News 2/10/12

Top News

The State of New Jersey will hand out $40 million in federal Medicaid money for first-round EHR incentive payouts this week. The largest payouts for hospitals and practices were $2.96 million and $403,750, respectively.

Reader Comments

From Truth Seeker: “Re: attestations. Each time I try to download the CMS attestation stats via your link, I get a 37,500 line spreadsheet that lists all of the vendors and products by state. I cannot find a column that lists the number of successful attestations (which, of course, is what I want to see)! Am I doing something wrong? Maybe this is why there are only 120 downloads.” I have downloaded the same data into Excel and then done various manipulations with groups and subtotals. If anyone has figured out an easier way to analyze the data, please share.

From Dr. Denominator: “Re: attestation data. The information someone sent you was inaccurate on the inpatient side. I don’t blame them since the data is very messy. The mistake most people make is attributing Epic physicians to Epic hospital numbers, because a couple of large, multi-specialty Epic clinics attested on the inpatient platform even though they are EPs. There are also some hospitals that reference multiple Meditech systems and show up on multiple rows, even though it is a single provider. And HCA needs to be folded into the Meditech numbers, because it is Meditech software after all.” And has been stated, none of this includes Medicaid attestation data either, so it’s probably dangerous to draw too many conclusions from it.

From Zen: “Re: animated ads. When are you getting rid of the rest of the animated ads?” With all the HIMSS prepping over the last few weeks, I have not made the time to pester the last few sponsors that have yet to provide us with non-animated ads. I admit I love the change and look forward to the day when there is total stillness on the left side of the page.

From HITandTiaras: “Re: judges. Who are the judges for the shoe and fashion contests at HIStalkapalooza?” For the “Inga Loves My Shoes” contest, RelayHealth’s Lindsay Miller will be returning and will be joined by Timur Tugberk from DrFirst. Our fashion judges will be Health 2.0’s Matthew Holt, the glamorous Rebecca Armato of Huntington Hospital, and last year’s red carpet lovely Jennifer Lyle of Software Testing Solutions. Matt wanted me to let contestants know that due to his poor sense of fashion, he is willing to accept all bribes.

From Carla Tortelli: “Re: HIStalkapalooza. I understand there will be IngaTinis. What exactly is that?” As far as I am concerned, it is any yummy martini-ish cocktail. However, the ESD folks told me that this year’s version is a mix of green tea vodka, orchard pear liqueur, elderflower blossom, fresh pear juice, and vanilla bean-infused honey. My consulting physician Dr. Jayne has advised me of the benefits of green tea and has assured me it increases calorie burning and stamina. I’ll thus be drinking a few.

From Cold in Tampa: “Re: Vitera update. Police were called to the Tampa, Alachua, and Scottsdale offices to ensure the quiet exit of over 300 laid-off employees.”

From SageYouLater: “Re: Vitera layoff. I count 33 gone in my area. Boxes were dropped off and an armed police officer was on site to make sure nobody caused trouble. Some we’d have voted off the island ourselves, but some were really good. Vitera’s parent private equity company made it clear that their goals are to increase revenue 30% in three years, requiring them to make acquisitions (AKA buy growth if you can’t grow it). Freeing up cash to acquire companies is how they’ll get that growth, probably via LBOs since it’s easier and there is no profitability target in their objectives. These guys are not product people, they are finance people.”

From NervousIT: “Re: our little hospital. News of a potential affiliation with a much larger organization broke out last week. Should I be nervous? How do these things typically go?” I’ve been through the process a couple of times from the big hospital IT side of the table, so here’s my experience in a nutshell, which may or may not be representative (OK, it might be a little bit tongue in cheek):

1. The big hospital sends its mid-level managers, who make twice as much as your highest paid person, to snoop around and try unsuccessfully to hide their contempt of your comparatively simple but more effective operation.
2. They say they are there to learn and assist, but in reality they are thinking, “How fast can we rip out their stuff and replace it with products that we already know and therefore are less of a pain for us to support, no matter what users prefer?”
3. The systems they want to put in your hospital are more complicated, partly because big hospitals like big, complicated products, but also because big hospitals have big egos and manage to make everything 10 times harder than it needs to be because all kinds of job-paranoid mid-level IT managers are always trying to justify their existence by increasing the level of specialization and complexity wherever possible.
4. Every decision is made on the basis of which option presents the least risk to the IT organization. Risk means anything that could require more employees, increase help desk calls, or put the bonuses of the top IT executives in jeopardy.
5. Any semblance of being a friendly, well-respected IT operation goes down the tubes as the new suits insist that nobody can talk to anybody without a help desk ticket, IT employees aren’t allowed to solve problems or make changes without reams of documentation, and vigorously enforced PC policies ensure that everybody except executives in IT and Finance are using the same hardware and software that has been dumbed down and locked down so that the lowest level employee in dietary or facilities maintenance can’t do anything that might require a help desk call. Think of this as computer socialism.
6. Endless meetings will be held in which nobody in the room has the authority to make a decision, but everybody is empowered to veto someone else’s recommendation or insist that the issue be studied further with even more people invited to the table. The chairs in conference rooms never have time to get cold before the next set of IT posteriors land on them.
7. You will for the first time see ambitious, back-stabbing IT managers trying to distance themselves from their humble programmer or networking origins by wearing a suit at all times and riding herd on their tiny fiefdoms like they are Steve Jobs, except without the charm, vision, passion, and brains.
8. On the other hand, you will probably get better benefits and possibly a raise, at least as long as your job isn’t too closely identified with one of the systems that will be unceremoniously dumped, in which case you may find yourself attached to it. You may not be able to look users in the eye, but your career prospects may improve because of better training, exposure to systems for which experts are needed, and a more recognizable employer name on your resume. If you are lucky, you may even get to stay on the periphery and avoid the soul-sucking part of the IT organization entirely. You’ll also realize that it’s not just IT described above – pretty much all big-hospital departments stack up to their small-hospital counterparts in exactly the same way.

HIStalk Announcements and Requests

From the HIStalk Practice world this week: Epic, Allscripts, and eClinicalworks represent over half of all EP attestations to date. I share the names of a few ambulatory EMR vendors I intend to visit at HIMSS. Proposed legislation would make it easier for providers to practice telemedicine in multiple states. Questions that practices should not send to technical support. Dr. Gregg overviews CareCloud’s EMR. Hayes Management Consulting’s Rob Drewniak shares tips for preparing for data breaches. Thanks for signing up for e-mail updates while you’re checking out the news. And thanks for reading!

Speaking of IngaTinis, Medicomp will be serving up a few when I participate in their Quipstar live game show Wednesday, February 22. The game is designed to demonstrate how quickly providers can be trained on Quippe and how easy it is to use. If you are interested in winning an iPad2 or some other nifty prize, you can register to participate. Before I agreed to play, the Medicomp folks had to meet a list of my diva demands that included IngaTinis for everyone and green M&Ms for my dressing room. I couldn’t refuse when they also agreed to make a hefty donation to my favorite charity. I’ll be playing to win.

I have to hand it to new HIStalk Platinum Sponsor Nordic Consulting for choosing one of the most memorable names I’ve heard, especially considering that they are located in Madison, WI. Nordic is the largest Epic-only consulting firm in the US, with 100+ consultants averaging four Epic certifications each and six EHR projects under their belt. Every Nordic consultant is Epic certified and 80% of them are former Epic employees (being in Madison obviously gives them an advantage in attracting top talent.) They’re prepared to help you run validation sessions, complete your Epic builds, perform system testing, create training materials, and provide go-live support. Eighty percent of the company’s engagements last more than a year and 90% of its placements are renewed at least once. Whether you need one Epic-certified consultant or an entire implementation team, and whether it’s clinical, financial, or interface applications you need help with, Nordic Consulting can help. I appreciate their support of HIStalk.

Supporting HIStalk, HIStalk Practice, and HIStalk Mobile at the Platinum sponsorship level is White Plume Technologies of Birmingham, AL. Their name is memorable as well, referencing the last line in the play Cyrano de Bergerac (“and that is … my white plume”) that symbolizes courage, integrity, and honor. White Plume helps 7,800 physician customers improve their PM/EMR systems (covering “the stuff they left out,” as they say), capturing charges better and faster to the tune of an average net savings of $0.83 per encounter. The company is so confident in its low-risk solution that it will happily sign daily contract commitments, letting its value stand on its own legs. Specific modules in its ePass (Electronic Practice Acceleration Solution Suite) include AccelaCAPTURE (an intelligent superbill on a tablet PC,) AccelaMOBILE (charge capture, rounding lists, and appointments on mobile devices,) AccelaSMART (rules-based management and workflow engine,) AccelaPASS (charge passing and validation,) and AccelaSCAN (a paper superbill with quick-scan processing, up to 1,200 encounter forms per hour.) Some of the vendor systems they work with: McKesson, NextGen, GE Healthcare, athenahealth, Allscripts, Vitera, and LSS. I found a YouTube video called Waiting on the EMR of the Future that provides some background, and they have a Top 5 Things to Know and slideshow on their site. Thanks to White Plume for its support of HIStalk, HIStalk Practice, and HIStalk Mobile.

Acquisitions, Funding, Business, and Stock

McKesson acquires peerVue, Inc., a provider of radiology workflow solutions.

Qualcomm makes a strategic investment in AirStrip Technologies via its Qualcomm Life Fund investment group.

Access signs a partnership agreement with pen tablet vendor Wacom to create a new e-Signature solution that will work with the Access Intelligent Forms Suite.

Revenue cycle management outsourcer Avadyne Health merges with revenue cycle workflow provider Benchmark Revenue Management. The combined companies will operate as Avadyne Health.

Nuance announces Q2 results: revenue up 19%, EPS 0.03 vs. $0.00, falling short of expectations after complicated acquisition costs. Shares dropped over 13% in Thursday after-hours trading.

Shares in CSC, which just announced the hiring of Misy PLC CEO Mike Lawrie as its new CEO, delays its fiscal year forecast and writes down $1.5 billion related to its disputed NPfIT contract in the UK.

Sales

The Arkansas State Health Alliance for Records Exchange selects OPTUMInsight’s Axolotl HIE for its statewide health record exchange.

WellStar Health System (GA) selects Merge Healthcare’s cardiology solution and Advanced Radiology of Columbia (MO) contracts with Merge for its radiology suite.

King’s Daughters Medical Center (KY) selects ProVation MD for its cardiology procedure documentation and coding.

People

Ken Edwards, formerly of GE and IDX, joins ZirMed as VP of operations.

Henry Schein names Gerard K. Meuchner (Eastman Kodak) VP and chief global communications officer.

Former Eclipsys CEO Andrew Eckert, now CEO of CRC Health Corp., joins Awarepoint’s board. The company also also names Carlene Anteau MS, RN (McKesson) VP of product marketing and Erica Davidson (Breg, Inc.) as VP of human resources.

Announcements and Implementations

Physicians at St. Mary-Corwin Medical (CO) begin electronic order entry in advance of the hospital’s May 8 Meditech go-live.

Government and Politics

The VA starts implementation of patient Wi-Fi systems in all of its hospitals.

Other

Weird News Andy rebrands himself as Wow News Andy in apparently excitement over this story. NASA’s implantable Biocapsule can diagnose and treat astronauts on long space journeys, using carbon nanotubes to secrete therapeutic molecules created by cellular metabolism.

A pretty good Forbes article by the CEO of healthcare consumer software vendor Avado says hospital CEOs should avoid the mistakes made by their newspaper industry counterparts. He had this to say about IT:

Just as newspapers were implementing multimillion dollar IT systems while nimble competitors were using low and no cost software to disrupt the local media landscape, health systems are similarly implementing complex systems to automate the complexity necessary in a multi-faceted system. Meanwhile, disruptive innovators are implementing new models at a fraction of the cost and time. For example, it’s well understood that a healthy primary care system is the key to increasing the health of a population. Imagine if a fraction of the billions being spent by mission-driven, non-profit health systems on automating complexity was redirected towards the reinvigoration of primary care. They’d further their mission and lower their costs. Of course, they’d likely see revenues drop but presumably maximizing revenues isn’t the mission of a non-profit.

Healthcare billionaire and healthcare IT dabbler/investor Patrick Soon-Shiong  is reported to be interested in buying the Los Angeles Dodgers.

Sponsor Updates

• eClinicalWorks provides details of its April 28-29 user group meeting in Chicago.
• PatientKeeper announces that Ashe Memorial Hospital (NC) successfully attested for Stage 1 MU using PatientKeeper’s CPOE solution.
• EHRScope announces its appointment as the Nuance distributor for Dragon Medical Spanish, v11.
• PeaceHealth’s Sacred Heart Medical Center at RiverBend (OR)  expands its use of Versus Technology’s RTLS into the labor and delivery area.
• Compuware announces a live customer Webcast featuring CHRISTUS Health SVP and CIO George Conklin.
• T-System releases a demo of its new ACO solution, T-System Performance Care Continuity.

EPtalk by Dr. Jayne

Medicomp Systems announces their Quipstar game show promotion for HIMSS12. You heard all of us gush about it last year, so be sure to experience it yourself. Those selected will have a chance to compete for cash and prizes. Topics include ICD-10, Meaningful Use, and “other industry challenges.” I wonder if they’ll include such questions as: what clothing item is Inga HIStalk obsessed with? Does Dr. Jayne prefer diamonds or pearls? What medical specialty shares Mr. H’s affinity for the forehead-mounted reflector?

Clinical decision support fans take note: an editorial in the Journal of the American Medical Association this week discusses “The Harms of Screening.” It highlights the varied (and often conflicting) recommendations that providers are faced with daily. If providers can’t agree among themselves what is the best course of action, how can we expect vendors to know what to build? The answer, in case you’re curious: build all of the various recommendations and let your clients turn off the ones they don’t want, rather than asking them to customize in the ones they do want.

Another piece in the same issue titled “Integrating Technology Into Health Care: What Will It Take?” tackles low uptake rates for electronic health records and personal health records. The authors note that “to fit into the lives of patients, technology must help patients do the jobs that they perceive as high priority in their lives.” Unfortunately “many patients perceive financial health and other concerns as more pressing jobs to be done than physical health.” Judging from the patients I’ve seen this week, those more pressing concerns include whether to get a new iPhone or just replace the case that’s losing its little crystal decorations; whether the new Kate Spade purses are really that cute; and whether or not the Super Bowl is overrated.

Early last year, the Office of the Inspector General (OIG) wanted to study why physicians opt out of Medicare. Now they’re ending the investigation, citing a lack of centralized data. Additionally, the poor quality of the data it did receive from Medicare Administrative Contractors and legacy carriers made them unable to “determine the characteristics of physicians who opt out of Medicare, the trend in the number of opted-out physicians, and why physicians choose to opt out of Medicare.” Two thoughts strike me here. First, if I gave bad data to Medicare, I’d be fined with penalties (just an idea? Maybe, maybe not). The second: have they heard of SurveyMonkey?

It’s been a while since I’ve been in the operating room, but unfortunately I’ve seen what happens when something is left in the body. Most surgical sponges have a portion of the weave that is visible on x-ray if the situation arises where one can’t be found. To help prevent lost sponges in the first place though, the University of Michigan is using barcoding technology to scan sponges when they’re used and again when they’re removed.

Only a few weeks left to get your Meaningful Use on for 2011. Have you attested yet? I’m still looking for some understanding of why some of those attestations have been unsuccessful. If you’re one of the unlucky few and are now working through the appeals process, we’d love to hear your story.

Score one for software developers working late nights. The Centers for Disease Control reveals that salty snacks such as potato chips are not the chief source of sodium in the American diet. The culprits include bread and rolls, cold cuts and cured meats, pizza, poultry, soups, sandwiches, and cheese. I didn’t see dark chocolate on there either, so I guess I’m good to go.

Have a question about Meaningful Use, the ideal percentage of cacao in chocolate, or which shoes are less cute (and thus more easily donated to Souls4Soles?) E-mail me.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Readers Write 2/8/12

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!

HIMSS, A Golden Opportunity: Insider Tips for Maximizing Media and Analyst Interviews
By Jodi Amendola

It’s hard to believe that HIMSS is just around the corner. In addition to meetings with new business prospects and partners, networking, and reunions with friends and former colleagues, you can maximize your HIMSS experience by arranging media and analyst interviews during the show.

HIMSS is a golden opportunity to meet one on one with these key industry influencers and differentiate your company from the competition. You can also leverage these meetings to identify and secure opportunities to be included in print or online articles, blog posts, and industry reports.

These industry movers and shakers are incredibly powerful. One positive mention and your sales leads could skyrocket. One negative comment and the opposite can occur. Don’t panic. The following media training “cheat sheet” can help you achieve your goals and generate positive coverage.

• Prepare. One of my most embarrassing HIMSS moments was when a client told an analyst that he “really liked his magazine.” The client obviously hadn’t taken the time to read our prep book! Before a meeting, research the background of the editor or analyst and become familiar with his or her areas of expertise and interest. Always customize your answers to address their audiences’ needs and pain points.
• Listen. Nothing is more annoying than being interrupted. Listen to the entire question being asked and tailor your responses. Address the questions within the context of the target audience(s) and avoid dominating the conversation with a product or service pitch. Sometimes it will be appropriate to share your knowledge, vision, and thoughts on the industry rather than focus on your company.
• Body language. Be confident, enthusiastic, and friendly. Smile, lean forward, and make direct eye contact. Don’t cross your arms or fidget. Remember, how you deliver your message can be as important as the message itself.
• Get to the point. Prepare an elevator pitch, a two- to three-sentence description of your company that is easy to understand. In other words, how would you describe your company and its products and services to your mother or the person sitting next to you on an airplane? Make sure it includes the key points you want editors or analysts to remember.
• Avoid jargon. Explain your product or service in layman’s terms. It’s your responsibility to make the pitch simple, clear, and memorable.
• Power of three. Focus on three main talking points and weave them into the conversation whenever possible. Often a reporter or analyst will ask if there is anything else that you would like to add at the end of an interview. Use this opportunity to restate your three core messages.
• Tie to hot topics. Demonstrate that you are a thought leader and can address hot topics such as Meaningful Use, ACOs, and where the industry is heading, not just talk about your product or company. Share the bigger vision.
• Zen of interviewing. When asked a difficult question, maintain eye contact, control your gestures, and breathe. Listen to the question and request clarification if necessary. Give yourself time to collect your thoughts and then respond. If you don’t know, don’t make it up. Offer to get back to the reporter or analyst with the appropriate information.
• Tell a story. People remember stories. Talk about client successes and lessons learned that highlight how your products deliver real-world value. If possible, include relevant ROI data in your storytelling.
• Relationships. Last but not least, it’s all about relationships. Be yourself, be genuine, and have fun. Let editors and analysts know that you can address multiple topics and to feel free to call on you for commentary or to discuss industry trends. Offer your clients as sources for future articles. Remember, these editors and analysts can have an incredible impact on your company’s reputation and marketplace visibility. Take the time to establish and strengthen these important relationships. Your investors, board members, and employees will be glad that you did.

Jodi Amendola is CEO of Amendola Communications of Scottsdale, AZ.

Comparing CEOS – Steve Jobs and Neal Patterson
By Reflective

Interesting comparison of Neal Patterson to Steve Jobs you made. 

Neal is, like most true visionaries, a complex person. I worked directly with him for many years, and while he can be quite the PIA to put up with at times, he is also incredibly compassionate and human and generous at others. He is a great leader, but not always a great manager  – and those are two entirely different things. He would agree with this assessment and has said as much in the book he wrote – manageIT.

As a leader, he sets clear direction to where he wants the company to go and the role he wants you to play in getting there. He defines aggressive and tangible goals that can be measured – and measure them he does. But he can be an impatient manager who doesn’t like to listen to reasons why goals aren’t accomplished (he views them as excuses). He is incredibly picky about the words you select in presenting your arguments. Words are VERY important to him, nearly as important as your intent. If you use the wrong words, he will come at you ruthlessly until you are embarrassed into retreat – many times, in a public forum. 

This is not an easy thing to deal with, and some might view it as unfair. But he does get his point across, and you surely do choose your words carefully the next time. And he has a great radar for detecting bullshit, so I would advising against trying. For your area of responsibility, you better figure out how to be more prepared than him, more informed than him, and have spent more time on the strategy than him – or you will not survive.

I have worked with several truly brilliant folks over the course of my career, and none of them have been easy. The things that they see aren’t always easy for the rest of us to see. The drive that they have to achieve comes from an inner place that we may not ever understand. They are different. They are difficult to be around because they are constantly judging and evaluating everything and everyone – making split-second decisions that can change the course of people’s careers and lives. 

The decisions aren’t always fair or even right , but they aren’t afraid to make them and live with the consequences. And once made, they do not live in the past. They only move forward. Leaders have it in their DNA to do this. Many managers do not.

But I have also observed that these truly visionary, genius-type folks are also acutely aware of their own mortality. They feel that they have a lot to accomplish in the short time they are on the planet. They are afraid they will run out of time to accomplish all they want to accomplish. They hear the clock ticking and they tend to steamroller over others that they feel will impede their progress, not always choosing a path that may yield less collateral damage. 

They are not always fair, and they sometimes listen to the wrong advice and situation summaries from folks with hidden agendas  because they don’t have the time to do everything themselves. Because they are forced to delegate, they can sometimes be manipulated. They may be brilliant visionaries, but they are not always the best judge of people. 

But leaders like these accomplish things that the rest of us cannot. They probably don’t like being labeled "genius" because they just see it as working harder than others. Being more driven than others. They have tenacity and a refusal to accept failure. I don’t think that they are necessarily put here to become beloved. I don’t think that is what’s important to them. What’s important to them is achieving their goals. Making a difference, leaving their mark, changing the world. The accolades, awards, and adoration are not what drive them, no matter how big their egos might be.

They can be incredibly charismatic when they want to be. They are successful leaders because, inevitably, their followers believe in the direction they are headed. They are leading their team into battle, and the team goes – because they believe their fight is right and just and winnable.

You don’t always love being around these types of folks. They are not easy. They wear you out. But it is their difference from the average that makes them successful. We need them. And most of us are changed by being around them. We are challenged to be better than we had been. We are less average by working up to their standards. For as long as we can stand it.

Too Much Football Without a Helmet
By Mike McGuire

I’ve managed to spend the lion’s share of my career in healthcare informatics. I’m not sure if that says I’m brain damaged or that I really admire not only the industry, but also the dedicated people I’ve met over the last 30 years.

I’m choosing to believe it’s the people, even though my bride believes anyone working in healthcare is brain damaged. Her view was formed by her experiences caring for her mother when it was discovered that she had cancer. We’re all too familiar with the story. Patient has multiple providers that are treating her, each focused on their part of the care. Between the drug interactions and multiple protocols, she managed to survive almost four years before she passed. While we were grateful for the time, the quality of those years will always haunt us.

Each of us have gone through a similar scenario or have known someone that has gone through it. Some of us have been around long enough to have survived the ‘80s and the introduction of clinical information systems. In the ‘90s. electronic medical records were introduced, and in the ‘2000s we had RHIOS, then CHINs and now HIEs and ACOs with still no solution in sight.

This weekend, like millions of Americans, I watched the Super Bowl. I marveled at the athleticism of the players, the size of the spectacle, and the precision of the execution of the game. When you think about how these are games scripted beforehand and how the coaches anticipate what the other team will do under certain circumstances, you wonder how they make all those pieces come together? And when they put together the plan, how do they modify it when a new piece of data or a new formation suddenly appears?

Like any battle plan, it’s only good until the first shot is fired, and then it’s constant adjustment. What I saw was that the quarterbacks of those teams had the ability to approach the line of scrimmage, access what they saw, and then had the wherewithal to call an audible. An audible is a new or substitute play called by the quarterback or a defensive formation called by a linebacker at the line of scrimmage as an adjustment to the opposing side’s formation. The audible is communicated by a series of hand signals, numbers, or colors called out by whoever is changing the formation. The players at each position then adjust their attack accordingly.

It’s a tribute to man’s ingenuity that the game of football has figured out a way to seamlessly react to change and adapt, yet we in healthcare can’t even exchange or share basic data. Now I hear the healthcare purists shuddering that the mere thought that I had the audacity to imply that somehow the exchange of patient data is analogous and on the same level as an audible in football. No. My point is that the NFL has figured out that in order to consistently win, you have to continually adjust and be able to communicate those adjustments in real time. This is something we cannot easily do in our healthcare environment.

Our healthcare game plan needs to be built around our two quarterbacks, the patient and the provider. Sustainability can only occur when the 880,000 physician quarterbacks can audible the other members on the patients care team, including the patient. Data exchange must be real time, succinct, and cheap. What we’re building is slow, difficult to maneuver in, and expensive.

Unless we design the game plan around the quarterbacks, my grandchildren will be writing articles about why ACOs and HIEs never delivered the expected results. We are better than this.

Mike McGuire is senior VP of sales for Holon Solutions of Roswell, GA.

HIStalk Interviews Andy Aroditis, CEO, NextGate

Andy Aroditis is president and CEO of NextGate Solutions of Pasadena, CA.

Give me some brief background about yourself and about the company.

I started in healthcare about 20 years ago. I worked for a large institution out here on the West Coast called UniHealth. I started off as a programmer and then I became a programming manager. I worked for a company that had an integration engine. I stayed there for quite a few years. That’s when I had my first exposure to EMPIs and patient registries.

The company that I worked for was STC, Software Technologies Corporation. Then we changed our name to SeeBeyond. We got acquired by Sun Microsystems and that’s when I left.

I set up NextGate with two other partners about seven years ago. The first couple of years, we focused on doing integration and doing upgrades of EMPIs. We stayed within the same space, because that’s our comfort zone and that’s where we stayed.

Gradually as things became available to us, either through open source or through creating our own intellectual property, we set up as a product company. We set up NextGate, which is a parody if you know the names — the engine that we put out quite a few years ago under STC used to be called DataGate and then it became eGate, so we thought it would be funny if we called ourselves NextGate.

Those early integration engine companies got acquired multiple times by large and impressive organizations. What do you think those big organizations saw in those technologies that made them want to be become part of it?

To a certain respect, they bought the customer base. The company that we worked for before, SeeBeyond, had a very large customer base. According to our ex-CEO, we had about 70% of the market. Maybe we had 60% of the market. So we had a lot of the customer base and therefore it made it easier for them to get in there.

If I can just go off on a tangent just for a couple of seconds, it also made it easier for us working for that company to generate new products. That’s how we generated the first EMPI back in the early ‘90s. We went back into our own customer base, and our own customer base guided us through the maze. That’s what makes the product successful, I suspect.

Who are your main competitors?

Obviously the main competitor is Initiate, which got acquired by IBM, which makes it even bigger for us.

When you look at what’s changed since those early days of the ‘90s when everybody was working on these different ways of integrating systems, what are some of the newer challenges and what are some of the solutions for patient identification?

If you remember in the early days, doing integration — and that’s where we spent most of our lives, doing integration –we were lucky to find systems that actually pushed out HL7 messages. The ones that didn’t didn’t really concern themselves too much with patient identification. When I was first asked to set up an EMPI or a master patient index outside the realm of the existing systems, it was unique in a sense because it hadn’t been done before, but looking at it from the integration perspective, it was really necessary.

A lot of the systems pushing out these transactions, HL7 or not, were not exactly accurate enough. They needed some kind of accuracy, because if you remember back in the early days, we all preached the same thing — buy best-of-breed, best-of-breed, best-of-breed and we will bring in an integration engine and integrate this.

But the integration engine wasn’t sufficient, because now you had Andy Aroditis and you had Andrew Aroditis. Trying to figure out how to match those two people wasn’t that easy, meaning matching the order going out from maybe an HIS system to receiving the results back. That’s how we first came up with the first EMPI system, in order to do that, believe it or not.

That’s really almost a simple problem comparatively because people were using the engine just for their own patients. They had multiple systems, but a fixed body of patients. Now with all the emphasis on population health, anybody could be your patient.

Absolutely, and try to deal with patient discovery now over multiple institutions. They used to compete in the past, and now they’re asked to play nicely with each other. 

The biggest thing that we rely upon as an EMPI service is how well the data is captured. A lot of the inaccuracies that you see in terms of the patients and actually maybe even introducing them to or exposing them to treatments that they don’t need is because each system has its own unique way of capturing the data if you can’t figure out how to merge all that and get to the accuracy that you’re looking for. I think that’s the biggest problem that we had in the old days. Imagine now that you didn’t wait 10 or 15 or 20 systems. Imagine how much worse it is today.

I would think it’s also a challenge because at least when it was just a hospital keeping their own records, they could make rules to say, “Here’s when we use a middle initial” or “Here’s how we spell things out instead of abbreviating.” But now that they’re being asked to share data with physician practices that may have a completely different set of data validation rules on the front end, it’s going to be tougher to say, “I’ve got 20 medical practices out there and I need to match those up with my inpatient records.”

You’re absolutely correct. The biggest issue now is if you go to a physician office, depending on how big the physician office is, it’s highly like that they would know you personally. They might have a little bit more accurate data or they have your home phone number because they’ve known you in the neighborhood.

Whereas now if you walk into a hospital, there are two huge scenarios. If you present yourself and you’re on a gurney unconscious and they’re trying to figure out who you are, the way they register you within a system varies from institution to institution. For example, you can go in as John Doe or **Unknown, and then at some point in time when they’ve gone through your pockets and discovered who you are, they will attach a name to you. By then it might be too late because they’ve already done six or seven tests, or they need to do six or seven tests. Imagine if you do that 10 times because now there’s 10 institutions that are trying to participate within the same HIE. Imagine how much worse it is.

Patients can never figure out why it’s so hard when they say, “I gave you my new address, why don’t you have it?” But if you’ve got different points of presence all using different systems, how do you figure out who’s got the most current copy of the address or the phone number?

That’s usually one of the biggest challenges that we have when we implement an EMPI. There’s a couple of phrases that we coined way, way back at the beginning where you installed an EMPI or a registry of some sort — passive mode or active mode.

If you install it in a passive mode, you do the clearing as an afterthought. That’s when you get yourself into a whole lot of trouble. Think of what is happening with NHIN Connect and the engines that they’re coming up with. They’re trying to do the patient discovery up front, and that’s what the active integration is all about. 

For example, if you are within Siemens and you’re looking for a patient, instead of just looking at that, you’re actually looking at an EMPI which is an external to your system. You have better accuracy, because obviously the matching algorithms are more sophisticated in the software that we have. We also introduce fuzzy logic to play into it. When we present a set of patients or a set of names back to you, we can actually rank them and even color them or do something that will attract you and get your attention so you can pick the right person.

Obviously you can never let people click and say, “I’m going to register a new patient” because they can create havoc. But at the same time, if you make it so easy for them not to generate a new patient, they won’t, and they will pick one from the list that you present to them. That makes it easier and more difficult at the same time, depending on how many patients you have to deal with.

I would think the cleansing after the fact is unacceptable now, where you’re trying to take on financial risk and you need to know what tests and treatments have already been done. Or whether this a readmission, where the patient is being seen by multiple facilities. Is that something that can even be tolerated by practices or hospitals going forward?

It’s still tolerated because that’s the foundation of everything, whether you do it as an afterthought or you do it as the point of entry within the healthcare organization. 

Think of it like plumbing. In all cases, you have to have it in place, even though you’re only doing it as an afterthought. Because remember, even if you’re doing an active integration where I hand over the patient’s demographics to the registration system, they still have the luxury of actually messing it up. What I mean by that is they can turn around and say, “Hey, even though your name is Andy Aroditis, now I decided that I’m going to change your address, I’m going to change your phone number, I want to change your cell phone number.”

When it arrives back at the EMPI, because all these records have to be looked at through the passive integration and the plumbing, we can still go through the same identification and say hey, we have certain overlays. For example, I handed you over Andy Aroditis and now you’ve changed everything including the gender and you’re sending that record back to me. You’re creating a situation where you’re putting the patient’s health at risk because now you’ve changed them totally. Or, you’re using the same medical record number, which is totally inaccurate and you shouldn’t be. Which again it puts the patient’s health at risk.

How does the whole idea of patient identification fit into the Nationwide Health Information Network?

The way that it works, at least from my vantage point, is that the moment that you walk in, they can issue what they call a patient discovery, and they can actually broadcast that. There’s been a couple of schools of thought as to how they do that and how they improve the accuracy. Because as you can imagine, if they broadcast it to maybe 50 or 60 different institutions at the same time, imagine all that traffic getting onto whatever network, trying to get all those responses back. There are different ways to do this. 

For example, if I show up in an institution on the East Coast, it’s highly likely that I’m an East Coaster. Obviously there’s people that do travel from the West Coast to the East Coast, so therefore they would search maybe the local one, so they do a patient discovery to the local participants before they begin to launch those patient discovery queries across the states, going from East Coast to West Coast. There’s some logic that goes into this before you can actually do it in a nice way, or do it in a way that it would serve your purposes.

Do you think that there’s enough sophistication within that process that it will be reliable? That if one facility updates a patient’s allergies, let’s say, that everybody else will accept and use that information?

There is, but also the warning is, what if I capture the data somewhat differently? Penicillin allergy to me means ABC whereas to you it means FEG. The data capturing and how you apply those quotes to specific cases even though we do have the ICD-9 and the ICD-10 to make life easier. I’m not quite sure if you can get down to that level in order to improve the accuracy, with people capturing it the same way.

You work with provider registries. Describe what those are used for.

The question that we were asked over and over again with a lot of these HIEs is that the we want to deliver results to a specific provider on a specific day or even on a specific time of that day. In order to discover where the provider provides — no pun intended — the service for that specific day, we need to have some central location to do that. In order for us to know which provider to deliver the results, we need to have the relationship between the patient and the actual provider or the PCP or the person that will receive it, because obviously we can’t just broadcast it to every single provider that is out there.

That was the premise of, how do we identify people, and at the same time, how do I identify the caregivers to those people? We set up the provider registry. The provider registry has the same kind of confusion that a patient registry would have where people are described differently, but it’s more of a deterministic nature. The reason for a provider registry is in order for us to provide a reasonable answer in terms of somebody asking us where do we deliver the results for Dr. Andy, where would he be on Wednesday between 9:00 and 11:00, and what is his fax number? 

That’s the reason why we created a provider registry. In addition to that we also have the relationship that says that, “PCP Dr. Tim is Andy’s PCP and I can deliver results because some other external system tells me that I can and I know where to find Dr. Tim.”

You mentioned that Initiate is a significant competitor. What capabilities differentiate your product from theirs or others?

In terms of functionality — if I can be modest enough, I’m also biased — we have every piece of functionality that they have and then some. The reason that I’m saying that, though, is because a lot of the NextGate employees that are currently working on the product and the delivery of it have been in the EMPI space well before even NextGate came on the scene, meaning we started our work for the company in—and I don’t know how long you’ve been in healthcare – but we used to use an algorithm by a company called Alta, which was up in Northern California. People would deliver tapes, and then the company would deliver reports in terms of the potential duplicates.

It was two guys who wrote a bunch of Pascal routines that would go through tapes and would identify the potential duplicates in those tapes. They would return paper reports back to the medical records department so the medical records department could merge the charts. I happened to discover them quite a long time ago because of my work that I did for UniHealth back in my early days — we used them at the hospital. We managed to get that algorithm and get it embedded within the first EMPI that we developed. All that processing that used to happen in batch, we could actually do it in real time. That’s how our system stood up. We do all the processing in real time and we deliver the accuracy in real time.

Any concluding thoughts?

We started with the EMPI, and we started with the provider registry and the provider directory. All these components and all these registries and the way that they play with each other — we see that as the healthcare data integration platform where you can integrate a lot of disparate systems as the engines used to do in the past, but now we can actually integrate your data from the outside looking in, as opposed to from the inside looking out.

What I mean by that is the whole design and the whole structure of our EMPI is designed to stand alone and be a feeder system from all the HIS systems that are out there, whether it’s a MedSeries4 or an Epic or a Cerner or what have you. Whereas a lot of the Epics and the Cerners and the Siemens, their EMPI is just central to their own operations, and therefore it’s really difficult for them to have that exposed to the outside world. 

That’s the space that we’re in. We think that with the HIS industry growing, we will grow with them.

API Healthcare Acquires Concerro

Workforce management systems vendor API Healthcare announced this afternoon that it has acquired Concerro, which provides hospital staffing and scheduling solutions.

J.P. Fingado, API Healthcare’s president and CEO, said in a statement, “Concerro’s products and client base are the perfect complement to API Healthcare’s existing solutions and markets. Working together we will reinforce our mutual commitment to innovation and dedication to the healthcare industry. This strategic move allows us to leverage a larger number of talented, diverse and clinically-based staff to deliver the high quality of service that separates API Healthcare from our competitors.”

San Diego-based Concerro offers SaaS solutions that include RES-Q (staffing and scheduling), ShiftSelect (shift bidding), ShiftPredict (predictive scheduling), CommandAware (emergency preparedness), and CareConnect (patient acuity). The company is on the Inc. 5000 list.

News 2/8/12

Top News

Cerner reports Q4 numbers: revenue up 23%, EPS $0.52 vs. $0.41, with adjusted earnings of $0.55 beating expectations of $0.53.

Reader Comments

From MU Jackie: “Re: latest CMS attestation data. It’s incredible that the CMS data has been downloaded only 120 times – it’s out there on a silver platter for vendors, consultants, press, etc. I did some quick and dirty pivot tables. For inpatient, if you add Meditech and HCA’s customized version of their product, they are the clear winner, with almost twice Epic’s numbers. For ambulatory, Epic has 2.5 times more than #2 and 10 times Cerner, probably because hospitals do ambulatory first to replace a mixed bag of junk. Coming in at #12 of 250+ vendors with at least one attestation, Practice Fusion shows that it’s real. It would be interesting to do a study of one-doc practices of how little you would have to change your paper ways to ethically attest.”

 From Jon: “Re: eHealth Nigeria. Good for this audience.” A couple of young Americans, one a technologist and the other a medical student, form eHealth Nigeria, working in that country (which has a population of 150 million and 50,000 women die from childbirth complications each year) to digitize healthcare records using the free OpenMRS. They’ve added SMS capabilities for both patients and caregivers since low-end cell phones are the ubiquitous technology rather than broadband-connected PCs. Their poster from the recently concluded mHealth Summit is here.

From Maren: “Re: question. We’re choosing a new HIS vendor and my boss keeps asking how many screens a nurse would use for her daily operations. Any way you can help me? I’ve never seen that statistic.” Neither have I, and I’d have to question its relevance to choosing a system. If it were me, I’d look at how long it takes to document the same activity on each system, then spend time walking with nurses and write down every single time they need a piece of information and where they were at that time. That will give you some idea of how much navigation they will have to do, which may be what your boss is really asking. Perhaps readers can help.

From 143: “Re: digital checklists. Electronic medical records are mentioned.” A detailed article on patient safety checklists mentions Holy Cross Hospital (MD), which has seven employees who review electronic patient records to see if doctors and nurses are following safety standards, which one doctor calls an “in your face” checklist that works even when she is tired or busy.

From SCCM Nurse: “Re: Cerner. Epic must be hurting sales – they just had Domino’s pizza delivered to a high-end Houston steakhouse. They were promptly asked to remove it. How do I know it was Cerner? A very large group of them were wearing their Cerner shirts.” Unverified and hard to believe, but I’ve learned not to argue with someone seeing something first hand (no pun intended.)

From Guillaume-Robert Montagne: “Re: Quebec EMR. Québec is set to expand its Dossier de santé du Québec EMR project to Montréal. The project, almost $1 billion over budget and ‘on track’ to be six years late, was called a ‘failure’ by the province’s auditor general in a report last year. The expansion will create a basic digital record for about 40% of the regional population, and will initially allow for electronic prescribing and the exchange of lab results and radiology data.” I notice they use the tired “unconscious patient in the ED” story to make it sound attractive.

From Woz: You Are Not in Cupertino Any More: “Re: Apple co-founder Steve Wozniak’s visit to Perceptive Software. He talked for about 15 minutes at an all-employee meeting where the software engineers especially just ate it up. He told the engineers that ‘to be a software engineer, have passion … repetition is always helpful to be better than anyone else … and you should mix pleasure and entertainment with your work.’ Having lured away a number of what Perceptive Software believes are some of Cerner’s best and brightest, and a very different culture that includes having a dodge ball court on-site (he autographed one of their dodge balls), it was not surprising that someone quipped ‘we really appreciate his insight, but that advice would have been especially helpful 20 miles to the southeast (the Cerner software engineering center)’.” I should mention that this comment came from an old friend of HIStalk who has no connections to Perceptive Software or Cerner other than having a family member who was there for the visit. Woz’s talk to the employees was captured on a YouTube video.

Speaking of Apple, this newly published Steve Jobs photo comes from the collection of original Mac team member Andy Hertzfeld. If you’re reading this on one of Steve’s smaller-screen devices, I’ll provide a hint as to why the picture is fun: he’s not pointing at the IBM logo, at least not in a polite way.

HIStalk Announcements and Requests

Your HIMSS prep to-do list:

1. Gather up shoes to donate for the Souls4Soles shoe drive.
2. Mentally and physically prepare yourself for the HIStalk Booth Crawl, where you have a good shot to win one of 55 iPads. You will need to schedule a couple of hours in the exhibit hall Tuesday or Wednesday to gather up the details, so make room on your calendar.
3. Find the perfect outfit that will put you in the running for HIStalk King, HIStalk Queen, Best Elvis Impersonator, and Best Left-in-Vegas attire. Fabulous prizes for the winners!
4. Pack your suitcase with shoes that will make you a winner in the Inga Loves My Shoes contest. Categories include the Poker Face (you can’t tell this one works in healthcare); the Russian Roulette (you won’t wanna mess with this shoe); Off to the Races (best boot in town); What Happens in Vegas… (this shoe should stay in Vegas); and the High Roller (this shoe always wins BIG.) The generous Mr. H is throwing in great prizes for shoe fashionistas as well. Dr. Jayne, by the way, tells me she is a shoe-in for one of these five categories.

Welcome to DrFirst, sponsoring HIStalk and HIStalk Practice at the Platinum level. The 12-year-old Rockville, MD company is an e-prescribing pioneer, offering Rcopia-MU, the ONC-ATCB certified modular EHR for practices that aren’t ready to commit to an EMR, who need to attest, or who need basic technology that doesn’t require a lot of implementation headaches or workflow changes in order to qualify for HITECH incentives. The company also offers solutions for hospitals, such as an acute care medication management system that gives hospital EDs the ability to create an immediate 12-month patient medication history by collecting e-prescribing data, along with a discharge module that performs clinical and eligibility / formulary checking of discharge prescriptions before sending them via Surescripts to retail and mail order pharmacies. A brand new offering is its EHR Advisor tool for choosing solutions from among its 200+ EHR vendor partners. Thanks to DrFirst for supporting HIStalk and HIStalk practice.

I checked YouTube for DrFirst videos that describe the company and ran across this one, which we’ve mentioned before. If you’re a “what’s in it for me” type and are going to the HIMSS conference, the company is free offering foot massages and a grand prize for commenting on the video over on YouTube.

Welcome to new HIStalk Platinum Sponsor Health Data Specialists, LLC. The company offers competitively priced consulting services to hospitals that use Cerner, Epic, Meditech, and Siemens, as well as offering assistance with project management, ICD-10, and Meaningful Use. Their consultants are highly experienced, with its Cerner consultants, for example, averaging 10 years of experience with Cerner applications and 21 in healthcare (even its Epic consultants average eight years of Epic experience and 23 in healthcare.) Their long list of clients includes Spectrum, VCU, Carolinas, and North Broward (Cerner); Children’s Omaha, Driscoll, Cleveland Clinic, and Sentara (Epic); and Alegent, KUMED, BayCare, and Yakima Valley (Siemens.) You may know CEO Bob Hayden since he’s been in the industry for 38 years, including serving as a large health system CIO and founding and running First Choice Consulting. Thanks to Health Data Specialists, LLC for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

Revenue cycle solutions vendor Recondo Technology acquires Trilogi, Inc., a revenue recovery firm.

Health Evolution Partners and Verizon Enterprise Solutions form a relationship to encourage companies to develop technologies related to mobile health, telemedicine, and health data management. Health Evolution partners chairman David Brailer is quoted in the announcement as saying:

The next generation of health IT will not be anchored to a desk. Clinicians and patients will expect technologies that support mobility and virtual care. Advanced broadband, video-based technologies and wireless devices that incorporate geo-location capabilities and sensors will change the landscape of health care from development to delivery. Our relationship with Verizon demonstrates the importance of bringing these innovations to market.

Radiology center operator Foundation Radiology closes on a $2 million offering led by Chrysalis Ventures. The healthcare IT connection is that the company’s CEO is former Misys Healthcare CEO Tom Skelton and one of its directors comes from David Brailer’s Health Evolution Partners.

Mediware reports flat Q2 earnings of $0.21 per share, despite an 18% increase in revenues to $15.6 million.

As part of its Q4 earnings report, HCA reveals that it received $306 million in EHR incentives for 2011 and spent $77 million in EHR-related expenses.

University of Washington spins off TransformativeMed, which uses Cerner’s MPages mobile data access technology to create add-ons to Cerner PowerChart. Modules include a rounding application and a quality dashboard.

Sales

Advocate Christ Medical Center (IL) selects PerfectServe’s clinical communication and information delivery platform.

Memorial Hospital of Converse County (WY) chooses Summit Healthcare’s Express Connect interface engine technology to connect Meditech with Avera Health’s eICU solution.

Southern California Hospitalist Network purchases PatientKeeper Charge Capture solutions for its network of physicians.

Radiology Ltd. (AZ) selects Merge Healthcare’s suite of radiology solutions for its nine imaging centers. Also, Southern Illinois Healthcare will implement Merge Healthcare’s cardiology suite across its six hospitals and clinics.

People

HIMSS honors Carol Bickford PhD, RN-BC, CPHIMS and Kathleen Smith MScEd, RN-BC, RHIMSS with its Nursing Informatics Leadership awards. Russell Leftwich MD is awarded its Physician IT Leadership award.

John Calabro joins Cognosante as managing director of HIT offerings for state and federal clients. He most recently served as HIT coordinator for the State of Oklahoma.

CSC names Misys PLC CEO Mike Lawrie as president and CEO.

Don Bauman (Isabel Healthcare), Andre duPlessis (Tulane Medical Center), and Gary Ferguson (TIBCO) join VoiceHIT’s board of directors.

Announcements and Implementations

Presbyterian Healthcare Services (NM) implements MRO Corp.’s release of information and audit tracking software and services.

Geisinger Community Medical Center (PA) will move to Epic as part of a five-year, $159 million capital improvement project funded by its new owner, Geisinger Medical Center.

T-System introduces T-System Performance eRX, an e-prescribing solution for EDs and urgent care clinics.

CarePartners Plus announces Wellby, a kiosk that collects patient perceptions immediately after their encounter to allow timely intervention and education.

Government and Politics

AHRQ announces a new Questions are the Answer public education initiative that encourages patients to talk to their healthcare providers. Practices can get free materials, including a video, brochure, and notepads. Above is a fun public service announcement that got me wiggling in my chair in time with the music.

A USA Today article says that Newt Gingrich’s Center for Health Transformation hired lobbyists and some of its employees used their experience there to land lobbying jobs, although Gingrich insists the organization performed no lobbying for its clients.

The British Government releases a mobile app to help citizens find hospitals and clinics.

Other

Massachusetts eHealth Collaborative president and CEO Micky Tripathi is featured in a Bloomberg Businessweek segment on healthcare data security. He first discussed the data breach on HIStalk Practice.

Alpha Financial Solutions files a $1.6 million breach of contract lawsuit against Wheeling Hospital (WV), claiming the hospital’s termination notice for the company’s billing services contract was not delivered in writing as required. The company also claims that the hospital made copies of its intellectual property, locked out its managers, and improperly hired 20 of its 24 on-site employees. It also says that he hospital “seized” its servers that contained the PHI of other customers.

Hospitals are using patients’ clinical and financial information stored in their systems, along with databases sold by consumer marketing firms, to selectively pitch profitable services to patients with private insurance. St. Anthony’s Medical Center (MO) spent $25K on targeted mailings for mammograms, personalizing each piece with a photo of a person of similar age and gender to increase response rates, and brought in 1,000 patients and $530K in revenue.

Sponsor Updates

• Kern Medical Center (CA) selects McKesson Revenue Management Solutions to interface with its existing Horizon Practice Plus.
• Healthcare IT professionals say that disaster recovery is their top priority for investment, according to a BridgeHead Software survey.
• Elsevier releases SimChart, a simulated EHR designed for nursing students.
• CareTech Solutions added 22 hospital service desk clients in 2011 and grew its revenues 22%.
• iSirona announces its successful interoperability testing at the IHE 2012 North America Connectathon. iSirona will also participate in the HIMSS12 interoperability showcase.
• Practice Fusion earns a nomination for “Biggest Social Impact” in the fifth annual Crunchies Awards.
• Campbell Clinic (TN) selects SR for its 43 orthopedic physicians.
• Mac McMillan, CEO of CynergisTek, will serve on the faculty of the inaugural Canada-United States Healthcare IT Summit.
• Barbara McNeil MD, PhD of Harvard Medical School joins Humedica’s Scientific Advisory Board.
• A Billian’s HealthDATA and Porter Research Webinar on healthcare business intelligence and analytics is now available for on-demand viewing.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

EHR Design Talk with Dr. Rick 2/6/12

Why T-Sheets Work

Disclosure: I have no financial interest in T-System, Inc.

There is nothing particularly high-tech about a T-Sheet. A T-Sheet (designed by T-System, Inc.) is a particular design for a double-sided, single-page printed paper form used to chart patient visits. T-Sheets are extremely popular and have been widely adopted by emergency department and urgent care physicians.

Why do many physicians prefer using T-sheets to the more technologically advanced EHR solutions that they are increasingly being required to adopt?

There are of course many reasons. One is so basic — and is such a defining property of the paper form in general — that we tend not to even notice it: T-Sheets assign each category of data to a box of fixed size and fixed location on the page.

A second reason T-Sheets are popular is that each presenting problem (chest pain, abdominal pain, headache, and so forth) has its own customized T-Sheet template. But regardless of the specific problem and the specific data collected, the spatial layout of data categories is kept exactly the same.

Here is an example of the front side of a T-Sheet for an emergency department visit that I have redrawn and greatly simplified to emphasize its high-level spatial design.

Regardless of the reason for the emergency department visit (in this case, chest pain), the box on the top right has a fixed size and location. It is always set aside for the review of systems (ROS). Similarly, regardless of the reason for the visit, the box on the bottom right has a fixed size and location. It is set aside for the family history. And so forth.

This means that once I learn where each category of data is situated on the page, I can just glance at that box to retrieve the desired information. Its position doesn’t change depending on how much data is written in the boxes above or next to it. The information remains readily available when I’m viewing a different box. I don’t have to carry it in my head.

The locations become automatic after a while. I don’t have to read the box headings. And if I need to compare the current visit to a previous one, I can just place the two T-Sheets side-by-side and glance at the same location on the two sheets to find the comparable data.

In my last post, Computer-Centered versus User-Centered Design, we saw how the spatial arrangement of data allows us to solve certain problems visually with minimal cognitive effort. But even if our task is just to take in and organize a large amount of data, a fixed spatial arrangement is a very good design.

Humans are visual animals par excellence. The human visual system is very good at organizing objects in space. T-Sheets and similar paper forms work because they enable us to use our extraordinary visual and spatial processing abilities to make sense of abstract data, even though these abilities evolved to help us organize physical objects in the real world.

Despite its simplicity, the paper form — with every data category assigned to a fixed location on the page — is a powerful cognitive tool. By allowing us to use our perceptual visual system to organize and retrieve a large body of information, it leaves our finite cognitive resources available for patient issues.

This all may seem obvious. Unfortunately, many EHR designs did not go in this direction, only in part because of technical constraints. Instead, clinicians often are required to navigate to multiple screens in order to enter or view different categories of data, as in the example below:

Of course paper forms have their own problems — how do you record more information than fits in a particular box, bring historical information forward to the next encounter without laboriously re-entering it, read illegible handwriting, and so forth? But still, assigning each data category a fixed screen location is a good model. So in rethinking EHR design, one strategy is to retain fixed spatial location as a high-level design element, but improve the paper design by making it interactive.

We need interactive T-Sheets.

Next Post:

Humans Have Limited Working Memory

Rick Weinhaus MD practices clinical ophthalmology in the Boston area. He trained at Harvard Medical School, The Massachusetts Eye and Ear Infirmary, and the Neuroscience Unit of the Schepens Eye Research Institute. He writes on how to design simple, powerful, elegant user interfaces for electronic health records (EHRs) by applying our understanding of human perception and cognition. He welcomes your comments and thoughts on this post and on EHR usability issues.

Curbside Consult with Dr. Jayne 2/6/12

The past week has been crazy, and unfortunately the crazy spilled into the weekend as well. I had visions of the perfect thought-provoking topic for this week’s Curbside Consult, but every time I tried to flesh something out, it escaped me. Instead, I found myself musing on what I planned to do at HIMSS and which vendors I wanted to be sure to check out. Mr. H and Inga are hard at work on their “must see” vendor list and I’m working on my personal CMIO hit list.

For the CMIO (or anyone involved in evaluating new products or making purchasing decisions) it can be a great way to sort the proverbial wheat from the chaff. Many products look great in brochures or on the Internet but pale when you see them in person. Last year one of my “hot items” (sad that I think this is hot, isn’t it?) was wall-mount swing-arm brackets for monitors. The true test of quality and sturdiness is being able to check them out in person rather than trust a marketing slick.

You may ask, why does a CMIO care about brackets, and should she? The answer is yes. If I have to use it every day, I want to make sure it’s going to work for me and for the hundreds of physicians I represent. That’s not to say that the CMIO should be out personally investigating everything that needs to be purchased. Generally I prefer that the engineering and purchasing folks work their magic first, culling the herd down to their top choices, then allow a small group of providers to make the final call.

This year I have a laundry list of things to look at. Some are a bit gadgety (washable keyboards, COWs), others are more esoteric. I want to see how vendors are progressing with natural language processing and where they stand with clinical decision support. Are they going home-grown, or incorporating third-party solutions? How are the attendees responding to them? Who has incorporated Medicomp’s Quippe product that blew our minds at HIMSS11?

Like last year, I hope to have some time to cruise the exhibit hall with Inga, but I will also have some time to peruse the booths with a few other CMIOs and share their opinions and thoughts. One of my friends is a first-time attendee, so watching his expression as he sees some of the people out there will be interesting. A note to ChipSoft: I see you’re exhibiting again. If you’re giving away the clog slippers this year, please stash some for Inga and me because we’ll be looking for them and you ran out last year.

The marketing materials from exhibitors are arriving much more slowly than I remember from last year. So far, my favorite marketing piece is from CDW Healthcare, with their “What happens at HIMSS definitely won’t stay at HIMSS” tagline and accompanying poker chip. Although I like the idea of taking home things I learn, based on the potential for Inga and Jayne to have a good time, I’m sure some things will be staying well within the 89109 zip code.

Speaking of marketing, I received quite a response to my comment on why the soles of Christian Louboutin shoes are red. One reader shared his shame:

I must know. During a Battle of the Sexes trivia contest, I and my fellow male panel of knowledge brokers failed to identify the maker of the famed red sole shoe. It was the tipping point in a tight contest that found us falling to the gals. I now must know why the soles are red…

A certain savvy reader provides the answer:

Just a quick comment to say I thoroughly enjoy your commitment to giving your readers a well-balanced education. Not just what’s up in healthcare, but why CL shoes have their distinctive red sole! A mundane process turned into a brilliant marketing differentiator. I’ll be looking out for them!

In short, it’s all about branding. Louboutin trademarked the red-soled look in 2008, fighting to protect the distinctive look when Yves Saint Laurent came out with a red sole in 2011. YSL claimed in court documents that red soles existed long before Louboutin trademarked them:

Red outsoles are a commonly used ornamental design feature in footwear, dating as far back as the red shoes worn by King Louis XIV in the 1600s and the ruby red shoes that carried Dorothy home in The Wizard of Oz.

There’s your fashion moment of the day, and hopefully some of you can leverage this newfound knowledge to win the hearts of your lady-friends who might have a thing for shoes, not to mention to triumph in the next battle of the sexes trivia night.

Have a favorite HIMSS (or other show-related marketing piece) to share? Does it belong in the Hall of Fame or Hall of Shame? E-mail me.

E-mail Dr. Jayne.

Monday Morning Update 2/6/12

From Kit Carson: “Re: Fletcher Flora. I’m interested in knowing what’s going on with shareholders. The final distribution statement was supposed to go out in November 2011.” We broke the news in November 2010 that Merge Healthcare had acquired the LIS vendor (I forget how I found out, but it must have been sneaky since I worded it as “HIStalk has learned,” which means I was snooping.) I don’t know anything about its shares, but I’ll run an update if anybody has one.

From Adele: “Re: HIStalk. As a sponsor, thanks for all of your hard work toward making HIMSS as productive as possible for your subscribers and for your sponsors. We are grateful that you all actually make the time to track our news and offer your suggestions to us when there are so many larger ‘fish to fry’ in your universe. HIStalk is one of the only places that provides for an equal voice for all of its sponsors, regardless of size, revenues, or politics. As a smaller company, we just can’t write a fat check simply to pay to play in some other channels. Moreover, we wouldn’t. For us, that is just not responsible stewardship of our clients’ resources.” Sometimes Inga and I need a little boost and this gave us one. Thanks.

From Vendor_Neutral: “Re: Epic. Wondering if you came across the online discussion spurred by the NYT piece?” I did see it, but like a lot of Internet discussion, I found it to be mostly hot air pontificating by industry sideliners and self-referencing, self-appointed experts who have never used Epic, aren’t clinicians, and don’t even work in healthcare IT (if you’re going to criticize a restaurant, at least eat there a couple of times.) Some of the least-informed comments drone on about Epic’s outdated technology, a clear signal that the authors have no experience in a business software environment, where customers value applications that are solid, scalable, and expertly managed over the latest iPad app or cool Web site. To dismiss the business and software savvy of hospitals that are buying Epic in droves is ludicrous, even if you (as I) doubt that most of them have the organizational fortitude to get the rosy ROI and patient benefits they expect when they fork over mega-millions. Somehow I doubt that Judy is losing sleep worrying that all the armchair quarterbacks will redirect their expertise into building a better mousetrap that will renders hers as obsolete as the company’s persistent detractors claim it already is.

From CDS Observer: “Re: FDA regulation of clinical decision support. This could be serious since it could involve a wider range of systems to be regulated, such as EMRs and simple apps. This would be a big blow to many smaller companies. Our company has joined CDS Coalition to make our voice heard and to keep members informed in case their product ends up getting included in the regulatory net.” I found the CDS Coalition’s Web page here. Companies pay $1,200 to $30,000 per year to join.

From Ambergris: “Re: KLAS scores of publicly traded companies. Didn’t you post something at one time?” That was actually Evan Steele of SRS, who made the point in October that five of the six top-rated EHR products are offered by privately held vendors, while eight of the nine lowest-ranked products are offered by publicly traded companies. To be fair, he’s only looking at customer support rankings of a specific ambulatory EHR category. However, I will add from experience, having had a few incumbent vendors go public or be acquired by publicly traded companies, that every one of them got worse afterward (I’ve written many times on the KLAS “first to worst” product phenomenon.) Investors replaced me as the company’s most important customer. I’d like to say it doesn’t have to be that way, but I can’t think of many exceptions. On the other hand, if you buy from the company after they’re public, at least you know what you’re getting and have less reason to be disappointed compared to the folks who knew them before.

From Jess: “Re: fast track clinic model for expediting medical services to patients coming to the hospital. I was hoping I could tap into your vast knowledge base to see what you know about this model.” I think you are overestimating the vastness of my knowledge base since it’s coming up empty on this topic (although come to think of it, “vast” usually means big but empty.) I will call in the assistance of expert readers to fill my void.

From The PACS Designer: “Re: Jobs biography. The biography Steve Jobs by Walter Isaacson has some interesting comments. Jobs said of Microsoft’s Bill Gates, ‘Bill is basically unimaginative and has never invented anything, which is why I think he’s more comfortable now in philanthropy than technology.’ Isaacson said this about Steve: ‘He was not the world’s greatest manager. In fact, he could have been one of the world’s worst managers. He could be very, very mean to people at times.’" I think that’s what I enjoyed most about the book – trying to figure out how someone so narcissistic, uncaring, and downright nasty could not only create arguably the world’s greatest company, but run it as a publicly traded company CEO almost until the day he died despite seemingly lacking all the important skills for the job. The only other example I could think of was Neal Patterson of Cerner. And Bill Gates. I guess the bottom line is that if you’re a visionary who started the company (see: Mark Zuckerberg), you can mold it to your bizarre personality, unlike the typical gunslinger, committee-vetted musical chair CEO that big corporations love who are loaded with MBA school bean-counting competency but short on anything resembling risk-taking, innovation, and vision.

The good news about offshore programming is that half of responding readers don’t automatically assume it means shoddy work. The bad news is that the other half do. New poll to your right, and this should be fun: who is most responsible for the glut of clinically useless EMR information?

Inga and I forget ever year just how busy we get in January and February in the HIMSS build-up period: interviewing, plowing through increasing numbers of pointless press releases to find the occasional newsworthy tidbit, adding new sponsors, and planning HIStalkapalooza. If we’re slow to respond, that’s why. I came home from a nine-hour day at the hospital Friday, chowed down the Wendy’s salad and baked potato helpfully provided by Mrs. HIStalk on her way home from work since she knew I was overwhelmed and had approximately 15 minutes of free time to eat, and worked eight straight hours on HIStalk stuff without even leaving my chair. Six hours later, I was back up and at it for another long day Saturday, where emerged like Punxsutawney Phil only long enough to see my own shadow during a brief lunch with Mrs. H, then get back to work. That grind won’t end for us until the conference is over. I will need (and am taking) a vacation afterward, assuming I survive until then, and Inga will be away the week after. The worst thing is that, like a crack user, I enjoy it and can’t see cutting back even though it’s probably unhealthy. While I’m away, I’ll plan my self-improvement for the rest of the year, so if you have ideas of books I should read, conferences I should attend, or things I should do, let me know.

Speaking of HIStalkapalooza, thanks again to ESD for putting together an outstanding event. It’s a big effort to have planners visit potential sites, work out food and entertainment details, handle logistics like registration and decorations, and of course write a huge check when it’s all over. They have been outstanding to work with, and since they get what HIStalk is about, they suggested some fun surprises that I heartily approved. If you need consulting help with your clinical systems projects (training, implementation, support, optimization, Meaningful Use, etc.) I’m sure they wouldn’t be opposed to taking your call. If you got an HIStalkapalooza invitation, please thank them when you get there. I wasn’t even sure I wanted to do another event this year, but I think it’s going to be cool.

Also fun: Medsphere is bringing over its 1971 VW open source bus, which Chairman Mike Doyle tells me will be available “to shuttle HIStalk groupies to your event on Tuesday.” I don’t know what they’ve planned for routes and all that, so maybe just flag it down if you see it if you need a ride to the Palazzo.

I’ll put in just a brief placeholder for our Booth Crawl, which will offer provider attendees of HIMSS what I would guess is their best chance to impress the fam by bringing home an iPad 2. Think of it as a scavenger hunt where you visit the designated booths to get the answers to secret questions (you’re visiting booths anyway, so you might as well hit these and get in the running for a swell prize.) You enter those answers online by Wednesday evening and watch HIStalk to see if you are one of the randomly drawn winners. You don’t have to get stickers or stamps on a card, you don’t have to drop your entry into a hopper, and you don’t have to be present to win. We have 55 iPads to give away, so the odds should be pretty good, plus you’re supporting our sponsors just by playing (not to mention that I noticed that a couple of sponsors have added prizes of their own.) I’ll be posting the form shortly. Nobody’s making money off this since we’re doing the work on our end for free and the sponsors happily donated the prizes, so for everybody involved it’s all about putting iPads into the hands of readers.

One last HIMSS note: if you aren’t attending, we will try our best not to make you feel left behind even though we have to write a lot about it. I think I speak for most readers in saying that the more years you go, the less you enjoy it and the more it becomes work instead of fun. I stay up until all hours each night at the conference writing everything up so you won’t miss anything important. The educational sessions are always iffy if you don’t research the presenter’s credentials in advance – I should hire someone to help me put on independent Webinars that would provide similar education without the travel and time off expense, which I’ve been talking about doing for years.

I verified that RelWare has closed its office and let half the staff go, having lost the client for which it developed its EXR EHR, Henry Ford Health System. HFHS went live on the $100 million system, then decided less than a year later to have a $350 million fling with Epic instead (note to self: don’t ask HFHS for long-term IT strategic planning help.) RelWare is sitting on a certified EHR (Inpatient and Modular Ambulatory) that is running in six hospitals and 100 clinics that will soon be homeless, so they’ll consider licensing arrangements or outright sale of the source code to interested organizations. My RelWare contact is somewhat informal, so I guess you can e-mail me if you’re interested and I’ll forward.

Travis has been writing some really good stuff on HIStalk Mobile lately. The fun mixture of pieces includes, in the three most recent posts, (a) a hands-on review of the Zeo Sleep Manager; (b) a new post that contains a lot of items that I hadn’t seen elsewhere; and (c) his take on mobile strategies for pharma. He’s a doctor and an mHealth startup guy, so while I’ve seen splashier sites covering similar ground, I haven’t seen any doing it better.

Thanks to the following new and renewing sponsors that supported HIStalk, HIStalk Practice, and HIStalk Mobile in January (click a logo for more information). You have to admire them for mailing off a check to a post office box to an anonymous, smart mouth blogger without so much as a phone call to sooth any concerns they might have. They either sign up after reading the information sheet or they don’t, and we appreciate those who do.

Epocrates earns Ambulatory Complete EHR certification for its EHR v2. I had forgotten they had one, to be honest. They acquired the iChart mobile app a couple of years ago and rebuilt it into a full product, announcing GA in July 2011.

TrustHCS names Dianne Haas PhD, RN as executive director of its consulting services division.

Morton Meyerson joins the board of Encore Health Resources. He’s the former CEO of Perot Systems and runs Dallas investment firm 2M Companies, Inc.

Office for Civil Rights has cranked up their HITECH-mandated spot-check HIPAA audits, with the first 20 lucky organizations being notified in December that they had been chosen (with 130 more planned for 2012.) CynergisTek and ZixCorp are running a free Webinar next week featuring former HHS HIPAA enforcer and attorney Adam Greene and some folks who participated in those first 20 audits. If anybody has time to sit in, let me know the gist.

Vince’s HIS-tory lesson this week gets a bit more personal, honoring former SMS VP Jim Carter. Vince’s stuff isn’t just for the long-timers – whippersnappers can learn from the HIT history books, too.

McKesson acquires the oncology clinical decision support tools of Proventys.

Lawson announces that its Cloverleaf integration technologies have met the highest industry standards at the IHE Connecthon.

Joint Commission investigates a complaint against University of Michigan Health System that says it waited six months before telling police that child pornography had been found on a medical resident’s flash drive in the ED. Joint Commission is considering whether the delay qualifies as a sentinel event.

Revenue cycle vendor Accretive Health, already being sued by the State of Minnesota over a lost laptop, has its debt collections license suspended by the state until it provides information about how it was using patient information for collections and how its collectors interacted with patients.

Apple CEO Tim Cook, showing more support for charitable activities than his predecessor, says the company has donated $50 million to Stanford’s hospital, most of it for new building construction. Maybe he should have looked for charities that don’t run a hugely successful business already given that Stanford Hospitals and Clinics reported a profit of $186 million in its most recent government reports, paying its president almost $2 million and the CIO $680K. I’ll say this: when I donate to charity, it’s never to a hospital, including the several I’ve worked for. They are making plenty of money already, wasting significant amounts of it, and not really helping improve health as much as just providing more episodic healthcare encounters. I’d rather support public health causes that keep people from becoming their customers, such as those addressing obesity, disease management, and preventive care.

HIE vendor Sandlot Solutions names Joseph Casper, formerly  of MedPlus, as CEO.

We asked readers to let us know if they were presenting at HIMSS after one expressed concern that as a first-time presenter, she might be standing in a nearly empty room. Here are those who submitted their information.

Session # 55: Tale of Two Health Systems: Implementing an Enterprise Data Warehouse

• Two major health systems (Orlando Health and Essentia Health) present their lessons learned and benefits achieved via an enterprise data warehouse initiative.
• Rick Schooler, Orlando Health Ken Gilles, Essentia Health
• Tuesday, February 21, 12:15 PM – 1:15 PM

Session #31: Marketing the Healthcare IT Project

• Effective marketing is a crucial part of any IT project- We will discuss innovative ways you can market to end-users and provide real examples from premier health systems to amp up the marketing initiatives within your organization.
• Chuck Christian, CIO Good Samaritan Hospital Steve Bennett, VP Kirby Partners
• Tuesday, February 21 @ 11:00-12:00 Murano 3303

Session # 42: EHRs: The New Drug Safety, Liability and Efficacy Battleground

• The rapid adoption of EHRs by U.S. providers creates a new and powerful platform to improve patient safety, professional liability protection, drug efficacy and regulatory compliance.
• Edward Fotsch, MD, Chief Executive Officer, PDR Network David Troxel, MD, Medical Director, The Doctors Company
• Tuesday, February 21, 12:15 PM-1:15 PM (Marco Polo 803)

Session # 110: A Community HIE that Makes Cents while Improving Health Location

• MyHealth Access Network, a Beacon Community in Tulsa, is focused on improving health with a community-wide infrastructure for healthcare IT learn their approach and associated ROI evaluations.
• David Kendrick MD, MPH, CEO MyHealth Access Network, a Beacon Community
• Wednesday, February 22, 1:00 PM – 2:00 PM

Session# 211: Increasing Nurse Leaders’ Informatics Skills: Building from the TIGER Competencies

• Provides a discussion of the application of TIGER competencies to create institutional education programs to increase nurse leaders’ informatics skills.
• Melissa Barthold, MSN, RN-BC, CPHIMS, FHIMSS IT Senior Clinical Solutions Consultant University of Mississippi Medical Center Jackson, Mississippi
• Friday, Feb. 24th, 2012 10-11 AM

Session #66: Extreme Makeover – ICD-10 Code Edition: Demystifying the Conversion Toolkit

• ICD-10 translation engine tools, code mapping tools, crosswalks, GEMs, code simulation tools, medical language/content management tools, computer-assisted coding software, and more — what’s a healthcare organization to use?
• Deborah Kohn, MPH, RHIA, FACHE, CPHIMS Principal Dak Systems Consulting
• Wednesday, February 22; 8:30 – 9:30 am

Session #153: How to Create a Care Coordination Team Using Spare Parts

• Learn about a primary care group’s innovative model of care coordination which combines standard EMR functionality + clinical checklists + low cost staff to make life easier for physicians and patients, while improving quality and saving time and money for everyone!
• Lyle Berkowitz, MD, FACP, FHIMSS Medical Director of IT & Innovation, Northwestern Memorial Physicians Group (NMPG) Associate Professor of Clinical Medicine, Feinberg School of Medicine at Northwestern University.
• Thursday, Feb 23: 9:45 AM – 10:45 AM (Marcello 4502)

Session #32: The New Millennium of Enterprise Patient Centric Care across the Revenue Cycle

• This presentation will review how the Cleveland Clinic is transforming traditional revenue cycle management by implementing an enterprise patient administrative management system, aligned to their Patients First Initiative.
• Lyman Sornberger, Executive Director Revenue Cycle Management, at Cleveland Clinic Health System, and Dawn Mitchell, Principal, Aspen Advisors
• Tuesday, 2/21 – 11:00am – 12:00pm

Session #406:  IT Governance for Hospitals and Health Systems

• Learn how to create an IT governance process that increases the number of projects that support your organizational strategy and are completed on-time and on-budget.
• Roger Kropf, PhD, Professor at New York University, Wagner Graduate School, and Guy Scalzi, Principal at Aspen Advisors
• 1 of only 12 HIMSS eSessions

Session #9: The People of Clinical Decision Support

• I’ll present results of a qualitative study I conducted along with OHSU’s POET research team at seven hospitals and health systems across the US focused on the types of people needed to carry out a clinical decision support program.
• Adam Wright from Brigham and Women’s Hospital in Boston
• Tuesday, February 21 @ 9:45 AM in Veronese 2503

Session #163: Applying Lean Principles to Ensure Clinician Productivity while Securing PHI

• In this session we will explore the process and results of applying Lean principles at Mahaska Health Partnership to measure clinician productivity and minimize waste when implementing security technologies.
• Kristi R. Roose Information Technology Director, Mahaska Health Partnership Dan Nikkel Continuous Improvement Director, Mahaska Health Partnership
• Thursday, February 23, 1:00 PM – 2:00 PM in Lido 3103

E-mail Mr. H.

Time Capsule: What Paul McCartney Can Teach Providers about Contract Penalties

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in February 2007.

What Paul McCartney Can Teach Providers about Contract Penalties
By Mr. HIStalk

This is top-secret provider stuff. If you work for a vendor, why not skip on down to the news items? I’m about to tell your prospects to take actions that you’ll dread.

As a hospital IT person, I would never sign a vendor’s software contract without including a variety of specific and severe performance penalties. From recent Inside Healthcare Computing articles, many or most hospitals will. I’m shocked. I like vendors, but money makes people (and companies) behave badly. Be friendly, but get everything in writing.

Vendors (software or otherwise) can say anything they want about their product’s performance and reliability. Those statements can have one of three possible outcomes:

• If the company is both knowledgeable and honest, you will be pleasantly unsurprised when their product works as advertised, but at least you won’t be caught unaware by a major meltdown. That’s the best (but not necessarily the most common) outcome.
• If the company is honest but doesn’t have broad enough experience with their product in a setting like yours, you’ll probably be miserable together, hoping they’re as responsive as they are honest. That’s bad. Sometimes you hit architecture or design flaws that can’t be fixed, in which case you’ll use resources to work around the problems.
• If the company is lying or has wildly oversold their wares, nothing else matters because you’ve been suckered into a long-term, expensive, and contentious relationship with a vendor that has already demonstrated its willingness to take your money under false pretenses. That’s the worst case.

The biggest mistake hospitals make is uncovering problems with previous implementations, but then buying the product anyway. The most common rationalization: “We’re smarter than those rubes who couldn’t make it work, plus we really like the product and the salesperson.” That combination of naiveté and misplaced bravado has lined many a sales rep’s pocket. It often benefits an executive recruiter, too, since the CIO who ignores a product’s well-known, spotty history often has plenty of free time to reflect after he or she has been shown the door.

Vendors may not be thrilled to see the list of penalties you want, but they aren’t your best buddies. They have their bottom line price and terms. You’ve got yours. Negotiation is meeting somewhere in that middle ground, fighting for the bigger chunk of the unclaimed territory on the table. If the vendor doesn’t visibly hate you during negotiations, you’re not pushing hard enough. Nice guys and gals don’t get good deals.

Contracts without penalties are binding only to the customer. If the software fails to provide value, crashes constantly, or can’t be used like you were told, you still pay unless you were smart enough to write in penalties. Your want their skin in the game with yours.

The most important eventualities to cover with penalties:

• If the software doesn’t do what you were promised in a way that makes it unusable.
• If you have problems that will cause you the most harm: downtime, poor response time, or cancelled development plans.
• If the software or vendor has weak areas that sound like trouble. If the salesperson’s teeth clench up when you lay out penalty terms for failing to deliver a richly functional ED package or a CPOE-to-pharmacy interface, maybe you haven’t heard the truth.

A hard-hitting, predefined penalty is your best hope for getting undivided attention when a problem arises. The cash won’t be much consolation, but it does create an automatic escalation path respected by all.

I know we all like to throw harmless little love words around like “partner” and “shared vision,” at least until you’ve signed the deal. Vendors pretend to be wounded when you sully the honeymoon bed with legal requirements. Take a lesson from Paul McCartney – maybe the vendor is a wonderful partner who loves you for something other than your money, but make them sign an air-tight prenuptial agreement just in case. Secretly, they’ll admire you for it.

HIStalk Interviews Brian Sherin, President, Besler Consulting

Brian Sherin is president of Besler Consulting of Princeton, NJ.

Tell me about yourself and about the company.

I got started in healthcare accidentally. I was doing an internship while I was in college, in an accounting department of a hospital. I can still see the face of the controller who I worked for at the time when I walked in, that look of, “I’m going to deal with this kid all summer?” But we got along well and I did that for two summers. I got involved in a lot of aspects of accounting, although my major was finance, not accounting per se. 

When I came out of grad school, I ended up in a very a bad economy, pretty similar to now, and I didn’t have a job. One of the guys I worked with in the accounting staff there called me and said, “Are you interested?” and I said, “Well, sure.” So I did that, and then about eight months later the controller asked me if I wanted to take the business office manager position. I lost a lot of respect for them at that point [laughs] –I thought he had better judgment than that since after, all I had virtually no experience. But he told me he had confidence in me and I could do it, so away we went.

Over the next 11 years, I moved from patient accounting to managing the overall revenue cycle, worked closely with HIM and other clinical departments. I eventually I took over on more administrative responsibilities. To this day, I’m really grateful for the guy having confidence in me at the time. He gave me an opportunity to learn so much and to set me on my career path.

As you can tell by now, I’m not an IT expert in any way, but I think from the business perspective I am very much an advocate of using technology to every advantage possible. I guess I could stretch it and say that I’m an IT user expert, or maybe advocate is a better way to put it. As I look back at my career, some of the more positive and exciting experiences I had were overseeing several HIS system implementations for the hospital. I just found them really very rewarding once completed. I’d like to do some more of that, but I haven’t been involved with those for a while. 

While still at the hospital, I talked to Phil Besler one day. He had founded the firm back in 1986 — this was probably the early ‘90s. I joined him. It was really a reimbursement firm back then. That’s all we did except some charge master work. We began to expand that and we moved into doing hospital revenue cycle consulting in the mid ‘90s. Those areas grew pretty quickly. Finally we established a coding accreditation compliance service line, which rounded out our service offerings.

Now I would define us as a financial and operational consulting firm. We have about 200 customers in 20 states and roughly 50 employees. Most of our clients are hospitals, though we count physician groups as well as other types of providers as clients. A majority of our business has been traditional consulting. 

In 2002, we did a former company called Innovative Healthcare Solutions, which we began by taking the charge master review software we had developed in-house — which I believe was in FoxPro at the time — and we developed a Web-based tool that we marketed. It was pretty exciting. We’d never done anything like that. Eventually we developed other decision support products. IHS was eventually sold to Accuro in 2005, then Accuro became part of MedAssets, I believe in 2008. 

In the last two years, we began to focus on software again. We launched our BVerified line of solutions last year. Our latest two products were launched early in January. The idea behind getting back into software and creating these solutions is that we want to be able to provide our customers these software products that allow them to receive the benefits of our expertise we’ve developed over the years, while at the same time creating the potential to drive additional benefits for our client through that software.

Between your consulting opportunities and now you’re more productized offerings, what revenue opportunities do you typically find that even pretty good hospitals and even your competitors might miss?

Most of what we’ve been doing is on the consulting basis with regard to some of our revenue recovery opportunities. We do the majority of our work as the primary vendor. However, we have found pretty significant opportunities going in either behind just solely internal processes on the part of hospitals or after other vendors. Depending on the particular issue, whether it’s on the DRG transfer rule or IME, very often we find up to 30% or so of additional revenue.

I think a lot of that has to do with just our approach. We’ve refined it very much over the years. We’ve identified some areas that we think are often overlooked either through internal processes or by other vendors. But at the same time, we’ve focused very, very heavily on the compliance aspects of it. We also have seen some processes that are not very compliant. We had a lot of input from our clients that they wanted something that they could be assured was entirely in compliance with all the rules and regs. We put a lot of effort and resource into that.

Is there a lot of concern out there about the RAC audits and all the other audits that the CMS is talking about doing?

I think there is, but my sense is it depends on what part of the country you’re in. Here in the Northeast, we haven’t seen a lot of RAC activity, but it’s almost like everyone’s waiting for the other shoe to drop. They know it’s coming — they just don’t know when. With their hands full with what they already have — with all the organizations out there doing audits and all the other demands they have on them, especially from the IT perspective — they’re very concerned, yes.

Do you think it will be like the IRS, where they will take a small sampling and make a high-profile example of any problems they find?

I don’t think that’s the way it’s necessarily going to go. Even on the RAC side, they’re still finding their way as well. I think some of it will come to that, where they’re going to realize that it’s so labor intensive to get through some of this. If you look at the recent demonstration project that CMS put out where if you want to join on, you’re essentially giving up your right to appeal short stays that are denied as inpatients, but they will allow you to bill them as outpatients. My guess is that one the reasons they’re going forward with that demonstration project is just because of the volume of appeals they’re experiencing. 

I think it’s going to take some time for everything to settle out. Eventually, you may find more of the old style initial teaching hospital audits from way back in the ‘80s, when they looked at 30 claims or 100 claims and decided that they were due $18 million. I don’t think it’s going to be quite that bad, but I think there’ll be more of that practice as we go forward.

Describe the problem with hospital readmissions and what clients are asking you to do to prepare them for that.

CMS is going to begin looking at data with regards to readmissions. They’re going to essentially identify the top quartile in hospitals in terms of unnecessary readmits or related readmits. It’s going to reduce your overall Medicare-based payment. A lot of hospitals are looking at that. It’s fairly easy to look at the Medicare data that’s out there to determine where you fall yourself within the three categories of diagnosis they’re going to be looking at. It doesn’t really necessarily tell you where you fall in relation to what quartile you’re in.

It seems to us from talking to a lot of hospitals, those who have a problem know they have a problem. In a lot of ways, they feel like they’re in a situation where there’s not a whole lot they can do to effectuate any real change in those patterns quickly. Another factor is that a lot of people don’t realize is that the readmissions include if you discharge a patient and they get readmitted to another facility. You don’t even know that, but that counts towards your readmission number. And that data is not generally available to everybody.

I think it’s something that everyone is trying to do a better job of coordinating care. Once patients leave the hospital, they’re trying to do a better job of communicating with patients, making sure patients are following through on physician orders and seeing their physician within a specified timeframe and so on. But there’s limited resources to be able to do that, and there’s limited ability to really change people’s behavior in that way.

With the emphasis on making clinical care delivery less episodic, the billing stayed episodic and only now is moving toward billing for non-piecemeal work. Are hospitals going to be able to adjust quickly with the emphasis on ACOs?

I think that’s a real problem. Physicians have had that issue over the years too, where in some situations, they’re expected to manage care well beyond when they see the patient. It’s difficult. There’s really no reimbursement for that aspect of it. I think that ultimately hospitals understand that that’s the way it’s going. Whether you believe in ACOs or feel that they’re going to be the panacea some people think they’re going to be, nonetheless, that is the way things are going.

I don’t think anyone will argue the fact that a better process to manage patients once they leave the hospital — make sure they are following certain care plans, make sure they are seeing the right types of providers in the proper timeframe — is going to reduce readmissions, it’s going to reduce inappropriate admissions, it’s going to cut down on emergency room visits, and it’s going to overall have the great potential to lower the cost of healthcare. But we’re asking a lot of providers out there that are not going to be reimbursed in any way for a lot of those activities to take that on. I think that the funding for that is going to become a really critical issue.

There’s probably not much appetite to pay more for care, and not much ability since the government’s such a large payer. I guess it’s the equivalent of telling a steakhouse, “As of next week, you’re going to offer the same menu except as a one-price buffet.”

I agree. I don’t think there’s going to be much appetite at all for the government to put out any more money for this kind of thing. I think they feel that through some of these programs such as ACOs, with some of the incentives and whatnot, that’s going to effectuate some of this. And it may, for those who decide to become ACOs or maybe are positioned to do that.

The fact is that most providers are not really positioned to become ACOs and the incentives that are there for them. Even some of the premier facilities in the country have indicated that they don’t see the advantages to going to that ACO model and getting involved in that whole program. If they don’t see the value, it’s hard to believe that any inner city hospital is going to have the funds or the abilities to be able to put any kind of model like that in place unless they’re somehow funded for it.

Hospitals are imitative. If one does it, everybody does it. If a consultant starts recommending it or it shows up in a magazine, everybody jumps in line to do it. Do you think they’ll experiment with the ACO and either back out quickly or lose their shirts before they realize maybe it wasn’t as good as it sounded?

I don’t know. I’ve done some speaking engagements and have been in a number of meetings where someone would ask, “Who here from a provider side is going to plan for being an ACO?” Almost everyone raised their hands. I think that was just because it was early on — the rules weren’t defined.

As more and more comes out with regard to what’s expected from ACOs and what the cost is going to be and the type of infrastructure you had to have in place to effectively manage an ACO, I think you’re seeing more and more back away from it. My guess is there’s not going to be a whole lot of organizations that actually go all the way through and become an ACO and actively participate in that project. So we’ll see. My guess is that as providers dig through it, they’re going to realize that there’s really not a whole lot of advantage to them.

Do you have real-world examples of what you’ve found with your BVerified process?

The very first client we had for the screening verification tool, which was really the first BVerified product we put out there, we immediately found something which looked … I won’t get into the details, but it looked very questionable. We immediately called them and it was something that they were aware of. They were actually pretty impressed that we came up with it so quickly.

Everyone’s had some kind of finding. Sometimes as you go through those, you identify that there are things that were corrected or maybe it was incorrect information that was submitted to do the verification and whatnot. But our clients have been very happy with it thus far. To them, it’s a one-stop shop. They don’t have to have multiple screening tools in place. They’ve been happy with the product and the results they’re getting out of it.

It’s to check the HHS’s database for excluded parties, correct?

Yes. It goes through and checks both federal and state databases. We can adjust that, because with regard to some state databases, there are timeframes and “how often” rules in terms of how often you have to check. We built all of that into it. Essentially it’s looking for excluded individuals. It also has some additional functionality — it allows you to verify licensure and things like that as well.

You’ve done services related to point-of-service collections. Money is being left on the table by letting patients walk away without, but consumers are pushing back about being asked for a credit card before they’re seen. How do the hospital know that they’re ready to initiate that planning for point-of-service collections and what’s involved with transitioning to that?

The time is well past when those programs should be in place. In talking to our clients, I’ve always maintained – and this goes back quite a ways – you need to start this now, because it’s not like you just put someone with a cash register at the door. It doesn’t work that way. Most hospitals serve a pretty much a specified community, and it’s a matter of changing that community’s understanding of how you function. There’s a lot of communication that has to go on with both the patient population as well as the referring physician population. They need to understand what you’re doing and why you’re doing it.

Physicians have been doing this very effectively for a long, long time. Maybe it’s not some of the same dollars that are involved in terms of physicians who are merely collecting co-pays, but I defy you to find anyone who’s covered by any kind of a managed care or a PPO plan who’s gone to their physician who’s gotten to see that doc without paying their co-insurance first. They’ve done an effective job of that, so physicians understand the need for it. 

The dollars are significantly more on the hospital side, but that can be worked through in terms of an arrangement with the patient. It takes a long time. It’s an educational process, it’s a community educational process. It’s not something you just turn the switch on overnight. What I’ve seen mostly is that hospitals have implemented it in maybe a few different areas within the hospital, but not universally. They do get pushback.

There has to be a commitment all the way up the management string, right up to the CEO and the board, that this is what we’re doing and this is how we’re going to do it. They’ve got to resist those calls that come in and say, “I was there the other day and I’ve been coming there for 30 years and now you’re asking for payment up front.” Everyone has to be on board, because as soon as you start making exceptions, it quickly loses its effectiveness.

What do you see as major areas of concern in the next five years and what should hospitals be doing now?

We’re addressing a lot of things on our end. With some of the other software tools we’ve developed, we’re trying to come up with ways that hospitals can take our expertise and our experience with a lot of things. We put them into a software tool so that the hospital can internalize them and gain greater control over some of those functions. Instead of doing it on a consulting basis, they have the ability to do it on their own. That works for some, doesn’t work for others. 

We understand that a software solution isn’t automatically the solution for everybody. We’re trying to do that because what we’re hearing from some of our clients is that they need to bring some things internally and they want to reduce their costs a little bit. That’s why we’ve done those things with the transfer DRG tool and the Medicare advantage IME tool and our revenue integrity auditor.

At a higher level, my feeling is that over the next five years, hospitals have to begin to fully integrate their clinical and their financial operations. There’s still a separation there to a large degree with a lot of hospitals. While everyone’s moving in that direction, I think it needs to be looked at more as a business. There has to be a way to bring together those two aspects of the operation in one cohesive whole.

While obviously patient care is the business you’re in and you want the highest possible quality you can get, there needs to be some control over that, in terms of how you best do that. I think that’s the whole ACO concept, which is good. I’m not convinced on the ACO model, but I think the ACO concept is good in that it makes you bring it all together, operate more cost-efficiently, and coordinate care across the whole spectrum of the services the patient’s going to receive in their inpatient, outpatient, physician, physical therapy, specialists, whatever it may be.

The most important thing over the next five years is to start looking at healthcare delivery – and I don’t mean this in any kind of impersonal way — as a business, bringing together the financial delivery of care and the clinical delivery of care so that you’re getting the most sufficient product you can.

Any concluding thoughts?

We’re experiencing the most interesting and fast-paced changes we’ve ever seen in this industry. More so than ever, the changes we’re seeing now will dramatically alter the way healthcare is delivered and managed from this point onward. Everyone’s got to be ready for it, because I don’t think there’s any turning back. There may be some stumbling along the way, but everything that’s been started now is going to move forward. As Bob Dylan said, “You better start swimming or you’ll sink like a stone, because the times they are a-changing.”

We’re changing our approach and trying to meet the changing needs of our clients. We continue to focus on trying to find all the revenue we can for our clients. We won’t stop that. That’s the reason for developing some of these software tools — to give something to our clients that has a demonstrable, compelling ROI.

It’s pretty exciting times, but they’re also very challenging times. I think the pace is only going to pick up. We’re going to see incredible rate of change over the next few years.

News 2/3/12

Top News

Shares of EHR vendor Greenway Medical Technologies rise 30% on its Thursday IPO, making GWAY the day’s biggest gainer on the New York Stock Exchange. Shares closed at $13, valuing the company at $358 million on revenue of $90 million. The company had revised its IPO price downward from $13 to $10 at the last minute, obviously leaving money on the table in hindsight.

Reader Comments

From Mr. Hospitality: “Re: HIMSS schedule. Do you know if there is a way to drop the HIMSS schedule into Outlook? Didn’t there used to be a way to do that?” I don’t use Outlook, but I couldn’t figure out an easy way to create a schedule in general from the HIMSS website. However, the HIMSS folks say an app is coming next week. I actually found it here, though it looks like it’s not quite complete since some sessions still lack specific details. The HIMSS12 Mobile Guide does allow you to select favorites and thus create a personalized schedule, though it’s not integrated with Outlook or other calendars.

From IT Guy: “Re: Reliance Software Systems. RelWare. the company that was developing the EMR for Henry Ford Health System, is no more. HFHS announced that it would implement Epic and sunset RelWare’s EXR product, leaving the company with no clients other than Ford. They have closed their doors and let their staff go.” Unverified. I e-mailed the company and received no response. Henry Ford went live less than a year ago on EXR.

From Randy Lugano: “Re: EMR character limit on assessments. Is this a common feature in popular EMRs?” A physician’s article in The New York Times in December bemoans her EMR’s 1,000-character limit as she tries to compose a usable assessment of a complicated patient.

I nip and tuck my descriptions of his diabetes, his hypertension, his aortic valve stenosis, trying to placate the demands of our nit-picky computer system. Nevertheless, I am still unable to fit a complete assessment into the box. In desperation, I call the help desk and voice my concerns. “Well, we can’t have the doctors rambling on forever,” the tech replies … Nobody, for example, leafs through a chart anymore, strolling back in time to see what has happened to the patient over many years. In the computer, all visits look the same from the outside, so it is impossible to tell which were thorough visits with extensive evaluation and which were only brief visits for medication refills. In practice, most doctors end up opening only the last two or three visits; everything before that is effectively consigned to the electronic dust heap. Most importantly, the electronic medical record affects how we think. The system encourages fragmented documentation, with different aspects of a patient’s condition secreted in unconnected fields, so it’s much harder to keep a global synthesis of the patient in mind. Now I’ve learned that file-size restrictions will limit the extent and depth of analysis. What will happen to the tradition of thorough clinical reasoning?

From CDMer: “Re: HIT testing. Another can of worms along the path of standardization.” NIST solicits bids for a Health Information Technology Testing Infrastructure that will “harmonize the efforts of healthcare standards test development and delivery to meet the demands for conformance and interoperability within the healthcare domain.”

From NYizMee: “Re: McKesson’s huge profits. I can’t understand how this company keeps making money. They do nearly everything so badly.” Healthcare has been very good to the company and its customers chose it willingly, so they must be doing something right.

From David Chou: “Re: Cleveland Clinic Abu Dhabi. Would love to share a Forbes piece on what we are doing.” David is the senior director of IT operations there. The 2.3 million square foot, 364-bed facility will open at the end of this year.

From Looking Out for the Little Man: “Re: CPSI. The little guy down in Mobile seems to be helping smaller hospitals meet MU, right behind Epic in the number of hospitals to attest.” The company’s fact sheet says 134 of its hospital clients have attested, giving it 22% of all attested hospitals, second only to Epic’s 164 hospitals.

HIStalk Announcements and Requests

Here’s a few things you might already know if you are a faithful HIStalk Practice reader: first-fill medication adherence improves when physicians e-prescribe. Doctors still prefer desktop PCs over other devices for accessing patient data in the office or at home. Some common problems causing 5010 rejections. CareCloud CEO Albert Santalo gives the low-down on his company in our interview. Dr. Gregg shares the inside scoop on the startup Health Care DataWorks. If you haven’t been a faithful HIStalk Practice reader, it’s not too late to change your ways and see the light of the ambulatory HIT work. Thanks for stopping by.

Listening: reader-recommended Rodrigo y Gabriela, a duo of former itinerant street musicians who play amazing guitar that includes everything from classics to heavy metal (one YouTube commenter called it “thrash metal flamenco.”) Check out Gabriela using her acoustic guitar like a drum kit.

Acquisitions, Funding, Business, and Stock

Clinical communications vendor PerfectServe closes on $10.9 million in Series C financing, led by PJC Capital.

Staff scheduling systems vendor OnShift closes on $3 million in Series B financing led by a client of West Capital Advisors.

TELUS Health Solutions announces the acquisition of Wolf Medical Systems, Canada’s largest cloud-based EMR vendor, and the creation of a new business line, TELUS Physician Solutions.

Trademark filings suggest that a possible name of the GE Healthcare-Microsoft joint venture is Caradigm. That trademark was held by Santa Barbara Regional Health Authority, but appears to have expired.

Canon Europe acquires Netherlands-based PACS vendor Delft Diagnostic Imaging, saying it plans to focus on medical imaging for future growth.

Medical payment processor MediSwipe acquires the assets of ReachMeDaily.com, a private social media platform that connects senior citizens in residential centers with their families.

California startup TigerText, which offers HIPAA-compliant text messaging for hospitals, raises $8.2 million in a second round of funding.

Telehealth vendor InTouch Health, which claims 400 hospital customers of its FDA-approved remote presence devices, gets a $6 million investment from iRobot Corp., best known for its Roomba vacuum cleaner.

The Advisory Board Company reports Q3 results: revenue up 33%, EPS $0.46 vs. $0.24.

Sales

MedLabs Diagnostics (NJ) chooses the Ignis Systems EMR-Link lab outreach solution to provide area practices with lab ordering and reporting capabilities.

The Danish health system selects InterSystems to develop and support its national HIE.

Upper Chesapeake Health (MD) picks Forerun’s FlexChart physician documentation software for its emergency departments.

Rush-Copley Medical Center (IL) selects Medicity’s HIE technology to facilitate affiliated physicians’ access to clinical results and reports.

NorthCrest Medical Center (TN) chooses Allscripts Sunrise Clinical Manager, adding to its previous deployments of the company’s ED and ambulatory EHR solutions.

Merge Healthcare signs 10 new Merge RIS customers, raising to 30 the number of radiology practices using it as a Complete EHR.

Scripps Health (CA) selects MEDSEEK’s enterprise software suite.

St. Mark’s Medical Center (TX) selects McKesson Horizon Medical Imaging for use with its Paragon HIS.

The Nebraska Medical Center expands its use of products from Streamline Health Solutions, adding its Epic integration suite to the content management and HIM workflow solutions it was already using.

People

Greater Houston HIE changes its name to Greater Houston Healthconnect and names James Langabeer PhD, formerly of the University of Texas Health Science Center, as president and CEO. He replaces Kay Carr, who became CEO last March.

API Healthcare appoints Peter Goepfrich (Vital Images, PwC) as CFO.

Brad Swenson rejoins technology financing company Winthrop Resources Corporation as SVP, chief product strategy and business development officer. He was previously with Surescripts. We interviewed him in May 2011.

Announcements and Implementations

Awarepoint signs 191 contracts for its aware360Suite in 2011, increasing its client base to 123 healthcare systems and 186 hospital sites.

Telehealth and remote monitoring solution provider Cardiocom and Delta Health Technologies, a provider of IT systems for homecare and hospice agencies, announce completion of a bi-directional telehealth interface between their systems.

St. Joseph’s Hospital and Medical Center (AZ) announces its deployment of MobileMD for the exchange and communication of clinical information.

Government and Politics

MGMA sends a letter to HHS Secretary Kathleen Sebelius outlining problems that practices are having with the 5010 transition and urging an additional delay in enforcing the change. MGMA warns that unless the government takes the necessary steps to resolve issues, many practices will face significant cash flow disruptions for practices and operational difficulties, a reduced ability to treat patients, staff layoffs, and even practice closure.

Other

Anthelio partners with Healthland to provide migration and implementation services for Healthland clients migrating to Healthland Centriq EHR.

The defunct St. Vincent’s Hospital – Manhattan (NY), obligated by state law to maintain medical records for six years after discharge, petitions the bankruptcy court to force Allscripts to help the hospital transfer its data from its own servers to a less-expensive system. The former hospital says Sunrise Clinical Manager is costing it $17K per month and another company offered to extract its store it for $1,200 per month, but Allscripts won’t help unless the hospital keeps paying the monthly tab.

UMass Memorial Healthcare announces plans to lay off 700 to 900 employees, under the gun to trim $50 million from its budget to avoid a loss for the year.

Sponsor Updates

• Billian’s HealthDATA reports that 35-45% of doctors are affiliated with hospitals in 10 states, with internal medicine ranked as the top specialty.
• CapSite’s SVP and GM Gino Johnson will present an overview of the HIE market at this month’s ZirMed’s Thrive User Conference.
• T-System announces that 42 hospitals have attested to Stage 1 MU using its T SystemEV emergency department information system.
• GE Healthcare introduces the latest version of its Centricity Patient Online portal.

EPtalk by Dr. Jayne

CMIO magazine publishes its 2012 Compensation Survey. No surprise: 87% of CMIOs are men, although women are increasing in the field – up from 8% to 13% this year. Apparently I fall into their target demographic since the majority of those surveyed work at multi-hospital organizations in the south.

For those of you who may be just a teensy bit behind in your ICD-10 implementations, my favorite Geek Doctor John Halamka offers the request for consulting assistance that his organization used. Also included is a letter to stakeholders to identify which applications use ICD-9 and need to use ICD-10. He promises to share as much as he can as their project plans and timelines unfold, so stay tuned.

I wonder if ICD-10 has a code for this? Physicians report an increase in cyberchondria. Patients reading online information are increasingly displaying unfounded anxiety about their health. To combat the increased worry, physicians report spending more time in office visits to discuss why patients think they have particular diseases and convincing them that it may be unlikely.

Some websites have recently caught my eye. AdverseEvents has gathered information from the FDA’s database. Users can search over 4,500 medication records. Clarimed is similar, but has information on medical devices as well as drugs and procedures. I’m sure the cyberchondriacs found them long before I did.

I just have to laugh. Earlier this month, the Department of Health and Human Services published new standards for electronic funds transfers (EFT) in healthcare as required by the Affordable Care Act. This is supposed to result in billions of dollars of administrative savings for physicians, hospitals, insurers, and states over the next decade. HHS Secretary Kathleen Sibelius is quoted as saying, “Thanks to the Affordable Care Act, healthcare professionals will spend less time filling out paperwork and more time focusing on delivering the best care for patients.” Unfortunately, the recent federal initiatives have actually increased burdensome busywork for me, as I am forced to review mind-bogglingly annoying reports about how many times I’m checking or not checking a particular box required for Meaningful Use calculations. Additionally, any reduction in paperwork due to EFT changes will likely be offset with increased mounds of insurer paperwork trying to deny care for sick patients.

A new study reports that “the majority of U.S. physicians are moderately to severely stressed or burned out on an average day.” That’s not good news for the people caring for you and your loved ones. Only 15% of physicians feel their organizations are helping them deal with the situation. Burnout has been shown to increase the risk of medical errors. Physicians cite their top stressors as the economy, healthcare reform, Medicare/Medicaid policies, and unemployed and uninsured patients. No surprises there. Executives, take note: show your docs some love and get those severely impacted staffers some help before it’s too late.

Medical Economics publishes its must-have gadget guide. One of my favorites is the MobiUS SP1 hand-held ultrasound unit which can transmit images via cell phone or Wi-Fi. Another favorite is the SleepView Monitor, which allows home testing for sleep apnea. If I would have had one in my little black doctor bag during a recent trip, I’d have slapped it on the gentleman near me on the plane. I seriously thought I was going to have to resuscitate him.

Hints on the Microsoft/GE venture’s name from Weird News Andy: “So, a portal-like product that allows information to flow between logical entities. Drawbridge is a little too intimidating. Hatch is too nautical. Aperture is too esoteric. Gates. That’s the ticket.”

Speaking of little black doctor bags, I’m still looking for the perfect little black dress to go with mine (and with the shoes!) for HIStalkapalooza. I thought I had my date squared away, but in a surprise last-minute showing, one of my secret crushes has agreed to attend (sorry, Farzad, I waited as long as I could – but if you decide to attend, I’m sure we’d be accommodating.)

Have a question about home monitoring devices, Las Vegas bail bondsmen, or why the soles of Christian Louboutin shoes are red? E-mail me.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

CIO Unplugged 2/1/12

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

The Bad Boss

New town. New job. I was stoked over what was essentially a startup within an enterprise. As a visual learner and teacher, I asked the office manager for a whiteboard.

No go. The president wanted to keep corporate operating costs low. No worries. I went to Staples, and for the cost of a Starbucks Grande Red Eye, I bought myself a whiteboard.

Before I had a chance to hang my would-be art piece, my boss stopped in and frowned. “What’s this?” After I explained my reasoning, he said, “Take it out.” He wanted all the offices to have the same minimalist look and feel.

Well, my kids loved it. That whiteboard became central to their homeschool activities. I’ve used it over the years for meetings at home.

Little did I know, the rejected whiteboard was only an omen of the legalistic reign under which I was now employed. I was tempted to pack up and head back south. After all, I had a 90-day “get-out-of-jail-free” card from my former employer who would graciously welcome me back. Our old home had not yet sold.

Tempted as I was to escape, I knew running away was wrong. If I quit now, I would never learn perseverance. I had made a commitment and I would keep it, no matter how aggravating. I knew I would use this challenging experience to prepare for the future. Angry and disillusioned, I stuck it out.

Most of us have had a manager who’s aggravated the heck out of us. National employee engagement scores from Gallup suggest that many are presently in such situations. Web sites such as Really Bad Boss are extremely popular. Numerous best-sellers have been written on the subject. And did you ever ask yourself why The Office and Dilbert are such big hits? Because we can all relate on some level to bad bosses. I suspect all of us will have the opportunity to encounter one along the way. This was mine.

I make an effort to understand these concerns because I don’t want to be a bad boss. And I’m very aware of my potential to become what I hate. We’re all susceptible.

That said, I’ve been blessed to work with predominantly good bosses. So here is what I learned to make the best out of bad-boss situations:

• Honor leadership. Part of my career plan is based on the premise of honoring those in authority over me. This can be tough. Clearly, you should never turn a blind eye to unethical behaviors or abuse. I am solely referencing a difficult and disagreeable boss. Actively give honor to them. It may not change them, but it will change you.
• Make your boss famous. Another toughie. Why would you make a bad boss famous? Because if you can make them better, there’s a chance your situation will improve. Don’t talk up how wonderful your division outcomes are, but give the glory for good things to your boss and take your lumps when things are not so good. Leadership demands humility. “There’s no limit to the amount of good one can do as long has he doesn’t care who gets the credit.” Author unknown
• Take the good. Most bosses are bosses because they have done something good and have the capacity for more. Seek out the good and apply it to your career. My anti-whiteboard boss taught me the importance of having a “kitchen cabinet,” developing key informal relationships that serve as a sounding board and advisory committee. Life is too short to not learn from all circumstances.
• Check the mirror. Take inventory of the bad and look for signs of these traits in yourself. If you find one, pull it out. Guard against bad-boss behaviors creeping into your own style. If your boss is inclined to knee-jerk reactions, don’t start flailing your arms every time you are faced with a challenge. Recognize bad-boss behavior and never replicate.
• Leading up. This might seem impossible, but keep faith that you can influence a change in your boss. Lead by example. Although your voice may not be heard, your actions will be noticed, subconsciously or otherwise.
• Think long term. Look ahead and remind yourself that today’s actions dictate tomorrow’s decisions. If you quit when things are tough, you will become a quitter. Stick things out. Don’t tap out too quickly.
• Speak no ill will. Avoid the trap of complaining about bad boss to other people. This will only exasperate the situation and make it worse than it is. Speak blessing instead.
• Seek first to understand. Figure out the drivers for bad boss behavior. They are likely stress induced. Most bad bosses are well-intentioned leaders who’ve lost their way because of personal and/or professional pressures. Identify the sources of stress and you might help reduce or eliminate it. At the very least, you will sympathize and realize the behavior is not a vendetta against you, albeit it feels like it.
• Avoid a bad boss. Forbes shares five tips to spot a bad boss in an interview. Gather your own references. Call the person who most recently held the position. Call on the other direct reports. If you are well networked, get the internal buzz on your potential boss. Many a bad-boss situation could be avoided if you research diligently and listen to what you hear. Don’t believe things will change because you believe you are better than your references. They won’t.
• Joy in suffering. This is the toughest one for me, but the most important. “Suffering produces perseverance; perseverance builds character; and character produces hope.” It’s an upward, spiraling cycle throughout life.

So if you have a bad boss, you have a choice. Life is too short to be in a bad boss situation, but you owe it to yourself, your people, your boss, and your organization to make it work.

I persevered with the anti-whiteboard boss. I established a “kitchen cabinet” as I’d learned from him. I was promoted out of that division and into corporate, where I became CIO. Hope never disappointed me.

And then I purchased the biggest damned whiteboard ever made.

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

News 2/1/12

Top News

McKesson reports Q3 numbers: revenue up 9% to $31 billion, EPS $1.20 vs. $0.60, beating estimates. The company announced that it will buy back an additional $650 million worth of its stock. Shares rose 4% on Tuesday, making MCK the third-best performing S&P 500 stock of the day. Technology Solutions revenue was up 4% with an operating profit of $69 million, although the company took a $42 million pre-tax charge against the termination of development on Horizon Enterprise Revenue Management and the move to Paragon as its go-forward platform. From the conference call:

• The company reiterated that it has no plans to sunset Horizon Clinicals, but also made it clear that customers will probably either choose to move to Paragon at some point or switch vendors.
• McKesson paid $6 million in severance related to the shutdown of HERM.
• The company talked up its payer and transaction businesses (like RelayHealth) in a manner that suggests it likes the steady, predictable revenue they generate compared to the sales-driven revenue swings of the software business.
• The company admitted that “as you know, we’ve had some challenges with the Horizon Clinical implementations.”
• My overall impression is that the company is being fairly open in describing its challenges with HERM and Horizon Clinicals, although in the last couple of quarterly calls they were quite upbeat about both. Publicly traded companies aren’t very good about warning investors of potential bumps in the road.

Reader Comments

From Baystatehockey: “Re: Mark Gorrell, VP/CIO of Baystate Health. Gone and replaced by Heather Nelson as interim CIO.” I think I can safely call this rumor verified based on Mark’s exuberant and obviously recently updated LinkedIn job title, which is darned cool. Here’s his blog with sailing photos and some really interesting thoughts about pursuing something he and his family always wanted to do, even though he says he’s risk-averse and prone to motion sickness.

From Duxelles: “Re: IBM. To acquire [publicly traded vendor name omitted] – any truth to this?” I haven’t heard anything and it doesn’t seem likely. Then again, neither did the rumor at HIMSS time awhile back about this company that turned out to be true, which made me glad that I at least mentioned so I didn’t look clueless. It is likely that quite a few big announcements of various flavors are being embargoed by several companies until the HIMSS conference, so I’m sure we’ll have lots to talk about in three weeks.

From Amish Boy: “Re: Epic’s support teams. At my previous hospital, I got to know our application’s assigned support person very well. I’ve worked with Cerner for years and they don’t have the same personal attachment. We used to joke that Cerner’s Immediate Response Center number was busy because the middle school bus hadn’t dropped the IRC employees off at Cerner HQ yet.”

From Bill Rieger: “Re: Flagler Hospital, St. Augustine, FL. Kicked off its Meditech to Allscripts SCM transition at a well-attended campus event. The IS department broke out in flash mob just before the CIO spoke about how hard it would be to tear down the walls of poor processes that have been built up over the years. We are engaged and involved and want to be dancing when we go live in June 2013.” Bill  is CIO at Flagler Hospital. Nice video.

From The PACS Designer: “Re: FuelBand. A new mobile application from Nike that is worn on the wrist and can track your daily activity with an accelerometer. It tracks calories expended, steps taken, and the time of day, as well as your NikeFuel score viewable on an LED display. Your score is based on an algorithm that assigns points to various movements.”

From BuffaloWings: “Re: Sandlot and Santa Rosa Consulting. To merge?” Santa Rosa already was a partial owner of the HIE technology vendor Sandlot (the other owner is a Texas physician group). I haven’t heard if they are taking that relationship further.

HIStalk Announcements and Requests

Mr. H and I were commiserating last night about our pre-HIMSS overwhelmed-ness. The last few days I have been working on the HIStalk Guide to HIMSS12, which includes an overview of what our sponsors will be featuring this year. We are also including contact information for at least a dozen sponsors who are not exhibiting, but that are available for one-on-one meetings with attendees. Look for the Guide to be published the week before HIMSS. Sponsors, make sure to send your information.

If you are attending HIMSS, you only have about 20 more days to prep. It’s not too soon to go through your old shoes (including your kids’ old shoes) to bring for our Soles4Souls shoe drive. We will have drop-off boxes on the exhibit floor at the DrFirst booth (5456) and possibly one other location. We’ll also accept donations at HIStalkapalooza for those who received invitations (with a free IngaTini for every pair you donate.)

We like highlighting cool vendor events at HIMSS since readers are always looking for fun stuff to do there. Here’s one: CSI Healthcare IT is offering cocktails and dinner at the Canaletto Ristorante at the Venetian on Wednesday evening (February 22) from 6:30 until 9:30. It’s invitation-only and you can RSVP by e-mail.

Speaking of HIMSS events, ours is full. We have a lot of friends and loyal readers, and if we had endless space and money, we would happily invite every one of them to the ESD-powered HIStalkpalooza. Since we don’t, we have no choice but to turn down requests, even for invitees who want to bring a guest (I’d estimate that we have close to 1,000 people who want to come that we don’t have room for.) Maybe next time I should also run a secondary event that’s cheaper to produce so that lots and lots of folks could come as a backup event, like renting some big New Orleans field, hiring a band, setting out pallets full of beer and wine, and passing out hot dogs and marshmallows to roast over a bonfire. That’s my kind of networking event.

Your honey-do list from Inga: (a) search our sponsors in the Resource Center; (b) take five minutes to get your consulting RFI request in front of several companies at once with the RFI Blaster; (c) click on some sponsor ads just to see where you end up; and (d) send us rumors and cool stuff. And while Inga, Dr. Jayne, and I don’t want you to feel like a number, you are, in a good way that we appreciate: one of almost 5 million HIStalk visitors since 2003 and over 110,000 this month; one of 7,861 subscribers to our e-mail updates; one of the 2,165 members of the HIStalk Fan Club that Dann started; or one of our LinkedIn connections or Facebook friends. Unlike HIStalkapalooza, those numbers can scale infinitely, so feel free to increase them. Sometimes we screw up in running an erroneous rumor or being slow in responding to e-mails, but one thing we never do is take readers and sponsors for granted, so thank you for being part of what we do.

On the sponsor-only Job Board: NextGen Training Coordinator, Epic Go-Live Support, Cerner Go-Live Support. On Healthcare IT Jobs: Senior Technical Advisory Consultant, Epic Certified Clinical Analysts, Epic Hospital Billing.

Welcome to new HIStalk Platinum Sponsor Lifepoint Informatics, which offers vendor-neutral data integration solutions, with an emphasis on lab outreach. Its EMRHub  provides fast, easy LIS-to-EMR connectivity (Web-based middleware with only one LIS interface required) for hospitals and any type of labs interested in strengthening physician relationships, developing new revenue streams, and earning Meaningful Use incentives. Its LPI CPOE ensures clean, valid CPOE lab/rad orders that meet medical necessity and ABN requirements. Its LPI Web Provider Portal is a cost-effective way to deliver a complete patient picture to providers, providing a unified clinical inbox, flowcharts, and reports using information from systems such as clinical labs, pathology, micro, AP, cyto, and cardiology via any Web browser, helping hospitals, labs, and groups meet the IT needs of their clients. The company just landed a big deal in providing Sparrow Laboratories, one of the country’s top outreach labs with 15 labs in Michigan, with solutions to extend its reach to current and potential customers. Other customers include Indiana University Health, Continuum Health Partners, Memorial Hermann, and New York-Presbyterian. Drop by Booth 153 at HIMSS for two reasons: (a) to see their tools in action, and (b) to get one step closer to bringing home an iPad 2 in the soon-to-be-announced HIStalk Booth Crawl, of which the company is a sponsor. Thanks to Lifepoint Informatics for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

IT professional services firm NTT DATA Americas announces that its Keane, Intelligroup, MISI Company, The Revere Group, Vertex, and Agile Net organizations will start doing business under the NTT DATA brand.

ADP acquires small-practice revenue cycle management company PhyLogic Healthcare of Springfield, MA and will offer its outsourced billing services to its ADP AdvancedMD customers.

Greenway Medical goes public Thursday, with its $80 million IPO providing a market cap of $330 million.

Sales

BCBS of Kansas City selects InterComponentWare to implement a master patient index to address demands for aggregated patient data in the HIE environment.

Shriners Hospitals for Children selects the MedeAnalytics Clinical Performance Manager solution.

Oswego Hospital (NY) contracts for Wolters Kluwer Health’s ProVation Order Sets.

Acadia Healthcare (TN) selects Healthcare Management Systems Inc.’s (HMS) financial applications for its 25+ facilities.

Banner Health contracts with MEDSEEK solution to deploy its patient, physician, consumer, and employee engagement platform.

Riverside Medical Group (VA) licenses Streamline Health’s physician workflow management solution to manage A/R and denials.

People

PwC US hires Andrew Kemmeling, formerly with Phoenix Health Systems, as a partner in its enterprise resource planning and business transformation practice.

Providence Health & Services, Southern California promotes Elizabeth Petrich-Kennedy to chief nursing informatics officer.

Former CSC and First Consulting CMO David Classen joins patient safety solutions vendor Pascal Metrics as CMIO. Former TheraDoc CEO Stanley Pestotnik also joins the company as a senior advisor.

PerfectServe hires former Krames Healthcare sales executive Michelle Piel as a VP of sales.

iSirona promotes Mary Carr, RN, BSN, CPN to Chief Nursing Officer.

Quantros promotes Gerard Livaudais MD, MPH to chief medical officer and SVP of content and product management.

Alerting vendor Extension hires Tom Berger RN as chief nursing officer. He was previously with Vocera.

Announcements and Implementations

Resource Anesthesia deploys the Shareable Ink Anesthesia Suite across multiple states and facilities.

KishHealth System (IL) implements the Pharmacy Xpert clinical surveillance and intervention solution from Thomson Reuters.

CynergisTek releases Surveyor for Business Associates, a risk management solution for demonstrating HIPAA/HITECH compliance.

The US Patent and Trademark office awards Medicity a patent for locating, indexing, matching, and sharing patient records among healthcare organizations. It’s the company’s third patent issued in two years.

Macadamian will launch its Usability Maturity self-assessment checklist at the HIMSS conference, building on previous work that found that easier-to-use EHRs increase productivity, decrease errors, and provide cognitive support to users.

DrFirst launches its EHR Advisor online tool to help physicians find a solution from those offered by the company’s partners.

HealthStream and Laerdal Medical, through their SimVentures collaboration, offer SimManager, a SaaS-based system for managing simulation-based healthcare training.

Government and Politics

In a Congressional subcommittee hearing, a VA official says its new paperless claims processing system will help reduce the department’s claims backlog and take out months of processing. The current number of pending VA claims is over 854,000, which is 100,000 more than a year ago and 500,000 more than three years ago.

A Congressional Budget Office report predicts that the cost of government healthcare programs will more than double over the next 10 years to $1.8 trillion, or about 7% of the nation’s economy. It predicts that Medicare spending will increase by 90%.

The COO of the West Virginia Health Network is named by a legislative auditor as being one of several retired public employees who are exploiting a loophole that allows them to collect both a pension and  paycheck at the same time.

Conservative group Judicial Watch calls on Newt Gingrich to release the full client list of his Center for Health Transformation.

Innovation and Research

Oracle Health Sciences Institute announces its first group of research projects, including a Brigham and Women’s/Harvard study that will use EMR and claims data to analyze treatment alternatives and a University of Maryland project to visualize longitudinal EMR and claims data to detect adverse events.

Other

The Robert H. Smith School of Business at the University of Maryland announces the “Innovate 4 Healthcare Challenge,” a nationwide contest for college students to develop HIT tools to improve patient engagement with healthcare providers. The challenge is supported by ONC and includes $30,000 in prize money.

I was amused to read that people  lie more when texting than when communicating by other methods, including video chat. I wonder if that carries over to clinical interactions, since I’ve only had one text conversation with a physician and I think we were both pretty honest. However, I’m now wondering  about the text from an old boyfriend who said he couldn’t meet for dinner because he was moving to South America.

Someday there will be a Steve Jobs of the EMR world who will come along and produce a system that listens in on my office visit with the patient, uses voice recognition and AI to produce an extremely accurate summary of the discussion, and schedules all necessary tests and medications based on what I explain to the patient—all without me having to even interact with a computer keyboard.  The note will be instantly dispersed to the patient and all other caregivers.  The program will suggest any useful therapies that I may have missed and provide educational resources to the patient based on the subjects discussed.  And, of course, it’ll hit all the high points needed by the coders and Medicare overlords. When this happens it’ll put every other EMR out of business; because, finally, we’ll have a system that actually helps us rather than hampers us.

A California hospital is fined $100K after a nurse in its long-term care unit replaces a comatose woman’s breathing tube, but forgets to remove the cap, suffocating the 81-year-old woman.

Six employees of the Food and Drug Administration who tipped off Congress about what they claim was the agency’s corrupt push to approve unsafe medical devices file a complaint against their employer, saying that FDA violated whistleblower protections by intercepting their personal e-mails and installing spyware on their PCs.

Sponsor Updates

• Kareo announces the opening of its Indianapolis office and its plans to add 50 new sales and customer service positions.
• Practice Fusion hires Jonathan Malek as SVP of technology and John Hluboky as VP of technical operations.
• OptumInsight announces that its HIE and computer-assisted coding solutions achieved the highest industry standards for interoperability at the IHE North American Connectathon.
• T-System launches Care Continuity, a Web-based patient referrals tool.
• The 37-provider Mendelson/Kornblum Orthopedic and Spine Surgeons (MI) selects the SRS EHR.
• Concerro hosts a webinar on disaster preparedness and emergency management.
• Hayes Management Consulting offers an EMR optimization webinar.
• A PatientKeeper survey finds that preparation for the ICD-10 transition is the highest priority of finance professionals in healthcare provider organizations.
• Allscripts facilitates a meeting with Surgeon General Regina Benjamin MD and 20 North Carolina business leaders.
• Altoona Regional Health System (PA) selects Access Intelligent Forms Suite for its three locations.
• Merge Healthcare adds six practices to its Merge OrthoEMR client base. 

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Curbside Consult with Dr. Jayne 1/30/12

Don’t Take Me Out of Context

Depending on the size of the communities they live in, CMIOs can sometimes feel isolated. Some may work in cities with multiple hospitals and health systems and have easy access to peers (and getting together over drinks is certainly fun!) but many work in towns with only one hospital. For the latter, finding and collaborating with peers can be a challenge.

I belong to a virtual community of CMIOs that contains a mix of big-city and small-town CMIOs. There are a couple of former CMIOs and a couple of young pups just starting out in informatics thrown into the mix as well. It’s been a great resource for idea sharing over the last several years and has helped me preserve my sanity on numerous occasions.

We recently got into a discussion about single sign-on options. Even those hospitals with single-database systems often have legacy systems with which clinicians need to interact. They also need to access a variety of homegrown and interfaced applications in order to care for patients and manage clinical data. Many hospitals have tackled this with single sign-on, proximity badges, or other strategies to reduce the need for clinicians to manage multiple passwords.

I’ve used several of these solutions and they are undoubtedly cool. However, they lack the ability for clinicians to rapidly access a single patient across multiple systems. Providers end up searching for the patient in multiple applications while they try to mentally create a unified view of the patient. This is less than ideal. One of the young pups in the group mentioned that he was looking at context-sharing solutions in an effort to remediate this problem. Luckily we have a few CCOW aficionados in our group. For best-of-breed shops, this can be essential to efficient access by clinicians.

For those of you who don’t know where I’m going with this, let me introduce you to CCOW. CCOW stands for Clinical Context Object Workgroup, which is an HL7 standard that allows clinical applications to share information. Through this standard, applications can participate in both user context sharing and patient context sharing.

From a practical standpoint, this means that when the clinician accesses a patient chart, all other applications that the provider is accessing synchronize to that patient. When user context is also included, it may also facilitate reduced sign-on into applications which are subsequently accessed. CCOW can go deeper than just user and patient context – encounter context can also be included.

CCOW (thanks to Health Level Seven, Inc. for the graphic) is often misunderstood by clinical and IT people alike. Although many vendors create their applications to be CCOW compliant, this does not mean that just installing two of them will “automagically” link them together. Context management is required. When the systems lack a shared master patient index or a common patient identifier, an intermediary mapping agent may also be necessary. Dedicated context management software may also need to be installed locally or on servers to help synchronize client-server and Web-based applications.

CCOW also doesn’t magically move data from one application to another. It simply allows users to access information on a single patient across disparate applications with a minimum of fuss and bother. Depending on the setup of the environment, CCOW may not work the same for users accessing from home or from non-network devices.

The use of CCOW also creates additional testing requirements during application upgrades in order to ensure that functionality remains unchanged. I know of at least one major vendor whose CCOW functionality has been negatively impacted by an upgrade, causing much consternation to the numerous hospitals live on its product.

There are multiple context managers out there, including Microsoft’s Vergence product (formerly of Sentillion) and Carefx Fusionfx. The fate of the Vergence solution is one reason that the recent Microsoft / GE Healthcare joint venture (first reported by Mr. HIStalk back in December) makes a lot of people nervous. Customers were already twitchy after Microsoft acquired Vergence from Sentillion in 2009, with reports of a decline in customer service and support.

Quite a few significant players in the hospital industry are customers, so hopefully that will be incentive enough for the as-yet-unnamed entity to resist making a mess of it. (Any idea on that name? I’ve been keeping my eye out, but haven’t seen anything, and there’s nothing on the Microsoft Health Web page yet, either.)

Most of the big vendors are CCOW compliant, but there are still some who don’t understand the value proposition to clients. Far from a gimmick or a “nice to have” feature, for organizations such as Mayo Clinic, Johns Hopkins, and many more, it’s essential. Once again, I was grateful to my CMIO coffee klatsch for a good discussion and plenty of humorous anecdotes. I’m looking forward to catching up with y’all at HIMSS12 in just a few short weeks!

Have a question about virtual networking, best-of-breed systems, or what the new Microsoft/GE entity should be called? E-mail me.

E-mail Dr. Jayne.

HIStalk Interviews Joe DeLuca, Knowledge Architect, Fulcrum Methods

Joe DeLuca is knowledge architect with Fulcrum Methods of Oakland, CA.

Give me some brief background about yourself and about the company.

I have been in the healthcare informatics and information technology industry for about 30 years. I started back in Wisconsin, primarily doing research work on effectiveness, the use of information technology to achieve what we would call the early ‘80s critical effectiveness, and better efficiency and efficacy. That started my career in wanting to help improve the healthcare through both consulting and the development of measurement tools. That culminated in the development of Fulcrum Methods.

At Fulcrum Methods, we provide methodologies, templates, and standard tools that help organizations go through the information technology planning, vendor selection, design, implementation, PMO processes – all focused on outcomes. The theme in my career has been aligning the specifics of a clinical improvement process or business improvement process with the use of technology. I feel very fortunate and privileged to have been part of this evolution over the last 30 years as it continues on.

You co-wrote the book, The CEO’s Guide to Healthcare Information Systems. What mistakes do you see hospital CEOs making with regard to IT strategy and their relationship with their CIO?

I think I would break that into a couple of components, if you’ll allow me to.

I think there’s been a tremendous shift in the awareness of the role of information technology and responsibilities of the CIO over the decades that I’ve been doing this. I think today the CEO-CIO relationship, whether it’s a direct report or not, is much more respectful than it was in the past. Progressive, if you will.

The mistakes that are made today have to do with incomplete involvement of the CIO in the strategic visioning process for the organization, and in the assessment of how information systems can progress, accelerate, and differentiate the organization. I think it’s better than it used to be, but it still requires some improvement.

For example, we have many technologies … I’ll pick on one because it was just recently noted in part of HIStalk … NCR’s healthcare kiosk was sold to QuadraMed. There was a time when the whole kiosk self-serve technology was foreign to the healthcare industry, and many regards it still is, depending on the adoption rates.  But there were some leading CIOs who came forward and said, “You know, we really need to look at this. This improves our patient convenience. It improves our satisfaction scores. It gives us better access to information, increases productivity, and so forth.”

That kind of thinking — bringing that forward — is something CIOs need to do more. That’s just a small example of that versus waiting for the CEO or the executive team to dictate more of what should be done based off of someone else’s doing it.

Because of Meaningful Use, people are making huge investments in clinical systems. Some of those decisions are being made fairly quickly and without a lot of publicly obvious analysis. Do you think those decisions are adequately involving the CIO?

I’m going to say yes to that. I think they are, because I think that the investment dollars and the potential for the stimulus dollars in inventive payments and then eventually, the Medicare disincentive payments and penalties are ironically forcing the CIO, because of that financial perspective, into a larger role with more credibility and more involvement on these decisions.

I think the patient safety initiatives that started to launch 5-7 years ago had a similar effect, though I think that bubbled off a little bit with the implementation of the systems and the increasing roles of the CMOs and CMIOs in the organization. So I would say there is adequate involvement, or an increased perspective.

I’d also say that today, with the emphasis on what’s going on at Meaningful Use, the CEOs have a better conviction, are more aware of and are focusing on the quality of the implementations that are occurring. At least in my consulting work, I see CEOs and CFOs actively sit back and go, “This is not just about getting the money. This is about doing it correctly. This is about doing it so that we permanently change our processes. In order to do that, we have to have a team of medical management, CMIOs, CIO, and other elements of the organization to achieve that.”

I’m sure some places consider the HITECH money they’re going to get as the initial return on investment. The CIO gets a pat on the back for achieving that. What pushes the next set of steps?

For the first point, in some organizations, I’ve seen the CIO and the team involved share some incentive bonuses relative to achieving Meaningful Use. Not large ones, but it’s certainly happening.

When the program was put in place and the set of Stage 1-2-3 distinctions were put onto the timeline, it was really quite an intelligent process out of Washington, DC. The emphasis on Stage 2 … some of it is just increasing the numerators on number of medication orders that are processed through the system electronically, but many of them, especially the physician requirements, the eligible professional requirements, really do focus on increasing the patient involvement, the patient interaction with care, transferring some data along the continuum of care in a consistent way that can be used and interpreted by the providers along the continuum. That clearly is the movement towards whether we want to call it accountable care or value-based compensation or pay for performance or population management – good things to do for healthcare, things that have been needed for a long time.

I think the impetus to continue will be the business value that’s now achieved from certified electronic health records as it moves towards managing a population, both for quality and for economic gain. At the end of the day, the health systems and eligible professionals are still going to look at what’s the financial benefit associated with Stage 2 and clearly Stage 3, with an emphasis on population health improvement, are the incentives to continue to move along to the end road further.

If a CIO realizes that most of their responsibilities and the expectations placed on them involve keeping systems up and running, having the help desk be responsive, and keeping cost under control, what are some strategies they can use with this opportunity that HITECH and the potential of Accountable Care Organizations have put in front of them to earn a more strategic role?

I think the first realization that CIOs have to come to grips with is that they can no longer think information technology, infrastructure, and application systems. Many have progressed beyond that. The CIO today, in order to advance and survive two, three, or five years from now, has to be thinking informatics. I use that term very precisely.

They have to be thinking about how the information that is managed through the information technology assets are actually used to achieve that business benefit for the organization, that clinical benefit for the organization. It’s really quite beyond just efficiency. Efficiency is certainly one element of it. Could I move my transactions along faster? But it’s really the informatics component. How do all of these different aggregations of data get transformed to clinical information that then improves both our care position with our population and our financial position?

The key survival element is to get very deep into this learning curve, if they’re not already there. Get in front of the questions that are being asked.  If someone today says, “I’m going to build an Accountable Care Organization. I’m going to need to have some quality improvement metrics.” Great. That’s certainly a starting point. The CIO needs to be saying, “How are we going to actually improve care? What’s the next step in those quality metrics? How does that integrate in with a patient-centered medical home? How much do I understand that, so that instead of waiting to be informed by the physician community, by payer community about this, I can actually inform my executive team about those needs two or three years from now?”

What structure and expertise does a CIO in a medium to large hospital or hospital network need that they didn’t need two or three years ago? What do they need to operationalize that change in philosophy about what IT is all about?

There are many demands on the CIO, operational as well as strategic. They need to have a strategic thinking department that may not actually reside within the IT department per se. That could be aligned very, very tightly with the strategic planning group ,with the CMO of the organization, and also since most medium or larger organizations today will have some form of a medical foundation or medical group affiliation, really aligning closely and understanding their needs and their vision going forward.

They also need to have a very strong data modeling capability within the organization. That’s not necessarily to build a custom clinical data warehouse or clinical performance reporting system, but to really be able to understand as all of a sudden, “Gee we have to plug into a patient-centered medical home that’s using remote management technology for congestive heart failure patients.” The minute we say something like that, we have a superficial vision of the clinical flow of information that moves along in order to achieve that. You need someone in the organization who can sit back and model that at a meta level, and inform all of the other elements, both within the IT department of the data characteristics, the patient transactions that need to occur along the way. It’s not really from a technical perspective, but it’s understanding of what’s behind the data and understanding what’s needed to make that data harmonious across all the different ownership patterns of the data.

I will also say that with the explosion of mobile technologies, the CIO really needs to have a good handle on mobile technologies and what that means.

Are IT departments going to be funded to do that? Are CEOs aware of these multiple priorities, everything from customer service to Meaningful Use to analytics to integrating with physicians and other partners, and giving CIOs being given the budget and the responsibility to carry those things out?

I think it’s a split vote right now. One of the concerns I have about Meaningful Use is that it’s forcing this huge investment up front in electronic health records. There may be a hangover effect similar to what happened with Y2K, where all of a sudden, “OK, you had your share. Now we will only fund and continue this progression in very select areas or in a marginal way.”

I’m actually seeing in the consulting practice about half of the organizations constraining IT growth rather than expanding IT growth. That’s resulting in extending the Meaningful Use deployment schedule. We won’t try to get all the money up front that we could, or we won’t try to get any this fiscal year, but we’ll string the investment out or two or three years and slide in right under the wire relative to the reporting attestation guidelines. I’m also seeing pulling back dollars that might otherwise be used for – I’ll call them experimental programs, but that’s not the right term – but for exploratory efforts that might be going on, like piloting that kiosk.

I think it’s going to get worse. I think as the cost pressures come in, we will see further emphasis on containing IT costs to some industry standard metrics that may be underfunding the environment.

I think we’ll also see – talking out of the other side of my mouth on this – a greater emphasis on system impact. If we can prove that it will speed things up, make things better, quicker, faster, improve patient safety, or support some form of a new reimbursement model … those will get funded differentially.

New systems always cost more than the ones they replace, and once the Meaningful Use money has been spent and forgotten, hospitals will be locked into high-cost maintenance. The hospital has a low margin and no real potential for it to get higher, but the IT budget has to grow because all of the systems that were optimistically brought. How will hospitals reconcile their original appetite for IT versus the ongoing cost to keep it?

I agree with those trends. Just as a footnote. I recently completed a total cost and ownership budget for an EHR purchase, working on a graph with percentage hardware, software, and implementation costs, and maintenance and support over time. I went back to a similar study that I did 10-15 years ago just to see what’s actually somewhat happening. As you would expect, hardware cost has gone down pretty significantly as a proportion. Software dollars were about the same as the total proportion, a little bit higher. Implementation costs and ongoing software support were almost twice what they were as the percentage of budget.  

I see that as a problem. The reaction from any organization will be, “These are fixed costs. We know we have to have the software vendor invoices paid, so we will cut end user support. We will trim down our help desk functions. Instead of using an N minus 1 release program,  we’ll go to N minus 2 or N minus 3.” I think that it’s a very real issue. There will be a constant tension in that environment.

I think the other thing that happens is the competition for resources between things like information technology and clinical services, when you have a revenue cycle and top-line revenue is flat or margin is under further pressure. Those contentions, those issues between those buckets of money, become even greater.

Give me some predictions or some unconventional thinking about what you see as the future of healthcare IT.

I think we will see, unfortunately, a major security breach that will damage the view of what we can do in information technology that will potentially hurt the long-term evolution of sharing of data amongst providers. We’re all somewhat very concerned about this. We have information in our silos. We know how to exchange it selectively. We’re now opening this up further with health information exchanges and so forth. I think that’s all very good, but I think we will have a breach that will somewhat shock us.

I think the role of the medical home will rapidly change to not only its physician-supported view, but we will have a new class of care attendants in the home environment. This could be, for example, myself taking care of a chronic asthmatic child or an insulin-dependent parent, where the technology that we will use will be much broader than what we perceive now as the PHR — Personal Health Record, and some monitoring that might be attached to it – that will really be into assisted diagnoses, some replacement of what we would consider to be normally a physician- or clinician-supported process. I see that coming fairly quickly within three to five years, especially as the health insurance exchanges come into play and we move a huge population of uninsured people into the insured population without an adequate supply of provider resources under the current physician labor model.

Last but not least, I think that the aggregation of some of the clinical information into our data warehouses and into our clinical performance reporting systems will support and provide breakthrough benefits for new disease management models. Once we really get some of this information consistently applied, we’ll be able to  overlay pattern analysis and other considerations that we don’t use today, which will help us improve population care.

Any concluding thoughts?

I would make a couple of observations. First, I appreciate the opportunity to do this. 

I have one other concern in the industry. Where’s our next generation of informatics leadership coming from? I am concerned about the CIO for now, concerned about incentives for CMIOs and CIOs to come into the industry and stay in the industry and to fight through the challenges and barriers that are out there. 

One of my closing comments would be, keep this dialogue going, keep people reading things such as HIStalk. Hopefully, that will provide the community that will support the evolution of us in the industry very different than 30 years ago.

Monday Morning Update 1/30/12

From You Know Who: “Re: RelayHealth. Jim Bodenbender out, announced abruptly on phone call. Jeff Felton, who ran the RelayHealth Pharmacy group and was a transplant from McKesson San Francisco, is taking over the entire division.” That appears to be true from the company’s management team page, on which Jeff Felton (above) is now listed as president.

From RAC Frustration: “Re: electronic RAC responses. I see that Medical Electronic Attachment (MEA) has become the latest company to be certified by CMS. I am curious how many HIStalk readers will use the esMD (electronic submission of medical documentation) for RAC and MAC responses?” MEA’s progam uses an NHIN gateway to send electronic responses to CMS’s post-payment audit requests of several flavors (RAC, MAC, CERT, PERM, and ZPIC.) I’m interested in how much transaction volume the average hospital will experience to keep CMS happy once esMD Phase 2 goes live in October and all documentation requests will be sent electronically. Comments welcome.

Surely the calendar is playing a cruel joke: it can’t be just three weeks until the HIMSS conference, can it?

My Time Capsule editorial this week from five years ago: Want Physicians to Use Systems? Standardize Screens Like You Do Back-End Databases. A free sample: “Hospitals never seem to get how illogical it is to physicians that every hospital buys a different system, but expects community-based doctors who cruise in for an hour a day to master all of them without burning up more hours of their self-employed day. They seem puzzled when doctors jeer at their zealous requests to bone up on Cerner when he or she is fuming at Eclipsys across town and McKesson at the university hospital.”

Listening: reader-recommend James, which I would characterize as jangly Britpop with strong vocals. They (it’s a band,  not a guy) remind me of the Smiths. They aren’t totally obscure, having sold 25 million albums in their 30 years. They probably would sell more if they had a more search engine friendly name, although come to think of it, that’s another similarity between them and the Smiths. 

A lot of money and effort is spent putting on the exhibit and educational tracks of HIMSS, but that’s just to provide the backdrop for the real reason people attend: to connect with folks for business and pleasure, two-thirds of respondents said. New poll to your right, as suggested by a reader: what reaction do you have when you hear that a vendor uses offshore programming resources?

Thanks to CSI Healthcare IT, supporting HIStalk as a Platinum Sponsor. The company is a leading national provider of IT and training professionals, both contract and permanent. The company’s team of 75 recruiters can often find local qualified resources, minimizing billable travel expenses to the client. Its pricing model has saved health system customers such as Sutter, Baylor, Texas Health, Clarian, and Sentara up to 60%. The company is vendor neutral, providing resources for projects involving McKesson, GE Healthcare, Allscripts, Epic, Cerner, Meditech, NextGen, and others. It can handle work ranging from providing a single resource to managing the projects of large health systems, also offering a specific package called Epic Community Connect that helps health systems provide Epic’s ambulatory systems to community practices (marketing, contracting, readiness assessments, implementation, and support.) Thanks to CSI Healthcare IT for supporting HIStalk.

Federal CTO Aneesh Chopra resigns and is expected to run for lieutenant governor of Virginia. You aren’t surprised if you read HIStalk on January 13, when my non-anonymous, well-placed informant chose the fantastic phony name of DeepThrowIT to tell us that Chopra was heading out. I think that might have been my first non-healthcare IT big scoop rumor.

I recently quoted some Epic facts provided by Chief Administration Officer Steve Dickmann in a recent talk he gave to a Madison group. The full video is here, from which I pulled a few more:

• The company started in a basement in 1979 doing UW psych department work.
• Epic went from 2.5 employees in 1979 to 30-40 employees in 1994, but then changed direction to focus on the electronic medical record.
• The product was changed from text-based to a graphical GUI in 1994, the same year when the database was scaled up for large enterprises.
• Epic Web came out in 1997; MyChart in 2000.
• The company gained competitive advantage from Y2K because it had minimal remediation to accomplish while its competitors had to redirect resources to work on that problem.
• Epic also gained competitive advantage from being in Wisconsin, which was an early adopter of large integrated delivery systems.
• Epic does not subcontract or acquire software; everything was developed in Wisconsin.
• The original motto was “Do good, have fun.” The “make money” part was added later.
• Epic focuses on large hospitals and clinics, children’s hospitals, and academic hospitals and turns away other prospects. The only exception they will make is for hospitals located in Wisconsin.
• Epic doesn’t do acquisitions because they would have to rewrite the code anyway to keep a truly integrated product.
• Competitors have 20-30% of their employees doing sales and marketing, while Epic has 1%.
• Epic’s culinary team has 70 employees and it also staffs its own horticultural team. It does not contract those functions out.
• All of Epic’s implementers fly out Monday afternoon, which ties up a good bit of the Madison airport’s capacity with 600-700 people all leaving at about the same time.
• Each customer has an assigned tech support team that knows the customer’s people and systems. The team is available 24×7.
• 91% of the HIMSS EMRAM Stage 7 hospitals use Epic.

Supporting HIStalk as a Platinum Sponsor is Versus, which offers real-time location systems for patients, staff, and equipment. Hospitals use that information to automate workflow, improve efficiency, increase patient safety, boost patient satisfaction, and increase revenue. The company provides interesting examples: (a) advancing patients to the next level of care based on events, such as completed labs or EKGs; (b) locating telemetry patients in distress wherever they are; (c) alerting the physician when patients are ready to be seen; (d) reminding staff to wash hands; and (e) alerting housekeeping to clean the room when the patient’s badge is dropped into the discharge bin. The Traverse City, MI company has been around for over 20 years, with its combined infrared/radio frequency system being endorsed by the American Hospital Association. Hospital customers have documented improvements such as cutting equipment losses from $1.5 million to $40,000 year, eliminating the need for clinic waiting rooms, reducing telephone calls by 75%, and increasing bed capacity by 25% with no construction. Interesting stats: the company has over 600 facilities using 500,000 of its components to track more than 1 million patients per year. The big announcement a few weeks back was that The Johns Hopkins Hospital chose Versus to manage staff and assets in real time for some locations after a three-year pilot of several RTLS systems, with additional deployments scheduled. Thanks to Versus for supporting HIStalk.

The Peace Corps has an RFI out for an EMR product, just in case you’d like to sell them one. They’re actually looking to have OpenEMR customized, along with Microsoft Dynamics 2011 and BizTalk for reporting.

In England, Homerton University Hospital allows its original NPfIT contract for Cerner and BT expire and signs its own seven-year extension directly with Cerner, declining to open the opportunity to other vendors because of its working relationship with the company.

The Bipartisan Policy Center releases its recommendations for using healthcare IT to improve care and reduce costs. Quite a few industry names served on the task force and provided their input. Some of its observations and recommendations:

• Even with new delivery models, the healthcare system continues to financially reward procedure and patient volume rather than better care. Recommendations: purchasers and plans should reward care that is higher quality and lower cost, incorporate those models into Medicare physician payments, expand pilots of new care models, and share lessons learned with private sector pilot projects.
• Despite a lot of HIE activity, not much patient information is actually being exchanged. Recommendations: improve the HIE business case by adding more stringent information exchange requirements to Stage 2/3 of Meaningful Use, develop long-term standards that make sense for healthcare delivery, assess the level of information exchange that is occurring, do more work related to two-way data exchange, and clarify the role of health information exchange in the several programs funded by HITECH.
• Consumer engagement with electronic tools is minimal. Recommendations: raise public awareness, help providers engage their patients to use technology, improve the usability of consumer tools and provide easy data import/export for consumer-facing applications, launch an awards program for consumer tools outcomes, share lessons learned, ramp up Meaningful Use requirements to include more consumer tools, and offer incentives to chronic disease patients to use electronic tools to manage their health.
• EHR and Meaningful use adoption is still low. Recommendations: raise awareness of incentive programs and expand RECs and similar programs, clarify Meaningful Use requirements, roll out lessons learned form federal programs to the whole industry and not just government contractors, encourage sharing of best practices, and improve EHR usability.
• Consumers are worried about privacy and security. Recommendations: require all entities that use PHI to comply with policies at least as stringent as HIPAA, clarify government guidance across agencies, development a national strategy for patient identification (a national ID was not specifically mentioned), and issue common sense security practices to providers.

I’ve previously mentioned the MIAA EHR mobile viewer app developed by a three-person Palomar Pomerado Health development team for its own use with its Cerner systems. A preview at a Toronto mobile healthcare conference generates interest, with the app going to pilot in March. The hospital hopes to commercialize it. Said a Canadian hospital IT director at the conference, “We need to look seriously at how a publicly-funded hospital in the States has been able to advance their technology like this when we seem to stumble on things like policy and rules.”

The Pennsylvania Health Department finds that nurses at St. Luke’s Hospital overdosed three patients in the past two years by incorrectly programming their PCA pumps. Hospital employees said the hospital did not require training on the devices.

An article covering successful businesses that did not use outside financing provides an example in eClinicalWorks CEO and co-founder Girish Kumar Navani, quoting him:

I don’t foresee leaving the company for at least 10 years. I would like to leave it a private company with no external investors and absolutely no thoughts whatsoever about Wall Street. I am having fun and take great pride in my freedom. There is no reason I would give that up. We are a cash flow positive company. We have recurring revenues and no debt. We have a large customer base that is growing exponentially.

Compuware says it will take its Covisint subsidiary public in its next fiscal year, which starts in April. Covisint, which has $74 million in annual revenue, offers an exchange platform that connects hospitals and practices, including services for identity management, collaboration, master patient index, and record location.

Vince’s latest HIS-tory: Part 2 of Health Micro Data Systems.

A column in The Atlantic revisits a 1995 article it published about Newt Gingrich, saying that some of his goofy, overly dramatic “we are at a crossroads” ideas (like colonizing the moon) prove that he can’t separate something that sounds cool if given little thought from pushing the government into spending huge amounts of money just to find out how cool it is or isn’t, even though the free market is better equipped to make that call. Healthcare technology was mentioned in that 1995 article:

Gingrich also thinks health care technology is cool. Serious students of this subject worry that insurance insulates patients from the cost of technology, thus yielding lots of high-cost, low-benefit use and in turn steering too much of society’s resources to the further development of such machinery. But Gingrich wants more. In 1984 he wanted more cat-scan machines, and he wanted the government to provide a $100 million incentive for the development of user-friendly dialysis machines–even though "there are already companies and researchers interested in this problem." The point here isn’t that Gingrich will now waste tons on technology. The current political climate will restrain this tendency. The point is that–in case you hadn’t noticed–there is little careful thought underpinning his enthusiasms, nothing solid beneath his unshakable self-assurance and his intense disdain for disagreement.

E-mail Mr. H.

More news: HIStalk Practice, HIStalk Mobile.

Readers Write 1/27/12

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 Top 10 Mistakes Salespeople Make at the HIMSS Conference
By Beth Friedman

A vendor’s sales staff is one of the company’s most important assets. While marketing, PR, and events management put it all together, the sales staff determines whether or not the HIMSS conference is a success.

Is your sales team engaged, interacting with prospects, and busy with pre-scheduled appointments? Or are they sitting around the booth, eating dinner together, and looking like Las Vegas wallflowers?

Here’s a Top 10 list of sales staff mistakes at HIMSS derived from our 30+ years of combined experience. Avoid them and you’re golden. Make them and you’re history. It’s that simple!

Mistake #1: Sitting Around the Booth

Your booth is crowded with salespeople, but no prospects. This is the most common mistake at any trade show.

Prospects must be enticed to enter your booth. They won’t come into it willingly. It is the job of your sales team to get them in. Yes, that means standing at the edge of the carpet and greeting attendees. A simple “hello” and smile works wonders. Multiply your smiles and see how many you get back. Hey, these guys and gals are competitive – have a contest!

Secondly, ask attendees easy, friendly, open-ended questions as they pass by. Get them engaged in a friendly conversation to start. Before you know it, you’ll be giving a demo! For example:

• How are you enjoying the show so far?
• What did you think of the keynote this morning?
• How are you finding the educational sessions this year?
• Did you go to HIStalkapalooza?

Mistake #2: Smart Phone Syndrome

All year you’ve made cold calls, left messages, and begged for appointments. Guess what? The same folks you’ve been trying to reach for six months via phone are here at HIMSS, live and in person. Dump the cell phone and talk to everyone in real time.

Avoid e-mail or any other electronic-based interpersonal avoidance. This includes time spent in the booth, between exhibit hall and hotel, in the elevators, during lunch breaks, and at the roulette table. Attendees are everywhere. Be “on” and smile at all times.

Mistake #3: Selling Too Much

Keep the sales pitch in the booth. If you meet attendees at events, poolside, or at the casino, keep conversation fun, personable, and low pressure. People are people. Everyone likes to meet someone personally first, professionally second. Overselling is one sure way to drive people away.

Mistake #4: Having Dinner Alone

Even if your company is small, make the most of having all your customers and prospects in one place. Arrange a dinner. Invite customers for cocktails. Host a small reception, focus group, or breakfast.

Breaking bread with fellow employees only is an opportunity lost. Make sure every meal includes a customer or prospect. You’ll be glad you did!

Mistake #5: Assuming One Size Fits All

Sales staff often uses a “one size fits all” approach to HIMSS attendees. Take a moment to ask questions and better understand your audience. See what problems they are trying to solve. If your company can solve it, great! If you company can’t solve it, don’t waste their time. Refer them to a company that can, and remember that smile!

Mistake #6: Avoiding Sessions

HIMSS offers a huge educational opportunity. Hundreds of sessions are offered and your prospects are sitting in each one!

Take the time to attend sessions. Sit next to someone interesting. Introduce yourself. Attending educational sessions is the best investment sales teams can make at HIMSS. Plus, it might make you smarter.

Mistake #7: Negative Selling

Talk your company up, not others down. Negative selling never works. And it especially doesn’t work at HIMSS. Enough said.

Mistake #8: Keeping Your Company’s Presence a Secret

You’ve invested time, money, and effort into HIMSS. Why not shell out a few more bucks to let everyone know? Direct mail is back. E-mail campaigns and promotions help. Unless attendees know you’re there, you’ll get lost in the noise.

And remember to attach promotion to your HIMSS efforts, and some emotion to your promotion. Give attendees a reason to visit your booth. And have some fun!

Mistake #9: Confusing Signage

OK, this mistake is usually made by the marketing folks and not sales. But confusing signage is a nuisance to everyone. Your company has less than three seconds to tell HIMSS attendees what you do. Make those three seconds count! Keep signage brief and communicate in familiar industry terms.

Mistake #10: Not Making Appointments

Failing to make one-on-one appointments with customers and prospects at HIMSS is inexcusable. Even if your company doesn’t have access to the pre-show attendee list, just call them! See if they are going. If your direct contact is not going, chances are that someone from their organization is. Call and introduce yourself. Schedule a cup of coffee or have a drink.

Reach out and touch someone before the conference. Because once everyone is in Vegas, it is too late.

Good luck. Have fun. Make the most of HIMSS. It only happens once a year!

Beth Friedman, RHIT is president of The Friedman Marketing Group of Atlanta, GA.

EHR Systems Can Be “Genius” to Use
By Seth Henry

In proper accordance to government regulations, approximately 50% of doctors’ offices nationwide have implemented some form of electronic health record (EHR) system. However, of these, only 25% have adopted the technology to serve in a meaningful and useful way. Most managers understand the mandatory changes that are underway, and in many cases, have begun the critical transition to these systems. Even if users have implemented the proper technology, they may be unsure of how to effectively incorporate it into their daily protocol or how to operate them with maximum benefits.

Compounding the financial investments required to implement an EHR system, there is an average of 1,000 hours of data entry required within the first year of adoption. Doctors and their staff are already pressed for time and money and do not have the proper resources to accomplish this tedious but crucial task. Moreover, they need to be focused on their real job – providing quality healthcare to patients.

The good news is that EHR systems can become user-friendly with the addition of proper infrastructure. Comparable to personal technologies, EHRs originate as a generic platform, with the responsibility of the owner to engage with the product to create a usable, tailored system.

Compare your iPod to that of your friends. No two are exactly alike after you each have the opportunity to personalize and import desired features and applications. Electronic health record systems are similar. They start with standard capabilities and can be uniquely personalized and adapted to meet individual facility requirements. The EHR technology requires applications to make them accommodate the needs for users to engage with the system on a daily basis to further benefit patients.

The most formidable part of any technical change is the actual use of the product and gaining consensus amongst the staff to implement it accurately and consistently. EHR professionals are constantly looking for better ways to educate, counsel, and instruct their client facilities on the technology as together they identify the most meaningful way to apply the tailored applications.

Taking a bite out of Apple’s famously coined “Genius Bar,” functional, hands-on training and support is the cornerstone to the successful use and implementation of any new product integration. The “Genius Bar” adapts the concept found at global Apple retail stores: in-person assistance for product-related education. Technology providers are retaining onsite, dedicated experts equipped with the skills, solutions, and passion for information sharing to guide facility staff through the program until they are 100%autonomous.

A single-style teaching approach is not an acceptable resolution to ensuring total integration of these technical upgrades. Thoroughly educating users in a personalized method, void of time constraints, will enable them to be properly trained to engage with the systems. Not everyone responsible for use will learn in the same manner or adapt as quickly as others. Therefore, the “Genius Bar” solution allows hands-on training and a continuous resource for resolving practical issues encountered as they implement the systems.

When the facility staff and doctors are comfortable with using the products, they are more inclined to incorporate the processes into their daily routines. In-person, ongoing support from their “Genius Bar” representative will help facilitate a smooth transition and implementation process.

The real benefit of an EHR system lies in generating, analyzing, and, ultimately using patient information to directly improve overall patient care. Tailored applications that enhance the EHR technology allow facilities and users to employ the appropriate features and accommodate their needs without the high cost of in-house IT infrastructure and staffing.

With the value of applying customizable, intuitive features, internal office support, and the help of the “Genius Bar” staff, facilities can succeed in long-term implementation and meaningful use of electronic health records.

Seth Henry is founder and president of Arcadia Solutions of Burlington, MA.