, but the company will remain independent and Vista Equity Partners, which bought the company from Misys, will continue as the largest single shareholder. The letter says the funds will be used to increase the field sales force, expand the regional consultant program, develop more products, create executive and strategic advisory boards, and possibly acquire other companies. My assessment is this: there’s not much of a safety net given the large amount of debt involved, but if management can use the money wisely and strategically to move to the next level, nobody’s going to worry about it. Like always, strategy and execution (in the form of management) will decide the outcome.

Listening: reader-recommended Dashboard Confessional, an emo band that I’m surprised I haven’t mentioned since I do listen to them occasionally.

KLAS just published its Top 20 Best in KLAS awards. I’ll probably dig deeper into it later, but here’s what has struck me so far:

• Epic was named as the highest scoring vendor overall, with Hayes Management Consulting taking the top spot among professional services firms.
• If you’re a single-vendor shop, the highest ranking software suite by far was Epic, but McKesson took two of the top four spots (Paragon and Horizon). Most surprisingly to me, Siemens Soarian came in #3.
• I always like to look at Worst in KLAS, the bottom-ranked products in the hospital application categories: GE Centricity (hospital EMR), CGI Sovera (document management and imaging), Emergisoft (ED), McKesson Pathways (scheduling), GE Centricity (lab), Cerner ProVision (PACS), McKesson STAR (patient accounting and patient management), Mediware WORx (pharmacy), Sunquest (radiology), and McKesson Horizon (surgery management).
• Some products did very well in one of KLAS’s subcategories, which means they can’t win an award, but some of them did earn a 100% “Would Buy Again” customer rating, which is to me the most useful measure of all.

RelayHealth’s RelayClinical EHR earns ambulatory EHR certification from Drummond Group, giving the company a trifecta of offerings (EHR, HIE, and PHRs).

Former Eclipsys CEO Andy Eckert is named CEO of CRC Health Corporation, which offers behavioral care services.

Xconomy Boston gives a status update of the integration of the former Sentillion into Microsoft. It’s still a work in progress and a lot of it is hush-hush, but former Sentillion CEO Rob Seliger has been promoted to GM of product management for all of the Healthcare Solutions Group, which includes HealthVault and Amalga, and references were made about new products yet to be announced.

I’ll take Things in Common for $200, Weird News Andy. And the Jeopardy answer is: blood pressure, surgeons’ egos, reimbursements, and meth users from the ceiling. The question: what are things that fall in the ED? A man shows up at a Louisville hospital’s emergency department with what he says are alcohol burns, but the woman who gave him a ride says his car-based meth lab had exploded. The police come, the man tries to climb into the ceiling to drop down into another room to escape, but he misjudges and crashes to the hallway floor. The police spokesperson’s assessment was cynically dry: “I would say it’s unusual for anybody that’s in the hospital to try and escape through the ceiling tiles.”

The VCs behind MedPage Today (which has an interest in the KevinMD site) sell out to Everyday Health, which runs ad-supported health and lifestyle sites that include that of Jillian Michaels.

Jobs on the sponsor-only Jobs Page: Application Consultant, West Coast (Nuance), Software/Implementation Engineer (MobileMD), Eclipsys Activation Consultant (Enterprise Software Deployment). On Healthcare IT Jobs: Client Manager, Soarian Clinicals Consultants, Dragon Trainer/Systems Analyst, McKesson Paragon Consultants.

Cerner founders Neal Patterson and Cliff Illig are sued for $3 million by their golf course partners, who claim the guys stiffed them on payments due.

I’ve said nice things about Nextgov, but this won’t be one of them. What were they thinking when they wrote the Wednesday story above? David Brailer quit as national coordinator nearly five years ago, in April 2006. David Blumenthal has been in that position since March 2009, but Rob Kolodner held the job between the Daves. Not to mention that its CMS, not ONC, that will “hand out” HITECH money (oh, if it were only that simple). When I saw the clumsily breezy headline, I thought that Health Evolution Partners was cutting Brailer’s pay and I wondered how (and why) Nextgov sleuthed that out.

A British hospital opens a communications room for hearing-impaired patients that offers assistive devices for hearing aid wearers and Webcam access to a sign language interpreter.

The board of 136-bed Rice Memorial Hospital (MN) approves $4.7 million to purchase a clinical information system. Its preferred vendor is Epic, which would make this one of the smallest Epic implementations ever, I would guess (assuming Judy goes for the deal). Now this is interesting since Epic contractually gags its customers from divulging what they paid, so you never see a price breakout: Epic was the cheapest of the five vendor proposals, with the cost detailed as $1.2 million for the license fee, $100K for hardware, $800K for implementation, and $2.6 million for five years’ of maintenance.

I was digging through the statement (warning: PDF) made this week by the FDA’s Jeffrey Shuren at the IOM’s Committee on Patient Safety and HIT meeting. Tidbits: (a) he implies that EHRs are medical devices for which FDA has elected not to enforce existing requirements, but FDA is interested in IOM’s opinion on whether it should start regulating them; (b) he suggests that clinical decision support will be a targeted area; (c) FDA believes interoperability should be standardized; (d) systems should be monitored with real-time surveillance. He points out that FDA oversight can take several forms: requiring manufacturers to register, running a voluntary post-market surveillance program, requiring manufacturers to follow ISO-like quality management programs, or require vendors to submit information before putting their products on the market.

Oracle announces Cloud Office 1.0, a Google-like suite of Microsoft Office-compatible word processing, spreadsheet, and presentation apps. That’s probably not the best news Microsoft has heard lately.

Former Allscripts EVP Mark Karch is named EVP of Apparture Inc., which offers Web-based marketing solutions for healthcare companies.

Strange: a woman in Australia reports to police that her iPhone has been stolen from her purse while she’s visiting a hospital. They track it down using its GPS-like application and call in a police helicopter to swoop down on the thief, a 16-year-old boy riding a stolen bike.

E-mail me.

HERtalk by Inga

From Eel Shoes: “Re: non-HIT matters. At this time of year, i don’t think we are hearing enough eel stories. I wondered if Inga had tried the soft but durable eel skin shoes?” I was quite amused by the reader that posted this comment, as well as the follow-up eel conversations. I am not an eel expert, though I once had a soft and durable pair of brown eel-skin pumps that have since been donated to Goodwill. As of late, my shoe fancy has been leaning towards new boots. Here is the pair I’d love to see under the Christmas tree (size 8, if anyone has Santa connections).

Cleveland Clinic will implement 3M’s Codefinder Computer-Assisted Edition software for inpatient and outpatient coding.

athenahealth expands its board with the appointment of its former COO, David E. Robinson. Before joining athenahealth, he was an EVP of SunGard Data Systems.

MedSynergies appoints former Dell/Perot exec James Dye as SVP of client management. MedSynergies also names Brid Kealey as SVP of human resources and Chris Walker VP of performance and change management.

Ephrata Community Hospital (PA) begins implementation of its Meditech EMR and expects to complete the first stage of the transition in early 2011.

Tool maker Stanley Black & Decker will pay $61.2 million cash for mobile workstation and asset tracking provider InfoLogix. InfoLogix will become part of Stanley’s Healthcare Solutions business, which Stanley is seeking to expand.

Hospital billing company and Tenet subsidiary Confer Health Solutions will close two of its seven offices as it tries to improve efficiencies. Conifer will close offices in Anaheim and Alhambra and consolidate its California work in its remaining Anaheim office. Closures will affect all 100 Modesto employees.

Colorado Regional Extension Center (CO-REC) announces its approved list of 14 EHR products.

Atlantic Health (NJ) forms an ACO that  encompasses a seven-county area. The health system has already aligned with more than 300 participating physicians.

The price tag for OSU Medical Center’s Epic EMR: $100 million over the next five years. Once implemented, Ohio State doctors and hospitals have the potential to earn $25 million in ARRA money.

Kaiser Permanente promotes CIO Philip Fasano to EVP and CIO. CEO George Halvorson says the promotion reflects the “magnitude of Phil’s impact and contribution to our organization.”

UC Davis concludes that EMRs impact physician specialties differently (duh). The initial implementation of EMRs decreased physician productivity 25 to 33%. Over time, internal medicine providers adjusted to the new technology and slightly increased their productivity, but pediatricians and family practice doctors did not recover to their original productivity levels. The conclusion: there is a  “mismatch between technology design and the work-flow requirements and health administration expectations” for different specialties.

Sponsor Updates

• API Healthcare introduces the Electronic Employee Record, designed for healthcare organizations to store and maintain employee information, track trends, and create forecasts.
• Wills Eye Health System (PA) contracts with NextGen for its EHR and PM products.
• Children’s Hospital Central California subscribes to CapSite to improve its capital expenditure process.
• Wellsoft signs a two-year extension contract with Premier, allowing Wellsoft to remain the sole contracted supplier of EDIS for Premier’s member hospitals.
• St. Tammany Parish Hospital (LA) selects RelayHealth as its partner to build its community-wide HIE.
• HIStalk sponsors placing in the KLAS top ten of all vendors are 3M, Philips, Picis, Sunquest, McKesson, and Merge Healthcare.
• Sponsors in the professional services top ten in KLAS are Hayes Management Consulting, Vitalize Consulting Solutions, Ingenix, and McKesson.
• Sponsor products earning a Best in KLAS title in their segment are eClinicalWorks EMR (ambulatory EMR 26-100 physicians), Greenway Medical PrimeSuite Chart (ambulatory EMR 6-25 physicians), e-MDs Chart (ambulatory EMR 2-5 physicians), McKesson Paragon (community HIS), Allscripts Sunrise EPSi Decision Support (business decision support), Wellsoft EDIS (ED), McKesson Pathways Financial Management, Materials, and HR Manager (financial/ERP), McKesson Horizon Practice Plus (practice management 26-100 physicians), Greenway Medical PrimeSuite Practice (practice management 6-25 physicians), e-MDs Bill (practice management 2-5 physicians), and Nuance eScription (speech recognition).
• Sponsors named Best in KLAS in the professional services category are Navicure (claims and clearinghouse services)and CareTech Solutions (IT outsourcing – extensive).
• Precyse Solutions ranked #2 in KLAS’s transcription provider category, but outscored everyone in report quality.
• UPDATE: we missed one! MedPlus’s ChartMaxx took Best in KLAS in the document imaging and management category, winning the #1 spot seven times since 2002. MedPlus has 140 implementations and 415,000 users.

E-mail Inga.

Readers Write 12/15/10

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

The Elephant in the Room
By Dana Sellers

I spend most of my time with provider organizations. Recently, though, I spent a day with a company that focuses on payers. As we discussed the many challenges our industry faces in today’s tough economic and regulatory climate, it hit me that we appeared to be coming at the problem from different angles.

One side of the room talked about patients, clinical data, and quality measures. The other side talked about members, population management, and risk reduction. It reminded me of the old story about the blind men who touch the same elephant, but describe it very differently. We were all talking about the same elephant, but we saw it and described it in our own terms.

There’s one thing both providers and payers have in common, though. Everyone’s trying to figure out how to play in a changing world that’s moving toward pay-for-performance, value-based purchasing, and ACOs. Providers are jockeying for position — buying physician practices, networking with community docs, and starting to think a lot more like payers.

Provider CIOs, who are just fully realizing how hard it is to capture the discrete data needed for the first 15 quality measures within their own walls, are facing the challenge of aggregating discrete clinical data over extended provider communities that include a hodgepodge of physician practices, specialty clinics, long-term care facilities, and home care settings.

Key payers are jockeying for position, too. Last week Aetna bought Medicity. Earlier this year, Ingenix, a subsidiary of UnitedHealth Group, purchased Axolotl and Picis. It makes sense that payers want into the HIE world. They need a way to gather clinical data, but more importantly, they want a framework that will allow them to influence the behavior of care providers to drive best practices back out to the point of care. These moves may really complicate things from a provider’s perspective, though.

How all of this will play out isn’t clear by any means, but there are a few things I’d be willing to bet on.

1. The 15 quality measures in Stage 1 are just the tip of the iceberg. Over the next five years, reimbursement will be increasingly based on data that must be captured, aggregated, and reported electronically, rather than through abstracting.
2. Physicians are key. To enhance the health of a population in a substantial way, you need to be able to connect with community-based care providers, manage handoffs, and influence decisions at the point of care. Whether it’s through acquisition or networking, healthcare organizations need to include physicians in their IT strategies.
3. The lines are blurring. Providers are starting to look and talk a lot more like payers, and payers are starting to move into areas long thought to be the domain of providers. We’ll see providers assuming risk and managing populations of members. Interesting alliances and new business models will emerge, and CIOs will need new information systems to support this new world.
4. Data will be the new gold in whatever finally emerges out of healthcare reform. Not just clinical data or financial data, but both combined … and lots of it. Payers have known this for years, and have invested heavily in systems to capture and report on member data. The organizations that come out on top will be the ones that figure out how to capture data, how to aggregate it, and how to apply the insights they derive from it to bring about real changes in quality. This doesn’t happen overnight. CIOs who don’t take the time to develop an analytics strategy will struggle to keep up.

So maybe at the end of the day, it doesn’t matter so much that we all have the same pachyderm perspective … as long as we can get it to do the heavy lifting.

Dana Sellers is CEO of Encore Health Resources of Houston, TX.

I Have an ONC-Certified EHR and Vendor Meaningful Use Guarantee, Why Do I Need Anything Else?
By James O’Connor

Software is a tool. An ONC-certified EHR captures and reports data, but an EHR system cannot characterize the gaps in your workflow and processes, initiate change within your practice, or foster teamwork to meet a common goal. These activities can be supported by a good software tool, but cannot be enacted by one. Here’s an illustration.

Recording demographics is a core requirement. To an EHR vendor, "readiness" means there is a form somewhere in the system that collects the information and there is a report that calculates the ratio.

To a medical practice, "readiness" means something else entirely. Certainly demographics are being recorded to some extent now, but one of the Meaningful Use requirements is to record a patient’s preferred language. To comply, practices must update forms (if patients still register on paper) and train staff to ask established patients the question (to fill in the gaps).

There is no partial payment for partial compliance. If the ratio doesn’t hit the minimum 50%, there will be no incentive payment. There are a number of requirements that depend on staff, not clinicians, to fulfill. These must be understood and incorporated into the workflow.

It is no great secret that Meaningful Use (at least Phase I) is not rocket science. The steps to prepare do require organization and a certain depth of knowledge. A small- to medium-sized practice willing to dedicate a competent individual to undertake this task can reasonably expect the person to succeed. 

It might take a little longer. There may be a few bumps in the road dealing with the HIPAA security assessment. There could be some resistance to change if the individual selected to head the effort has a "regular" job that does not ordinarily have the power to influence senior members. But surely it can be done.

On the other hand, there are benefits to bringing in an outsider: no subtraction from practice productivity, no power struggles, no learning curve, greater objectivity, expertise with security assessments. Also, you can fire a bad consultant, but dealing with a staff member who isn’t performing can be touchy.

Regardless of the path chosen, be sure to read the EHR vendors’ guarantees closely. They generally offer to credit the monthly usage or maintenance fees for a limited period of time if the practice doesn’t receive the incentive payment. Practically speaking, how will that work? 

The incentive is paid to individuals, but fees are typically paid by the practice. Does that mean if one physician does not qualify, then there are no fees for the entire practice that month? Does it mean that a portion of the fee will be credited?When you really think about it, what is a monthly maintenance fee compared to $44,000? 

Yes, you need an ONC-certified EHR system, but don’t depend on an EHR vendor’s guarantee to get you ready.

James O’Connor, MD is CEO of MDcohort of Ashburn, VA.

Electronic Medical Records, HITECH, and Your Health Information: Does Bureaucracy Inhibit Innovation?
By Doug Wallace

In case you have not heard, the economic stimulus program that passed in 2009 includes a little something called the Healthcare Information Technology for Economic and Clinical Health (HITECH) act, funded in excess of 20 billion dollars.

Your doctor is now required to computerize your personal health records. All of them. Boom!

Gone will be your current paper medical charts. But where will they go? Scanned and computerized for easy access and review. And why?

The current administration has claimed that, “To improve the quality of our healthcare while lowering its costs, we will make the immediate investments necessary to ensure that all of America’s medical records are computerized”.

While productivity and efficiency is a necessary goal, who is to decide how to accomplish such an initiative?

Much as the Transportation and Security Administration (TSA) claims that upon purchasing a ticket for air travel, you may well than “give up a lot of rights”. Will this hold true for your medical information?

In the move to enforce compliance of HITECH and physician adoption of electronic medical records, some immediate barriers to this initiative have become evident. Among them: doctors are not moving as fast as the money is flowing; the healthcare market already is positioned to deliver on what HITECH demands; any “preferred EMR systems” in good favor of Health Information Exchanges (HIEs) would hinder free market choices.

Is it fair to use regulation as a way to bypass legislation? Or just let bureaucrats decide? The US healthcare system is approximately 2.5 TRILLION dollars, or 18% of the GDP. Should measures such as our personal medical information be placed on a relative fast track whose journey has just begun, for an outcome that is uncertain?

Doug Wallace is executive VP, business development solutions for My EMR Choice of Doylestown, PA.