News 12/15/10

From Nasty Parts: “Re: InnerWireless. Their VC backers want their money. Look for it to be acquired soon.” Unverified. The Richardson, TX company offers wireless infrastructure. It struck me as odd that its board of directors has four members, all of them money guys from different VC companies.

From THRGuy: “Re: JPS Health Network, Fort Worth. The interim CIO, has been named CIO. So a complex hospital implementing a complex EMR hires a CIO who has never had that job before?” I thought maybe he’d been there a long time, but it’s just been a year. His LinkedIn profile indicates no college degree, either. But it’s the same argument that college football teams go through: do you pay huge dollars to bring in a big-name ringer who could fail or bail, or do you figure your chances are about as good going with a known quantity who seems capable? Especially when a successful EMR implementation shouldn’t be under the CIO’s control in the first place. I will say from the cheap seats it does seem like a puzzling choice, but I have to assume they have the knowledge and incentive to pick the best candidate. And like coaches, CIOs are replaceable if things don’t work out, even when it’s not their fault. UPDATE: Joe Venturelli e-mailed to say that he obtained a bachelor’s degree in design from School of Visual Arts, which I see he’s updated on his LinkedIn profile. He also notes that he was CIO for NewHope Bariatrics. Thanks for the update.

The IOM’s Committee on Patient Safety and Health Information Technology, which is conducting a year-long study on the safety of HIT, held its first meeting Tuesday, continuing through Wednesday. Tuesday’s presenters: Gail Warden (University of Michigan), David Blumenthal (ONCHIT, which is paying for the study), Peter Pronovost (Johns Hopkins), Lawrence Shulman (Dana-Farber), Rainu Kaushal (Cornell), Dean Sitting (University of Texas Health Science Center at Houston), Sumit Rana (Epic), Madhu Reddy (Penn State), Ben Schneiderman (University of Maryland), and folks from NQF, Geisinger, AHRQ, FDA, CMMS, and CCHIT. I’m not exactly sure why Epic had someone presenting (or CCHIT, for that matter – what about the other EHR certification bodies?) The key agenda item was the last one in Tuesday’s session – what is the government’s role in overseeing HIT safety?

David Blumenthal will deliver a keynote address at the eHealth Initiative’s annual conference in Washington, DC on January 19-20. He speaks at a lot of events, but I don’t ever see anything quotable, so I assume he sticks to the standard EMR stump speech.

Weird News Andy is intrigued that patients in England are raising huge amounts of money for US cancer treatments after being told by NHS that nothing can be done and being offered no financial help, only to find that the same treatment is actually being delivered in England as part of clinical trials. Some parents claim their kids were turned down for the trials because those running them didn’t want make their study look bad.

Cathy Bruno, CIO of Eastern Maine Healthcare, wins the CIO of the Year award from the New England HIMSS chapter.

Cerner opens an employee health and wellness center this week for Deffenbaugh Industries, a Kansas City trash company. I noticed that Liking Deffenbaugh on Facebook puts you in the running for a Stinky the Garbage Truck toy, just in case you haven’t chosen a Christmas gift yet for that special someone.

Federal CTO Aneesh Chopra, speaking at a Brookings Institute forum on Internet policy, talks up the healthcare data sharing platform Direct Project as an example of the government’s role as a convener to facilitate innovation.

The Tampa VA hospital launches a $3 million Smart Home project to rehabilitate veterans with traumatic brain injury. Apartments are set up to keep patients re-learn activities and to monitor their movement using a real-time location system.

Healthcare IT vendor Cegedim clarifies news reports suggesting that up to 4,000 French pharmacies rigged its software to underreport taxes due using a secret code, with authorities estimating revenue loss of up to $534 million over three years. The company says it highly doubts that the one known tax fraud case translates into 25% of all pharmacies in France, also pointing out that the change is traceable if they tried anything sneaky.

Massena Memorial Hospital (NY) gets a local newspaper mention for its use of Meditech’s bedside medication barcoding system.

A study published in Archives of Internal Medicine finds that patients who receive care from multiple hospitals and EDs have more medical errors, treatment delays, and duplicate testing, with the conclusion being that data-sharing technology might pay its way by improving that situation. At least what the (free) abstract says about the (not free) article. Sometimes I wonder why you still have to pay for medical journal articles in an age where publishing costs are close to nil, especially since much of the heavy lifting is done by unpaid peer reviewers anyway.

iSoft sells its financial management software group, trying to pay down debt and focus on its core clinical systems business.

The government of Ontario seizes Hôtel-Dieu Grace Hospital due to high executive turnover and a wrongful termination lawsuit. The hospital was under review for a series of pathology and surgery errors.

E-mail me.

HERtalk by Inga

CHRISTUS Health plans a seven-state rollout of Medicity’s ProAccess Community and MediTrust Cloud Services, plus ambulatory order initiation, physician referral, and CCD exchange. They were already using Medicity’s Novo Grid technology.

Now on iTunes: Dragon Medical Mobile Recorder from Nuance Communications. The app allows users to dictate at the point of care via iPhones, which is then delivered to the eScription and Dictaphone Enterprise Speech platforms or to Nuance’s outsourced transcription services.

Moses Cone Health System (NC) implements Proficient Health’s Proficient Orders to streamline communication with local physicians and facilitate future participation in the North Carolina HIE.

Discovery Health Records Solutions completes a $2 million equity offering with the backing of Silverhawk Capital Partners.

CCHIT names three new members to its board of trustees and 11 commissioners to start terms on January 1.

Elliot Health System (NH) implements EMC and VMware solutions to virtualize and consolidate its IT infrastructure. EHS says the VMware vSphere platform eliminated the need to purchase 130 physical servers and resulted in a 50% reduction in data center power usage. EHS, which runs Epic EMR and McKesson financials, next plans to deploy a private cloud to deliver EMR services to physician practices.

MedVirginia announces that it’s the first community HIE to connect with the VA’s and DoD’s Virtual Lifetime Electronic Record (VLER). MedVirginia is leveraging its existing open source CONNECT gateway to the NHIN to enable clinical information exchange based on the CCD C32 format.

Surprising: almost 90% of providers are actively planning or piloting a PHR solution, according to a new KLAS report. Providers are trying to decide whether to partner with their EHR or HIE vendors or choose a free-standing, no-cost solution. Many providers are interested in free options because they can brand them as their own. Microsoft is the most-considered PHR vendor, followed closely by Epic and Google.

Also new from KLAS: satisfaction scores for ambulatory clearinghouses. Navicure, ZirMed, EDI Gateway, and Capario earn the top scores while Emdeon’s indirect product was noted as “most improved.” KLAS also points out that providers are willing to pay higher fees for more functionality if it can make practices significantly more efficient and shorten A/R cycles.

Community Memorial Health System (CA) chooses Wolters Kluwer Health’s ProVation Order Sets as its electronic order set solution.

The executive director of the 10-county Rochester RHIO says all 15 hospitals in its region are connected, as well as labs, elder care agencies, and health insurance companies. In addition, over 360,000 patients have signed consent forms to allow their doctors’ offices see their records online.

Salinas Valley Memorial Hospital (CA) sends a company-wide memo announcing that between 100 and 120 employees will lose their jobs by the end of the year as the hospital tries to trim operating costs. Affected workers include 40 nurses, unit assistants, clerical workers, housekeepers, and nutrition workers. The hospital has already eliminated 205 employees since July. I am pondering the exact wording on that memo. Perhaps, “Merry Christmas! You are Fired!”

MMRGlobal names Sunil Singhil EVP and adds two new members to its board of advisors. Singhil is a co-founder of  Nihilent Technology and its former COO. Joining the board are Qualcomm VP Michael J. Finley and Spalding Surgical Center CEO John R. Seitz.

A Michigan pilot dupes the AMA, hospitals, and specialty colleges into believing that he is a physician. Apparently William Hamman attended medical school, but dropped out. At some point over the last 20 years he tweaked his resume to include a medical degree from the University of Wisconsin-Madison. He had spoken at meetings and universities since 1992 and for five years served as the co-director of Western Michigan University’s Center of Excellence for Simulation Research. He joined William Beaumont Hospital (MI) in 2009 as an educator and researcher. A routine background check by Beaumont eventually uncovered Hamman’s lack of credentials and he resigned. Nice job of vetting over the first 20 years.

Emergisoft partners with Crystal Cruises to implement EmergisoftMaritime, the first EHR designed specifically for cruise ship healthcare. I believe I must do a site visit in order to provide readers with a full product evaluation.

Sponsor Updates

• SCI Solutions wins an eHealthcare Leadership Gold Award recognizing its outstanding healthcare Web portals.
• CDW Healthcare signs up to be a channel partner for Greenway Medical Technologies, offering Greenway’s PrimeSUITE.
• Lower Bucks Hospital (PA) selects Wellsoft EDIS.
• Mindray signs a deal to become the sole distributor of iMDsoft’s MetaVision in China and will also make it available to customers in 10 other countries.
• Hopkins County Memorial Hospital (TX) chooses the Access Intelligent Forms Suite for printing barcoded and data-populated forms on demand.
• The Alaska eHealth Network picks Orion Health to provide its HIE solution in a hosted SaaS mode.
• Lisa McVey, VP and CIO for McKesson Provider Technology and RelayHealth’s provider and consumer business units, wins a Women in Technology award in the enterprise business category.

E-mail Inga, MD, PhD, FACP, CPA

CIO Unplugged 12/13/10

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

Fit to Lead

What to do? Our flight left Jackson Hole way behind schedule. Sitting next to me was a colleague from our cross-town rival. We both grew anxious about the possibility of missing our connecting flight out of Chicago. We landed late.

Within 20 minutes, we had to traverse O’Hare to catch the commuter to Hopkins. Conference fatigue might have been a factor, but before we exited the jet bridge, evidence suggested that we were not going to make it to the departure gate. At least not together.

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New Year’s is fast approaching. This is a traditional time for reflecting on the past and setting a vision for the future. Crafting plans. I do this annual exercise for myself, my career, and with my family.

Need a new challenge?

Consider making 2011 the year of managing energy and getting fit. If you can’t do this for yourself, then do it for others. The people and communities you serve and influence deserve the best you can give (not to mention your family).

Energy is our most critical resource, yet most of us fail to manage it effectively. Year after year, leaders are asked to do more with less, be more productive, and remain fully engaged. If our bodies are not trained to handle the stress load, then the demands on our energy will exceed our capacity. This state of poor health results in lower productivity, disengagement, unfulfilling relationships, and compromised leadership.

I want to live a satisfying life. But am I willing to do what it takes to get there? Are the benefits worth my effort, my sacrifice? According to my wife’s trainer, “You’re never too old to see changes.”

The resources are out there, so ignorance is no excuse. I like the American Heart Association model, and I urge everyone to take their short The Simple 7 assessments. I was shocked to learn that less than 1% of the US population meets The Simple 7 criteria. Retired Generals and Admirals recently sounded another alarm bell this year with their treatise on Too Fat to Fight.

Casual observation suggests that healthcare leaders are not immune. How can we get to accountable care without first living it ourselves?

Ample evidence shows positive correlations between fitness and energy levels and performance and life satisfaction. The Human Performance Institute offers a course for the corporate athlete, which I recommend. In their holistic approach, which encompasses the physical, emotional, mental, and spiritual aspects of life, the Institute reported the following results amongst graduates:

• 75% report they are more engaged with life
• 62% report they are more engaged with their family
• 65% report they are more engaged in taking care of their health
• 48% report improvement in self-confidence
• 57% report they are more productive at work
• 42% report they get better sleep
• 61% report they are more likely to take positive action to make changes in their lives

Being fit provides other benefits. I worked for an organization that gave health insurance discounts based on compliance with one or more of their five measures of health. I worked to meet each criterion, and my health insurance costs were zero!

If I want to keep up with my wife, I’ve gotta be fit. She reminds me that someday we will have grandchildren, and she wants to be able to run and play with them. Heck no, I’m not going to be left to sit on the playground bench. At family reunions, my nephews love to play soccer and touch football, and I’m determined not to be outdone…by too large of a margin, anyway. I have significant interests outside of work, and I know I could not perform any of them well let alone attempt them without adequate energy management.

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I had a choice to make that day in O’Hare. Stay with my colleague and watch our flight depart without us or leave him behind. I decided that making it home to spend time with my family was more important than time with a rival. I moved along and made the flight just as they were closing the door.

Yes, that is a silly story, but how many connections do we miss in life because a lack of energy? We’ve all missed personal and professional flights — and regretted it.

New Year’s is upon us, so make a resolution: 2011 — The Year of the Fit Leader.

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

Monday Morning Update 12/13/10

Half of readers from hospitals say their CIO reports directly to the CEO, with a fairly even split of the remainder reporting to the CFO and COO. New poll to your right, for providers: if an HIE’s technology platform is owned by an insurance company (as in Axolotl and Medicity), would your organization be less likely, more likely, or equally likely to participate in that HIE? Click the Comments link on the poll to add yours.

The president of the Australian Medical Association says the government’s EHR efforts should focus on making information available to doctors in real time: labs, rads, meds, and discharge summaries.

Trustees of Campbell County Memorial Hospital (WY) vote to buy themselves iPads and 3G accounts, claiming their $15,000 hospital cost will save time and copying expense. Otherwise, it’s an all-paper hospital, with CPOE and ED order entry “in the mill.” That jibes with my personal experience: electronic executive toys (and the IT support to keep them running) are always of highest priority, with no justification required except, “These are cool … we want them.”

A CDC survey finds that around half of physician practices uses EMRs, but only 25% of practices use a system that meets “basic system” functionality, with just 10% using a “fully functional” EMR that includes medical history, drug interaction checking, e-prescribing, electronic ordering of lab and radiology tests, and viewing electronic images. Still, the use “fully functional” EMRs has gone from 3.1% to 10% since 2006. Laggard states include Kentucky, Louisiana, and Florida, in which more than 60% of physicians in practice do not use any form of EMR. Leading the pack is Utah, with 51.5% of office-based doctors having access to a basic EMR.

ONC announces December 10 approval of two more certification bodies: ICSA Labs and SLI Global Solutions. They join CCHIT, Drummond Group, and InfoGard Laboratories.

Children’s Dayton chooses Medicity’s Novo Grid for exchanging information with its physicians and partners.

An EMT who took a crime scene photo of a dead woman and posted it on his Facebook avoids jail time, but is sentenced to 200 hours of community service and the permanent loss of his EMT license. His attorney blamed the man’s “raw sense of humor.” Social networking may also have been involved in the woman’s death: her parents say she was killed after an enemy spread false rumors on MySpace that she was romantically involved with the man who was eventually convicted of killing her over the incident.

The Army is testing the AHLTA EMR on mobile devices that include the iPad, iPod Touch, iPhone, Sprint HTC EVO, and Samsung Epic.

An ortho tech at Memorial Medical Center (CA) is arrested and charged with stealing 23 computers from the hospital.

An interesting WikiLeaks disclosure: drug company Pfizer hired investigators to check out Nigeria’s attorney general, hoping to uncover evidence of corruption that would force him to resign. A Nigerian state had sued the company for $2 billion, claiming its testing of meningitis drug Trovan there had killed 11 children (it was later heavily restricted in the US and banned in Europe). Pfizer settled for $75 million in July, but the AG had already been removed after corruption articles were run in local newspapers.

Above is a good interview with Stuart Rosenberg, MD of Beth Israel Deaconess Physician Organization, which just signed an “Alternative Quality Contract” with Blue Cross that pays the group a fixed amount for its HMO patients. He was paid over $700K in the organization’s most recent tax return, which despite being an ample income, doesn’t seem all that excessive considering what non-clinical hospital executives make.

E-mail me.

News 12/10/10

From Patella Poker: “Re: Joint Commission. Big news on medication reconciliation. They’ll start scoring again on July 1 with no phase-in period. I bet a lot of hospitals will have to rush to squeeze this in with all their other initiatives.” The “streamlined and focused” version of the National Patient Safety Goal for hospitals includes creating an admission medication list (and developing a policy for doing something similar in non-inpatient areas), comparing the home meds brought in against those ordered, providing written medication information at discharge, and instructing the patient to keep an up-to-date list and let providers know of changes.

From Kiosk Guy: “Re: VA. They have again selected Vecna. They originally won the award in July 2010, but it was protested by a competitor and the competition was done over last month.”

From Hirudo M: “Re: Aetna. What does its purchase of Medicity say about Aetna’s ongoing partnership with IBM? Aetna is using IBM’s HIE strategy and infrastructure for ActiveHealth.” Good question. That deal was just announced in August and there was a big press release about some Aetna-IBM HIE work in Puerto Rico just a couple of weeks ago, when Aetna was quietly well into its Medicity courtship.

From The PACS Designer: “Re: Pogoplug. We’ve been hearing more about different types of cloud apps lately and now there’s a personal cloud appliance called Pogoplug. Pogoplug turns your hard drive into an Internet accessible device so you can use any browser to call up your files with your iPhone and other mobile devices through a free online service.” The hardware component is $70 and the service is free. You can even stream music videos from your home PC anywhere on the Web, including your smart phone. The pitch is that in 60 seconds you’ll have your own personal cloud running your own content from an external hard drive.

Listening: reader-recommended Ned Evett, which I loved instantly. Well-produced killer guitar riffs, powerful drumming, excellent vocals, and good songwriting and big hooks. Forget the endless technical mention that he’s a “fretless” guitar player and focus instead on some really rhythmic blues, pop, or prog (it could pass well for all three). I’m really liking the Middle of the Middle album on Rhapsody (Shine Like a Diamond on Me is amazing, like the Beatles meet Pink Floyd). I’ve listened to all four albums and they’re excellent. This would be among the best stuff I’ve heard in a long time. I can’t get enough, other than my fingers are getting sore from drumming along on my desk. He’s opening for Joe Satriani on some tour dates.

The webcast of ONC’s day-long PHR Roundtable from last week is now online. They’ve also posted 16 new 90-second Beacon Community videos, one of which I’ve included above.

HealthCare Partners Medical Group goes live on Unity RIS/PACS from DR Systems.

Say hello to NCR, supporting HIStalk as a Platinum Sponsor. The Duluth, GA company is the #1 provider of patient self-service solutions, offering pre-registration, appointment scheduling, and bill pay online, which as they point out, can help preserve the patient experience as hospitals face being swamped with 32 million newly insured patients. Some of its healthcare self-service offerings a check-in kiosk, the eClipboard wireless unit for check-in and registration, mobile reminders and results, ED triage and check-in, revenue cycle management, patient portal, and a wayfinding kiosk. There’s a good video from Richmond Bone & Joint Clinic on their site, featuring the clinic’s CEO. Thanks very much to NCR for not just coming along for the HIStalk ride, but chipping in for gas.

Weird News Andy uses a deadpan delivery for this story, captioning it “You might be expecting twins, Mr. Plettell.” A British man receives a letter from a hospital inviting him to drop by for his ultrasound, urging him to bring along his maternity record. His mates (I’m picturing Andy Capp lookalikes) are encouraging him to show up in a dress and wig, which probably wouldn’t really be all that odd in England since they seem to find cross-dressing endlessly hilarious.

Greg from Citizens Memorial Hospital (MO), the super-progressive 74-bed hospital, tells me about work they’ve done there with Google Health.

We implemented Google Health in March of 2010. The initial response was large, mostly due to local TV news coverage. We send medications, labs, procedures, allergies, and conditions to Google Health. Our next step is working on sending radiology and other reports. We have the ability to import Google Health information as an external document in the EMR. It’s currently a manual process that has to be initiated outside of Meditech, but in the future, we’re planning to automate this process. As more patients and other providers start using the service, it will become a more valuable report. Since we are the only provider in our area sending data to Google Health (with the exception of a few national pharmacy chains), most of the reports we import have only the data we sent.We promote Google Health in conjunction with our Clinic Patient Portal. Users can sign up for both on our website. Information is verified by our HIM department and we contact the patients if necessary to verify their identity before linking their records.  We also have guest PCs in our rural family practice clinics so that patients can sign up at the clinic.

Ross Martin MD MHA, esteemed leader of The American College of Medical Informatimusicology, makes his Interoperetta available as an MP3, explaining that 85% of all humans should listen to it to provide herd immunity against dangerous subliminal messages that could be introduced by the questionably motivated fan who requested the MP3 version in the first place. I think Ross is simultaneously opening and closing the loop, in other words. I’m trying to cajole him into creating an HIStalk theme song in preparation for future HIStalkapaloozas.

On the Jobs Page, for sponsor postings only: Payer/Provider Connectivity Project Manager, Eclipsys Activation Consultant, Segment Marketing Manager. On Healthcare IT Jobs: Cerner ePrescribe Builder, Director EHR Systems Division, McKesson Paragon Consultants.

Orlando Portale, chief innovation officer for Palomar Pomerado Health (CA), tells me he’ll be demonstrating some prototype Android healthcare apps for tablets (EHR access and remote physiological monitoring) at Cisco’s Community for Connected Health Summit, which will be held Monday of the HIMSS conference. Jason Hwang, co-author of The Innovator’s Prescription: A Disruptive Solution for Healthcare will open the session.

Speaking of Cisco, I notice that they’ve released a personal version of their high-quality video telepresence system called umi (there’s supposed to be a bar over the non-upper cased U, but darned if I know how to type that character, which might have been one of those marketing-inspired gaffes since nobody can actually type out the name). Unlimited service is $24.99 a month, although the broadband specs are pretty beefy for non-FiOS residential customers (1.5 mbps upload). It works with your HDTV. I’m picturing a Webcam porn industry vertical sales, but there are probably other uses.

Cerner’s innovation subsidiary is assigned a newly awarded patent for a genetic banking system for securely storing genetic profiles.

I know it will seem odd since the Thanksgiving to New Year’s period is pretty slow for a lot of people, but Inga and I are super-buried at the moment. We’re working on lots of news items, several interviews, and a heavy load of new sponsor activity (thanks for that!), not to mention that we need to start planning for our HIMSS events and the HISsies nominations and voting. It’s the funnest job in the world, of course, but be patient or maybe even forgiving if you are waiting on something from us. I don’t expect our loads to lighten until after the conference. We may need to hire someone or something.

In the first Microsoft Amalga news I’ve heard in awhile, UW Medicine (WA) finally pulls the trigger after a two-year evaluation and licenses Amalga for translational research. That’s one slow sales cycle.

An Ohio doctor, angry that his uninsured patients can’t afford the lab tests they need, strikes a deal with LabCorp and an online lab test marketer to offer his patients discounted tests (example: a $148 lipid panel costs his patients $18). The patients simply order their tests from the county medical society’s site, pay by credit card, and go to LabCorp to get the tests. Everybody can use the service except residents of NY, NJ, and RI. Says the doc: “It’s like using Amazon.com to buy your lab tests.”

Drug and device companies are arming their sales reps with iPads for showing sales pitch presentations to doctors. Medtronic just bought 4,500 of them, Boston Scientific 2,000, Zimmer Holdings 1,000, and Abbott 1,000. It figures that the coolest, state-of-the-art technologies in a doctor’s office will be carried by a drug rep trying their best to keep healthcare costs high.

E-mail me.

HERtalk by Inga

From Camus: “Re: Drummond certification. Am I the only person finding it bizarre how fast the companies certified by Drummond have gone from relative obscurity to MU certified? What happens when practices pick these companies and the company goes out of business in nine months? It’s like wine — you just don’t go from planting vines to world-class cabernet in six months.” The issue is not unique to Drummond. I see plenty of “obscure” vendors on CCHIT’s list. I’ll also point out that Drummond’s certification clients include plenty of familiar names that are hardly fly-by-nights, including Allscripts, GE, and McKesson. I suppose your point is that certification does not guarantee a company is financially sound. Agreed. And I might point out that just because a company is financially viable and has a certified product, a buyer may still be left out in the cold if the vendor makes a business decision to sunset a certified product.

The HIE space continues to heat up as health systems and regional exchanges align with vendors. Recent announcements include:

• Beacon Community of the Inland Northwest (WA), a regional collaboration led by Inland Northwest Health Services, chooses the Orion Health HIE solution.
• Vantage HGT RHIO (PA) selects Verizon’s Health Information Exchange platform.
• The Children’s Medical Center of Dayton (OH) picks Medicity to provide bi-directional connectivity between the medical center and affiliated physicians and partners.

Tift Regional Medical Center (GA) implements the remote access management solution of Minicom Advanced Systems as part of its two-year process to consolidate two data centers.

Cymetrix aligns with Siemens Healthcare to provide conversion support for clients moving from legacy patient accounting systems to Siemens Soarian.

Maryland’s REC, CRISP, has signed up its 200th client.

Anvita Health, a provider of clinical analytics, hires Darren Schulte, MD, MPP as VP of Clinical Strategy. He was previously at Alere Health, where he served in executive positions related to clinical product strategy and development.

In Australia: 98% of GPs use computers for some clinical purpose and almost two-thirds are paperless. A mere 2% of the GPs use paper records only.

Rush-Copley Medical Center (IL) chooses Thomson Reuters Pharmacy Xpert, a clinical intelligence dashboard that helps pharmacists with medication management.

The VA awards Carefusion and technology integrator MicroTech a contract to supply Pyxis to 153 VA medical centers and 17 outpatient centers.

Providence Care of Kingston, Ontario, contracts with QuadraMed for QCPR, Enterprise Scheduling, and Electronic Document Management. Providence Care will also use QuadraMed technology to share clinical data with existing QuadraMed clients Kingston General Hospital and Hotel Dieu Hospital.

Wolters Kluwer Health acquires iCare, developer of an educational program that trains nursing students how to document care in an EMR.

Streamline Health Solutions posts Q3 revenues of $4.5 million, up 9% from a year ago. Earnings were $95,000 ($.01/share) compare to last year’s $296,000 loss ($.03/share.) The company says the improved results are a result of higher license system sales and increased recurring revenue from maintenance contracts.

This week I posted some new videos to HIStalkTV, including a few product demos, an interview, and a fun Lady Gaga spoof by Nuesoft. I must admit the posting task is time consuming, but only because once I get on YouTube I’m easily distracted by other fun videos that have nothing to do with HIT. For example, when I was looked at the Swype demo, I noticed a suggestion for the World’s Fastest Typist from a 1985 David Letterman episode. How can one not get sucked into watching a competition between shoulder pad-wearing women typing on IBM Selectrics with Letterman commentary?

Troubling: only 15% of CIOs think they’ll be ready to qualify for Meaningful Use incentives by April 1, 2011. That’s about half the number who said in April that they’d be ready. CIOs cite CPOE implementation as their biggest challenge, with more than half noting concerns with getting clinical staff to use the systems.

MED3OOO appoints John Wallace as a SVP on its business development team. He was previously SVP at mPay Gateway and served in leadership roles at Misys Healthcare.

Wemedx earns top marks in a KLAS report on outsourced transcription services. KLAS says overall the market “remains a high-performing, competitive segment.” Other top vendors include Precyse, Encompass, and TransTech.

This week’s must-read items on HIStalk Practice: GPs in the UK head to supermarkets. Hayes Management Consulting gets into the holiday spirit. Social media increase participation in online health programs. Building physician alliances in Northern California.

Sponsor Updates

• InSite One will offer its InDex image archive management and access solutions as a per-site license, independent of its hosted and on-site cloud services.
• Keane Optimum earns ONC-ATCB certification as a complete EHR from CCHIT.
• Berkshire Health Systems (MA) chooses Allscripts PM/EHR solutions for its employed physicians and will offer to host and support it for its 300 affiliated doctors.

E-mail Inga.

Healthcare IT From the Investor’s Chair 12/9/10

Ask the Chair

Apologies to all for the delay in posting the first question, but we still thought it might be relevant and/or interesting to some readers.

What was RSNA like? How does it differ from HIMSS?

RSNA is short for the annual meeting of the Radiological Society of North America. This year was its 96th Scientific Assembly and Annual Meeting.

A long-time attendee (the late CEO of Hologic) once told me that the reason it’s held Thanksgiving weekend in Chicago is because it was started as the Midwest society meeting. It allowed all the radiologists’ wives to do their holiday shopping on Michigan Avenue, the “Magnificent Mile”. I’m sure everyone loves flying in to one of the country’s busiest airports on one of the most-traveled days of the year, but there you have it. I, for one, am glad I can take the train!

RSNA is the largest medical conference/trade show in America (and if not the largest in the world, still one of the top two or three). Why? Radiologists use expensive toys and they’re here in force, along with everyone wanting to sell to them. How many? This year saw an astounding 60,000 medical and science professionals from all over the world (unlike HIMSS, RSNA is truly a multi-national show) and over 700 vendors … I mean technical exhibitors … selling them everything from lead aprons to coding software to MRIs and CT Scanners.

In contrast, I believe HIMSS 2010 attracted about 28,000 registered attendees, of which fewer than 14,000 were actual IT professionals. Yes, HIMSS has more vendors (over 900 last year), but some were virtually on card tables. The cost of admission and scale of RSNA keeps out more of the wannabes.

I’ve attended RSNA for over a dozen years. The scope and scale continues to amaze even this jaded HIMSS veteran. GE and Philips’ booths alone are the size of small city blocks, chock full of demo areas, gleaming machines, and conference rooms where the magic happens.

That’s another key difference: people actually bring their checkbooks to RSNA. Deals are done on everything from the big magnets (MRIs) to the mobile X-ray machines. Restaurants and hotels (not to mention the “helpful” McCormick Place staff) lick their chops at the prospect of separating exhibitors and their sales professionals from their T&E dollars.

The pure-play HCIT companies tend to be lost a bit in the noise of imaging systems, but the usual suspects that have a meaningful radiology offering (such as Cerner and McKesson) had a respectable booth presence that seemed well attended. I actually think I saw a tumbleweed or two blowing through the booth of NLP coding vendor A-Life Medical (recently purchased by Ingenix). Not sure if it’s a coincidence, but its competitor CodeRyte’s booth seemed pretty active.

Speech rec vendors Nuance and M*Model also seemed highly active each time I walked by. Merge Technologies seemed to have a hopping booth, some of which was likely due to the Tesla (see my new picture below) and the candy and video games they were providing, but also no doubt as a result of its re-emergence (no pun intended) from the purgatory of bad accounting and management with a new story and a new CEO. I’m looking forward to seeing what they do at HIMSS.

What’s your take on Medicity’s acquisition by Aetna?

Speaking from my usual perch in the peanut gallery (as I’ve done work for neither company), I’m fairly astounded by the price. Rumor has it that $500 million (twice what Ingenix paid for Axolotl) is approaching 8x revenues, a princely multiple that dwarfs, say, Allscripts’ purchase of Eclipsys for 2x revs or even Ingenix’s purchase of Picis for 3x revs.

Medicity appears to be the leader in its space, with over 750 hospitals and 125,000 physicians using its system. Still, it’s a huge bet on the HIE market that’s not quite emerged.

I believe a good part of the excitement (dare I say frenzy) around the HIE/clinical messaging space is that the emerging government regulations which mandate a minimum proportion of premium dollars that a payor spends on actually taking care of sick people (known as the medical loss ratios) appears to allow them to count this type of business towards the MLR (as opposed to say, marketing spend, corporate art, or even executive salaries). Therefore, I’d posit that United and Aetna see this as a way to improve their MLRs while actually improving patient care.

With health reform reducing the payors’ arsenal to maximize their profits (by prohibiting them from underwriting away sick people and mandating certain forms of community rating), they now have a greater incentive to reduce loss through what HIEs can, in theory, bring: reduced duplicative tests, better access to patient data, etc.

What I wonder most, however, is what will the fact that Axolotl and Medicity are now owned by payors do to their sales prospects, both near and long term? I’ve little doubt that a fair number of potential customers would rather douse their dollars in kerosene and torch them before giving them to the same insurance company that has tormented them (in their view) for years. The half-billion dollar question is: what percent of the market does this preclude them from selling to? I’d guess more than 15%, but less than 50%. I can only assume the buyers took that into account when developing their valuations.

Then again, maybe they didn’t need to, as discussed in a previous post. Lack of materiality can hide a multiple of sins, including overpayment or failure to integrate. I’m not suggesting either is the case, incidentally, just observing that we’ll likely never know. Meanwhile, I’m sure Sandlot, db Motion, CareFx, and the sales forces of other competing vendors are pretty excited.

Best wishes to all for a happy holiday and a joyous new year! I hope to connect with readers at HIMSS in Orlando, if not before. In the mean time, please keep those questions, cards and e-mails coming.

Ben Rooks is the founder of ST Advisors, a consultancy which has worked with dozens of HCIT companies and investors typically on issues around strategy, financing, and outcomes/exit planning. He has served time as both an equity research analyst and investment banker covering the sector. ST Advisors advised A-Life Medical in 2009, Sandlot in 2010, and really enjoyed sitting in Merge’s Tesla last week.

News 12/8/10

From Pecos Bill: “Re: physician-run ACOs. Why am I not surprised that MD bullies want to muscle their way to the head of the line to run ACOs? I’m certain they’d be just as ‘successful’ as they were running IPAs.” The AMA tells CMS that accountable care organizations can’t succeed unless doctors run them, so they want to remove any government bias that favors big health systems. If it’s like private practice, the first thing the male docs will do is put their wives in charge.

From One-Eyed Mike: “Re: Medicity acquisition by Aetna. Makes sense. This is a nice adjunct to the ActiveHealth Management business and Aetna wasn’t shy when they bought that. The even more interesting question is how the other big payers will react. You would think that Wellpoint, Cigna, and Humana have to start thinking through an HIT strategy given their competitors’ (Ingenix, Aetna, HCSC) actions.” As a refresher, Aetna acquired decision support and health analytics vendor ActiveHealth Management for $400 million in 2005. Co-founder Lonny Reisman, MD is still with the company, since promoted to CMO.

From No More Coffee: “Re: Medicity acquisition by Aetna. Am I the only one raising eyebrows? Does anyone think they will use the data to improve patient care?”

From Enrique Palazzo:”Re: plagiarists. I have proof by time and topic of some sites using your information and story finds without credit.” That’s OK. The HIT journalism business model is pretty much non-experts cleverly rewriting press releases without applying any kind of filter or analysis (thank goodness there are a couple of pros that I usually name by name for doing “real” journalism). Here’s my proof: I don’t think I miss important HIT stories or developments very often, yet you’ll notice that I never link to an HIT publication or site. I don’t have to — they rarely run anything useful that isn’t available from the original source (newspapers, press releases, etc.) If they trust my news judgment better than their own, then I’m flattered.

From Dandy Don: “Re: UCLA. With UCLA signing with Epic and announcing a wildly optimistic timeline, things will get ugly as they compete with Cedars-Sinai for the fairly small Epic talent pool in LA. Epic-certified staff already have a lot of market power there.”

From Ummagumma: “Re: UCLA. Just FYI. UCLA and LA County have virtually nothing to do with one another. UC is a state entity and LA is one of the five UC sites that have a healthcare campus. LA County has its own healthcare group (Dept of Health Services – LA DHS) that manages Olive View, Harbor, and I think parts of USC, as well as probably other locations, like clinics. The only official connection between UCLA and LA County is an academic one — Olive View and Harbor are both academically part of UCLA, which means that their physicians are professors at UCLA, and with King-Drew where their students are involved with the UCLA School of Medicine.  Otherwise all management, budget, decision-making, etc. with regard to HIT and budgets are totally separate. This is a common mistake, though, because both Olive View and Harbor have played up the UCLA part of their name. Also, in answer to one of the comments, we UCLA wasn’t on any one system – it’s very best-of-breed. Epic will be replacing at least 10 vendor systems and a half dozen homegrown ones.” The above Web shot is from the LA County Health Services site. Another reader clarified that what most people think of as LA County Hospital is actually part of USC’s teaching program, but it’s UCLA Center for Health Sciences (now Ronald Reagan Medical Center) on the UCLA campus that’s going Epic. What struck me most, though, is that of several people who e-mailed clarifications (most of them UCLA MD faculty) none seemed absolutely certain about how it all fit together and their explanations didn’t fully jibe, so it must be darned complicated. Anyway, a good source tells me that nearly 100 clinics are going up on Epic first, then revenue cycle, then inpatient. It’s supposedly a five-year, $250 million deal with a full expectation of blowing that budget.

From California Dreamin’: “Re: CareFusion. I’ve heard they may be in financial trouble. Is the CFO replacement the symptom or the cause?” The Cardinal spinoff (Pyxis, Alaris, MedMined, Jaeger, V. Mueller, etc.)  promotes James Hinrichs to CFO. The chairman and CEO is retiring in February, probably with a bundle. Shares have meandered since the spinoff, trading low in the 52-week range at the moment, with a market cap of $5.2 billion.

From Sleepless in Snowland: “Re: McKesson STAR. Support sent out an urgent e-mail around noon on Friday saying an emergency downtime would be required that day to fix a Y2K-like date problem. This despite the fact that the STAR HISNET listserv had been buzzing about this topic for over a week and McKesson apparently has known about the problem for MONTHS. And then…nothing. No further official word from McK until 2:30 a.m. the next morning, and oh, the fix has to be applied by 8:00 p.m. Saturday. Much wailing and gnashing of teeth by HISNET users who were the only source of information for the 14 hours between official notifications. Another blow for a vendor who’s having a hard time winning new business or keeping existing clients.” I found the above messages and others on the listserv.

Bellevue College (WA) and HIMSS get an NSF grant to develop some kind of national HIT certification and curriculum program for community colleges and high schools. HIMSS is setting the certification criteria, so I assume they’re planning to sell certification credentials.

Thanks to MobileMD, a new HIStalk Platinum Sponsor. There’s a lot of green in the KLAS scores (overall score over 93%) of the Warminster, PA HIE platform company. I always check out the management team of new sponsors to see if I know anyone and theirs is not only loaded with lots of HIT experience, they have several executives with military leadership backgrounds, which I see as a plus (CEO Todd Fisher was Special Forces and other company execs were officers in the Air Force, Navy, and Army, including grads of the Naval Academy and West Point, so thanks to those guys for their service). I guess I should finally get around to saying what they do. MobileMD offers a SaaS-based, turnkey HIE platform that can be brought live in 30-60 days. Its solution supports data exchange that include feeds to physician EMRs, transmission of CCR- and CCD-formatted documents, interoperability supported by a standards-based API and Direct Project (formerly NHIN Direct), a clinical portal, provider-to-provider messaging for referrals and consults, analytics, and iPhone/iPad access. Its technologies can qualify providers for Meaningful Use, of course. Some of its clients: Catholic Healthcare West, Pinnacle Health, and South Jersey Healthcare. Thanks to MobileMD for supporting HIStalk.

This is interesting: hospitals and doctors are using Facebook as a substitute PHR, looking up information on patients who can’t communicate. Case in point, in an article co-written by Newt Gingich and a neurosurgeon: hospital doctors checked the Facebook of a comatose stroke patient and found her detailed descriptions of her health in her own words (meds, symptoms, hospitalizations). They found that she had a history of blood clots, performed the indicated brain surgery, and she’s out of the coma and recovering. The article concludes, “Yet it also reminds us that at the heart of our 21st century health system is the individual patient. A personalized system that puts the individual at the center and helps us make decisions based on the needs of the individual will become even more accessible — and more important — as the digital world expands in ways that can save lives and save money.”

E-mail me.

HERtalk by Inga

The University of Colorado Hospital chooses InterSystems Ensemble for enterprise-wide integration as they migrate to Epic.

A new partnership between the VA and the Utah Health Information Network will facilitate bi-directional data exchange between the VA and rural providers. The Utah HIN uses Axolotl’s Elysium Exchange applications for its HIE.

eLINCx (OH) plans to implement GE Healthcare’s eHealth Information Exchange across Wooster Community Hospital, Dunlap Community Hospital, and area physician practices.

OnShift, a provider of shift scheduling software, closes $2.3 million in VC funding. The company says its customer base is growing 500% year over year. It will use the new funds to accelerate sales and marketing efforts.

Lutheran Medical Center (NY) achieves 93% CPOE adoption two weeks after implementing Medsphere’s OpenVista EHR.

Seventeen percent of healthcare CIOs are planning staff increases in the first quarter of 2011. Top positions in demand across IT in general are network administrators, Windows administrators, and help desk and desktop support professionals.

Lehigh Valley Health Network fires an internist for delivering personal patient information on 2,200 patients to MDVIP, a concierge medical network to which he was applying. MDVIP used the data to conduct a telephone survey. Lawsuits are being considered and possible HIPAA violations are being reviewed.

St. Clair Hospital Outpatient Surgery Center (PA) adds the Versus Advantages RTLS to provide automated nurse-to-patient assignment.

Citizens Memorial Healthcare (MO) selects Summit Healthcare as its integration vendor. That’s Denni McColm’s place.

Health reform will require collaboration and information sharing between hospitals and physicians, but one in five physicians don’t trust hospitals and six in 10 hospitals think it’s difficult to get health information from community physicians, according to a survey. Nearly 3/4 of doctors are already aligned with hospitals and most want even closer financial relationships to reduce their financial and administrative burdens.

CHIME elects George Hickman (Albany Medical Center – NY) and Gretchen Tegethoff (George Washington University Hospital – DC)to is board of trustees.

Health IT complications make the top five on ECRI Institute’s list of potential technology hazards for 2011. The federal safety organization ranked data loss, system incompatibilities, and other HIT complications as the fifth most hazardous technology issue warranting critical attention by hospitals. Suzy, RN, rejoices and says, “I told you so.”

I wanted to weigh in on the question from Cliff on how to break into HIT sales with no sales experience and the top 5-10 companies to work for. I must side with Grizzled Veteran and El Jefe: it’s going to be tough to get a sales gig with one of the top companies with no sales experience. The possible exception would be if you are already working for one of those companies and they offer some sort of junior sales rep program to groom new salespeople. I am sure some will disagree, but I think it is easier to teach an individual HIT than it is to teach great salesmanship. I’ll also add that sales isn’t for everyone and often isn’t nearly as glamorous it seems. It requires thick skin, hard work, and a decent offering to sell. All that being said, I would recommend you consider working for a smaller company where your can give sales a try and at the same time leverage your HIT background. After a couple of years, if you are successful, you will have a much better chance of getting the attention of bigger vendors.

Sponsor Updates

• Ingenix makes its ClaimsManager software available in a cloud-based version, targeting small and mid-sized physicians offices with fewer than 50 doctors.
• iMDsoft partners with Anesthesia Business Consultants (ABC) to offer the MetaVision solution to ABC clients. iMDsoft will also market ABC technology and create an interface between MetaVision and ABC’s billing technology F1RST Anesthesia.
• eClinicalWorks is named a silver winner in the Massachusetts Alliance for Economic Development Seventh Annual Team Massachusetts Economic Impact Awards, which recognize companies making outstanding contributions to the Massachusetts economy.

E-mail Inga.

Aetna To Acquire Medicity for $500 Million

 
Aetna announced this morning that it will acquire health information exchange vendor Medicity for $500 million. The Salt Lake City, UT company’s technologies serve over 760 hospitals, 125,000 physician users, and 250,000 end users.

“This acquisition will enable Aetna to offer a set of convenient, easy-to-access technology solutions for physicians, hospitals and other health care providers. That, in turn, can help improve the quality and efficiency of patient care,” said Mark T. Bertolini, Aetna CEO and president. “Strategically, we believe this acquisition will enhance Aetna’s capabilities and accelerate our growth in the health information technology and health information exchange space.”

“We are excited about joining Aetna, with the shared vision for improving the health care experience for all stakeholders,” said James K. ‘Kipp’ Lassetter, M.D., Medicity chairman and CEO. “The combination of Medicity’s connected health care platform for providers with the clinical decision support capabilities of Aetna’s ActiveHealth Management subsidiary can help physicians make better decisions in real-time as they collaborate and coordinate care.”

Medicity will operate as a separate Aetna business unit under the company’s current management.

Thanks to the anonymous HIStalk reader who tipped us off early – the same one who provided the earlier and equally accurate rumor that Ingenix would acquire Axolotl. I posted the teaser on Facebook last night after confirming the rumor, which I didn’t report in detail since it involves a publicly traded company.

HIStalk Interviews John Loyack, Thomson Reuters

John Loyack is director of product management for the healthcare division of Thomson Reuters.

Tell me about Thomson Reuters Healthcare and what you do there.

Thomson Reuters Healthcare is the healthcare and science business of Thomson Reuters. Within that business, we have a variety of business units. The three on the healthcare side are our payer business, management decision support, and clinical decision support.

The clinical decision support business is what you might be most familiar with. It’s a number of different offerings that you loop through to a number of acquisitions through the years, but the Micromedex business is probably the largest portion. Another important element of that business was MercuryMD, which was acquired in 2006 and now referred to as Clinical Xpert Navigator.

I’m the director of product management. I oversee the Clinical Xpert Navigator suite of products.

You mentioned the MercuryMD acquisition. What motivated the company to make that acquisition and what’s been done with the products since then?

I think the motivation there was to embed the evidence that Micromedex had available even further into a clinician’s workflow. Pharmacists, nurses, and physicians were very familiar with using Micromedex products. It is a very well-known brand and has been available for years, but it was one of the things that were obviously separate from clinical workflow.

I think the acquisition of MercuryMD provided a pretty strong answer for that, or at least answers the question of how we further embed the clinical evidence that we know clinical staff are using into their workflow. It’s one of our most recent releases. Pharmacy Xpert is our first introduction on what we refer to internally as our Intelligent Evidence suite of offerings. It’s all based on the Clinical Xpert Navigator platform.

There weren’t many CPOE users in 2006 when the acquisition went through. Now that clinicians are interacting directly with systems, it must be easier to present that decision support and clinical evidence.

It’s true, but providing real-time access and patient data for a variety of clinical staff is just an amazingly important driver for this. It’s something that we hear from users even today — that being able to give their clinical staff access to the right information at the right time remains a critical, critical element that helps them avoid drug events and helps them improve performance in a number of different ways.

I remember MercuryMD being the highest-ranked product in KLAS for years, going back nine or10 years ago. How would you characterize the competitive landscape in which it plays and why the scores have always been so high for what is now the Clinical Xpert product?

Mobile patient data systems were MercuryMD’s sweet spot. Providing a variety of clinicians with access to mobile patient data, making it very intuitive and easy to use, and also, very importantly, something that was a predictable and replicable implementation process — something that we could do over and over again regardless of what type of infrastructure the hospital had.

Even though we see lots of standardization today, one of the reasons we’ve been able to maintain this position is the fact that every hospital we deal with has a very different infrastructure. They’re using different vendors. Even within the hospital’s walls, they may be using one vendor for the ADT system and using a different vendor for the pharmacy. Or maybe there’s been an acquisition and Hospital A has acquired Hospital B and one’s using Meditech and one’s using Siemens.

Being able to provide a bridge over top of that, which also addresses one of the major pain points of physicians, is something that MercuryMD and our Clinical Xpert specialize in. That offering alone and our ability to do that constantly over and over again, and being able to go in and say that we can implement the solution in 8-10 weeks and actually delivering on that, is what led to those KLAS results. That hasn’t changed for us, so even now we see hospitals coming to us to say that they’ve decided to move or standardize with this HIS vendor or that one, and we’re very happy to continue to work with them.

I like to think that we have a pretty good relationship with the HIS vendors. We’re providing something that, from the competitive perspective, not all of them offer. Its technology has increased in a number of different ways, whether we’re talking about the speeds of networks or the computing power of devices, but it is something that I think we, along with just a handful of other vendors, are able to offer today. We’ve been able to maintain that position with KLAS by coming through time and time again in terms of the implementation process.

If I remember right, in the old days, the product ran on synched Palms. I would imagine that the iPhone and the iPad have made mobile application strategy completely different than what it was then. How do you think that’s going to play out as far as how your development efforts will be focused with those new tools for clinicians to use?

You’re taking me for a stroll down memory lane. Our first offering did not have a desktop element at all. In 2000, when we first came out with the MData Enterprise System — which was the MercuryMD product offering — that was something that ran on the Palm OS only. It wasn’t until 2002 that we introduced what at the time it was Pocket PC, but then Windows Mobile.

In 2006, we moved over to BlackBerry.  We’ve got a number of sites that are very happily standardizing on the Research In Motion infrastructure and devices today, but we’re also happy to recently announce that we’ve moved on to iPhone as well. Android is clearly part of our roadmap. It’s something that we are working on now and we’ll keep everyone up to speed on our progress with that.

I think by moving in that direction and by keeping up with what the market is asking for, that’s one of the things that allow us to maintain the position that we’re in and continue to show continued value by keeping up with all this. It’s not easy. You could imagine just on those different operating systems that I just mentioned. I haven’t even given any consideration to all the tablets that have been introduced, or the different web browsers that might be used, but those are the other things that we keep up on as well.

Speaking of the iOS in general, we’re very pleased to put our solution over there. I think the results are going to show for themselves. Our clients are thrilled that we’re able to introduce something that runs on the iPhone, the iPod Touch, as well as the iPad. It’s not just one device that we’re moving to. We’re actually able to, as we move from one operating system to the next, keep up with a number of different devices.

When you look at both the increase in demand because of the iPhone, iPad and iPod Touch applications, and also what people are trying to do with Meaningful Use to be prepared, how do you see those playing together and affecting your business?

I think we’re seeing a very positive affect. Thomson Reuters just issued a statement recently on how we support Meaningful Use in general.

This actually might be a good segue into one of the other things that we’ve done with the legacy MercuryMD product line, but the Clinical Xpert Navigator product suite as well.  We’ve taken a look at a number of the specific Meaningful Use objectives and we’re moving down a path to certify a number of our offerings. I think the most important from my perspective is the CareFocus offering, which is a part of the Clinical Xpert Navigator suite.

Our plan is to certify to support core objectives to implement the clinical decision support rules related to a high-priority hospital condition, as well as giving hospitals the ability to track compliance with that rule. It is something that I think from a mobile perspective, the core offering is still one that’s resonating within the market, but we’ve also moved significantly beyond that by introducing our CareFocus offering.

These two offerings, Clinical Xpert Navigator and CareFocus, are providing us with a foundation for the future of the Thomson Reuters clinical decision support business by giving us our foundation that will allow us to introduce what we’re referring to as our Intelligent Evidence product line as well.

I noticed that in hospital reports about use of the CareFocus system, which I would characterize as a patient surveillance system, some of your users have claimed that they had reduced patient mortality by identifying high-risk patients and then suggesting or offering interventions to clinicians in real time. How important is the real-time aspect of that, and have traditional clinical systems vendors developed something similar?

I certainly hope I don’t come across as dramatic, but it is a question of life and death. When you’re giving someone access to important, constantly-changing information about a patient, giving them access to something that is as close to real time as you possibly can is critical. That’s the kind of thing that our sites, our clients, have seen that has led to the success stories that they’re seeing.

In the past, perhaps you had a critical care response team or a critical assessment team that was ultimately looking at a patient and going through information manually and trying to judge it. A lot of times, we were hearing from some of our clients that it was coming down to a judgment call. Folks were going in, and based on their experience, making a judgment on a patient. Certainly, it’s not something that allows you to predict 100% of the time the true situation with the patient, but if you’re doing that in combination with real-time access to patients, I think that’s a really powerful combination.

By giving users the ability to essentially pull the needles out of a haystack, they can say, “I’m a part of a critical assessment team and these are the five that I need to be aware of right now. These are the five that may potentially crash. One of them recently saw a temperature spike, so I need to go give them the attention they need.”

I think the other element that’s important here is not only is it the surveillance, not only is it the real-time element, but we’re giving them something that’s accessible on a mobile device. We’re giving them something that they can access on their BlackBerry and on their iPhone, so now they’re able to go to the point of care and review those results, or they’re checking out for the day and there was something about that one patient that I wasn’t quite sure about. Now a lab result just called in and I can call back to my partner and ask them to take a look at that patient because something’s just changed and I want to make them aware of it. Without a mobile aspect, without a real-time element there, you wouldn’t be able to react in the time that really is required.

I mentioned the announcement of Pharmacy Xpert, the clinical intelligence dashboard for pharmacists. I know you have some folks that are already using it. Tell me how they’re using it and what the results have been.

I don’t think we’re quite at the point where we’re seeing the results pour in, but we do have a number of sites that are using it.  Shall I give you a description of the product overall?

Sure.

The elements that we’ve been talking about so far — Clinical Xpert Navigator and that platform — that ability to integrate into the hospital’s information system and pull data for disparate systems, that’s the core platform combined with the real-time surveillance solution provided by CareFocus. Those two elements, those two components provide the platform for that.

Built on top of that for the very first time, we have integrated Micromedex content, so things like the DrugDex database, DiseaseDex, Drug, and IV Index. We have some profiles that have been built as a part of CareFocus by our editorial staff — our Knowledge Development Team in our Denver office – who have created pharmacy-specific profiles that are an important element of that as well.

Then we introduced a number of pharmacy applications on top of that where the design actually supports pharmacy decision support. It links into the hospital information system. It provides access to the Micromedex content that pharmacists are used to using. To take things a step further, we’ve introduced a number of calculators that are a part of that. Features and benefits that improve the overall pharmacy workflow and provide the total solution combining all those things together.

It sounds like the focus is going to be real-time information and then either mobile access or push-type information. Where do you take the product line from here?

We have a Patient Xpert offering that is something that’s essentially providing access to patient education from any HIS we’re working with. Offerings like our CareNotes offering — that’s another part of the Micromedex suite. We have a pediatric offering that’s under development.

We have a number of things going on in 2011 that will take advantage of that single, consolidation platform that is complimentary to all the EMR/EHR platforms, but something that addresses a variety of different clinical decision support needs. We can do that through a combination of workflow solutions, mobile solutions, and real-time surveillance combined with the evidence that Micromedex has been well known for.

The mHealth market is pretty big, but if you look at just the part of it that affects physicians practicing in hospitals in the United States, what’s your big-picture view of where you see that whole segment going?

I can promise you it is going to be a lot more mobile. We’re reaching a point where some of the research estimates I’ve seen show that we’re going to be in the 90th percentile in terms of physicians using smart phones or mobile devices or a combination of mobile device and mobile health applications just over the next few years.

In the early days of this business, we were very excitedly seeing numbers — and this goes back to 2001-2002 — that said by 2006 we would see 50-some-percent of penetration of mobile devices being used by clinicians, predominantly physicians. It’s just becoming a more and more mobile world. I think that is something that we are very happily looking forward to and beyond that.

I saw a press release from another vendor recently that talked about the iPad’s impact on healthcare and how healthcare alone was I think, the third-ranked industry that was embracing the iPad and using it in very specific ways today. That’s something that I see — healthcare and mobility are two areas that have gone hand in hand for years and will continue to do so.

Final thoughts?

I think being able to provide one patient platform is something that will allow us to reach many, many users. When I think about the base of users that use our solutions, it’s certainly not just physicians – it’s also nurses and pharmacists. Pharmacists tend to be some of our power users. Certainly physicians, of course, but even beyond that, case managers, care managers, and a number of different folks throughout the hospitals that all have access to this type of solution and tell us what an impact it’s having.

As a part of one of our recent releases of CareFocus last year, we introduced the ability to provide alerting functionality. Or, if one of your CareFocus profiles returned new results, users would have the ability to be alerted by e-mail or text notification. That anyone subscribing to a particular list would be told that a targeted patient had been identified.

We continue to take things that step further. That’s something that has introduced us to even newer audiences. We have folks even within the IT department who were supporting all this and rolling this out to folks who are now some of our user base as well.

It’s been a very interesting ride. I can certainly say that it’s an industry that has been a pleasure to watch grow over the last 10 years or so. There’s still room to grow, which makes it exciting. There are a lot of good things going on.

Monday Morning Update 12/6/10

From Mighty: “Re: CMS. They’ve apparently again changed the MU denominator for the ED.” The FAQ is updated to say that providers must use the same denominator for all measures, either the Observation Services method (ED admissions plus those treated in observation units) or All ED Visits (all patients).

From Catatonia: “Re: UCLA going Epic. LA County is QuadraMed’s biggest client. Not sure if that includes UCLA, but if so, QuadraMed will lose a huge customer just as they are struggling with implementations. Rumor is that the company’s HIM and MPI business will go to Ingenix.” I tapped a key UCLA contact and HIStalk reader, who explained that only UCLA proper is going Epic. LA County is working on requirements for their EHR selection, with the obvious potential bidders being Cerner (already being used in the county’s 200-bed jail hospital), QuadraMed (they’re still running QuadraMed Affinity – not QCPR – in all DHS facilities), and Epic (if they would really want to take on a complex client like LA County). I appreciate that update. I hadn’t heard the Ingenix rumor.

From Wildcat Well: “Re: NJ. The NJ Physicians Group web site enrolls 1,500 docs and receives $350,000 for a EMR selection process while reviewing, in depth, about four out of 200 EMR systems. NJPG has stepped out quicker than the Colts left Baltimore. Now the NJ HIT REC has endorsed ITelagen as the EMR of choice. Will NJ back room deals never stop?”

From Cliff: “Re: sales. I’m working in HIT and would like to move into direct sales. What tips can you offer and who would you consider to be the top 5-10 companies to sell for?” I told Cliff that I have zero sales experience but would open the floor to readers, so feel free to add a comment to this post to help Cliff out, for which I’m sure he’d be grateful.

From RegularReader: “Re: MedAssets / Broadlane. Let the synergy begin! I don’t know if the acquisition has closed, but the layoffs have begun. Many people in the St. Louis office have been given their walking papers and in some cases a personal escort out the door. Happy Holidays! As you say, Mr. H, my condolences to those that have lost their jobs.” I hate to see employees have their jobs taken away, but I’m also aware that nobody wrings their hands for employers when key employees voluntarily walk for a better opportunity. That’s the hazard of employment at-will. Ed Marx said you have to “go to grow” and I believe that, even though for some people they don’t make the “go” decision but still benefit from it in the long run (most of the people I’ve known who were laid off ended up better off). Still, Christmas is always a lousy time to be shown the door.

Listening: reader-recommended Kristy Lee, an undiscovered folksy blues singer-songwriter from Mobile who sounds to me like a cross between Johnette Napolitano of Concrete Blonde and Tina Turner (meaning she has a BIG voice). She’s not a pretty, choreographed lip-syncher – it’s real music that she could play in your living room unprepared if you had a guitar in the corner, which is kind of what music is supposed to be.

The “who’s an informaticist” poll was close, but the winning answer is “clinicians who learned on the job and who have no formal credentials.” A commenter pointed out that the academic and certification programs are new enough that they aren’t common yet. It’s still a divisive topic: 23% of respondents think someone can be an informaticist without either education or clinical experience. New poll to your right, requested by a reader: if you work in a hospital, who does your CIO report to?

Joe Heins PharmD, former Eclipsys SVP and DocuSys COO, joins First DataBank as global product management and marketing VP. I remember him from his Cerner days, where he ran some of its pharmacy systems business. He gets extra points for being in the 1,229-member HIStalk Fan Club on LinkedIn (I’m sending every one of you a Christmas card, so if you don’t get yours, I’m calling that darned post office).

Inga got clarification from RTLS vendor Awarepoint: Jay Deady was named president and CEO last week, but Brad Weinert is still there as COO.

Ashe Memorial Hospital (NC) chooses PatientKeeper’s CPOE, physician portal, and mobile results solutions. Pretty slick stuff for a 25-bed hospital. I’ve been to Jefferson, NC several times and love it — canoeing the New River there up in the mountains is fun, not that that has anything to do with the hospital unless I fall out next time and crush my skull on a rock, in which case I’ll provide a first-hand PatientKeeper update.

Meditech Magic version 5.6.4 earns ONC-ATCB certification from Drummond Group. 

Want to earn your EHR (Esteemed HIStalk Reader) incentive? Here’s the roadmap: (a) put your e-mail in the Subscribe to Updates box to your right, since even if you’re a casual visitor, I guarantee you’ll miss something useful if you just wander over whenever you think about it; (b) Friend or Like Inga and me on Facebook since it’s a publicly visible barometer of our tortured, anonymous existence; (c) send me your news, rumors, pictures, or guest articles about anything HIT related; (d) show some sponsor love by reading and clicking the ads to your left, which will confirm to them that I wasn’t lying when I claimed I had readers; and (e) shake your right hand with your left, pretending it’s Inga and me thanking you for supporting HIStalk even though we may not meet face to face.

The Eye Care Institute (KY) implements the ophthalmology EHR from Medflow, which is an ONC-ATCB certified complete EHR. It’s pretty slick-looking, although some of the screens are unbelievably busy.

A hospital reader from Switzerland sent over a Huffington Post article called Don’t Repeat the UK’s Electronic Health Records Failure. It points out that the UK’s NPfIT, being dismantled after mixed results and colossal expense, is similar to what’s being done here. The reasons it failed, according to the article: it was too ambitious and it was overly dependent in several for-profit companies implementing proprietary systems while offering too little support to clinician users. Their conclusion: HITECH should be slowed down, penalties should be eliminated, and thorough studies should be conducted before mandating EHR use. “Simply following the lead of ‘IT Believers’ and salesmen without the requisite evidence will repeat the UK’s failures.” All valid criticisms, but the big problem is with out Bailout Central: ARRA is stimulus money, so the idea is to just throw the money out there and hope for the best. The real coup for vendors is that providers have to spend money quickly on EHRs to (possibly) earn money quickly via HITECH, which will goose sales a lot more than thoughtful studies.

Marty Mercer sent over the results of a little survey he did of 25 senior HIT sales types (this is for a class he’s teaching). Factoids from it:

• The #1 CXO strategic issue is MU/ARRA, closely followed by access to capital and ACOs.
• The worst things a salesperson can do is to not listen, show up unprepared, make assumptions, and bash competitors.
• The #1 information source was, by far, HIStalk and HIStalk Practice. (thanks!)
• Top pearls of wisdom: prepare before making contact, focus on care quality and not IT stuff, and be patient since HIT sales cycles are long.

Memorial Hospital (CA) uses Skype to conduct virtual visits between moms and their newborn babies that require ICN admission, hoping to reduce separation anxiety. They also use it to let far-flung family members check out the new addition.

A UK hospital says it will save $400K per year by using a privately developed dictation system that will send letters electronically between clinics and physicians. It uses WinVoicePro to create letters and other documents, including progress tracking and countersigning, that are then sent through the hospital’s data transfer service.

Patty Lavely, SVP/CIO of Memorial University Medical Center (GA) will serve as commencement speaker for Georgia Southern’s fall commencement ceremonies at 9:00 a.m. this Friday.

University of Chicago Medical Center chooses Sun SPARC servers and the Solaris OS (both now owned by Oracle) to run Epic.

I’m fascinated for some reason by pictures taken of abandoned amusement parks and formerly famous places, so this video someone took while prowling around the former Mansour Hospital in Jeanette, PA (just outside of Pittsburgh and home to the excellent DeLallo Foods) is both creepy and interesting. The hospital was shut down in 2006 and the bank is trying to sell the buildings.

The Street runs a really good overview of athenahealth and CEO Jonathan Bush. He comments specifically on the risk to his business as hospitals buy up practices that might have become athena customers: “Our job is to be an information infrastructure between various models. Certainly, hospitals have not been our historic wheelhouse, but if you think about it rationally, the cloud-based solution can lower business risk for the hospital CEO. The hospital CEO is taking a multi-$100 million business risk depending on standard health care information software applications … There’s no question that some of these marriages will work, but others, when rates do come down and hospitals can’t subsidize doctors at these levels, will fail. There’s a $100,000 subsidy to a primary care doctor for selling out to a hospital, and for a specialist it’s even higher. How many primary care physicians will bring in one million dollars in business each year for a business like a hospital, with an operating margin of 3%?”

Bizarre: a former hospital receiving clerk is indicted on charges that he stole $4 million from Memorial-Sloan Kettering Hospital by ordering $3.8 million in printer toner cartridges and reselling them. The $37K per year employee lived in Trump Tower (!), with neighbors wondering where he was getting his “his car, his jewelry, and his women.”  Imagine what he could have done with drug ordering.

So how do you work this into the healthcare cost equation? Partners HealthCare makes a $195 million profit for the fiscal year (much of that from your taxpayer dollars in the form of stimulus money for research) even as other Boston-area hospitals struggle to keep their doors open.

A high school basketball coach who saves his star center’s life by performing CPR on him after the boy collapses in practice credits a $1.99 iPhone app. The coach had purchased the app the night before and went through it as a refresher. It includes pictures, voice instructions, single-button 911 dialing, and other first aid advice.

E-mail me.

News 12/3/10

From EHR Geek: “Re: Sunquest. Gets bought again.” Several readers sent this link over. Huntsman Gay Global Capital LLC is leading an investor group that’s planning to pay $208 million for 51% of hospital ancillary systems vendor Sunquest Information Systems from Vista Equity Partners, which paid Misys $381 million for the company in 2007. There’s some tricky financing involved, with Sunquest apparently borrowing $655 million. The deal values Sunquest at a healthy $1.2 billion. I asked one of my Wall Street experts to explain. He said it’s “an odd transaction structure and a risky one” because of the amount of debt and the chance of changing conditions that could make it hard to repay. The big winner is Vista, who gets multiples of the cash they put in just three years ago and gets to keep 49% of the company. I asked Inga to contact Sunquest for a statement, but obviously they can’t really say anything, so she got the expected “we can’t comment.” Huntsman Gay, started by the guy who invented those environment-fouling Styrofoam Big Mac coffins and who also served in Nixon’s White House (but atoned somewhat for those sins by becoming a philanthropist), appears to have no other healthcare holdings is pretty much all over the place in its $1.1 billion fund (oilfield maintenance, bedding, business process outsourcing, and equipment for electrical utilities). Maybe BCBS will be somehow involved since a company subsidiary runs a venture fund for them.

From Epicdude: “Re: Epic. UCLA just signed an enterprise contract.” Unverified, but I found fresh UCLA job postings looking for Epic people.

From Wildcat Well: “Re: what are we missing here? The American College of Physicians, based in Philadelphia, birthplace of the US, presents AmericanEHR, developed with Cientis Tech of … Canada.” Maybe they left off the North part.

Weird News Andy first pointed out that bedbugs shut down a hospital floor, but he amended that statement that PEOPLE were the problem. NYU’s Hospital for Joint Diseases closes an entire floor because a patient claimed she saw a bedbug. Sick outpatients were told not to come in, leading one quoted in the newspaper to say she’s taking her business to Beth Israel. I don’t know that I blame her: does one unverified bedbug sighting really justify closing a hospital floor, especially given the far more dangerous bacterial types crawling all over? Maybe it was a ruse to get a less-affluent Saudi royal their own entire US hospital floor like the King got over at NYP.

WNA also weighed in with a “Say What?” on my story about patients in China having to pay cash for medical services because someone stole the cable carrying a hospital’s Internet connectivity. He summarizes thusly: “We moving towards a government-run health care system and people in China have to pay out of pocket? Weird news indeed.”

The Meditech 6.1 implementation at Kootenary Boundary Regional Hospital (BC) apparently went well, judging from the lead story in their December hospital newsletter. From the picture of their war room, you can almost smell the stale leftover “everything” bagels, human sweat from IT people working long shifts, and the oxygen-depleting fumes emitted from overheated laptops and whirring laser printers.

In England, the National Accounting Office will investigate the $850 million contract that BT got last year, with MP Richard Bacon suggesting that up to $695 million of that amount was excessive given the scope of work performed.

I got paged at home tonight by the hospital and dialed the number on the cordless phone. Nothing happened. Then I realized: it’s not like a cell phone where you dial and then press the button – you have to press the button, get a dial tone, and then dial. My brain knows this, of course, but my fingers sometimes forget because I don’t dial the land-line all that often. I bet I’m not the only one.

National eHealth Collaborative is looking for new board members. Your hat must be in the ring by December 22 (and yes, shockingly, it’s December already).

Omnicell announces a new version of the Pandora drug diversion detection system it bought in October. They’re at ASHP, of course, like most vendors of anything pharmacy-related.

Terri Steinberg MD MBA, CMIO of Christiana Care, sent over their patient safety submission that just won them a Cheers award from the Institute for Safe Medication Practices. She mentions some ways to influence doctors via CPOE that I had talked about the other day: when considering the choices to offer, put the best one first, make it the default, and standardize the list. They won the award for work with hydromorphone injection, with better success with CPOE than they’d had on paper. They defaulted lower doses, forced choosing a pain scale reason for high doses, required an indication for use, and added CPOE dosing alerts. They successfully reduced too-high initial doses and increased the number of doses within the recommended range. I’ll stick with what I’ve always said: CPOE will reduce some errors, but its greatest (but less flashy) benefit is helping doctors do the right thing, or as the paper says, “prescribers will not go out of their way to change predefined content unless warranted by unique patient characteristics.”

Cerner shares have been on a rocket lately, going from the mid-70s in September to Thursday’s close of $92.03. Market cap is $7.62 billion, pushing the value of the holdings of founders Neal and Cliff to nearly $400 million each. That’s a one-year chart above.

Jobs on the sponsor-only Jobs Page: Payor/Provider Connectivity Product Manager, RN Clinical Content Specialist, Segment Marketing Manager, VP Solutions Management ePharmacy. On Healthcare IT Jobs: Director EHR Systems Division, Horizon Physician Portal – Remote, Implementation Engineer – Integration, Epic Clarity Interfaces Security.

A former Deloitte Tax LLP partner and his wife are arrested for insider trading. The SEC says they gave tips to family members about impending transactions, including the buyout of Kronos by a private equity firm in 2007 and the McKesson acquisition of PerSe that same year.

RAPID Chiropractic Software is certified by CCHIT as an EHR module, giving its chiropractor users a shot at getting 44,000 taxpayer dollars for demonstration Meaningful Use.

Strange: the website for 988-bed Guam General Hospital has some interesting pictures, job postings, and contact info that includes a toll-free number. The problem is, there’s no such hospital – the pictures are of other hospitals and the telephone number has an Atlanta exchange. The local newspaper called the number and the guy who answered said it was indeed the hospital. They’re speculating that it might be a hiring scam that targets nurses from the Philippines. The FBI is looking into it.  

You just know that WikiLeaks is going to eventually expose something on a hospital or healthcare agency. While you wait for that, note that one of the confidential government documents it just released says that Venezuela’s hospitals are a mess – loaded with crime, unpaid suppliers, and doctors quitting medicine. Blamed: inefficient community clinics that provide free care, many of them staffed by Cuban doctors making $400 per month, that take funding away from the public hospitals that the public prefers.

E-mail me.

HERtalk by Inga

Former Eclipsys EVP Jay Deady joins Awarepoint as president and CEO. Before Eclipsys, he was a SVP and GM at McKesson Provider Technologies and a GM and VP with Cerner. Curiously, the press release doesn’t mention what happened to Bruce Weinert, who is still listed at president and COO on the Awarepoint website. The seven-year-old Awarepoint recently raised $9 million in a combination of equity and debt.

Evan Steele of SRSsoft says the company has listened to its customers and will seek ONC-ATCB certification for its EMR. Steele has been an outspoken critic of Meaningful Use criteria, suggesting the measures negatively impact physician productivity and are not relevant for specialists. However, Steele says participation has become more inviting since David Blumenthal recently clarified the exclusions that can be claimed by specialists.

Norton Healthcare (KY) will use Microsoft Amalga and HealthVault for its regional accountable care organization.

The US Army is testing EMR applications on the iPhone and Android devices to determine if they can be used in the field. Some of the hurdles include encryption requirements and signal certification from the DOD and local sources.

Health system value in the US is getting better in some critical areas and slowly gaining ground on its international competitors. According to the Business Roundtable’s Health System Value Comparability Study, the US is behind its G-5 peers, but is making substantial improvement as hospital errors are reduced and smoking rates decline. Rising obesity levels and per capita healthcare spending are two of the biggest factors keeping the US’s health system value behind Canada, France, Germany, Japan, and the United Kingdom.

Hillsdale Community Health Center (MI) goes live on CPSI’s electronic medical records.

The Senate unanimously approves legislation to exempt small businesses, including physician practices, from Identity Theft Red Flag Rules. The bill now goes to the House.

The Leapfrog Group names 65 hospitals to its 2010 Top Hospital list, based on a survey that measures hospitals’ performance in patient safety and quality. Kaiser and Northshore University did particularly well, taking 20 of the spots. It’s interesting to note who made the list, and, possibly more interesting to consider those who were not mentioned (Johns Hopkins, UPMC, MD Anderson, UCLA, Mayo Rochester, Mass General, etc.)

As part of a draft privacy report, the FTC proposes a “Do Not Track” list that would allow consumers to stop web sites and services from tracking online browsing. The report also recommends that businesses not store more information than necessary to meet specific business purposes, suggesting its use to build consumer profiles raises privacy concerns. For example, “the retention of location information about a consumer’s visits to a doctor’s office or hospital over time could reveal something about that consumer’s health that would otherwise be private."

New on HIStalk Practice this week: a new poll for practices, asking if they are currently running an ONC-ACTB complete EHR.  Also, medical liability insurance rates increase for providers adding EHRs. The non-traditional president of Physicians Computer Company. Dr. Gregg Alexander dishes on some recent EMR demos. Dr. Alexander, by the way, sent me this shot of the HIStalk Practice hit counter, which hit the 200,000 visitor mark today when a reader from Harvard dropped by.

Dick Hull joins Acuitec as VP of business development. He was previously with Premise and Surgical Information Systems before that.

The ONC sends the Office of Management and Budget a final rule to establish a permanent EHR certification program. The temporary certification program is expected to run through December 2011.

I am happy to report that my laptop is back home, safe and sound. For $65, my local computer nerd cleaned things up and removed several viruses (including a root virus), malware, and trojans. I am now running Symantec Endpoint Protection (for those of you that asked,) as well as the Mr. H-recommended Spybot Search and Destroy. I appreciate all the advice from readers, except the clever individual who suggested I stop downloading porn. Maybe next time I need a computer I will go the Mac route, but for now, I am feeling relatively safe from the unwanted PC infiltrators.

Sponsor Updates:

• Cumberland Consulting Group promotes Joe Mayberry to executive consultant. He joined Cumberland a year ago after three years with Accenture.
• Ashe Memorial Hospital (NC) purchases PatientKeeper CPOE, Physician Portal, Mobile Clinical Results, and NoteWrite.
• MEDecision is named as one of the 100 best places to work in Pennsylvania.
• Apple Valley Medical Clinic (MN) chooses e-MDs for its 13 family physicians.
• The VA awards Picis a contract to implement its perioperative solutions across the VA’s Stars & Stripes Healthcare Network. With this contract, a total of 42 VA hospitals have selected Picis solutions.

E-mail Inga.

Readers Write 12/1/10

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

To Be or Not To Be — Certified; That is the Question
By Frank L. Poggio

The ONCHIT Certification process is in full swing. There are three interim firms designated as Authorized Testing and Certification Bodies (ATCB). Over 100 products and about 70 firms have been approved. The key question is this: should you, as a vendor or in-house system developer, get certified? 

I think we all can agree that if you sell a full EMR or EHR system to health providers, certification is a must. If you do not get certified, it is unlikely you will install another new client. Worse, your existing clients will start leaving in droves.

But what if you are a niche vendor? What if you sell a best-of-breed (BoB) package, such as a lab system or a therapy or a dietary system? And what about vendors that sell smart medical devices?

For these situations, according to a strict interpretation of the rules, you do not have to get certified (unless, of course, your clients and prospective clients request that you do). And therein is the rub. ONCHIT is not telling vendors they must get certified before they can sell systems (as does the FDA for blood bank software). ONCHIT is going to let the market tell you.

The potential impact of the Meaningful Use bonus / penalties can add up to millions of dollars over the next five years for a given health facility. The responsibility for realizing bonuses and avoiding penalties will fall on the CIO (or maybe COO) of the health facility. If the facility misses out on a bonus or gets hit with a penalty, it is likely that the responsible executive’s job is on the line.

Given that real personal concern, it is fair to assume the CIO /COO will purchase only certified systems and de-install ones that are not.

Even in situations where a niche product does not directly deal with certification “modules”, it could put meeting MU approval at risk. In a recent discussion about certification by the HITECH Policy Committee, it was explained that if you have a ONCHIT-certified clinical data warehouse and use it to generate quality and MU performance measures, if a non-certified system accesses the warehouse and/or places data into the warehouse, the warehouse could be deemed non-certified. I call it “contamination through association”.

Considering the vast amount of PHI and clinical data that moves daily to and from interface engines while finding its way into, and passing through, multiple systems, you can see where a CIO/COO would not want to take a chance on a non-certified product, regardless of how insignificant the application may be to the overall facility’s operation.

This “contamination” issue is not unique to facilities that favor best-of-breed solutions. It cannot be avoided by purchasing an EMR from a single vendor since no single vendor covers the complete waterfront for all applications needed by a provider.

In fact, many medical device vendors will be faced with the same challenge. For example, if a device such as an IV pump, drug dispensing cabinet, or digital imaging equipment is considered “smart” (that is, receiving and communicating patient information and communicating the data over the core hospital infrastructure), then if the device is not ONCHIT-certified, it could be deemed as a potential “contaminator”, thereby rendering the entire EMR as non-compliant and not eligible for MU. Remember: fail just one criterion and you don’t get a bonus.

Unfortunately (or fortunately, depending on your view), there is a now a new cost of doing business in the health systems marketplace: ONCHIT certification. The unfortunate outcome may be that this is a new barrier to entry and will scare off new HIT startups while further embedding the current ones.

The second challenge for a niche IT vendor or device manufacturer is navigating your way through the MU “module” tests. There are 44 certification criteria today.  Additional ones are promised for Years Two and Three that will increase the list by orders of magnitude. As a niche player, your product(s) is considered an “EMR Module” and does not have to meet all test criteria. You are required to meet eight privacy and security tests and just one of the remaining 35.

But this may create a real competitive concern. What if you are a BoB vendor or have a smart medical device and none of the 35 criteria apply to your application? From a regulatory standpoint, you do not need to go through certification. Yet your arch-competitor’s application touches just one module criteria and they submit on that one along with the eight P&S criteria and get certified. Whose product or software will the CIO be most comfortable with?

On the surface, you may think it best to try to meet as many criteria as you can, but there are real risks and costs in doing that. Selecting which to pursue, and which to pass on, must be both a strategic marketing and critical development decision.

In summary, it’s hard to see how a niche player can avoid diving into this pool. The more important question is — how deep? 

Frank L. Poggio is president of The Kelzon Group.

Is Your Vendor About to Deflate?
By Alan Jack

One of the problems in HITland is the inability of many vendors to hire and keep talented staff, especially in the R&D area. Compared to other sectors , healthcare software companies pay lower salaries, need folks to stay on call 24 hours a day, have long hours, etc. Many vendors do not have great internal cultures, either. The result is that many companies have a reputation problem.

When demand for software developers is good, HIT companies start having problems recruiting, while at the same time, headhunters are targeting their employees. Added to the normally high turnover in the software industry, the losses can start snowballing as workloads go up and more folks bail. Developer numbers will start shrinking despite efforts to recruit more. Software will be delayed just at the time when it is needed most.

Do not think that the vendor will willingly disclose issues with customers. The total headcount at companies experiencing issues will likely be going up, in fact, as other roles are hired: project managers, sales and marketing, and other folks in the easier-to-recruit categories. Employees will often switch roles in those time periods, requiring backfill.

As the economy comes out of the Great Recession, this will become an increasingly difficult problem to deal with. Several companies I’m familiar with are already having issues recruiting.

Given that software developer degrees area unpopular with college students at the moment and the reputation problem companies are having have spread overseas to areas where H1B visa people are recruited, don’t look for things to change soon.

Back to School For a Master of Biomedical Informatics Degree – Part II
By Jeremy Harper

Many HIStalk readers are past the career stage where education adds life-changing value. In fact, they are the men and women who will be interviewing and hiring students in the upcoming years.

This post will discuss the differences students will offer from someone who has experience, but no formal education. It will also discuss some of the general education required for a MBI. Lastly, it will briefly mention internships and how a proactive company could interact with students who would be more inclined towards working at their company upon graduation.

As you saw in my introductory post, I am at the beginning of my career. While I have seen a rapid progression in my career, having entered the full-time healthcare work force in 2007, it would probably take an additional 20 years of experience and luck before I could become a CIO without higher education.

What this degree shows for me — and every other student — is that the person receiving it has a passion for the industry. It shows that that the student is willing to take years out of their life to receive a breadth and depth of knowledge that cannot be equaled solely by work experience. It shows they can determine a long-term goal and marshal the necessary resources to achieve it. These are valuable skills to consider when hiring these students to senior team member and management positions.

As someone with experience at both a vendor and a hospital system, I know the value that real-world experience offers. However, that same experience has a narrow focus. A formal educational setting is changing my perspective on past work to look beyond the scope of the project to see how it fits into the overall arena.

This quarter in pathophysiology, for example, we’re doing clinical reviews every week with a physician. We learn how to do the same types of HX&PE medical students perform (lacking their expertise, of course). We will also shadow a healthcare provider with the specific goal of observing their workflows and reporting them to our fellow students.

The people leaving these degree programs will educated in a variety of different methods, but they will have the ability to adjust and learn to use any system necessary to accomplish a goal. Students learn about disparate topics like database structure, biostatistics, and report writing. This provides a confidence to accomplish more than a work force operating solely on experience.

As a real-world example, I have interacted with two separate interface teams closely in my career. One had exceptionally practical experience, having learned via the school of hard knocks. The other also had practical experience, but also formal clinical education prior to working with the interfaces.

The former team would not modify any data pushed through the interfaces. The closest to modification they would come was translation tables. The latter used their specialized knowledge and depth of understanding to successfully accomplish a stronger interface between two systems that did not inherently talk to one another or have data that could be simply translated with a table.

To close, the OHSU program requires two quarters of real-world internship in whatever specialized field the master’s degree student chooses. In general, the other programs I investigated also required some type of internship and capstone.

These programs had a wide variety in what they were looking to accomplish with the internship. Many past projects from my research were evaluations of an EMR implementation, assisting with EMR implementations, working for software vendors on improving their product, or doing general research for scientific endeavors.

If you have a school in your area (check here)or an internship that can be done remotely, you can start forming professional relationships with these schools and students that will enrich your work force.

Jeremy Harper is a student at Oregon Health & Science University of Portland, OR.

News 12/1/10

From Specialty EHRland: “Re: ONC FAQ regarding Core and Menu Set items. I sent this question to ONC in September and they punted to CMS, which hasn’t answered. The rule is unclear as to whether vendors must require their clients to pay for and use all components of the certified complete EHR even if the client chooses not to qualify using those menu set measures. Why should a vendor of specialty systems where diagnostic lab results and growth charts are outside the scope of provider practice be forced to develop those features knowing that the providers will be given an exception by ONC and CMS anyway?” This was in response to a confusing ONC FAQ that I tried to interpret. I think the intended guidance, despite some misinterpretation by some publications, is that vendors must demonstrate capability for all Menu Set items to earn certification even if all of their customers plan to pass on those items in meeting their required five of 10 Menu Set items. The impact is on vendors, in other words, not customers (other than having to pay for features they know they won’t use).

From Frank Drebin: “Re: Black Book Rankings. Have you heard anything about the quality of their market research? I’m not wealthy enough to purchase the results of their recent HIT vendor surveys and I’m not an expert in statistical analysis, sadly, although it does not sound dissimilar to what KLAS already does. As a side note, I have three co-workers and a few nurses still quoting, ‘There is a fracture. I need to fix it.’ whenever we run into pedantic problems.” I don’t have a clue – the company seems to popped up out of nowhere with press releases blazing. It’s a recently acquired subsidiary of Datamonitor and one of the principals was Doug Brown, formerly of Avega and McKesson. Their site lists the vendors by category in order – alphabetical, that is (seeing them in score order costs from $799 to $4,995 per report). They sell the reports only through Amazon, oddly enough. Here’s the excellent “Orthopaedics vs. Anaesthesia” cartoon that won me over.

From Wildcat Well: “Re: Black Book Rankings. They rank top EMR vendors, which includes … everyone. Next they can rank the top 32 NFL teams. Morons.”

From Truth Seeker: “Re: news postings. A group says it’s posting stories on KevinMD and The Health Care Blog, saying they are the two most widely read healthcare blogs in the United States. What about HIStalk?” I don’t follow KevinMD, but HIStalk gets more readers than The Health Care Blog. October numbers: THCB, 67,534 visits, 110,191 page views; HIStalk, 95,366 visits, 134,141 page views. Maybe they’re talking only general healthcare sites.

From Mr. Excitement: “Re: Cerner. How ironic it is that they’re being snake-bitten after all those years of selling snake oil.” Cerner’s $400 million office building and soccer stadium project (of which $232 million is being paid by Kansas taxpayers) is jeopardized when two endangered snake species are found on the site.

From Charles De Mar: “Re: CEO salaries. Sturdy Memorial Hospital pales in comparison to its New England counterpart Lifespan, where the non-profit CEO took home a $9 million payday and employees had no raises that year.” I’d like to say that shocks me, but hospital executive salaries are so ridiculous that it doesn’t. Tiny hospitals paying million-dollar salaries is just absurd.

From RFIDebaser: “Re: HIMSS RFID technology. You wrote about HIMSS using RFID to track attendees on the exhibit floor and in educational sessions. You should ask them to talk about what exactly they are doing here and how they will use/sell the data. You can opt out at registration, which I will.” A few folks got worked up when I wrote that HIMSS will use attendee-tracking RFID chips embedded in the conference badges, but most didn’t seem to care. The idea is that your chip feeds leads to vendors in real time and allows them to deploy salespeople when someone of lofty provider rank enters their perimeter. The opt-out wording says that vendors won’t see your e-mail, phone, or address if you allow them to track you like a stray dog, but only the dimmest of vendors won’t figure out how to Google that since they’ll have your name, title, and employer. Needless to say, I’d recommend checking the opt-out box (or disabling the chip).

From The PACS Designer: “Re: Swype. Inga mentioned ShapeWriter this past June, which is now a division of Nuance Communications. ShapeWriter’s Swype application is now becoming a quite popular choice for replacing keyboard touching to speed up data entry in mobile apps and could help win over physicians who shun typing into medical records while treating patients.”

Weird News Andy concludes that “It’s good to to be the King,” at least if your kingdom sits on a lot of oil. King Abdullah, monarch of our supposed democracy-loving ally Saudi Arabia, has everybody else booted from the entire VIP wing of New York Presbyterian / Weill Cornell Medical Center so he can recover from back surgery in private. Relocated, lower-ranking VIP patients are whining that he’s getting special treatment, apparently missing the irony completely. I guess the hospital runs itself like any other business, taking the highest bidder’s cash in return for hanging out a “closed for private function” sign that keeps the tax-paying citizens away from its not-tax-paying doors.

Allscripts VP Rich Elmore, who the Communications Workgroup leader for ONC’s Direct Project (formerly NHIN Direct) offers this clarification of Direct vs. CONNECT:

The Direct Project (formerly NHIN Direct) is a project to create secure transport specifications for point to point messaging of protected health information using the Internet. While the Direct Project does make it easier for providers to communicate directly with one another, this is in comparison to the fax machine, not CONNECT. CONNECT is a software stack that implements health exchange specifications. The CONNECT roadmap includes support for the Direct Project specifications, which will allow any organization running the CONNECT stack to implement the Direct Project specifications.

I: Global Intelligence for the CIO will be running a version of Ed Marx’s July HIStalk post called The Authentic Leader (Death to the Cliche).

The Economist is running an Oxford-style debate and poll on privacy, pitting Microsoft’s Peter Neupert against Patient Privacy Rights’ Deborah Peel. Two-thirds of voters are siding with Peel so far.

Athenahealth CEO Jonathan Bush compares data-sharing among providers to friending someone on Facebook, describing an athena service that will allow providers to share and update patient information. That’s an alternative to “financial integration”, which he describes as the Kaiser-like model where hospitals buy other providers just to assemble their data into a single, proprietary repository.

Indian IT services vendor MphasiS, whose majority owner is HP, says it’s testing a new HIM product for small- to medium-sized hospitals in emerging markets as its entry into healthcare.

Internet image-sharing vendor lifeIMAGE integrates its product with Microsoft HealthVault, allowing physicians to send images to a patient’s account.

An iSoft press release touts the huge reduction in prescribing errors enabled by its medication management system. My critical review based on the abstract of the original work (since I don’t feel like paying for the article itself): (a) the study involved only 72 patients in four weeks as the “before” group and 58 patients in five weeks as the “after”, all of them patients in a psych unit where medication usage is about as different as it can be from the usual med-surg unit; (b) the rate of the most significant errors, such as wrong dose or wrong drug, didn’t change; (c) system-related errors averaged nearly one per patient. In other words, patients didn’t really benefit since the errors prevented were minor or almost certain to have been caught anyway. That’s usually the conclusion of studies involving CPOE, mostly because they focus on error reduction instead of improved ordering practices (putting the best choices first on the selection list, giving only reasonable choices, calling attention to duplicate orders, improving the timeliness and accuracy of order delivery and response, etc.)

Speaking of iSoft, acting CEO Andrea Fiumicelli is announced as CEO at the company’s annual meeting in Sydney. He was previously COO. The call transcript is here. Most of it involves reduced revenue because of the fall of NPfIT, cost-cutting measures, the hope of selling systems outside of the UK, and the usual streamlining efforts (reduced locations, discretionary spending freeze, sunsetted products). They’re still confident in Lorenzo given its relative youth and sales prospects outside of NPfIT, including in the UK itself as more NHS trusts get to make their own decisions.

Australia’s government says its $380 million (US) telehealth program may install service centers in drug stores and could be staffed by non-physicians for online consultations of low-acuity medical problems.

A hospital in China loses telephone service and Internet connectivity for the second time in a month when someone steals a section of telecom cable running through an apartment complex. Doctors wrote bills by hand and patients had to pay in cash.

University of Iowa Hospitals and Clinics says the MyChart part of its $60 million Epic system is a hit with patients, with 35% of them activating their account, 48% of those checking lab results online, 12% looking up appointments, and 11% sending an electronic message to a provider.

Piper Jaffray is holding its healthcare conference in New York right now (November 30 – December 1).

The odd campaign promise by an incumbent Australian politician to buy every doctor an iPad with government money is apparently history after he loses the election.

In England, NHS lists a few abuses of its emergency services: a woman who wanted her toenails clipped, a drunk man brought by ambulance because his wife locked him out of the house, and a child brought in because she had stepped in dog droppings and her mother was too squeamish to clean her up herself.

E-mail me.

HERtalk by Inga

From Hercules: “Re: Cerner fun fact. There’s a full gym right on the Cerner campus with trainers. Most associates don’t use it unless they are trying to get promoted quicker, but this does eliminate the need for them to leave the parking lot.” I figured that Neal Patterson was a pro-fitness kind of guy, given his strong support for soccer. Funny that fitness helps those on the fast track.

KLAS recognizes DR Systems as the leading PACS vendor for large hospitals with Infinitt ranking first for community PACS. In the same report, 92% of KLAS respondents say they don’t plan to replace their PACS in the next few years.

MedLink completes an aggregate of $2.25 million in financing, including $1 million in private placement. It will use the money to increase sales and marketing efforts, for working capital needs, and for the acquisition of MedAppz.

Hill-Rom hires Brian Lawrence as SVP and CTO. He was CTO of Life Support Solutions for GE Healthcare.

M*Modal and Virtual Radiologic announce a strategic partnership to integrate M*Modal’s Speech Understanding technology into the vRad Enterprise Connect 3.0 Technology Suite.

Genesis HealthCare System (OH) deploys BIO-key’s biometric identification solution, enabling clinicians to establish their identity when ordering or administering meds in Genesis’s Epic system. In its next phase, Genesis will implement fingerprint biometric user logon with the Sentillion Vergence SSO product.

Bill Sterling, the former director of healthcare systems for Vocera, joins clinical workflows company EXTENSION as VP of channel and business development. Maybe he can convince them to ditch the all-caps name.

The CFO for Cincinnati Children’s Hospital Medical Center says the health system plans to add 500 new employees over the next year, in addition to the 480 who were hired over the last year.

Advocate Good Samaritan Hospital (IL) wins the 2010 Malcolm Baldridge National Quality Award in healthcare, which honors performance excellence through innovation, improvement, and visionary leadership. Other healthcare-related winners included MEDRAD(medical devices) and Studer Group (healthcare coaching and consulting). 

A subsidiary of Wolters Kluwers Health enters into an agreement to acquire Pharmacy OneSource, a provider of clinical decision support tools for the hospital pharmacy market.

The Leapfrog Group names the University of Maryland Medical Center and Virginia Mason Medical Center (WA) as its Top Hospitals of the Decade. The recognition was based on their public commitment and patient safety and quality innovations.

I don’t recall if I had mentioned this before, but Mr. H generously bought me a new laptop over the summer. The 30-day trial version of antivirus software ran out a few months ago and I have been “too busy” to load new antivirus. I am now realizing that was a pretty stupid excuse since I have now picked up a nasty virus which is preventing me from getting on the Internet. After spending an hour cursing and trying to fix it myself, I took it to a local computer nerd for repair. Now I’m working on the old laptop, which is missing four keys and runs slowly. I only mention this as a reminder, just in case you are also one of those really busy people that has failed to keep your antivirus current. It’s best to take care of these matters as soon as possible in order to reduce the number of expletives you utter.

The CIO of Northern Hospital of Surry County (NC) says the hospital’s implementation of EMC and VMware virtualization solutions has allowed them to eliminate 20 physical servers, decrease power usage, and reduce network congestion. Northern Hospital claims it has saved hundreds of thousands of dollars despite a 30-40% growth in data and the addition of a couple thousand medical devices.

Tensions appeared high at a recent Regional Medical Center (SC) trustee meeting. Trustees were informed that for a one-month period, charges from the pharmacy system were not passing to the billing system. The hospital is working with their HIT vendor (Cerner) to resolve the problem , but had to reissue 3,600 bills. The situation did not please trustees, who had just approved  an additional $2 million for the hospital’s Cerner project, including $628,000 for Meaningful Use upgrades. Now here is where things get a bit testy. One trustee, Danny Covington, says that if the hospital had used Meditech, it could have met the Meaningful Use objectives for less money. Here is the play-by-play in the local paper:

"That is not so," trustee Milton Dufford said.

"I know you want to believe …" Covington said.

"Don’t tell me what I am going to believe now," Dufford said.

"You wanted to believe that we had everything for ‘meaningful use,’" Covington said. "What you think and what you believe are contrary to the end result here."

Why can’t we all just get along?

The 70-provider Riverside Radiology and Interventional Associates (OH) adds ZixGateway Inbound to scan incoming e-mail for unsecured PHI.

CHRISTUS Health and United Regional Health (TX) are some of the dozens of healthcare customers who recently signed up with Catapult Systems for Microsoft IT consulting services.

A study published in the Archives of Internal Medicine concludes that lower-income families with out-of-pocket medical expenditures are more likely than higher-income families to delay or forego medical care. They are also more likely to question services requiring out-of-pocket expenditures.

Sponsor Updates

• ICA wins Best of Show honors in the provider and insurance categories at the recent Everything Channel’s 2010 healthcare IT summit.
• Wellsoft ties for first place in the best of breed category in KLAS’s recent EDIS report.
• The 13-physician Apple Valley Medical Clinic (MN) selects e-MDs for its EHR and PM system.
• Indiana Hand to Shoulder Center (IN) will implement SRS Unified Desktop (PM, EMR, PACS) for its 35 providers.
• Springs Memorial Hospital (SC) chooses the check printing solution of the Access Enterprise Forms Management suite.
• Orion Health announces that its HIE solution has been enhanced to include a modular suite of components to match specific needs of individual healthcare organizations and allow them to scale out projects over time.
• Nuance Communications introduces PowerScribe 360, a radiology and communications platform that combines capabilities of PowerScribe and RadWhere. The solution also works with Dragon Medical to provide core radiology reporting.

E-mail Inga.

CIO Unplugged 11/30/10

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

Go to Grow

In 2007, I dropped off my oldest child at Biola University in LA. We arrived a few days early so Brandon and I could attend the student-parent orientations. In the name of father/son tradition, we also squeezed in some workouts and ate bad but tasty food.

After we got his belongings organized in his dorm, we huddled for a final prayer and blessing. We embraced, shed a man-tear or two, and then I left. Sitting in my car in the parking lot, I watched him walk to the final student orientation.

Leading up to this point, I had planted seeds: encouragement to grow, encouragement to test his personal boundaries, and warnings against complacency. Brandon was officially beginning his journey into the future and to independence. The results of my optimistic seed planting were soon to blossom.

What happened next surprised me. As I drove down the Pacific Coast Highway, I began to wail. From the depths of my soul, I cried so hard my stomach convulsed. Wheezing in breaths, I mourned my treasured son’s rite of passage. Then mourning turned to dancing, and I rejoiced for Brandon and his future. I can only imagine what the drivers in the cars next to me must have been thinking of my spectacle. I pretended to be singing.

Three years later, Brandon graduated. We’ve seen amazing growth in our son — growth that could not have occurred had he stayed home. Despite an enriching and loving environment, his potential would not have been fully realized without a dramatic change and challenge. Part of us would have loved to have him stay, but we knew and accepted the truth that he needed to go to grow.

My career has been much the same. I can’t think of a single employer that I have ever wanted to leave. Yet with each one, I knew at some point I’d need to go to grow. Indisputably, my former employers offered ample career growth and challenges. But to gain exponential growth, I had to enroll myself on a journey of sorts. I had to break out of my comfort zones and push the envelope of security.

Each successive move has pushed me out of man’s natural bent toward complacency. They’ve shaped and sharpened my abilities. The breadth and depth of divergent experiences have broadened my skill set in an extraordinary fashion. My talents have gained a sharper focus and my leadership quotient has multiplied. I have become a better servant. I attribute my personal and professional growth to pushing my boundaries and circumventing the traditional career path.

Naturally, we need to create internal opportunities and have career ladders — something for every kind of employee. Yet at some point, the best thing for some will be a new environment, a place that challenges them to accelerate to the next level. I believe it is a leader’s imperative to fight complacency in the workplace and encourage others to go to grow. If it benefits our children and ourselves, then we must be willing to encourage subordinates and peers to do the same.

Sound inconceivable? Untraditional? Scary? An exceptional leader is not afraid or insecure to give away their best.

I have helped some of my best go. I have brought them opportunities for external advancements and served as their reference. At each departure, I felt the loss of their daily presence, skills, and talents. I cried in secret, yet I never regretted a single endorsement. I’ve stayed in touch, and what a thrill it is to see how they’ve grown in ways far more enriching than the opportunities I or my employer could have given them. They had to go to grow, to reach their fullest potential.

I recall a sunny afternoon run along the San Diego harbor with one of my colleagues, the president of a well-known hospital. We spoke about “go to grow” and the fruit we have seen in careers as a result. He resigned a short time later, citing this conversation as the catalyst for him to leave a secure position and take on a new growth opportunity leading a health system on an opposite coast. Catching up recently, he shared that it was the best career decision he had made. His growth has proved exponential.

Are there people in your life and work who need to go to grow? Does complacency have a hold on your organization? Are you selfishly clinging, or do you have a heart to see the best opportunities made available? (Picture the able-bodied forty year old still living at home).

If one of your staff has significant potential but circumstances are such that you can’t fully exploit that, do you give that person the freedom to advance elsewhere? Are there other staff members who need you to encourage them to leave for these same reasons but who won’t on their own out of fear?

We only have one year left with our teenage daughter. We will cherish every minute. But we’ll also do our best to prepare her mind to take on challenges and enriching opportunities. In love, we will push her to learn from the past and fail forward, to maximize the present in preparation for the future. Ultimately, the time will come when she will go to grow, just like her brother.

Now it’s your turn. Go to grow!

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

Monday Morning Update 11/29/10

From Bit Byter: “Re: Samsung Galaxy Tab. I’m interested in it.” The new $600 iPad tablet competitor (discounted by carriers selling data plans) runs on Android, has a 7-inch touchscreen (the iPad is 9.7”), two cameras, integrated GPS, Flash support, the cool Swype typing system, Wireless-N, Bluetooth, and seven-hour batteries. It’s too early to say (or buy, probably), but it looks like a reasonable alternative to the iPad for anyone who wants one (just like there are many smart phones better than the iPhone in some ways, but that most people don’t want because they aren’t iPhones).

From Train Wreck in Progress: “Re: CONNECT. ONC can shuffle paper, but they are screwing up real software and progress in treating the CONNECT team like unloved stepchildren despite multiple awards and demonstrated progress in connecting VA, DoD, and Kaiser. It’s a sad day when initiatives like CONNECT are not celebrated, embraced, and supported. Doug Fridsma’s framework was attacked at the HIT standards meetings as not practical, yet he marches on.” The top two CONNECT consultant managers quit as the program stalls while GAO investigates a complaint from Harris, the incumbent contractor, over a new contract awarded to CGI. The open source CONNECT platform, which won WSJ’s technology innovation award for HIT this year, was developed by a group of more than 20 federal agencies to support secure healthcare information exchange among providers, insurers, government, and consumers. ONC standards director Doug Fridsma says ONC wants to make it easier for providers to exchange information directly through NHIN Direct.

From Capiche: “Re: ONC clarification. Any thoughts on hospitals and practices being required to implement all Core and Menu items?” It’s a ONC FAQ that seems to mix vendor and provider requirements in a confusing way, but I’m interpreting it as being applicable only to providers with self-certified, homegrown EHRs. To do that requires implementing all of the Menu set items even though as providers, they could qualify for MU by using a vendor-certified EHR to meet only five of the 10 menu set items. But another interpretation is that all providers must meet all 10 Menu items even though CMS requires reporting only five. Click the above image to enlarge and let me know what you think it means. Or maybe someone from ONC can clarify their clarification since it’s a pretty big deal if that latter interpretation is correct.

Hospitals may lock down their internal e-mail systems with malware protection and tools to prevent PHI transmission, but docs can just go to their Web-based e-mail on those same PCs and do whatever they want, so say 80% of respondents to my poll. New poll to your right, rekindling an old argument — who should be calling themselves “informaticists”? As usual, click the Comments link in the poll to support your position.

Listening: reader-recommended Ry Cooder’s I, Flathead. I haven’t warmed up to all the music yet, but I like that he’s a non-conformist roots music songwriter who doesn’t really care what the masses think. This one’s a third of a three-part concept album series dealing with the Southern California culture in the first half of the 20th century. The alternative to auto-tuned, air-headed, ad-packaged Barbies and Kens singing about lust. And Watching – one more thing I hadn’t thought of that you can do on an iPod Touch: stream your Netflix movies over WiFi, which I did this morning in watching MST3K while brushing my teeth in the bathroom, just because I could.

A five-year study using trigger tools (instead of unreliable self-reported errors) finds that hospitals have made no progress in reducing incidents that cause patient harm. Nearly one in five hospitalized patients were harmed by the care they were given; nearly two-thirds of their injuries should have been prevented; and those injuries contributed to their deaths in 2.4% of the cases. The article concludes that preventing mistakes isn’t rocket science since every hospital knows that they should be doing. The problem is that they aren’t doing those things consistently: handwashing, medication reconciliation, decubitus prevention, etc.

A good article with the great title of The Doctor-Patient-Laptop Relationship looks at how doctors typing into computers changes the doctor-patient dynamic. A past president of the Connecticut State Medical Society says medical schools in her day taught doctors not to see patients from behind a desk since it served as a barrier, but they aren’t teaching today’s medical students ways to keep computers from becoming an equally disruptive barrier. It makes an excellent point: writing makes no sound and people can do it while they’re talking, while keyboarding makes noise and requires most people to look at the keyboard and monitor. I was thinking about that and I agree: when someone’s typing, I usually stop talking because they won’t hear what I say anyway.

Politicians get involved in the plans by two Canadian hospitals outsource IT to Cerner. They don’t like losing local jobs and they also don’t like the fact that Cerner sells de-identified patient data from this side of the border. Meanwhile, the IT department’s “whistleblower” who heard rumors of the discussions and quit in protest says the hospitals are making a mistake in turning over system knowledge to contractors who will have the hospital over a barrel. Anything related to HIT is a touchy subject in Ontario after audits last year found that eHealth Ontario was wildly overpaying no-bid consultants who were filing padded expense accounts, kicking off a political scandal in which heads rolled. The papers are making a big deal about the fact that IT staffers weren’t consulted in advance of the outsourcing discussions, which is ludicrous – in what world does management seek the input of those who would be negatively impacted by one of the two potential courses of action?

Inga interviewed David Delaney MD, CMO of MedAptus, about revenue cycle management tools.

NEJM runs the case study of the Mass General surgeon who performed the wrong surgical procedure on a patient and went public afterward to help prevent errors elsewhere. The Swiss Cheese Effect was in full force, with several potentially minor problems adding up to one big one in which the surgeon performed a carpal tunnel release instead of a trigger-finger release. Contributing factors: (a) the patient did not speak English and the hospital had no interpreter available; (b) the surgeon did several hand cases the same day; (c) the nurse had not marked the planned incision site; (d) the OR suite was changed because other cases were behind; (e) the change in room also involved a changed in staff, including the nurse who did the pre-op assessment; (f) the change in rooms delayed the surgery, so the surgeon saw another patient while waiting; (g) the circulating nurse fell behind in her documentation to go find a missing supply item; (h) the patient’s site marking was washed off when the area was cleaned; (i) the surgeon spoke to the patient in her native Spanish, so the circulating nurse assumed that was the mandatory time-out and didn’t call for one; (j) the nursing team changed mid-procedure; (k) computer monitor placement in the OR forced the nurses to look away from the patient. The best takeaway came from another physician in the case review:

Surgeons need to take ownership of these policies. When the airline industry evaluates a crash, the pilot is not considered responsible except in two circumstances: the pilot was under the influence of drugs or alcohol, or the pilot did not follow protocol. All hospitals need to have a culture in which surgeons feel responsible for making sure the protocol is followed.

Another HIMMS sighting, as even trade show supply companies can’t spell it right.

Funny: Steve Wozniak, the goofball half of the founding team of Apple Steves, mistakenly says in an interview that Apple has acquired speech recognition vendor Nuance, sending that company’s stock on a tear. The Woz says he must have read something wrong.

A court rules that the Iranian government owes McKesson $44 million for illegally seizing its dairy there in the 1979 revolution. The company was Foremost-McKesson back then.

Here’s why you probably don’t want to buy penny stocks of companies more competent at selling shares than product. Shares in would-be HIT vendor Healthmed Services, which I mentioned last week along with pictures of its “headquarters”, go down just as quickly as they’d gone up when pumped earlier in the week. Share price was less than four cents on Monday, up to over 12 cents on Tuesday, now back to under four cents and dropping. Considering the company has zero revenue and prospects for earning any, even the current $7 million valuation is ridiculous. Penny stocks aren’t usually worth even a penny.

IT application coordinators and analysts working for Kaiser Foundation Hospitals get a $2.91 million settlement from Kaiser for being misclassified as salaried instead of hourly. The employees were part of the HealthConnect go-live team, which required uncompensated travel, overtime, and on-call support responsibilities.

In the UK, a hacker gets 18 months in prison for send spam-infected e-mails that allowed him to take control of the PCs of anyone who clicked a link. He bragged on being able to turn on the webcams of infected PCs and to browse their files without the knowledge of their owners. One of his targets was a hospital. About one in 250 of the spam recipients clicked the link. The man is a father of five, runs a computer security firm and did his hacking from his mother’s living room.

The founder of India-based Apollo Hospital Group judges healthcare ideas for a reality TV show about entrepreneurship, choosing Medsynaptic. The Pune company offers imaging solutions, including PACS, low-bandwidth teleradiology, and image workstations.

The South Asia president and CEO of GE Healthcare says the company’s “de-featured” (up to 40% less expensive) medical devices will improve healthcare efficiency, adding that “India will teach the world healthcare innovation.” GE’s healthcare business there is growing 25% a year and they’re planning to hit annual revenue of a billion dollars within five years.

Strange: a UK nurse who accidentally killed a premature baby by giving 50 ml of sodium chloride injection instead of the ordered 5 ml gets in more trouble when the dead baby’s parents find that she posted a Facebook picture of herself asleep beside the baby’s bed a week before the mistake. Afterward, she posted messages asking for friends to “wish her luck” in the inquiry, and when allowed to return to work after her suspension, posted a message saying, “Has had a fantastic day! Is goin 2 treat herself 2 bottle wine!” The hospitals says they knew about the posts.

The Australian government issues $55 million in grants for interoperability projects, or at least that’s what I assume the article is referring to with the term “personal e-health records.” The government is looking for vendor bidders, just in case you’re interested.

A patient sues Halifax Health (FL), claiming his ex-wife, a former hospital employee, provided information from his electronic records to a hearing officer in their divorce and child custody trial. The hospital had already fired her for accessing the records of another plaintiff, which one might assume is hubby’s new love interest.

Nuance will collaborate with Montage Healthcare Solutions to offer radiology users the ability to search their Powerscribe 360 reporting database using voice commands or keystrokes. They’re demoing at RSNA if you want to drop by for a peek.

Surely we can agree this is excessive: the CEO of 128-bed Sturdy Memorial Hospital (MA) is paid $1.18 million per year. You know the excuses: they have to dig deep to prevent her from leaving, the not-for-profit hit its performance targets that enabled it to bank a big surplus, etc.

E-mail me.

The Obligatory but Heartfelt “What I’m Thankful For” Thanksgiving Post

This will be one of those really rare times where I get all reflective and maudlin, it being a holiday and all. I was moved by Inga’s Thanksgiving post. I might have sniffled a little, but I did cook Indian food for dinner, so it could be that the oils from the chili peppers I was chopping for the aloo matar found their way from my fingers to my nose. That’s my story, anyway.

What I’m most thankful for is that I don’t have to think hard to come up with a “what I’m thankful for” list every day of the year. That’s the great thing about having low expectations and a cynical outlook. Any day above ground is a good day.

I love my day job and the hospital that pays me OK for doing it. It’s the best place I’ve ever worked. I’m just as happy when the alarm goes off Monday morning as when it doesn’t on Saturday.

I am thankful for my family and that I found a woman early who not only tolerates my eccentricities and insecurities, but appreciates them. We ought to be sick of each other after all these years, but the first thing Mrs. HIStalk said when she came home tonight, instead of complaining about the paint-peeling stench of my simmering chana masala that she detests, was that I looked sexy. That’s doubtful (especially since I had just sneezed violently from accidentally inhaling sinus-searing masala vapors) but characteristically commendable of her to say. She’s as cute to me as the day we met in college.

I’m happy that I’m healthy, protected by those in military service, and still moved by good music. I’m glad I don’t care much about money, power, and fame since I’d be worrying all the time about losing them even if I managed to get them in the first place.

I’m glad I started writing HIStalk way, way back in the dark ages of 2003. Nobody was reading and I didn’t care, but somehow it has improbably allowed me to meet some pretty amazing people who are trying to make a difference. Sure, and a few douchebags too, but that’s a small minority. We have our differences and our debates in healthcare, but we always end up on good terms.

I’m thankful for everybody who spends their valuable time reading what I write (even the music recommendations, especially the weird ones). I’m grateful that companies support HIStalk just because they appreciate my work and knowing that I’m still going to rag on them when they deserve it.

I appreciate everyone who takes the time to e-mail me, write guest articles, submit thoughtful comments, be interviewed, and tip me off to news and rumors. You make me look smart and your efforts benefit many.

I’m really thankful for whatever cosmic forces sent Inga my way. She keeps me sane and amused, balancing my negativity with cheery optimism and funny e-mails. The insecurity oozed from her early writing as she struggled to keep inside her tiny industry comfort zone. Now she’s confident, insightful, and eagerly read by her many fans (and just as insecure). You’d like her even more if you knew her in person.

I’m thankful that Mrs. HIStalk knows her culinary limits without me having to remind her, so I’ll be doing the cooking Thursday (after popping Zantac all night because the chutney for the samosas was a little too hot). She does make a mean pumpkin pie, though. I’ll just need to crank up the iPod while she’s watching those idiotic televised parades she likes so much.

Have a fabulous Thanksgiving, Black Friday, and the long weekend. And, in my final “what I’m grateful for” item, thanks for reading.

News 11/24/10

ONC invites the public to weigh in on personal health records as long as they do it by December 10.

A just-in report from Canada says that two hospitals there are talking to Cerner about outsourcing IT.

Central DuPage Hospital (IL), a long-time Lawson customer, says it has implemented Lawson Contract Management in less than four months.

Listening: new from My Chemical Romance, high-energy, defiant punk/pop with some nice hooks that provide a needed break from auto-tune singers and phony country warblers. Driving music.

St. Joseph Medical Center (TX) develops a 10-physician hospitalist program with Intercede Health, which includes the use of the company’s Order Optimizer software. It provides SaaS-based diagnosis-specific order sets and order set management tools, medication alerts, physician favorites, and a nine-week implementation time. That product is also available separately from a subsidiary.

In Ontario, Sunnybrook Health Sciences Centre partners with Telus Health Solutions to roll out a consumer health portal / PHR that will allow Telus employees to upload and enter medical information that providers can review. Its underlying technology is Microsoft HealthVault.

Happy birthday to Ed Marx, whose special day was Tuesday. You can post belated best wishes on Facebook.

Jobs on the HIStalk sponsor-only job page: Implementation Consultants and Project Managers, Director of Technical Readiness, Implementation Consultant. On Healthcare IT Jobs: Health Information Technology Support Manager, IS Senior Project Manager, Ambulatory EMR Implementation Specialist.

I received a nice response from AMIA President and CEO Ted Shortliffe about a reader’s question as to whether the organization will decline financial support from vendors who won’t go on record as not using “hold harmless” clauses in their customer contracts. He says AMIA’s vendor contracting task force received redacted contract copies and have no knowledge of how specific vendors are writing contracts. He mentioned that Senator Chuck Grassley had sent letters to vendors asking that very question, but he has not made whatever responses he received public. Ted says AMIA’s role is as an educator, not an enforcer, so it made strong recommendations. I can see that point of view: other than Epic, most vendors aren’t going to walk away from business if the prospect insists on removing clause like that one. Nobody makes customers sign on the line which is dotted.

Speaking of that, I’m amazed that hospitals allow vendors to provide the first draft of a contract, loading it with vendor-friendly boilerplate and making sure to look astonished and hurt at any suggestion from their “partner” that it be changed before they hand over their large check. Job #1 is to create your own contract draft and give it to the vendor as the starting point for negotiation. I’m thinking of starting a telenegotiating service where I whisper electronically in the ear of hospital and practice IT people, telling them what to say and how to use classic negotiating techniques to their advantage. Customers are always complaining about the bad deals they got without accepting blame for taking what was offered without a whimper. In negotiation, 80% of the money on the table is going to be split equally between the two parties. When you’re negotiating, you’re fighting for a bigger share of the remaining 20%.

Investment bank TripleTree will host a Webcast about cloud computing in healthcare on December 1. The panel includes top executives from Castlight Health, SCI Solutions, MedVentive, and Connextions. Two of those four are HIStalk sponsors (SCI and MedVentive), so tune in and support them if you’re so inclined.

Nuance announces Q4 numbers: revenue up 17.7% to $310 million, EPS $0.01 vs. $0.02 after some accounting adjustments. 

British company Cambridge Consultants announces the Minder smart device, which transmits medical data in real time to EMRs. It can also receive checklist information from providers to instruct patients. Technologies used: Bluetooth, Wearable Mobile device hardware, accelerometer, the Continua-compliant Vena platform, and input devices that include a blood pressure cuff and scale.

iSoft’s former auditors face misconduct charges over – what else – allowing questionable recognition practices.

Odd: Healthmed Services, which has staked its fortune on some kind of iPad-to-desktop communication tool for healthcare use, floats a bunch of press releases touting its vaguely described agreements with Facebook and Google. Its also-vague Web site features a video of President Obama and a lot of generic information about the vast healthcare IT market it plans to conquer. The company today announced a development agreement with Veritas Software Systems, which might sound like the big backup system vendor unless you recall that Veritas was acquired by Symantec in 2005 (and its name was actually Veritas Software Corp. – this particular company has no Web presence that I could find). It also announced this week a new Web-based practice management system called HealthTrac, with no details whatsoever. What’s really newsworthy about the company: (a) it just filed an 8-K disclosure that it paid a company $600K to develop its flagship product, armed only with an oral agreement, but that company is holding them up for more money; (b) the company’s stock was being pumped and dumped by cocaine-smuggling New York longshoremen (note this “monster pick” that ran up the price 93% on Monday, with 42 million shares changing hands); and (c) its SEC filings from August indicates that the company had zero revenue, had no expectations of any revenue, and was down to its last $52 in the bank. I Googled its listed address and came up with the Las Vegas building above from Google Maps, which I assume is a mail drop. The address it uses for its SEC filings is a one-person virtual office in California that’s currently for rent for a minimum period of one night (that photo is above, too). The CEO quit in August and the CFO was replaced. Shares are at $0.08, with a market cap of $14 million. Maybe I’ve finally found that HIT vendor who’ll have me on their board, enjoying the corporate headquarters any time I can come up with the daily rent.

Odd: Spirit Airlines refuses to give a surgeon’s pregnant wife water while their overheated plane is sitting on the tarmac, offering instead drinks for sale. He makes a scene and makes vague references to terrorism, his son kicks a flight attendant in the groin, the flight crew kicks the family off, the surgeon is suing for $11 million.

Attachmate acquires Novell for $2.2 billion, if there’s anyone left who cares. A Microsoft subsidiary chips in $450 million to get a bunch of Novell patents, leading to speculation that their interest is either in suing other companies or perhaps porting .NET to Linux.

I think we probably won’t have enough news to be worth posting new issues of HIStalk, HIStalk Practice, and HIStalk Mobile through the holiday, but I’ll have the usual Monday Morning Update. Inga has written a sweet Thanksgiving piece that I’ll run on HIStalk Practice and I may write one myself for HIStalk since we are both sentimental, dreamy-eyed romantics anxious to give our BFF readers a clingy holiday hug, just like the watch-those-hands Uncle Bill on the porch after a little too much spiked eggnog and cheap Thanksgiving wine. We’ve been ultra-busy with new sponsors, interviews, and party planning, so we will enjoy the short break. if you’re headed off to RSNA this weekend, travel safely and make sure to crack up your fellow airline passengers in the security line by loudly delivering a few carefully rehearsed jokes about TSA’s full-body scanners. Have a wonderful Thanksgiving.

E-mail me.

HERtalk by Inga

Fun fact: at Cerner’s on-site cafeteria in  Kansas City, color-coded serving tools prompt employees to notice good food choices. Green handles indicate a great choice (think broccoli), yellow handles suggest you might want to limit your portion (pimento-stuffed olives), and red handles (burgers and fries) mean you might want to make time for a workout after work (that is, if you can sneak out of the parking lot without Neal noticing).

Austin Regional Clinic (TX) implements Webmedx’s Enterprise5 platform for its outsourced transcription and speech recognition services.

CMS will give providers online tracking capabilities to check the status of their Meaningful Use incentive payments. The payment information will be available online once a provider is notified that they have met Meaningful Use requirements.

In an article profiling Epic, the story’s author notes that the company rarely advertises and doesn’t encourage media articles. Apparently the reporter had difficulty getting answers to some basic questions. After several phone and e-mail attempts, she was basically told no one was available to assist. Finally an Epic spokesperson told her that the company’s “managers and leaders were too busy to speak with newspaper reporters, even if the reporter in question was writing a major feature story about them.” I bet lots of companies wish they were that busy.

Meanwhile, another local publication points out that Epic makes financial contributions to over 100 nonprofits. The company also donates older computers to local school districts, supports the local public library, and hosts area high school graduations in its auditorium.

The US Bid Committee announces  that Cerner is now an official partner in efforts to bring the FIFA World Cup to the US in the 2022. The committee chair says that Cerner has “clearly demonstrated” its commitment to the sport “in their innovative web-based health surveillance system for professional soccer players in the United States.” I was aware of the Cerner / Kansas City Wizards connection but didn’t realize Cerner also has an “athlete-focused” solution that was launched earlier this year and is now used by all 16 Major League Soccer teams.

Microsoft’s Peter Neupert says the company is abandoning efforts to make HealthVault profitable because of the complexity of the country’s health system. Neuport told  the Financial Times that HealthValult’s benefit to Microsoft was simply to increase the brand relationship” by raising Microsoft’s image with customers as “important, critical and trusted.” Compare those thoughts to what Neupert had to say at HealthVault’s unveiling three years ago:

The way we make money is by encouraging online activity, and through our search application.We know that search is a big business, it’s an important tool, it’s where consumers are today. And by growing the overall search market and delivering more value to consumers, and delivering a better end-to-end search experience, that’s where we can make our money to support this effort.

Florida doctor Arturo Carvajal sues a restaurant after injuring himself while consuming an artichoke. The doctor claims the restaurant failed to “explain the proper method of consuming an artichoke.” Carvajal, a brain surgeon, ending up eating the entire outside of the vegetable, which caused him "severe abdominal pain and discomfort," ultimately resulting in "disability, disfigurement, mental anguish," and "loss of capacity for the enjoyment of life".  OK, Carvajal really isn’t a brain surgeon, but I thought that sounded funnier than family practice, which is his real specialty. Regardless, I hope he has better luck eating his turkey and that someone advises him not to eat the wishbone.

Sponsor updates:

• NextGen Healthcare partners with Scimage to release a jointly develop the NextGen Medical Image Integration Module. The new module will give NextGen EHR ambulatory users the ability to view images produced by any imaging modality or PACS from within the NextGen EHR.
• Eight MEDSEEK healthcare clients win a total of 14 awards at the Strategic Communications eHealthcare Leadership competition. The program recognizes outstanding health web sites.
• Consulting firm North Highland hires Rebecca Whitehead Munn and Brent Holman as account managers. Munn was formerly the SVP of sales and marketing for Consensus Point. Holman comes from a large for-profit healthcare system (which I assume is HCA since both Munn and Holman are based in Nashville).
• North Sunflower Medical Center (MS) will deploy a suite of McKesson products, including Paragon HIS, Practice Partner EHR, and RelayHealth claims and eligibility  processing solutions.
• Surgical Information Systems says its SIS Version 5 is the first perioperative system to be certified as a modular EHR.

E-mail Inga.

HIStalk Interviews Edward Fotsch MD, CEO, PDR Network (EHR Event)

Edward Fotsch, MD is CEO of PDR Network.

Tell me what PDR Network does.

PDR Network distributes drug safety information, typically FDA-approved drug safety information. The full FDA-approved labels, drug alerts, the new REMS programs, and now increasingly collects drug and device safety information. Our focus is really on the collection and distribution of drug and device safety information, including the appropriate use of drugs and devices.

We publish the PDR, we have PDR.net, PDR Mobile, and a growing suite of services integrated into electronic health records.

Why was EHR Event formed, by whom, and via what process?

We work with a not-for-profit board called the iHealth Alliance. They Alliance is made up of medical society executives, professional liability carriers, and liaison representatives from the FDA. They govern some of the networks that we run, and in exchange for that, help us recruit physicians. Professional liability carriers, for example, promote our services that send drug alerts to doctors because that’s good and protective from a liability standpoint.

In the course of our conversations with them roughly a year ago, when we were talking about adding some drug safety information into electronic health records, we came across the fact that there were concerns from the liability carriers that there was no central place for reporting adverse EHR events or near misses or potential problems or issues with electronic health records. They were interested in creating a single place where they could promote to their insured physicians that they could report adverse EHR events. Then it turned out that medical societies had similar concerns.

Rather than have each of them create a system, the Alliance took on a role of orchestrating all of the interests, including some interest from the FDA and ONC in creating an electronic health record problem reporting system. That’s how it came into play.

Our role in it, in addition to having a seat on the iHealth Alliance board, was really in network operations — in running the servers, if you will, which didn’t seem like a very complicated task. Since business partners we rely on for our core business were interested in it, it was easy to say yes. It frankly turned out to be somewhat more complicated than we originally thought, but now it’s up and available.

What is the relationship with FDA, AHRQ, ONC, and some of the existing tools, such as the MAUDE database?

AHRQ has a thing they call the Common Format, which is a common set of questions for reporting patient safety-related events. They try to promote the use of their common format so that there can be some standardization of patient safety across multiple different reporters or reporting systems. We incorporated the AHRQ common format.

The role of the FDA is pretty much what is expressed in the press release, which is that they’re very supportive. They’re interested in seeing information about EHRs and issues associated with EHRs.

The exact relationship with the FDA and electronic health records, at least from my reading of the press, isn’t clear. Our goal is not necessarily to clarify that or be a spokesperson for the FDA, but we appreciate their support and their promoting the idea of reporting of electronic health record vendors participating in EHR Event.

They currently have some voluntary reporting associated with EHRs, but it is far from ubiquitous. At least based on my understanding of it, it’s more focused on inpatient systems, where EHR Event pretty much looks at inpatient or outpatient systems. One of those areas of perceived growth is in in the outpatient — the typical doc practice.

I’ve now exhausted my knowledge of what’s going on inside the FDA, but we certainly appreciate their support.

I think that Dr. Blumenthal and ONC did a great job of explaining their position. I think any network or new system that’s being rolled out appropriately has some kind of feedback loop, so they were quite supportive. I don’t know if you know if any kind of adverse reporting is going to be a part of Meaningful Use requirements, but if it is, it would certainly make sense. EHRs have great potential. It’s not just because they turn paper into electronic format, but they represent a communications platform to US providers.

To the extent that the federal agencies that either have systems in place or algorithms in place like AHRQ are generally supportive of the effort. This is sort of a “more the merrier” kind of thing.

Assuming ONC doesn’t mandate the use of reporting and FDA hasn’t had much luck in getting people to report into its database, how will it be different with EHR Event?

To my knowledge, the FDA hasn’t had any outreach at all to providers — docs like me. If they made the call, I missed the message. I don’t know how they’ve gone about other reporting initiatives. I certainly know what they’ve done with device and drugs and MedWatch and that kind of thing. From my standpoint, it’s comparing something that doesn’t exist.

I think the reason we got reports rolling in the door within 24 hours, frankly, is because of the relationship that exists between the liability carriers or medical societies and their insured or their members. Actually someone had called and said, “Why isn’t the FDA doing this?” I assume what they were saying is,  “Why hasn’t the FDA created an EHR adverse event reporting system.”

There’s probably a lot of political reasons. I don’t work for the FDA and I wouldn’t speak for them, but I have had a medical license in the US for the better part of three decades and I would say that for any federal agency to take any action is not always a quick process. I don’t know all the steps, but I imagine there would be public notice and this and that, perhaps some politics involved. I’m not an expert. I don’t work for the federal government and I suspect I never will.

There’s also the reality that most physicians, I think, if you ask them, would indicate that they would be more comfortable with a system that is operated largely by their professional liability carriers and their medical societies with whom they have great trust and a longstanding relationship.

Do you think those insurers and medical societies will mandate, to some extent, reporting of errors to back their members?

I don’t think that a medical society has any authority to mandate anything of members. Again, I don’t work for them and wouldn’t speak for them, but how would they do that? Docs practice medicine based on state licensure. I supposed you could talk to the state medical boards, but I think that’s a long slog.

The other problem, of course, is that even if someone mandated that you reported EHR events, how would you actually enforce that? How would you know that they did it?

I don’t look at this so much as a mandate. I look at this as liability carriers are in the business and regularly reach out to their insured doctors saying, “These are the kinds of activities that we suggest you do and these are the kinds of activities that we suggest you avoid.” Having written checks for hundreds of thousands of dollars to professional liability carriers in my years of practice, I can tell you that you know that the only goal they have is to improve patient safety and protect your liability.

I think mandate is probably not the right word. I think educate and encourage and promote are the kinds of things that medical societies and liability carriers are doing and will continue to do.

FDA is supportive and interested, but not to the point they did it themselves, which would seem to be something they would have done if they were all that interested. Is there a plan to share the information that’s collected in EHR Event with FDA?

I guess the premise of your question I’m not in agreement with, which is that if the FDA were interested, they’d do it. I’m sure the FDA has a lot of things they’re interested in. Whether they do it or not probably has to do with budgets and politics and the reality of what it would take to actually get something going.

Again, I’m not an expert in government process, but I’ve been around long enough to know that the federal government doesn’t turn on a dime. The FDA has to follow the rules of the federal government, which has a fair amount of process around it, at least as far as I understand.

But to your question about the FDA learning and getting smarter from the EHR Event reporting system, as a federally designated PSO, there’s some contractual requirements for any third party — whether they be federal, private, not-for-profit — to get reports from the PSO. I assume that the FDA, based on our discussions with them, will enter into an agreement that’s dictated by AHRQ for access to the kinds of reports that will come out of EHR Event, as will liability carriers, as will medical societies, as will regional extension centers.

The big parties that you didn’t name are the vendors of the systems that are having errors reported about them. What involvement have they had or will they have?

They have the option of participating, which means they sign an agreement with the PSO and reports that are pursuant to their system are routed directly to them. But they certainly don’t have to do that. Everyone who participates in this is doing it on a voluntary basis.

So far, the response has been very favorable. I saw the quote in the press release from the e-MDs folks. But I think all of them understand that the systems aren’t perfect.

Probably what we’re seeing more often than not, the real challenge with EHRs like any technology, turns out to be some form of user error. “I didn’t know it would do that,” or “I didn’t know that it pre-populated that,” or “I didn’t know I shouldn’t cut and paste,” or “I wasn’t paying attention to this,” or maybe the user interface was a little confusing. Actual software errors appear to be the exception rather than the rule as it relates to EHR events. That’s at least as I understand it. I don’t get to see the reports because I don’t have that right within the PSO structure.

Anecdotally, from hearing the kinds of issues that liability carriers had talked about that they had seen, and hearing it from the high level of reports that have been coming in, they’re actually more frequent that you have a learning curve type issue, which is I think anticipated and the point of the exercise, which is most liability carriers promote electronic health record adoption, but although they promote it, they also know that these are new systems and new workflows and there’s a learning curve. The interest is in getting as much information as quickly as possible.

Is this is a business? Is there a revenue stream? Does PDR Network make money from this service?

I wish I could say yes, but the truth of the matter is that it’s more or less pro bono work that we’re doing on behalf of partners whose relationship is important to us. There’s other types of adverse event reporting that we’ll be rolling out over the next year that you can actually make money from. We certainly aren’t smart enough to figure out how to make any money off EHR event reporting.

Fortunately, because we are in the business of collecting and disseminating information and run networks and servers and integrate with EHRs and do all that stuff anyway, it’s not a heavy burden for us. But it is not a revenue center. I’m reasonably good at figuring out how to make money, but I haven’t cracked the code on this one.

If I’m a provider, what’s the benefit to me to submitting a problem report?

I guess the same as if it was an adverse drug reaction. Sometimes I have to say that just knowing docs, sometimes it’s sort of being a doc, right? You raise your hand when you see a problem. You certainly don’t make any money for doing it and not everyone will report every problem, but it’s amazing how frequently docs do the right thing even though they’re not getting paid to do it.

I think in this case, there’s probably a general feeling, at least among the target audience, that if nobody says anything about a problem, the problem never gets fixed. The analogy that I would make is that there are 500,000 adverse drug events reported into MedWatch every year, and to my knowledge, nobody makes a cent from reporting them, but they report them anyway. My view is this what docs do. They often do the right thing even though they’re not necessarily getting paid or otherwise not getting some benefit for it.

If I’m a doc and submit my incident, what happens next? How does that help fix the problem?

It goes in the PSO. Those who have the right to do that, which are only a handful of people, will create reports. Other physicians will know that inpatient hospital systems are having these kinds of problems or those kinds of problems, or maybe there’s a software problem, although again more often than not, it seems to be user error type things. The reports will go to groups like professional liability carriers.

I don’t know what the FDA would do. I assume they’re going to access PSO reports because they’ve indicated that they plan to, but the liability carriers and the medical societies and regional extension centers will turn the reports into education programs. There’s an effort to create CME programs that the liability carriers will promote to docs, the specific CME program for docs who want to adopt electronic health records. Oftentimes those programs from liability carriers are tied to patient safety credits that actually reduce liability carrier premiums. But most of the focus is educational.

As for the reporting physician, they’ll get a response back, “Thank you for the report.” If they wish, they can enroll in a monthly update newsletter sort of a thing that will be an extract of the PSO reports — here’s how many patient safety-related reports we got this month, here’s some high-level stuff — although PDR Network, at this point, isn’t planning on creating any CME programs from this. But we know that some of our partners are and we’ll probably help distribute links to the CME programs.

With the FDA’s drug reporting system, there would be capability to immediately trigger some sort of a black box warning or recall. If I’m a provider submitting to this database, do I have any assurance that other providers using the same system, if it’s a system problem, will find out what I reported or that I’ll find out what they reported?

There’s a number of pieces to that. First of all, if you’re familiar with the MedWatch system, it’s quite a bit more complicated than what you described. There’s not really lightning-fast turnaround from MedWatch reports. Black box warnings have to go through an entire process before they come out. Some of them may be triggered by MedWatch, oftentimes not. Often it’s based on post-market studies or some other piece.

Secondly, 95% of of MedWatch reports don’t come from providers directly. They come from the manufacturers. Out of 500,000 that the FDA gets, only 5%, one in 20, are directly reported to the FDA. Most of them go to the manufacturers, who bear the responsibility for chasing down the information and getting all the facts and details. The FDA is certainly not staffed to do all that legwork and the manufacturers have a regulatory requirement to do that.

That kind of infrastructure is not in place for EHRs, or least that I’m aware of. Perhaps it will be someday. I don’t really know what the regulatory environment is going to be for EHRs.

If I have a problem with an EHR and I report it, there’s two pieces to it. One is that my vendor has a responsibility, if it’s a problem with their system, to correct or improve the systems and notify other people of the problem. If they didn’t have a regulatory reason to do that, they’d certainly have a liability reason to do that. We will route those reports dutifully, but we’re not a regulatory agency and we’re not attorneys.

What we can do is get the reports and get them into the hands of groups like liability carriers, medical societies, and regional extension centers and then let them reach out their physicians and educate them. If it turns out that it’s a specific software problem, most of the burden for that will fall on the vendor.

I’m sure that will come up more frequently as an education issue, so how do you educate docs? Part of that is the vendor’s responsibility, part of it’s the liability carrier’s responsibility, part is the regional extension center. That’s why they get, whatever it is, a third of a billion dollars to educate docs about electronic health records.

From the standpoint of who bears the responsibility of acting on a software problem, that will largely be the EHR vendor. They have that responsibility now. Hopefully we can add to the flow and speed of information to them.

Anything else?

Most of folks who’ve called, whether they be press or … we’ve heard a little bit of, “This is overdue.” [laughs] I’m sort of like, “OK, now here it is. Sorry we were too slow.”

I’ve heard a fair number of people say, “The federal government should be doing this” without much knowledge of what it would take for the FDA or some other agency to create a system. There was a real concern, frankly, among the liability carriers that any involvement by the federal government might actually reduce the amount of reporting that occurred. I certainly heard it. It resonated with me as a doc. It’s one thing to report something to my liability carrier or medical society, but as soon as you get the federal government involved, someone’s going to say, “I’m less likely to report that because I just don’t want to deal with it.” 

I think there are challenges associated with it. I think this is a point along the way on education related to EHRs. It’s not a regulatory effort. The federal government is going to do or not do whatever they’re going to do. This is some federal government support and cheerleading and participation, but this is not a mandate from the federal government. Whether that will ever occur or not I really don’t know.