Curbside Consult by Dr. Jayne 3/12/12

I’ve been wearing my faculty hat more than I’m used to lately. It’s a little sad but not surprising that increasing numbers of medical students are questioning their career choices. Although I historically precepted students in traditional medical rotations, I’ve more recently led electives in practice management and health informatics.

For those of you who aren’t in academic medicine, this week is “Match Week,” which is the time when the National Resident Matching Program (NRMP) spits out residency program offers to medical students who have spent the better part of the last year filling out applications, traveling to interviews, and generally trying to one-up each other on important clinical rotations.

The truth comes out on Friday the 16th at 1 pm ET. Across the country starting at noon, fourth-year medical students will participate in a variety of events (from formal ceremonies to all-out keggers) and receive a sealed envelope that tells them their fate.

Think of sorority / fraternity rush on steroids. These students have spent tens (if not hundreds) of thousands of dollars on tuition then several more to go through this process, where they rank residency programs and the programs in turn rank them. That hopefully results in a match that allows students to pursue their post-graduate training program of choice. Most of them will move to another city, then embark upon three to seven years of additional training (some moving again between the first and second year due to residencies that don’t have integrated internship programs) and ultimately be able to join the rest of us in the trenches.

For those students that don’t match, there used to be an aptly-named “scramble” process where lots of phone calls were conducted to try to find an open slot. This year there’s a new process called SOAP – the Supplemental Offer and Acceptance Program. Students who are eligible for SOAP received e-mails last Friday night and now will have to go through eight “offer rounds” starting on Wednesday. Hopefully the process ends with a match by Friday at 5 pm. Each round will have fewer offers available, so potential residents are encouraged to accept a first-round offer if it is satisfactory. The offers are essentially binding contracts.

The entire SOAP process hinges on brand new software that, hopefully for the students’ sake, has been well-tested. I know more about this than I probably should due to this year’s increased number of students showing up on my doorstep to discuss their options. Many of the students who have rotated with me are thinking about going the administrative or informatics routes with their careers. They tend to stay in touch since there aren’t a lot of mentors out there and other faculty members tend to try to shame those students to some degree about “wasting” their training.

A number of them have decided (against my better advice) to not even do an internship or residency. There’s a growing sentiment that it’s just not worth it and that medicine has gone into what one termed “the death spiral.” One recently said, “If I’m going to wind up not being able to control my life, at least if I go into administration or to the pharma industry, I’ll be well paid.” The downside of not doing an internship is that you can’t be fully licensed, but some industries don’t care, and schools of business and law definitely don’t mind.

Looking at this year’s graduating class, there are nearly a dozen headed to business school, law school, or straight into the workforce. The number of students choosing careers in primary care is low – family medicine is almost a curse word at my institution. We’ll have to see what Friday brings. Over the last two years, the number of students matching to family medicine programs nationwide was up, but if the nation looks anything like our current student body, we’re in trouble.

It’s also interesting to look at the demographics of specialty matching. Last year in family medicine, 94% of available slots were filled, but only 48% of those by US grads. As a physician staring down the barrel of an onslaught of aging baby boomers, seeing that US grads don’t find family medicine attractive is concerning. Not surprisingly, NRMP data shows that some specialties continue to be filled with high numbers of US grads: anesthesiology (80%), dermatology (93%), emergency medicine (79%), neurosurgery (90%), orthopedic surgery (93%), otolaryngology (95%), plastic surgery (93%), radiation oncology (94%), diagnostic radiology (80%), general surgery (81%), thoracic surgery (92%), vascular surgery (97%). I’ll let my very intelligent readers climb the ladder of inference and figure out where these specialties fall on the pay scale compared to primary care.

So here’s to The Match – one more third-party hoop for physicians to jump through in preparation for a career containing many more. But even better – here’s to a Friday afternoon that allows those of us who are not on call to start drinking at lunchtime, officially sanctioned, with the Dean picking up the tab.

Have a question about residency programs, the challenges of subinternship, or which pumps look sassiest with your interview suit? E-mail me.

E-mail Dr. Jayne.

EHR Design Talk with Dr. Rick 3/12/12

Humans Have Limited Working Memory

Consider a very common, high-level EHR design. The screenshots that follow are from a particular EHR, but many vendors use a similar design.

A row of clickable tabs at the top of the screen is used to designate the different categories of data that make up the patient visit. When a tab is clicked, the window for that category of data opens to full screen size. The tabs can be clicked in any order.

The screenshot above shows what I would see after having clicked on the History of the Present Illness (HPI) tab and having entered some data.

If I were then to click on the History (Hx) tab and enter some data, the new screen would look like the one above. The HPI data is no longer visible because the HPI window automatically closes when the Hx tab is clicked.

This EHR design is completely logical. It is also completely usable, if usability is defined as being able to easily navigate from one part of the record to another with a single click. In fact, it is a totally reasonable design if it weren’t for one problem — humans have absolutely terrible short-term (working) memory.

It used to be thought that humans could retain about seven unrelated elements in working memory, but recent work suggests that the actual number is more often in the range of four to five. In contrast, a modern computer has no problem retaining thousands of unrelated data elements in random access memory.

Given our severe limitation in working memory, this EHR design doesn’t work very well. Every time I click on a new tab, the previous window closes and that data is no longer visible. I have to carry that information in my head. Furthermore, the row of tabs itself contains no information. It just serves as a navigation tool.

In other words, this design is based on how a computer — not a human — thinks. It is a computer-centered, not a user-centered design (see my first post).

As a clinician, I need to devote my full cognitive resources to my patient’s health issues. I need to be able to retrieve information from any part of the record quickly and effortlessly. While completely logical, this very common EHR design just doesn’t do a good job of extending my working memory. From personal experience, I can tell you that using a system like this is enough to drive you crazy.

So what’s the alternative? The alternative is to design an EHR based on what humans are good at — using our visual system to make sense of the world. The data needs to be organized spatially, assigning each module to a fixed location on the screen the way that T-Sheets and other paper forms do (see my previous post). Instead of making the overview of patient data just a row of information-less tabs, display the actual data in a one- or two-screen view, allowing the clinician to see the information rather than forcing him to remember it.

Of course, every design requires compromises. If you decide to use a compact, fixed spatial layout for your high-level design, then you need to solve the twofold problem of what to display in the default view and how to display more information on demand.

In my next post, I will present an example of one widely used EHR design solution to this problem.

Next post:

The Problem with Scrolling

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

Passport Health Acquires STAT Technologies

Passport Health Communications announced this morning that it has acquired STAT Technologies. The Hazlet, NJ company offers Web-based inpatient and ambulatory applications for patient scheduling, eligibility verification, charge capture, transport management, physician portal, patient self-service, and an HIE platform.

Passport CEO Scott MacKenzie was quoted as saying in the announcement, “Scheduling is a natural expansion of the Passport eCare NEXT Suite. It enables hospitals to begin revenue cycle functions at the point the order is received from a physician office, and improve coordination when there are different systems between the hospital and outside physician offices. Within a hospital organization it supports coordination of schedules, precertification, and onboarding between all departments, facilities, and silos of patient information, where disparate scheduling tools and other IT systems often exist.”

Financial details of the acquisition were not disclosed. Passport said in the announcement that it expects to acquire additional companies this year.

Monday Morning Update 3/12/12

From N2InformaticsRN: “Re: Ed Marx and Jim Murry. Did a nice job discussing mobility in healthcare on CIO Talk Radio.” That’s pretty cool – the audio sounds like a real radio station.

From @Cedars: “Re: Cedars-Sinai CPOE go-live. As a consultant going from project to project, it’s easy to forget why I began to work in healthcare, but this weekend I was reminded of it. This means everything to our industry, as past failure is redefined forever. This project has been done right in every way. I was inspired by this note from CIO Darren Dworkin. Please, please interview him.” I think I’ve asked Darren before. The CPOE implementation and quick de-implementation at Cedars-Sinai years ago gives it an honored spot in the Healthcare IT Failure Hall of Fame, right up there with BIDMC’s massive network outage, Kaiser’s waste of $500 million hiring IBM to develop IT systems that were abandoned before completion to instead passionately mate with Epic, and El Camino’s near-shutdown after implementing a patient-endangering Eclipsys medication solution. Feel free to suggest new nominees since every one of these examples provided painful but valuable lessons for not just those involved, but also for the rest of us gawking at the smoking wreckage from the safe side of the “do not cross” yellow tape. All of those organizations learned from their mistakes and came back better than ever, although iterative learning isn’t necessarily a good thing for patients.

From Sinking Ship: “Re: GE Healthcare. Cancels the 2012 Healthcare Technology Symposium due to mounting budget pressures.” The reader provided a copy of what appears to be the announcement letter from VP/CTO Mike Harsh. UPDATE: I asked GEHC what this event is since I could find no reference to it. It’s an internal-only event, so it has no customer implications.

From Bed Manager: “Re: HIMSS13. They are pre-booking hotels and relatively few rooms are available in New Orleans. Did attendees wise up and book early, or are rooms being held back for exhibitors, or does New Orleans just not have enough rooms to handle the increased size of the HIMSS conference? Both hotels of my choice are sold out and they aren’t even in the HIMSS block.”

From Epic Employee: “Re: Farzad Mostashari. Will be speaking at Epic on April 24. Pretty cool.”

From John: “Re: HIMSS conference exhibit layouts. The problem was because it was at the Sands Expo Center instead of the Las Vegas Convention Center, which has high ceilings and a long hall. I heard that the conference was supposed to be in Chicago but fell through at the last minute, leaving the Sands as the only alternative. HIMSS missed revenue since it sold out the Sands space weeks before the show, although I liked the Sands because it involved less walking and easy access to the Strip.” I don’t know if HIMSS planned to return to Chicago after what I would consider a predictably terrible first and only trip there (snowstorms even after screwing up the schedule by moving the event back, surly union workers in the hall, wildly overpriced hotels), but I thought they originally announced a permanent rotation of only Orlando, New Orleans, and Las Vegas. I don’t think that plan lasted long since they’ve been to Atlanta since then. New Orleans was OK last time, but that was right after Katrina when hotels and restaurants really didn’t have enough employees to keep things running smoothly. I’ll still hold out for San Diego as my favorite HIMSS experience and I heard they were expanding the conference center to handle the huge annual comic book convention.

From VA Doc: “Re: digital pens. The VA puts out an RFI for the technology, which has matured to the point where it makes sense to move beyond case studies.”

From MT Hammer: “Re: Clinical Documentation Industry Association. Ceasing operations, annual conference in Baltimore cancelled, financial pressures cited.” CDIA was a trade association for clinical documentation services, basically transcription. HIMSS could have possibly taken it over given a few familiar names among its dwindling list of members: Acusis, Arrendale, Diskriter, MD-IT, MedQuist, M*Modal, Nuance, and Verizon. The former Medical Transcription Industry Association (MTIA) rolled out its new name at the HIMSS conference in 2011, but a year later, both the organization and the conference are defunct.

From Sagacity: “Re: International Society for Disease Surveillance. Seeking comment on syndromic surveillance guidelines for the ambulatory and inpatient settings, targeting potential application for Meaningful Use Stage 3. The organization did the same thing for emergency and urgent care in the past, which led to MU Stage 1 specs.” Information here.

From Just a HIT Guy: “Re: WellStar. Moving off McKesson, NextGen, and GEMMS Cardiology, going to Epic. Internal memos released this week.” I’ll list this as unverified because I agreed to wait for a formal announcement as a courtesy to WellStar, but as usual, the organization’s long list of inpatient Epic job listings tell you everything you need to know anyway.

From EMR_Guru: “Re: WellStar. Announced to physicians they are scrapping NextGen and going with Epic. Wellstar has acquired a large number of physician practices over the last several years, Imagine getting bought and deploying NextGen only to be told a few months later that you have to scrap it and go with Epic.” That’s one of many risks involved in deciding to work for a hospital instead of for yourself.

From Prevailing Winds: “Re: Allscripts. You mentioned a vague acquisition rumor about Allscripts and IBM, but here’s something I’ve heard mentioned that I should say is completely unsubstantiated but potentially related. I’ve heard rumors of a potential buyout of Xerox/ACS by IBM. Allscripts remote hosting is outsourced to Xerox/ACS, so maybe the rumors refer just to that business instead of the whole company. Just rumor mill grist that may or may not mean anything.”

From Bony Moroni: “Re: HIMSS evaluation survey e-mail. It contained confusing instructions, misspellings, and a splash screen apologizing for errors in the e-mail. And we wonder why our industry is the butt of jokes by non-healthcare people. Here’s a crazy thought for an IT association in an industry known for sloppy work: test the damn e-mail merge program first. Not only was the merge done incorrectly, the ‘brief survey’ has a million questions on 11 pages, a status bar instead of an idea of what’s to come, and a pointless listing of the name and company of each recipient apparently just because they could. Obviously this is a contracted vendor, but does HIMSS really want this shoddy effort being the last thing people remember about the conference or the quality of work that HIMSS puts out?”

I’m back and rested after a week off out of the country, woefully behind, facing 500+ e-mails in my inbox, and regretting the loss of an hour due to springing forward since I’m already re-immersed into chaos even before I get back to my “real” job at the hospital. Actually I’m not that well rested since I got only four hours’ sleep Saturday night after downing my first-ever Red Bull to stay awake until  getting home at 3:00 a.m. Still, I’m happy to be back in my multiple saddles even though the horses tend to take off in different directions most of the time. Thanks to Inga for  keeping the HIStalk fires burning in my e-mail free absence. I’m sure I’ll repeat some items she’s already mentioned in trying to catch up, but that should be a one-time occurrence before things get back to normal with Tuesday’s news.

Thanks sincerely to everyone who completed my annual reader survey. It helps immensely and I’ve already made a to-do list for the next year based on the results. Obviously I almost cheated on my no-Internet vacation pledge to Mrs. HIStalk, but rationalized it to her by explaining that it took only seconds to download the results, even if I did spend several frowning and chin-stroking hours thinking about them and furiously taking notes. The preponderance of supportive comments was touching, although I probably won’t run them all here since that seems rather vain (as does re-reading them repeatedly, but at least I keep that particular vanity to myself.)

Readers grade ONC’s MU Stage 2 performance as maybe a D+. New poll to your right: does your PCP document your encounters in an electronic medical record? Mine does, even though the system he uses is about to get the boot in a hospital-mandated EHR replacement.

How did your Daylight Saving Time switchover go? Let me know if you had problems at your hospital. I’m always curious since vendors (some at my hospital, anyway) still haven’t worked out the bugs and punt by just suggesting shutting everything down for a couple of hours. Most of the problems are in the fall, when the “fall back” causes the 2:00 a.m. hour to be repeated, driving some badly designed systems crazy.

My Time Capsule editorial this week happens to be maybe my favorite one (at least until next time): Want to Anger a Nurse? Make Smug Comments about Grocery Store Barcoding. A desensitization dose: “They would buy Doritos by the bag, but would have to repackage and label individual chips and then track every chip – who bought it, who ate it, and whether they ate it in an appropriate quantity and with only complementary foods and according to dynamically calculated nutritional needs. ”

Fujifilm Medical Systems donates $25,000 to a laid-off radiology tech to save her foreclosed home, as seen on the Ellen show. 

Former HHS CTO and athenahealth co-founder Todd Park is named CTO of the United States, replacing Aneesh Chopra. Who would have put their money on the first HIT’er in the White House not being Allscripts CEO Glen Tullman?

Doug Stacy is named CIO at Labette Health (OK.) He was previously CIO at Coffeyville Regional Medical Center (KS.)

Dean Marketti, previously with BCBS, is named the first CIO of Morris Hospital & Healthcare Centers (IL.) I almost gave up trying to figure out what state the hospital is in given the common small-town newspaper website practice of not giving their location, apparently convinced that if you don’t already know, you couldn’t possibly care. Which I’ll concede is pretty much the case. 

Scott & White Healthcare names Matthew Chambers as CIO. I’m guessing he was interim while working for KPMG since his LinkedIn profile says he’s had the job since July 2011.

Holon Solutions (solutions for telepharmacy, order entry, results reporting, and the CollaborNet data sharing solution) names industry long-timer Mike McGuire as CEO. He was previously with MET-test.

Cincinnati Children’s Hospital (OH) and the local technology incubator launch QI Healthcare to commercialize the hospital’s quality improvement software that analyzes EMR data to identify improvement opportunities. I’m a bit skeptical about how easy it will be to commercialize any EMR data analysis application given the inconsistency in how each product and user stores and uses data, but hopefully they will figure out how to make that giant leap from Customer #1 to Customer #2. It took forever to find the startup’s Web page, which appears to be due to a combination of (a) lack of search engine optimization and Web content (just a leering stock art doctor on a GoDaddy parking page,) and (b) a poor choice of names that’s always going to give unrelated Google results. I continue to be amazed that new companies still choose names that won’t stand out in an Internet search.

It’s old news since I’m catching up, but First Databank mentions HIStalk (“the influential industry blog”) in the announcement of its rebranding, which I think is the first time a large, respectable organization has mentioned the name of this small, not all that respectable one in a significant announcement. I was impressed.

In the UK, Lord Carter of Coles, who heads up an NHS group to ensure fairness to its suppliers, is pressured to resign after the newspaper belatedly realizes that he’s also chairman of the UK division of McKesson (which he clearly disclosed when he took the job) and is part of an investment group that owns chunks of several healthcare companies. NHS pays him $90K per year for his two-days-per-week job, while McKesson pays him $1.25 million. Not surprisingly, nobody is suggesting that he quit the McKesson job.

Here’s Vince’s Part 2 of the CliniCom story.

The local paper covers the implementation of McKesson Paragon by McLaren-Bay Region (MI.) I think that’s actually McLaren Health Care, which makes a lot more sense.

A study at Minneapolis Heart Institute finds that surveillance software was able to retrospectively detect problems with implantable cardioverter-defibrillator devices long before the routine monitoring performed by the device manufacturers. The problem, of course, would be in collecting data in near real-time from the universe of patients in order to capitalize on the lead time.

The founder of SAP backs MolecularHealth, which offers software that matches the genomic data of individual patients to scientific evidence to suggest optimal cancer treatments. The application, which the company calls clinical decision support for oncologists, is being refined at MD Anderson.

Inga ran an anonymous reader’s rumor suggesting that GE Healthcare’s Centricity Perinatal could be on the sunset list. Not true, according to GEHC, and I’m sorry we ran that without asking the company for verification. GEHC is really fast and courteous about getting answers to my questions or rumor reports and I would have asked them for confirmation before running it. Inga doesn’t know the contact and probably figured she wouldn’t get a response.

Mrs. Dennis Quaid #3, the mother of the twins who were overdosed on heparin at Cedars-Sinai four years ago that were the subject of Dennis Quaid’s 2009 HIMSS conference keynote speech, files for divorce from the actor.

BCBS of North Carolina rolls out a mobile website that lets patients view claims, check their plan benefits, find a doctor, get a treatment estimate, and comparison shop drugs and insurance plans. The site, developed by Kony Solutions, supports Android and Apple platforms.

Philip White, historian and PR manager of electronic forms management vendor Access, appeared on Fox News last week after the release of his book about Winston Churchill’s Iron Curtain speech in Missouri in 1945. They asked him whether the lessons learned from the previous cold war still apply in situations related to Iran’s nuclear capabilities.

The local paper covers Oakwood Healthcare System’s (MI) $80 million Epic project, to be kicked off in August.

A fun Bloomberg BusinessWeek article discusses the joys of attending a conference in Las Vegas. It contains interesting mentions of the HIMSS conference, including four Craigslist “casual encounters” ads targeting HIMSS attendees like the one above.

A Kaiser Health News/Fortune article profiles Farzad Mostashari and HITECH. A quote:

Remarkably, in an era of partisan government, Mostashari’s program enjoys bipartisan support — or, at least, bipartisan tolerance. While only three Republicans voted for the stimulus bill in 2009, which provided the program’s funding, few have spoken out against it. The fact that the information technology industry is a big supporter — giants such as IBM, Microsoft, General Electric, Hewlett-Packard and a host of smaller health-care specialty technology companies — doesn’t hurt. The $27 billion will flow their way, and plenty of high-priced lobbyists are working hard to keep it flowing.

The New York Civil Liberties union criticizes the state’s privacy and security policies, saying HIEs should require patient consent to access their records and that the all-or-nothing approach to privacy means doctors see a lot of confidential information they don’t need to do their jobs.

Utah Business names Amy Rees Anderson, CEO of HIE technology vendor MediConnect Global, as its CEO of the Year.

State auditors discover that 269-bed Salinas Valley Memorial Healthcare System (CA), which earned scathing headlines last year when auditors found that its retiring CEO was paid over $5 million, did $21 million of business over a five-year-period with firms in which its executives held a financial interest.

A woman whose pending Supreme Court lawsuit argues that the federal government can’t force individuals to carry health insurance files bankruptcy after the family car repair business fails. Among the debts she’s petitioning the federal court to allow her not to pay: several thousand dollars owed to hospitals and physician practices. She had opted not to purchase health insurance.

E-mail Mr. H.

Time Capsule: Want To Anger a Nurse? Make Smug Comments about Grocery Store Barcoding

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

I wrote this piece in February 2007.

Want To Anger a Nurse? Make Smug Comments about Grocery Store Barcoding
By Mr. HIStalk

One reason we hospital IT types aren’t taken seriously is the “grocery story” analogy. You know, when some well-meaning government official, non-healthcare CEO, or your next-door neighbor smugly proclaims, “There’s more automation in the grocery story checkout line than in most hospitals.” Ha, ha, what an insightful observation – first time we’ve heard that one.

Randy Spratt, McKesson’s CIO, recently trotted out the old warhorse in an interview with Fortune. I’m sure his intention was benign (i.e., “buy more of our barcoding stuff to enlarge my executive bonus”) but perhaps his lab systems background makes him insensitive to how steamed nurses get when someone trivializes the barcode verification process on their end. If it were easy, everyone would be doing it.

(Hint to Randy: those same nurses are often involved in barcode system selections, with one of their possible choices being your employer’s product. Better stroke them a little next time.)

Ann Farrell, BSN, RN and Sheryl Taylor, BSN, RN sent me a list of why the grocery store analogy is not only inappropriate, but offensive to nurses. Their list was detailed, persuasive, passionate, and soon to be published, so naturally I decided to go more for the ironic and humorous by creating my own imitative list. Until their higher purposed tome sees daylight, this will be your amuse-buche.

If grocery stores were like hospitals:

• They would buy Doritos by the bag, but would have to repackage and label individual chips and then track every chip – who bought it, who ate it, and whether they ate it in an appropriate quantity and with only complementary foods and according to dynamically calculated nutritional needs.
• They would have to set up an internal barcoding factory since grocery makers would refuse to barcode their products until all stores collectively agree to pay extra.
• Each clerk would serve 15 checkout lanes simultaneously.
• Every customer would enter the store at precisely 9:00 a.m., 1:00 p.m. and 6:00 p.m. and clerks would have to check all of them out within 15 minutes.
• It would be the clerk’s job to prevent customers from buying both Doritos and potato chips since they serve the same purpose.
• Barcode scanners would be poorly designed by programmers, grocery store managers, and former clerks who haven’t worked in a store in 10 years. Clerk training would require two days and a 500-page manual.
• Stores would not be self-service. Instead, clerks would take the customer’s list, try to decipher their illegible handwriting, and run around the store to assemble several such orders for different customers at the same time. Each item would have to be documented twice: one when pulling it from the shelf and again when giving it to the customer. Customers would be encouraged to change their lists constantly. Most stores would not have the capability update the clerk’s list electronically, so the clerk would have to scratch off and write in items on the same ratty sheet of paper.
• Somber-looking inspectors could show up unannounced demanding to see a list of customers who bought hot dogs in the last year or the complete grocery purchases of a specific person named John Smith, but only the right John Smith.
• Clerk supervisors, exasperated over loss of productivity, would suggest keeping paper copies of commonly used barcodes to save time over scanning the real thing, flagrantly bypassing the whole purpose of buying the system in the first place.
• Instead of wheeling their cart to the checkouts, customers would ring the little “I need help” button wherever they happen to be, requiring the clerk to lug the cash register to their location to scan their item.
• The loyalty card of every customer would have to be scanned before selling them anything, even if they ruined its barcode by taking it into the shower.
• Soda would be sold like paint – the clerk would have to mix and label whatever flavor the customer wants using stock ingredients.
• Once barcodes were scanned, instead of being recorded electronically, the information would print a duplicate paper receipt to be filed forever.
• Clerks ringing up the wrong price could kill the customer, would be barred from future clerk jobs, and could be jailed.
• When working alone in a 24-hour store after everyone else has gone home, the clerk would cut meat, mop the floors, make pastries, unload the truck, show compassion, attend to family needs, and humor abusive superiors who take credit for accomplishments that mostly occurred while they were offsite making ten times what the clerk is paid.

News 3/9/12

Top News

National Coordinator for HIT Farzad Mostashari, MD takes issue with the recently published report that found doctors with online access to patients’ charts ordered more tests. Mostashari disputes the study, which raised questions as to whether or not EHRs cut costs. Mostashari’s contends that the study was based on 2008 data and before the start of the Meaningful Use program and thus does not address certified EHRs’ capabilities for data exchange and clinical data support.

Reader Comments

From EFMHead “Re: OB data management. Rumor has it that GE Centricity Perinatal is to be discontinued and that CPSI is auctioning off its OBIX product. Thoughts? If true, this signals an odd and sudden exodus of two major players from the OB data management market space.” Unverified. UPDATE: per GE Healthcare, the Centricity Perinatal rumor is not true.

From CW “Cake. Here’s a picture of the cakes that were prepared for Vada’s retirement. She was also presented with a quilt that reflected all the company names and colors over the last 24 years.” The cakes were prepared in honor of the retiring Vada Hayes, a longtime Allscripts/Misys/Medic support supervisor.

HIStalk Announcements and Requests

Highlights from HIStalk Practice this week include: a handy two-page summary of Stage 2 for EPs, prepared by two e-MD physician users. US physicians charge two to three times more than their French and German peers and achieve similar outcomes. MGMA urges Secretary Sebelius to consider adding due diligence to the ICD-10 timeline and limit required adoption to hospitals. A survey finds that 30% of physicians have implemented an EHR that meets MU criteria, 14% will in the next three years, and 17% have no plans to do so. Check out the rest of the goodies on HIStalk Practice and be sure to sign up for the email updates. Thanks for reading.

HIStalkapalooza’s  own singing Elvis is seeking  music video contributions for “Gimme My Damn Data,” as debuted at HIStalkapalooza last month. Dr. Ross D. Martin, MD encourages anyone wishing to promote access to their electronic health information to submit a video clip by March 26th. Check out the video clip – fun stuff.

Mr. H will be back in front of his computer this weekend, following his week-long get-away with Mrs. H. Of course I’m ready for him to be back at the helm, especially since he is the one most likely to feign amusement by my witty e-mails. He did a pretty good job staying off the Internet this vacation, meaning his inbox is likely overflowing; no doubt he’ll immediately be back to his workaholic ways.

Acquisitions, Funding, Business, and Stock

Medivo, a provider of decision support and analytics software, acquires WellApps, a developer of mobile disease management applications for chronically ill patients.

Sales

The 150 physician Holston Medical Group (TN) selects Humedica MinedShare as its clinical intelligence solution to be used in a joint venture with over non-Holston 1,300 physicians.

WellStar Health System (GA) selects PerfectServe’s clinical communication platform.

University Health System (TX) expands its Allscripts portfolio with the selection of Allscripts Community Record, powered by dbMotion, to share data across its 24 locations.

Watson Clinic (FL) selects MedAptus’ Professional Intelligent Charge Capture for its 294 multi-specialty providers.

Oakwood ACO (MI) contracts with Wellcentive to provide its the Wellcentive Advance healthcare intelligence solution suite for Oakwood ACO physicians.

Fairview Health Services (MN) chooses Amcom Software’s communication solutions, including smartphone-ready encrypted messaging and nurse call alerting on mobile devices.

Brattleboro Memorial Hospital (VT) selects Unibased’s ForSite2020 solution for enterprise scheduling.

CSC signs a nonbinding letter of intent with the NHS to move forward with additional implementations of the Lorenzo patient records system, beyond the 10 that have already been rolled out.

People

The Cal eConnect board of directors appoints Ted Kremer as president and CEO. Most recently Kremer served as executive director of the Rochester Health Information Organization.

Former Nuance Communications executive John Shagoury joins Eliza Corp. as president. Shagoury replaces company co-founder Alexandra Drane, who takes over as chairwoman and chief visionary officer of the patient engagement company. Shagoury is the former president of Nuance’s healthcare division.

Physicians Interactive, a provider of mobile and Web-based clinical resources, names Gautam Gulati, MD (Digitas Health) as CMO and SVP of product management and Joe Caso (King Pharmaceuticals, Pfizer) as EVP of new business development.

Announcements and Implementations

Datawatch Corporation partners with HIT consulting firm Jacobus Consulting, enabling Jacobus to incorporate Datawatch’s Monarch Report Analytics platform into its client offerings.

Bayscribe partners with Health Fidelity to integrate Fidelity’s NLP platform into BayScribe’s clinical documentation solutions.

Government and Politics

The Stage 2 proposed rules for Meaningful Use were officially published in the Federal Register Wednesday, marking the start the 60 day commentary period. CMS is accepting feedback through May 7th.

Other

Solo and small practices are now outpacing larger practices in EHR adoption, with single-doctor office adoption growing from 31% to 37% for the second half of 2011. Overall EHR adoption rates remain higher as the number of physicians practicing at each site rises.

Moody’s Investor Service predicts even more consolidation among hospitals over the next few years as institutions look for ways to enhance efficiencies, improve competitiveness, and drive higher payments from insurers.

Forbes profiles Epic founder and CEO Judy Faulkner, whom it dubs “healthcare’s low-key billionaire.” The magazine estimates her net worth at more than $1.5 billion, making her the only woman to reach the rank of billionaire by founding her own technology company.

Weird News Andy checks in with a few goodies, including a story of a three-year-old who ingested 37 Buckyball magnets. The magnets snapped together in the child’s intestine, tearing holes in the intestine and stomach. WNA says, “No MRIs, please.”

WNA wonders how much the living received in overpayments, after an audit finds that Washington, DC paid nearly $700,000 in Medicaid payments for dead people, including one nearly nine years after the patient’s death.

And in an overachieving moment, WNA adds the story of a Texas dialysis nurse, accused of injecting bleach into the dialysis tubing of patients, killing five.

Sponsor Updates

• API reports it added 38 contracts with new and existing clients between Q4 2011 and Q1 2012 to date.
• BCBS North Carolina launches a mobile version of its member web portal that is based on Kony Solutions’ mobile technology
• States and regional HIE’s drive demand for technology from Medicity, Axoloti, and Orion.
• Gwinnett Medical Center (GA) launches MedGift, an online gift registry powered by RelayHealth.
• Pathology Service Associates, a division of MED3OOO, prepares to move into a new, $5.5 million 32,000 square foot headquarters in Florence, SC.
• Health 2.0’s Matthew Holt chats with Kareo CEO Dan Rodrigues about the current state of the one to four physician market.
• iSirona releases DeviceConX 4.0, its latest version of connectivity software.
• Hayes Management Consultant’s Anita Archer, CPC, provides recommendations for preparing for ICD-10.
• Vitalize Consulting Solutions ranks third in the 2011 Best in KLAS Awards for software and services. Apparently KLAS inadvertently left VCS off the original report published in December.
• The Advisory Board reports that nearly 50% of hospital CIOs will hire consultants to help achieve MU.

EPtalk by Dr. Jayne

Nuance announced plans to drop $300 million in cash to acquire Atlanta-based medical transcription and speech editing vendor Transcend Services. The move is aimed at expanding Nuance’s customer base in the small- to mid-size hospital market. We’ll have to see if employees still embrace the “It’s better here” motto after the dust settles.

In other acquisition news, CareFusion will PHACTS LLC. CareFusion hopes that by adding PHACTS to its existing Pyxis products, pharmacies can better manage inventory, manage drug shortages, and of course improve the bottom line.

IBM has named nine members of the Watson Advisory Board to “focus on medical industry trends, clinical imperatives, regulatory considerations, privacy concerns, and patient and clinician expectations around the Watson technology and how it can be incorporated into clinician workflows.” Seven of the nine are physicians, including family doc Douglas Henley MD who is CEO of the American Academy of Family Physicians. I learned at HIMSS that family docs can be a lot of fun so I’m excited to see him on the Board.

ONC is seeking public comment on how health care providers and health systems user mobile devices to access, store, and transmit health information. Laptops, PDAs, smartphones, and tablet computers were specifically called out but storage devices were excluded. Comments are being accepted through Friday, March 30^th.

CMS will be releasing new online billing statements intended to help seniors find bogus charges. The “consumer-friendly format” goes live Saturday on Medicare’s secure web site. Features include larger type and explanations of medical services in plain language. Revised paper statements are coming next year. I cruised the site looking for samples but couldn’t find any, so I’ll use my next best research source: grandma. I definitely want to see one before patients bring them to me to discuss. Apparently the site also allows beneficiaries to check claims status and use an online appeals form. It also includes the Blue Button.

HIMSS released its online photo gallery in case you want to purchase photos of your favorite ONC, CMS, and HIT crushes. Although it’s not from the official HIMSS site, I’ve been told this pic depicts the response of a certain someone when informed that he missed the chance to dance with the ladies of HIStalk at HIStalkapalooza.

No, that’s not a sample of the tattoos that Inga and I had done while we were in Las Vegas – but one of my favorite readers did send an article about the growing phenomenon of medical tattoos. It’s low tech but does make a point for patients with health conditions or who want to make sure first responders understand an individual’s wishes for resuscitation. The tattoo chosen by the reader in question: “afraid of needles.”

Have a question about voice recognition, clinical decision support, or just want to share what you’d choose as your medical tattoo? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

CIO Unplugged 3/8/12

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

CAUTION! Teambuilding Ahead

My affection for teambuilding sparked during the journey through cubscout and webelos. Army experiences further revealed that survival depended upon team. We had to work as a unit to navigate our way through a forest or through complex situations while under fire. Eventually, I recognized the transferable benefits to the corporate world. Today, few things thrill me more than getting my team outdoors to test and build our collective capabilities.

Of course…there is an element of danger involved in these pursuits.

The Burn. My first civilian ropes course. I was a Director at Parkview Medical Center, and all leaders were required to attend this training. We had a blast pushing the boundaries. That is, until we got to the capstone element: the Power Pole. “One participant climbs to the top of a utility pole using staples. Upon reaching the top, the participant leaps from the pole and attempts to catch the trapeze bar suspended in the air.”

A 45-five foot pole towered above me. Few attempted to even reach the top, and I couldn’t blame them. I was the last to go, and peer pressure and pride kept me from bailing out. I climbed to the highest point, and I still recall the effort it took to reach above the climbing staples and hook up to the safety line. Then I stood on top of the 12-inch wide utility pole. It swayed with the wind, keeping me off balance. About 10 feet out and 2 feet lower than my line of sight, the trapeze bar beckoned. I’d never felt so scared in my life—except the time I got arrested for joyriding when I was fourteen.

My halfhearted plan was to make it look like a strong attempt for the trapeze then just fall and wait for the safety line to catch. I removed my gloves, crouched, and made the leap. Before the safety caught, I grabbed the climbing rope attached to the trapeze. Gravity sucked me down about 10 feet until the safety jerked me into a halt. I hung in pain. The skin on the insides of both hands had ripped away.

Once I was lowered, the CNO and ED Director took me straight to the hospital. More agonizing than the burn was the ED doc cleansing the wound before working on it. Even writing this makes me want to clasp my hands shut as I had done after the injury.

Lessons Learned:

• Never do anything half assed or expecting to fail
• When handling ropes, wear gloves!

Rapids. My team had accomplished the incredible. Over 18 months, as part of a start-up, they installed a new application across 23 disparate and independent minded academic departments that represented 750 physicians plus residents. To celebrate, they chose the teambuilding activity of river rafting. A month later, we entered the Class III/IV rapids of the Youghiogheny River. Although I rafted a bit in simulated beach assaults with the Army, I had zero experience with rapids. I became raft captain by default.

We hit the first Class II rapids (easy), and I fell out. My raft-mates grabbed for me, but the current was too swift. Floating downstream and getting beat up by underwater boulders I then remembered the training: float feet first and on top of the water. Easier said than done. The rafting company had a three-tier safety layer in place in the event a bozo like me fell out. Tier one failed. I was headed straight for serious Class III and IV rapids. A Tier two guide in a kayak couldn’t reach me. I started to panic, which made matters worse. In the distance, the Tier three guide stood on a large boulder in the middle of the river with a rope. She threw out the safety line, and my eyes affixed like laser beams on my last hope. She couldn’t have been more than 100 pounds, but she was all I had between life and death.

I grabbed the rope as I hit the Class IV rapids. A “keeper hydraulic” took me under. The jet-like flow ripped through every crevice of my life vest and helmet until I felt as if the water would strip away all my safety gear. The current pushed me under, and I fought for air. I saw the proverbial flash of my life. That one-hundred-pound saint on top of the boulder…to her credit, she remained steadfast and eventually pulled me into an eddy. I stood there, shaking. The Tier two kayak made its way toward me, and the sliver of courage I had left got me back in the water and reunited with my team. And yes, this entire event was caught on video thanks to the “package” we purchased from the tour group.

Lesson learned:

• Listen to and consider all safety precautions
• Don’t stick your ass out too far unless you’re willing to accept risk (that’s how I fell out of the raft)
• If you fall, muster your courage and soldier on

Slide for Life. Prior to being commissioned as an Army Officer, all cadets had to acquire a RECONDO certification. One of the activities in the course was the Slide for Life. You slide down a zip line across a lake, keeping your eye on the flagman on the far side. When the red flag raises, you extend your legs straight until your frame forms an L-shape. When the flag lowers, you let go of the zip line and drop into the water. Given the trajectory, this posture enables you to hit the water butt first and the world is good.

With great amusement, I lingered after completing this event to watch the other platoons execute. Most did fine, but every once in a while, someone decided against the L-shape and let go in an I-shape. The soldier hit boots first resulting in spectacular somersaults. In other cases, some were too scared to release at all and ended up crashing into the sandbags at the end of the zip line.

Lesson learned:

• Follow instructions
• Fear causes paralysis

After a string of traumatic experiences, I chose safer team building activities. Here’s what happened:

Curling. One of my directs was a curling fanatic, so I agreed to some ice time. What could possible go wrong? We dressed warm and headed for the Mayfield Curling Club. My CTO was tall and aggressive. We were in this to win. I shoved our stone down the ice where he was sweeping to heat up the ice and influence trajectory. He pushed too hard on the broom and his feet came out from under him. He fell face first. When we rolled him over, blood gushed from his mouth where his teeth had punctured a hole through his lower lip. Our CMIO and two nurses applied first aid. Given the severity of the cut and apparent concussion, we called an ambulance.

I could just hear my CEO. “We lost our CTO to what? Curling?” Thankfully, the man was released the next day following observation and stitches.

Lessons Learned:

• Ice is slick as hell
• Don’t make fun of curlers

The “low-key” retreat. I held an offsite retreat once with no outdoor events. One of our team accidentally slipped and fell and messed up his knee before the meeting even began. A great object lesson in teamwork followed: The CMIO did an evaluation. The combat medic rounded up some gauze and wrapped the knee. The CTO ensured the meeting room was set-up to accommodate the wounded. The non-clinicians fetched ice and painkillers. And, in the ultimate display of team and knowing nothing was broken, the injured refused to seek medical attention until after the day was done.

Lessons learned:

• Injuries can happen in any environment
• It is smart to have clinicians as your direct reports!

Despite the potential for injury, if you haven’t escaped with your team to develop relationship and strengthen the bond, then plan one today. Mmmmmm…perhaps climbing mountains should be avoided….

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 andFacebook and you can follow him via Twitter — user name marxists.

Nuance to Buy Transcend Services for $300 Million

Nuance announces Wednesday morning a definitive agreement to acquire Transcend Services, a provider of medical transcription and speech editing services, for $300 million, net, in cash. The acquisition accelerates Nuance’s expands the company’s presence in the small- to mid-size hospital market.

Janet Dillione, EVP and GM of Nuance’s Healthcare business said, “The acquisition of Transcend will expand the delivery of our innovative voice and Clinical Language Understanding solutions especially to small- and mid-size hospitals. With Transcend, we will drive change and improvement to the way these hospitals capture and leverage clinical information. The acquisition is a natural extension of Nuance’s existing healthcare business, and will strengthen our solution and services portfolio, as well as enhance our profitability.”

Transcend acquired electronic clinical documentation provider Salar in August of 2011.

News 3/7/12

Top News

Physicians using computerized patient records are more likely to order new tests, leading to higher healthcare costs. Researchers, whose findings were  published in Health Affairs, found that physicians with point-of-care access to imaging were 40 to 70% more likely to order more tests, compared to doctors relying on paper records. Researchers could not determine the reason for the trend but theorize that doctors on computerized systems order more studies because of the the ease of online entry.

Reader Comments

From WallE “Re: HIMSS musings. I think the show would have been better if the floor plan and layout was simpler. After looking at New Orleans floor plan I’m thinking it will be better.They are returning to the single hall with a large “main street” walkway down the middle of the show.” I also prefer the main street, one hall layout, although the argument could be made that there was less walking required with this year’s floor plan.

From CTO “Re: Music.  It was good to ‘see’ you at the sponsor lunch at HIMSS. Since you have the helm this week, how about some insight into your taste in music?  I always like to read about  what Mr. H is interested in.” First let me say that Mr. H and I have very different tastes in music. Mine is a bit eclectic but a short list of my all-time favorite artists include Lyle Lovett, Bonnie Raitt, Aretha Franklin, and Allison Krauss. Some of the more current groups I find fun include Chiddy Bang, Flo Rida, and Bruno Mars.

From Ralphie “Re: Burger, Babes, and Vegas. I thought you might get a chuckle out of what I heard walking back from the HIMSS conference to my hotel behind what looked like two slick make vendor-types.  One turned to the other and said that he had been propositioned by two prostitutes and one of them offered her services for $35. The other one quipped, ‘Wow, that is less than the room service cheeseburger and fries I had last night.’” Love it.

From IDXwatcher “Re: More GE layoffs.  GE Healthcare layoff confirmed March 2nd.” According to an article in the local press, fewer than 30 people (about 2%) were let go last week. GE says the cuts were necessary “to increase competitiveness.”

From Aaron Brrr “Re: Madison Dolly comment on v12 of Epic. Madison Dolly said that v12 of Epic was shown at HIMSS and coming soon. Two questions: what’s in it and when did they change policies about showing that which isn’t available?” Anyone?

From Wondering aloud “Re: Epic. Epic is having a great run like SMS did with INVISION in the 90’s, but their business model is more like MEDITECH’s. Wondering if “in the know” readers think Epic will struggle the same way MEDITECH has recently with 6.0 when Epic attempts its inevitable near term re-platforming as well?”

From HIStalk Fan “Re: Allscripts. A recent analyst report discusses a Q3 restatement involving software transaction, as well as Allscripts’ disclosure of a subpoena in connection with a grand jury investigation and recent litigation involving Medical Services Associates.” Allscripts filed a 10-K last week related to a restatement of a bulk sale and delivery of licenses through a complex structure based on a decision that future performance obligations require the deferral of revenue. The net reduction to operating income was $3.1 million and a $0.01 reduction in EPS. I asked one of HIStalk reader/analysts for his take on the restatement and his opinion was the adjustments were very minor and reflected Allscripts’ conservative approach to revenue recognition. As to the litigation, MSA alleges Allscripts negligently caused the loss of medical billing data, intentionally misrepresented certain facts regarding the computer sold to them, and breached certain aspects of their contract. My take: Allscripts and vendors of their size are regularly hit with similar lawsuits and thus it’s not a cause for alarm.

From Stringer “Re: Medical software sales guy. This guy was convicted today of 1st degree murder of his wife. Very ugly situation, first trial was a hung jury. As you can see he is ALWAYS referred to in the press as a medical software salesman but have never mentioned the company. Thought it might be a good HIStalk expose.” Jason Young was convicted of brutally murdering his pregnant wife five years ago. Young contends he is innocent. I did a bit of digging and could only find one Jason Young in Linked In that could have potentially been a match. If you know the scoop, please share.

From OldTimer “Re: Allscripts send-off. Allscripts says goodbye to 24-year veteran Vada Hayes. Luminaries in attendance included John McConnell, Eric Sellers, Alan Winchester, Steve Shepherd, Bob Bothwell, and many, many others. There were four cakes: Medic, Misys, Allscripts, and the current color scheme. That’s cakes in green, purple, orange, and lime.” Would have loved to seen the cakes, but here is a shot of the retiring Hayes, along with former Medic/Misys CEO John McConnell.

HIStalk Announcements and Requests

A few readers mentioned having difficulty getting onto the HIStalk sites today. Of course I can’t find Mr. H’s email from four years ago that explained who to contact if this ever happened. Hopefully Mr. H will check in soon and the issue will be resolved. Thanks for your patience.

Thanks to all the wonderful readers who sent encouraging e-mails about relief from post-HIMSS exhaustion and to remind me a vacation is in my near future.

Acquisitions, Funding, Business, and Stock

DocuTAP, a provider of EMR/PM solutions for urgent care providers,  secures a two-stage $12 million investment from Bluff Point Associates.

Healthcare software and service company iMedX completes its acquisition of the medical transcription assets from The Inner Office Ltd.

Sales

Iowa Health System contracts with MediRevv for accounts receivable conversion assistance as it transitions its core hospital system to Epic.

The VA selects HP Enterprise Services to continue as a prime contractor for its claims processing program, CAPRI.

Upper Peninsula Health Plan chooses the MedHOK platform for integrated care management, quality, and compliance.

CPU Medical Management Systems selects NDS’s Provider Edge product to automate payment processes and convert EOBs into ANSI standard 835 ERA.

The state of Louisiana contracts with CNSI for a 10-year, $185 million project to develop and deploy a new Medicaid claims processing system.

People

Healthcare data analytics company Qforma promotes Mark Feeney to VP of client services and Joann Flynn to senior director of business development operations and employee development.

AirStrip Technologies announces the addition of Connie McGee (KPMG) as VP of strategic accounts and the opening of a regional office in the Nashville area.

The Open Source EHR Agent (OSEHRA) names James Peake, MD (CGI Group), John Halamka, MD (Beth Israel Deaconess Medical), and Michael O’Neill (VA) to its inaugural board of directors. OSEHRA is a not-for-profit organization tasked with serving as the custodial agent of an open-source development project to upgrade the VA’s VistA EHR system.

Announcements and Implementations

ZirMed launches www.StarStopICD10.com, a site designed to gauge industry opinion and gather comments surrounding the ICD-10 implementation timeline.

The Cleveland Clinic expands its EMR to include a visual repository with diagnostic images of patient X-Rays, lab tissue samples, photographs and other images.

All 15 of the independently owned primary care clinics in the Integrity Health Network (MN) transition to EMR.

QuadraMed launches a remote hosting service for its identity management, RCM, and HIM solutions. Cabell Huntington Hospital (WV) is the first hospital to utilize the service.

McLaren-Bay Region (MI) goes live on McKesson Paragon EMR March 11th.

Intermountain Healthcare (UT) launches a 90-day pilot telehealth program, allowing patient employees to connect with providers via video chat.

Aetna announces the availability of an enhanced version of its iTriage app, which Aetna acquired in late 2011.

Government and Politics

An analysis of eight years worth of Medicare claims data reveals that Hospital Compare, Medicare’s public reporting initiative for hospitals, has had minimal impact on patient mortality. The study found the reporting of quality data led to no reductions in mortality beyond existing trends for heart attack and pneumonia and led to a modest reduction in mortality for heart failure.

Technology

RTLS provider AeroScout partners with McRoberts Security Technologies to introduce a Wi-Fi-based campus-wide infant security solution that enables hospitals to attach an RTLS tag to the infant’s umbilical cord clamp.

Other

The Galveston County HIE (TX) and the HIE of Southeast Texas join the Great Houston Healthconnect, making it the state’s largest HIE market with 133 hospitals and over 14,000 providers.

Mayo Clinic rehab nurse Andy McMonigle and three physicians say an iPad helped saved McMonigle’s life when he suffered a heart attack. The nurse, who was exercising in a Mayo Clinic fitness center for employees, felt the onset of the attack and quickly found three doctors in the center. One of the physicians pulled out his iPad and accessed McMonigle’s online medical chart and previous EKGs. Because they had immediate access to his chart, the doctors quickly identified the issue and had  McMonigle transported to the cath lab to remove a blood clot blocking his artery.

Smartphones are the most popular technology among doctors since the stethoscope, according to this study which looks at the global growth of mobile phone technology in healthcare. The use of mobile technology healthcare has the potential to reduce the cost of elderly care 25%, reach twice as many rural patients, and reduce the cost of data collection by 24%.

Speaking of smartphones, almost half of Americans now own one, making it the most widely adopted type of cellphone device.

Sponsor Updates

• Summit Medical Center (TN) shares how its OB/GYN physicians are using AirStrip Technologies to improve patient care during labor and delivery.
• MEDecision hosts a March 21st webinar on best practices and technology to enhance value-based healthcare.
• Wolters Kluwer Health and HealthStream partner to offer the Lippincott’s Professional Development Programs suite to HealthStream’s client base.
• Billian’s HealthDATA partners with RealTime Medical Data to provide Medicare payment data and analytics through RealHealth Analytics.
• Trustwave signs an agreement to purchase M86 Security to enhance its security product portfolios.
• Versus customer Dr. Brett Daniel of Pacific Medical Centers discusses his organization’s use of Versus RTLS at this week’s AMGA 2012 Annual Conference.
• Ignis Systems releases its free webinar schedule for March and April.
• Medicity client Michigan Health Connect receives second place in the Healthcare Informatics Annual IT Innovator Awards for its use of iNexx to create electronic-referral networks throughout Michigan.
• Memorial Healthcare System’s Joe DiMaggio Children’s Hospital (FL) goes live on GetWellNetworks’ IPC solution.
• LRS offers a Webinar featuring speakers from Carilion Health System and Sisters of Mercy Health System, who discuss ways to lower costs and simplify document management in Epic print environments.
• Shareable Ink customer Dr. Brian Woods, CMO of NorthStar Anesthesia discusses his experience automating with Shareable Ink’s technology.
• The Huntzinger Management Group (HMG) publishes Nathan Kaufman’s HIMSS presentation entitled, “Preparing for the Inevitable Perilous Journey from Entitlement to Accountability.”
• SRS EHR customer Pediatric Associates of Savannah (GA) chooses SRS Patient Portal for its 10 provider practice.
• Inland Empire HIE (CA) selects Orion Health’s HIE suite for its 48 participating healthcare organizations.
• GE Healthcare initiates a 90-day free evaluation period for its Global Safety Network, an online community for hospitals to collaborate on improving patient safety.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Curbside Consult by Dr. Jayne 3/6/12

The League of Extraordinary Gentlewomen

A few days ago, I had lunch with some friends. Anyone walking by might have thought it was simply a table of ladies who lunch, but it was much more than that. The reason – three of the five women at the table were, at one time or another, my boss. I’ve written before about bad bosses and bosses who don’t know what to do with CMIOs but today I wanted to talk about bosses who do it right.

I haven’t always been a CMIO – I’ve been an EHR pilot (read: guinea pig) as well as the nebulously-named Physician Champion. I’ve been a Department Chief, faculty member, and front-line physician depending on which hospital I was rounding at on a given day. I’ve also been a teacher, worked retail, and changed my own oil. The point is that many of us come to the table with a variety of experiences. A good boss will recognize the way in which experiences shape employees and draw from those experiences. They will seek to get to know their employees and what they can bring to the table besides title and credentials alone.

All three of these extraordinary bosses saw different things in me. One saw a fairly-green but passionate physician who had a vision and passion for technology. Choosing me over other ‘safe’ choices to provide clinical oversight for my first major IT project could have been a career limiting move for her (and more than once I pushed it to the limit, I’m sure.) Still, she cared enough to get to know me as a person as well as in the capacity of being her employee. Understanding what made me tick and how I reacted to change helped her advise, counsel, and mentor me and increased my value to her team.

She taught me how to dig in when the going got tough as well as how to quickly assimilate huge quantities of data into something useful for physicians to evaluate. I learned about process and methodology, how to work with consultants, and how to recover after getting one’s posterior handed to one by other physicians. She taught me how to leverage those difficult physicians and involve them in the project so that it became “our” project rather than the loudest physician’s idea of what things should be.

With different management styles, different bosses can motivate people to achieve in different ways. My second boss was able to build on what her predecessor had done – taking it to the next level with lessons in political strategy and operational tactics which have been invaluable to me as a CMIO. Although I was familiar with physician to physician politics, when hospitals and payers are involved there is an entirely different level of gamesmanship needed. She taught me to be confident in what I knew to be right as well as how to stick up for it without being obstructive.

She also taught me how to survive when being forced to do things I absolutely didn’t want to do or didn’t believe in – skills which have been critical when dealing with certain kinds of disagreeable organizational strategies that we all face. She gave me space when I needed it and didn’t micromanage, letting me find my own groove and set my own goals.

The other extraordinary gentlewoman at the table was my peer before becoming my boss, which happens to many of us at least once in our careers. We learned together how to swim in the choppy waters of health IT and having shared that experience she knew how thoroughly I would be willing and able to back her up when things got tough. She understood the way physicians make decisions and our ability to take multiple pieces of complex information and quickly arrive at a conclusion that balances patient safety, quality, and efficiency. She understood that I saw the applications we supported as patients and that I was constantly assessing their new ‘aches and pains’ and integrating new discoveries and features to try to come up with the best diagnosis and treatment plan. With that background, she was able to help others in the IT department understand that although it may have seemed like I was just throwing out an answer quickly, it was well-reasoned and also helped me learn to better explain my thought process so that people weren’t spooked.

(So help me, though, if you ever show up as a trauma patient in my Emergency Department, don’t expect me to explain what I’m doing in gory detail just so you can feel better about how quickly I arrived at a conclusion. When you’ve got a chest wound, I guarantee you want the doc to be rapidly processing the situation at the same time she’s giving orders and executing a well-thought and rehearsed plan. There’s no consensus-building when someone’s bleeding out and my reflexes are going to take over and get things done. I do promise though that I’ll explain it to you when you regain consciousness.)

Besides leadership styles and management skills, I learned another key lesson from these extraordinary women – that work/life balance is essential to avoid burn out. We worked in extremely complex situations, short on budget and resources and long on demands and expectations. They taught me how to care for myself so that I could continue caring for others (and also so that I could continue working my tail off for them, which I happily did.)

I truly wish that each of you has, at some point in your careers, one boss that you would walk through fire for. When you do, you’ll understand what I mean – someone who so totally inspires confidence and motivates you, that you’d do anything they ask. And if you’re really lucky and the stars align – you might just be lucky enough to have three.

E-mail Dr. Jayne

Monday Morning Update 3/5/12

From Observer “Epic CIOs. After seeing that two more Wisconsin CIOs that are installing or expanding Epic have lost their jobs recently, I noticed an interesting trend that I call ‘Epic – the Teflon Vendor Effect.’ Have you noticed that when an Epic clinical system install stumbles and fails, it is the CIO’s fault and when the same thing happens with a different product, it is the vendor’s fault?” I will defer to readers on this question,  but following the same logic: does Epic and not the CIO get (or deserve) all the credit when a project succeeds? And do CIOs get the credit when other products are successfully  implemented?

From Reluctant Epic User “Re: Anodyne. My large practice (over 200 providers) is considering Anodyne for BI. The word is that it can extract Epic’s data at the flip of a switch. Do you know or have you heard anything about their implementation? How much effort was required to by the Clarity SQL writers to connect Anodyne to Epic’s Clarity Database? Thanks in advance for the amazing work you, Mr. H, and the two doctors do. It really does make my job and life easier.”Thanks for the kind words. I know very little about Anodyne but I bet we have readers who are experts and willing to share their experiences.

Mr. H has left me to my own devices for the week while he is taking some R&R with Mrs. H. I must confess I am wildly jealous of Mr. H’s gallivanting across the globe, especially since my mind and body are still  experiencing a HIMSS hangover. Do a girl a favor and drop me an email this week and tell me all the secrets you would have told Mr. H. Or,  just send a note reminding me that my vacation will be coming soon. And thanks for reading.

A tornado rips the outside wall from three patient rooms at Harrisburg Medical Center (IL) and forces the evacuation of patients. The storm damaged multiple windows and tore heating and air conditioning systems from the building’s roof. Hospital administrators estimate damages in the millions.

Saint Alphonsus Health System (ID) signs an an agreement to implement MedVentive Population Manager and MedVentive Risk Manager.

The House Energy and Commerce Committee’s subcommittee on commerce, manufacturing, and trade hears testimony in favor of helping state build interoperable drug monitoring systems to reduce prescription drug misuse.

In case you didn’t get your fill of HIMSS and booth critiques, Dodge Communications sent a link to their fun post highlighting the best and worst from the exhibit floor. They name GE’s booth “Best in Show” based on its approachability and messaging. They also poke some fun at a few vendors’ lack of creativity:

Now, we know it’s tough to find relevant imagery in this business. And we see lots of free stock photography depicting smiling, multi-racial healthcare workers reveling in their use of the exhibitors’ technology. Definitely not easy. But pictures of bridges (“Bridges to meaningful use!”), stethoscopes (“We’re in healthcare!”), puzzle pieces (“Putting all the pieces together!”), and chain links (“We’re the missing link!”)  are not cool! C’mon people, be more creative! The most effective way to see if your imagery resonates is to test it with the market. It’s easy to test, and it doesn’t take long to realize that your audience doesn’t think it’s cool either.

Geisinger Health Plan reports that its use of telemonitoring technology has reduced 30-day hospital readmissions by 44%. Using interactive voice response technology from AMC Health, case managers track post-hospital discharge patients’ biometric and symptom information in real-time.

Oakwood Hospital and Medical Center (MI) prepares for its August 1st go-live of Epic’s EMR.

A PwC study finds that 61% of hospitals and physician groups have formal clinical informatics programs and most plan to add additional technical analysts and clinical informaticists over the next two years.

Cumberland Consulting Group promotes John Waters, Charles Flint, and Leah Wilson to executive consultants.

First Databank launches a corporate rebranding initiative designed to focus attention on the company’s growth and future in clinical decision support. Mr. H checked in from his vacation long enough to point out that FDB’s press release mentions their sponsorship of HIStalk, which they call an “influential industry blog.” We like that.

EHR Scope launches AIMSConsultant, a service to provide anesthesiologists and operative facilities with information on anesthesia information management systems.

The Milwaukee paper profiles the Wisconsin HIE, which currently connects 13 area hospitals. No surprise here: the HIE’s executive director notes that the organization’s biggest obstacle to growth is not technology, but money.

HFMA awards Winthrop Resources its “Peer Reviewed” designation, based on the effectiveness, quality, price, value and support of Winthrop’s offerings.

CincyTech and Cincinnati’s Children’s Hospital Medical Center form QI Healthcare, an HIT company to commercialize Children’s proprietary quality-improvement software. CindyTech and Children’s are each investing $200,000 and have named John Atkinson (WebMD, Mede America, SourceMedical)as the new entity’s CEO.

HKS Medical Information Systems changes the company’s name to OTTR, d/b/a OTTR Chronic Care Solutions. OTTR is a provider of transplant patient tracking solutions.

E-mail Inga.

News 3/2/12

Top News

The Defense Department appoints former Harris Corp. VP Barclay Butler to serve as director of the Defense Department/VA Department Interagency Program Office to manage the development of an integrated EHR for both departments.

Reader Comments

From HairClub: “Re: Shafiq Rab. The CIO at Orange Regional Medical Center is taking the VP/CIO position at Hackensack University Medical Center.” Unverified.

From Free Lunch: “Jason DeSantis. Joining Zanett’s healthcare division as executive director of business development.” Unverified. He’s division CIO at University Hospitals in Cleveland.

From Last Man Standing: “Re: GE Healthcare. Layoff today of 5% targeting services and support.” Unverified. Many of the GEHC rumors I get are somewhat true but exaggerated, so if the company provides an update (which companies usually don’t for HR-related issues) I’ll run it here.

From Printgeek: “Re: Epocrates. Laid off their entire EMR staff on Tuesday and are shutting down their EMR project. The BOD lost patience, as crazy sales expectations were set by previous CEO and CFO. They expected to sell 1,500 docs in 2011 with an uncertified system that was release in July. This exec team did a good job hiring talent, but failed to listen to their feedback on what it takes to actually sell EMR and the subsequent expectations.” I think there’s a lesson to be learned here: if selling EMRs was easy, everybody would be doing it, and HITECH has accelerated the polarization of the successful and unsuccessful vendors. If Epocrates, which has an impeccable brand recognition in healthcare and was seemingly doing all the right things, struggled to meet sales numbers for its EMRs, clearly the age of the mom-and-pop EMR is over. Actually, there’s an even more applicable lesson here: publicly traded companies may say all the right things about being dedicated to healthcare, but quarterly numbers can send them fleeing for cover almost instantly. Whatever docs just bought their EMR are now finding out what it means to be on the wrong side of their vendor’s “core business.” The one-year share price chart doesn’t inspire much confidence that a steady hand on the tiller is what’s needed – shares are down almost 60% in the past year.

From HIT Student: “Re: Connected Care Challenge. I thought some of your readers might be interested.” Janssen is offering $250K in awards for easily adopted, low cost technology solutions that can improve information sharing among hospitals, patients, caregivers, and community physicians, with the goal of improving post-hospital care and lowering the cost of unnecessary readmissions. Submissions are being accepted through March 25.

From Non-Sequitur: “Re: SNOMED. Here are examples of the proposal to require SNOMED in Stage 2/2014 Edition. In the 45 CFR Part 170 Standards Companion, see Pages 45 (cancer registry), 52 (problem list MU objective), 58 (summary care record MU objective), and 90 (lab results to public health agencies MU objective.)” Thanks. I know several readers are interested in the potential requirement to use SNOMED.

From I Was There: “Re: HIStalk sponsor lunch at HIMSS. Great location, great food, a nice mix of heavy hitters and rising stars, and great networking with lots of cards being passed and commitments for follow-up discussions. Art Glasgow’s talk was very well received, talking about how HIStalk plays a part in his daily activities as Duke University Hospital CIO, how vendors and providers should help spread the word about it, and the shifts he made going from the vendor world at Ingenix to Duke. The focus was on the three of you as people were trying to figure out who you are and checking out Inga’s shoes. I thought the event was great.” It was really cool that 100+ folks from our sponsoring companies took time away from a very busy first day of the HIMSS conference to let us say thanks to them for supporting what we do. Naturally Inga, Dr. Jayne, and I felt simultaneously ridiculous and vulnerable appearing in disguise, but we did our best. Most of our sponsors understand that we’re going to objective and fair to sponsors and non-sponsors alike and, to their credit, they support us even when what we say isn’t going to be popular back in their offices. If you were there, thank you very much.

From Judy Judy Judy: “Re: Epic consulting firm. Last week Judy F. of Epic met with executives of [consulting firm name omitted] about their violation of Epic’s non-solicitation clause. An Epic client turned them in to Epic after the firm poached a handful of the client’s employees. Epic banned the firm for a year (which was ‘negotiated’ to a shorter term) from selling to or doing business with any new Epic customers. Seems like a slap on the wrist based on recent discussions with Epic Consulting relations personnel and their stringent expectations for consulting partners. Why not take away their preferred certification program as well?” Unverified, so I’ll leave out the company name for now.

From MD Informaticist: “Re: digital pen technology – mightier than the mouse? Are they really making an impact on usability and clinical documentation? I would be interested in your opinion of the Verizon and other digital pens and clarify for us: can this technology re-energize a dormant innovative industry?” What I’ve seen of them seems pretty cool, but I’m interested in hearing from readers about who is actually using them and what results they are getting.

From Mark Schmidt: “Re: HIMSS. It’s become such a large event that the Booth Crawl brought back feelings of those early days when it was possible to spend time with just about every vendor. I learned a lot and heard the latest from Sunquest, which has not been sitting still as the industry has progressed!” Mark, CIO of SISU Medical Systems of Duluth, MN, won a Sunquest-provided iPad last week. He and I have swapped occasional e-mails going back to early 2008.

From Just a Fan: “Re: 5010. Anyone else having issues with a claims clearinghouse not being ready? Our cash on hand is taking a beating because our claims have been sitting at the clearinghouse and are only just now starting to trickle out to payers, which are requesting information required on 4010 but deleted in 5010. And the enforcement delay was good why?” We keep hearing anonymous rumblings with no specific examples. Give us details and we’ll see what we can find out.

HIStalk Announcements and Requests

This week on HIStalk Practice: Dr. Gregg pulls a double shift in an an attempt to diffuse last week’s “mournful silence” on HIStalk Practice while I was busy drinking IngaTinis and walking my high heels off at HIMSS. Dr. Gregg missed HIMSS this year, but still offers some fun HIMSS musings. A proposed rule would require physicians to return improper Medicare payments within 60 days of  notification and allow auditors to investigate 10 years of records. Most physicians believe EHR use is valuable for improving quality and managing patient care, but less convinced that EHR improves diagnosis accuracy or treatment planning. Black Book Rankings announces its ambulatory EHR vendor rankings. Athenahealth CEO Jonathan Bush likens his company to a “snippy kind of overconfident Chihuahua jumping up and trying to nip at the tails of the Dobermans.” By the way, we are conducting a reader survey on HIStalk Practice that is in addition to the HIStalk version; we’d love readers to take a moment to  have a  to provide input. Thanks for reading!

I appreciate the support of Levi, Ray & Shoup (specifically LRS Output Management) for supporting HIStalk as a Platinum Sponsor. The company’s expertise is in document solutions for hospitals, so let’s use a typical Epic shop as an example. Maybe your big Epic print jobs fail; you need centralized capability to monitor and reprint jobs without re-running them on Epic; you are maxing out out your Windows print queues or the Windows print spooler; or you’d like to save print costs by allowing users to preview reports before printing and automatically route large reports to more economical printers. With the LRS solution, you gain centralized control, you can implement load balancing, you avoid installing multiple print drivers on each workstation, and you get rid of the unreliable science fair of printing solutions (UNIX to JetDirects, multiple printer types, a mix of Epic text and ERTF documents, etc.) and you can even require users to verify their identity before printing patient documents to an unattended printer. It doesn’t matter how cool Epic is if the tangible, patient-critical label or report it creates as an end product is hanging out there in the ozone because of a cobbled-together print solution that is far less enterprise grade than the system that drives it. One hospital with four FTEs handling printing issues cut back to just one after implementing LRS Output Management, which can handle anywhere from hundreds to thousands of printers. And while Epic is a good example, the solution works with any application (Lawson, SAP, etc.) Check out their case studies from Carilion, Hopkins, UVA, etc. Thanks to Levi, Ray & Shoup for supporting HIStalk.

Liaison Healthcare Informatics is supporting HIStalk as a Platinum Sponsor. The Atlanta-based integration and data management company has over 9,000 customers all over the world, including more than 600 in healthcare. The company’s cloud-based data integration solutions provide a platform for the secure exchange of data among providers, payers, patients, and HIEs. Some of the pain points it addresses are HIPAA, HITECH, DEA Form 222, Safe Harbor qualification of encrypting PHI data at rest, electronic file transfers, and avoidance of data breaches. Its Liaison Protect solution makes sure you are securing your databases, integrating encryption, tokenization, key management, and logging. Its Liaison Exchange managed file transfer software suite allows cost-effective management of ever-increasing volumes of file transfer exchanges both inside and outside the organization. If you need to accelerate your HIE or ACO efforts, securely share patient information with other organizations, or gain control over risky and poorly monitored file transfers, give their offerings a look. Thanks to Liaison Healthcare Informatics for supporting HIStalk.

Inga mentioned the reader survey — you have one last chance to provide input that we’ll use to plan the next year of HIStalk. Thanks. It really does help us given that we work largely in a vacuum and have to pick and choose our projects since we have limited time to get things done.

For our numbers-obsessed reader(s), we had a record-breaking 125,867 visits in February, along with 196,565 page views. The e-mail blasts go out to 7,935 subscribers, while Dann’s HIStalk Fan Club has 2,268 members (OK, I admit that we’re not entirely comfortable with the idea of having fans, but it’s slightly satisfying to reflect on that fact during our frequent bouts of feelings of inadequacy and lack of accomplishment.) You can move our emotionally needy needles by (a) subscribing to the updates; (b) connecting with us on Facebook, LinkedIn, and Twitter; (c) supporting the sponsors who support us by poring over their ads, clicking those of interest, checking out their Resource Center pages, use the Consulting RFI Blaster to quickly solicit consulting help; (d) sending us news, rumors, guest articles, or anything else that would interest your fellow readers; and (e) feeling the positive thoughts Inga, Dr. Jayne, and I are beaming your way for supporting what we do in whatever form that support takes, which means a lot to the ladies and me.

A reader asked about WellStar’s ambulatory EMR project. I have the information, but agreed to sit on it for a few days. Stay tuned.

The overachievers at API Healthcare, not content to simply mail Gabe Davis (right) of Texas Health Partners his iPad prize from the recent Booth Crawl after he had to leave the HIMSS conference early, sent VP Kyle Allain (left) to his office to hand-deliver “the famous HIStalk iPad” personally. This was Gabe’s first trip to HIMSS and he had nice things to say about HIStalk and API’s support of it. His 16-year-old son will get the iPad and is apparently pretty stoked about it, and rightfully so because iPads are darned cool even if you aren’t an Apple fanboy.

On the Jobs Page: Financial Systems Consultants, Meditech CPOE Go-Live Support, Epic Certified Builders. On Healthcare IT Jobs: Senior Health Information Technology Specialist, Implementation Consultant, Project Manager CMIO Informatics, McKesson Paragon Consultants.

I’m taking a little break to escort Mrs. HIStalk to somewhere warm and sunny where laptops are as rare as bathing suit tops (OK, I’m kidding on that one) so the eminently capable Inga and Dr. Jayne will be holding down the fort as I try to fight the urge to stay off e-mail (I’m rarely successful.) I don’t know about you, but I’m really tired after all the HIMSS-related activities over the past few weeks and I want to see what it feels like to sleep more than five hours in a single night.

Acquisitions, Funding, Business, and Stock

Teledermatology provider Iagnosis raises $1 million from 11 investors.

Accretive Health releases its Q4 numbers: profit of $13.2 million ($0.13/share) compared to last year’s $5.5 million ($0.06/share.) Net services revenue grew 53% to $260.1 million.

HP Enterprise Services notifies the State of Wisconsin that it will be eliminating 157 Medicaid program jobs in Madison and Milwaukee.

Sales

DR Systems announces six new contracts for its Unity platform totaling more than $2.07 million.

Cancer Treatment Centers of America signs an agreement to deploy Unibased Systems Architecture’s ForSite 2020 application suite across all its facilities.

People

Beacon Partners appoints Christina Bertsch (EMD Serono) VP of human resources.

The National Quality Forum board of directors announces that President and CEO Janet Corrigan will resign as of June 2012.

HHS Office for Civil Rights names attorney Juliet K. Choi (American Red Cross) as chief of staff and senior advisor.

Announcements and Implementations

Four Lakeland Healthcare (MI) hospitals go live on their $50 million Epic system.

T-System licenses its clinical terminology to Prognosis HIS, allowing Prognosis to incorporate into its ChartAccess EHR more than 200,000 clinical phrases.

MED3OOO chooses Macadamian to help develop a new product that it says will expand the usability and adoption of its ambulatory systems.

Shareable Ink incorporates Pentaho Business Analytics to create a data analytics platform for healthcare.

Michigan Health Connect wins second place in an IT innovator awards contest for its electronic referrals solution app, powered by Medicity’s iNexx, that was rolled out to nearly 1,000 physicians over 28 counties. 

Government and Politics

The Advisory Board Company does a nice high-level summary of the proposed Meaningful Use Stage 2, nice for CIOs prepping peer execs for what the IT agenda will look like.

In England, two NHS trusts seek a supplier to take over their IT help desk and infrastructure in what would be the first outsourcing contract of its kind. The deal is valued at  $50 million.

I liked Doug Fridsma’s post on HHS’s blog about the Interoperability Showcase at HIMSS. He says Farzad Mostashari showed up there by surprise and challenged the participants to demonstrate impromptu interoperability with another participant with whom no relationship existed. He gave them one hour to make it happen technically, which involved overcoming challenges such as authentication certificates, vocabularies, and firewalls. The result: NextGen sent a C32 to Allscripts, EXCITA HIE and Medical Informatics Engineering exchanged a transfer of care document in ER discharge summary format, and Enable Healthcare sent a CCDA discharge summary to Verison to create a new patient chart. That’s pretty cool.

Other

Ochsner Health System (LA) announces that its neurologists recently completed their 1,000th patient consult as part of Ochsner’s  telehealth stroke treatment program.

KLAS reports that some providers are concerned with a number product gaps and weaknesses in the McKesson Paragon product and wonder if Paragon can scale to larger hospitals, especially those with more than 400 beds.

Jackson Health System (FL) announces the layoff of more than 1,000 people in an effort to save the organization $69 million.

Trinity Health’s Michigan hospitals sign an agreement with University of Michigan to explore ways the organizations can work together to coordinate care, with one of the areas of discussion being information technology. 

A physician’s assistant who sued her former employer, Mercy General Hospital (CA), for sexual harassment is awarded $167 million.

The folks at MED3OOO asked Inga and me to choose and announce a winner from the six finalists in their contest to create the best video testimonial. They offered to pay for our time, but we said it either had to be (a) free to them because they’re a sponsor, or (b) if they really wanted, they could donate whatever amount they wanted to a charity of our choice. Thanks to MED3OOO for their donation to Best Friends Animal Society, a highly rated charity whose mission is “to bring about a time when there are no more homeless pets.” And congratulations to the winner, Kyle Adkins, administrator of Golden Valley Medical Clinics of Clinton, MO (he’s in Interview 1 on the finalist page) which implemented the InteGreat browser-based EHR from MED3OOO. My favorite quote: “You don’t ever make this decision well the second time or a third time. You may make a better one if you’ve made the wrong decision, but there will be someone else making the decision.” Great job, Kyle, and for that you win an all-expense paid trip to MED3OOO’s 2012 National Healthcare Leadership and Users Conference in St. Thomas, US Virgin Islands in October.

Sponsor Updates

• World Wide Technology is sponsoring Geek Day 12 in Washington DC, April 11-12, complete with showcase labs, breakouts, and birds of a feather session divided by industry focus. The event is free and so is lunch.
• API Healthcare partners with Presagia Software to offer Presagia’s workforce absence management solutions to API clients.
• ProHealth Care (WI) goes live with iSirona’s connectivity technology to deliver patient data from anesthesia monitors into Epic EMR.
• A survey by BridgeHead Software finds that most hospitals want vendor neutrality with more control over their image data.
• Black Book names Quest Diagnostic’s Care360 EHR the best EHR for single physician practices and for e-prescribing. It was also ranked eighth on Capterra’s most popular EMRs.
• Alexander Orthopaedic Associates (FL) selects White Plume Technologies’ AccelaSMART resolution engine to bridge the gap between its Exscribe EHR and ADP’s AdvancedMD’s PM system.
• MEDSEEK and BrightWhistle partner to offer a search and social media marketing solution.
• Lawson Software enhances its Cloverleaf Secure Courier and Global Monitor for its Cloverleaf Integration Suite to increase speed and provide greater connectivity.
• New York-Presbyterian Hospital goes live with Awarepoint’s RTLS at its Columbia University Medical Center campus.
• Aventura will participate in the World Congress Inaugural eHealth Innovation Conference this month in Cambridge, MA.
• Santa Rosa Consulting advisor Matt Wimberley  discusses confidentiality, integrity, and availability in the HIPAA security rule.
• Bruce Friedman MD, emeritus professor of pathology at University of Michigan Medical School, keynotes at the Lifepoint Informatics User Conference 2012.
• Evergreen Healthcare (WA) shares how API Healthcare’s Time and Attendance and Staffing and Scheduling technology helped the organization get its productivity and costs under control.
• MedAptus launches a revenue cycle reporting and performance analytics module for its Professional solution.
• Coastal Cardiovascular Consultants (NJ) will implement the SRS EHR at two locations for its six providers.

EPtalk by Dr. Jayne

The American Journal of Preventive Medicine recently published an article about cybercycling. It shows that riding a stationary bike which hooked up to interactive videogames could increase brain function in older adults compared with a standard exercise bike. Elderly study participants who took 3D tours and raced computer generated avatars showed better memory, attention, and problem-solving abilities. Not surprisingly, some reported knee and back pain as well as “frustration with interacting with a computer.” Now we just have to wait for a vendor to allow the cybercycling data to flow through the patient’s PHR into their EHR charts.

Shades of Eliot Ness: Even without federal approval, Illinois is getting tough on Medicaid fraud. The state will start matching Medicaid patient data with the state driver’s license database to make sure only Illinois residents are receiving benefits. Applicants would also have to show additional proof of income to maintain benefits. Even without federal blessing, this seems like a reasonable idea – recently 6% of Medicaid cards were returned as undeliverable or having an out-of-state forwarding address.

It looks like there might be another way for vendors to expand their offerings. The Department of Health and Human Services recently announced plans to look as far back as 10 years when auditing Medicare overpayments. I forsee a whole new subset of vendors offering data archiving and retrieval specifically for Medicare billing. As Medicare goes, so go the rest of the payers, so it’s only a matter of time before providers are forced to maintain massive amounts of data. And we thought seven years for the IRS was bad.

For those of you who work directly with providers, it will be interesting to see how upcoming changes to the Medical College Admission Test (MCAT) affect the physician pool. The test is being updated to gauge “knowledge of the psychological, social, and biological foundations of behavior” as well as critical thinking skills. The goal is to “better prepare students to be doctors in today’s changing health care system.” It will be interesting to see if this really makes a difference in patient care, but I do hope it will also make a difference in being able to intervene with colleagues who are ripping their hair out due to the continuous onslaught of ever-changing federal and payer regulations.

USA Today reports that Hawaiians rank at the top for residents having the best overall sense of well-being. Don’t attribute it all to the sunlight and tropical breezes though – North Dakota, Minnesota, and Alaska also made the top ten. West Virginia finished last. Gallup gathered the data by calling 1,000 people daily for all but 15 days of 2011.

I’m still poring over all the Stage 2 documentation that’s coming across my desk (and phone, and e-mail, and the water cooler) and for better or worse, it seems like I’ve become comfortably numb as far as finding something noteworthy to discuss. Have a thought about your interpretation of those 455 pages of bliss? E-mail me.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

CIO Unplugged 2/29/12

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

Are You an Insider?

My siblings and I took a beating from our peers because of the Bavarian clothes our parents insisted we wear long after our arrival in USA. We were, however, embraced on the futbol pitch. The seven of us kids had the benefit of growing up on the soccer field in Germany. When we arrived here in the mid ‘70s, American soccer was in its infancy. Coaches welcomed our soccer finesse, experience, and smarts. It took time for our teammates to accept us foreigners who played with a different style, but our impact proved undeniable.

What was good for those teammates is equally good for IT.

One of my first healthcare jobs held a single yet challenging objective: “make docs happy.” In that competitive environment, physician loyalty was paramount. My role was one-third ombudsman, one-third consultant, and one-third party planner.

I loved it. I met with physicians daily to make sure their concerns and ideas were appropriately vetted with hospital administration. I dived deep into practice management and provided consulting services ranging from business development to system selection to establishing regional CME events. The most enjoyable aspect was organizing some serious parties to celebrate accomplishments and recognize the medical staff and their contributions to our healthcare system.

Despite my established healthcare background, I transitioned into the position of IT director as an outsider. I brought with me a different skill set. I viewed things differently from my tradition- oriented IT peers.

It was not easy for me or my new cohorts at first, but we helped each other. Mixing outsider perspective and experience with solid IT operations made for a dynamic environment resulting in vastly improved performance and outcomes.

As a believer in the diversity approach, I’ve purposefully sought to develop teams comprised of traditional and non-traditional workers. In a former post, “Got Clinicians?” I share the absolute necessity for ensuring appropriate clinical insights. Now I aim to encourage you to build a healthy mix of non-healthcare experienced talent into your fold.

Most would agree that healthcare, conservative by culture, is three to five years behind the technology curve. Bringing in outsiders who have worked in progressive industries such as finance or international business will help push the organization forward and help ensure currency. Not just currency, but also what is on the horizon. A couple of the chief technical officers I’ve hired have had zero healthcare experience. On both occasions, my organizations experienced a massive technological bounce.

Promoting only from within will continue to retard the growth curve as compared to other industries. It’s all about striking that healthy balance.

So, what about you and me? Even outsiders eventually become insiders. How do we stay fresh and think with the objectivity of an outsider? Spend at least 50% of your learning outside of healthcare.

Some methods to avoid becoming a healthcare IT junkie:

• Conferences. Choose wisely. Skip HIMSS every other year and go to the consumer electronics show instead. You will see things that will eventually be shown at HIMSS three years later.
• Blogs. Read posts that are on the bleeding edge.
• Magazines. Check your subscriptions. At least half should be outside of healthcare and, of course, a high percentage should be business and non-technical.
• Peers. Spend time with non-healthcare peers. I previously posted on how we compare notes regularly with companies in different verticals. Next up, Kimberly-Clark.
• Organizations. Actively participate in professional groups such as SIM where you are exposed to peers from across industries.
• Hiring. Keep yourself on your toes by hiring outsiders who are smarter than you.
• Diversity. Don’t hire your twin
• Advisory boards. Participate in those that are vertical agnostic.

Fitting in to please everyone is a worthless pursuit. Avoid that temptation. Hiring outsiders is healthy for your team. This will create more opportunity as new technologies are transferred to the team. Hiring outsiders is beneficial to your organization as you begin to deploy new tools that will enable mission fulfillment. Hiring outsiders advances healthcare. You’ll leverage technology and help reduce the cost of healthcare, elevate patient and clinician satisfaction, and ultimately improve the quality of care.

Most of us German-transplant kids had successful soccer careers in high school and beyond. We helped our coaches take our teams to the next level. Goal! And for at least a few hours each week, we were free from our lederhosen.

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.

HITlaw 2/29/12

Exposure Disclosure. Liability and Accountability.

HIPAA has been around for a while. I would not say we are generally complacent about it, but I believe we have become at least comfortable with it.

Enter the HITECH Act, which puts real muscle into HIPAA. Providers should recognize the urgency of reviewing not only their current internal policies regarding protection of patient information, but also the agreements they have in place with entities that use and access patient information on their behalf. With everything that is approaching under HITECH (or here already), providers may be unsettled to find that they are exposed to more potential liability and financial consequences than originally contemplated when HIPAA first came on the scene. That said, the good news is that accountability will now be shared with those entities to which you contract services involving patient information.

Capitalized terms refer to defined terms under HIPAA and HITECH Act, and I am purposely avoiding long explanations and citations with the assumption that these terms are known already to HIStalk readership.

As a quick refresher, the HIPAA Privacy Rule (effective in 2003) and Security Rule (effective in 2005) set out the regulations applicable to health care providers (Covered Entities) and their protection and treatment of patients’ Protected Health Information (PHI). Covered Entities were required to enter into Business Associate Agreements that secured written agreement from Business Associates that they would protect PHI from unauthorized disclosure. At that time it was suggested but not required that the Covered Entity secure an indemnification from the Business Associate, protecting the Covered Entity in the event of an unauthorized disclosure of PHI due to the actions of the Business Associate (optional indemnification language was even previously included in the HHS Office of Civil Rights (OCR) sample Business Associate Agreement).

All providers should undertake a complete review of their existing Business Associate Agreements, while also reviewing their own policies regarding privacy and security of PHI. Business Associate Agreements should be amended or replaced as necessary in order to address the changes to HIPAA resulting from the HITECH Act. While reviewing the Business Associate Agreements, identify those that do not have an indemnification provision whereby the Business Associate indemnifies the Covered Entity for unauthorized disclosures of PHI caused by the Business Associate. This one factor alone is worth the entire review process. See HITlaw February 18, 2011 for a brief indemnification explanation.

HIPAA and HITECH

There is a ton of material worthy of elaboration packed into the following points, but space is limited. Being the straightforward type that I am, here goes:

• HIPAA requires that providers review and update their policies, procedures, and safeguards with regard to the privacy and security of PHI.
• HITECH mandates audits of providers to determine compliance with HIPAA (which would include determining if a provider has updated its privacy policy).
• OCR was given authority under HITECH to enforce HIPAA, is investigating data breaches, and has imposed penalties on providers in excess of $1m (two of these in 2011).
• HITECH final regulations will put the bite into HIPAA that until now has had mostly only bark, including required enforcement and mandatory penalties in certain situations.
• HITECH extends compliance regulations and penalties to Business Associates.

In addition to reviewing privacy policies, all providers should review their actual operations with regard to protection of PHI, because while a policy may look good on paper, non-adherence in daily operations will undoubtedly become evident in the event of an audit or investigation.

Liability

Here is the most important item to understand. Just because your organization contracts with a Business Associate that performs certain tasks and operations on your behalf does not mean that responsibility for any data breaches and unauthorized disclosures of PHI is automatically passed on to the Business Associate. Your organization, as the health care provider and Covered Entity, is ultimately responsible to the patient. Having an indemnification provision in the Business Associate Agreement ensures that if a breach or unauthorized disclosure of PHI occurs that is in any part the fault of the Business Associate, you will have legal recourse in order to pursue financial contribution from the Business Associate.

The potential impact on a provider organization without this protection is significant. Suppose a breach occurs and it is completely the fault of the provider’s staff. The provider organization is responsible and pays the price. Suppose however that a breach occurs and it was the fault of a Business Associate. The provider organization is still responsible and will pay the full price if it cannot shift some financial responsibility to the Business Associate under an indemnification provision.

Refer back to the bullets above. Before HITECH, everyone in this industry was fairly settled in with HIPAA and knew about the obligations to protect PHI. With the advent of HITECH, HIPAA takes on a much stronger presence. Audits will be performed, failures in compliance will be discovered, and penalties will be assessed (assuming adoption of the HITECH final regulations that amend HIPAA happens in the not-too-distant future). On a practical note, while assessment of a penalty on either the Covered Entity or Business Associate does not by any means guarantee a patient plaintiff a verdict in court, the very existence of any imposed penalties (on either the Covered Entity or its Business Associate) will certainly be introduced in legal actions by patients for unauthorized disclosure of PHI.

As for the Business Associates (vendors) in the industry, HITECH also requires that Business Associates obtain written agreement from subcontractors that they will comply with the Business Associate requirements to which your companies are subject with respect to your provider customers. All the above advice is applicable to your agreements with your subcontractors, and the indemnification from the subcontractors is essential for protection of your companies. Just re-read the above, and put “my company” in place of provider or Covered Entity, and “subcontractor” in place of Business Associate. Civil and criminal penalties, formerly applicable to Covered Entities under HIPAA, may be imposed on Business Associates for HIPAA violations under HITECH. Careful review of your company’s policies and procedures, especially with regard to administrative, physical and technical safeguards, is important. HITECH mandates Business Associate compliance with these HIPAA requirements, so if you do not have a privacy and security policy in place, this should become a top priority for the very near future.

Accountability

Clearly the HITECH Act calls for increased accountability. First, on the part of providers through audits, investigations, and penalties. Second, by extending compliance requirements (and audits, investigations, and penalties) to Business Associates. This is the real game-changer for technology companies in this industry. Prior to HITECH, the impact and exposure of any breach of a Business Associate Agreement for the Business Associate was dependent on action by the provider customer (Covered Entity). HITECH changes all that and brings accountability, responsibility, and the possibility of civil and criminal penalties right to the Business Associate.

The inclusion of Business Associates in the compliance and penalty aspects of HIPAA though the enactment of HITECH is a strong message from Washington that it is understood providers in some cases are not responsible for data breaches and unauthorized disclosure of PHI, but they alone (until HITECH) were accountable and subject to penalties in those situations. HITECH’s amendments to HIPAA permitting or requiring penalties for Business Associates for their violations is a clear statement of recognition that the penalty, if imposed, should lie where the fault occurred and not just with the Covered Entity which, through no fault of its own, was previously subject to penalty for the actions of others.

I suggest that vendors consider the accountability aspect of HITECH and realize that taking on responsibility and liability is truly becoming a cost of doing business in the industry. Providers did not impose HIPAA and HITECH on themselves. Just as Business Associate vendors should obtain protection from subcontractors for their faults and failings, they should also realize the potential impact on provider customers of any breach with regard to PHI. Fairness dictates that what you require from your subcontractors for your protection you should consider providing to your client base for their protection.

Note I am not anti-vendor, nor am I anti-HIPAA or anti-HITECH. We must all deal with HIPAA and HITECH and the associated benefits for patients, as well as the negative aspects for both Covered Entity and Business Associate offenders. What I suggest is fairness for all, with parties being responsible for their actions.

Providers

Review policies, practices, and Business Associate Agreements and update all accordingly. Note: just because HITECH extends civil and criminal penalties to Business Associates does not mean that liability and responsibility to patients for disclosure of their PHI shifts from Covered Entities to Business Associates. While penalties may be imposed, they are not for the sole purpose of compensating patients whose PHI was disclosed. Some portion of the penalties is intended for this use, but this does not mean that your patients will in any way be prevented from bringing action against your organization directly. This enforces the need for indemnification from your Business Associates.

Business Associates

Review policies and procedures (or establish them now), and obtain a written “Subcontractor Business Associate Agreement” from all subcontractors. In any action for data breach or unauthorized disclosure of PHI, attorneys for the patients will try to bring in as many entities as possible, from the provider Covered Entity to the Business Associate to the subcontractor of the Business Associate. Another practical note – just as the existence of a penalty for violation of HIPAA does not guarantee a patient plaintiff a favorable verdict in legal action, neither does the absence of penalties suggest a verdict for the defendant Business Associate (or Covered Entity). Make sure you are in compliance with HIPAA and have indemnification from your subcontractors as described above.

Although to some the information here may seem basic or obvious, I can assure you that it is not so for all readers. I have composed this posting over the past few months based on real inquiries from, and interactions with, people in different areas of responsibility and levels of leadership within the healthcare industry. Some were truly surprising.

In my various engagements, I represent providers as well as technology companies. This gives me a unique perspective, and in postings like this I try not to take sides but rather to offer advice to all. I also throw in a generous dose of fairness because that is what I believe is most important in structuring and negotiating agreements between parties.

William O’Toole is the founder of O’Toole Law Group of Duxbury, MA.

News 2/29/12

Top News

Epocrates reports Q4 numbers: revenue up 9%, EPS –$0.18 vs. $0.01. The company reduced 2012 revenue estimates and says it will seek strategic alternatives for its EHR, which includes a native iPad version, since “the effort has hindered our ability to aggressively pursue such [physician network] opportunities.” Maybe that list of EHR mistakes is of theirs.

Reader Comments

From BeenThere: “Re: WellStar. Shutting down its ambulatory rollout of [vendor name omitted].” I’m looking for confirmation and will provide more details if I get them.

From Non-Sequitur: “Re: SNOMED. My manager attended Dr. Mostashari’s session and is able to substantiate what you wrote down about SNOMED and the problem list. He captured the talk on a Flip and we just listened to that segment talking how ‘we now have a standard for this or that’ ontology. Here’s specifically what he said regarding problem lists: ‘There is now a single standard for problem lists: SNOMED.’ I concur with the other people who have commented there is no mention of a requirement for SNOMED in the currently released document. We’ll see if what is published in the Federal Register provides additional detail.“ Thanks! I was hoping I hadn’t dreamed that part so early in his talk.

From Jockey: “Re: Allscripts. Curious if you’ve heard rumors of an acquisition by some big non-healthcare guys.” Two anonymous readers have said that IBM (and possibly Oracle) might be making a move, but I have nothing substantial to back that up.

From BrazosKid: “Re: KC area eClinicalWorks user group meeting. Surprise guest was CEO Girish. Said a few words and took some questions, made time for anyone who wanted to talk to him. A very personable and approachable CEO. You should interview him.” I have, actually: in 2006, 2008, and 2009. Girish Kumar Navani is one of my favorite people to talk to: honest, logical, and insightful, not to mention fun and an excellent businessman.

From Phil: “Re: HIStalkapalooza. The flipbook with Elvis was the highlight of the memorabilia I brought back!” Those were cool. Check them out in the video if you haven’t already. I may need to make Elvis a fixture at future events since he was fun.

From Kathy Wheatley: “Re: thanks for the Booth Crawl iPad from T-System. Coincidentally, some of our facilities use T-System and love it. Paper T’s in the past, but the electronic version is very easy, fast, and reliable. Thank you T-System for sponsoring HIStalk. I get my information from HIStalk, HIStalk Practice, and HIStalk Mobile, pull out applicable info, and copy it in another e-mail for our leadership team. My boss told me not to stop sending them – he was getting a lot of good market info from them. You have a great knack of pulling together applicable and trend information to hand it to your readers with a great synopsis and links to the full articles, which I have used often. I appreciate the writings of Inga, Dr. Jayne, and Dr. Gregg as well, and I enjoy reading Ed Marx – so spot on. Thanks for being the glue that holds this together.” Thanks for those nice comments from Kathy from HCA, for which I’m sure I’m speaking for T-System as well. I also got  nice e-mail from Jason Blunk, who won his iPad from MedPlus and said he enjoyed checking out booths he would have missed otherwise.

From Sagacity: “Re: Meaningful Use Stage 2 references. Along with the bookmarked version of the NPRM, here is a bookmarked version of the ONC Standards, Implementation Specifications, and Certification Criteria. It comes with the added bonus of clickable MU Objective links, which take you back to the CMS MU objective being referenced in the CMS document. (Just be sure to save both in the same folder).” Thanks for sending the links.

From The PACS Designer: “Re: iPad 3. When the iPad 3 is released next month, you’ll find that the majority of changes will be inside, since rumored details indicate that there will be no change in the size of the screen. One new upgrade coming is better High Definition, where the number of pixels will double by using a 4×4 matrix instead of 2×2 currently in the iPad 2.”

HIStalk Announcements and Requests

If you’ve completed my once-a-year Reader Survey, thanks. If not, I’d appreciate your input.

Acquisitions, Funding, Business, and Stock

Halfpenny Technologies secures $2.25 million in VC funding co-led by Vital Financial and Emerald Stage2 Ventures. The company also announces that it has won approval as the first pilot by the Laboratory Results Interface Pilots Work Group.

T-System acquires Clinical Coding Solutions, a provider of technology for facility and professional charge capture and coding for EDs, observation, urgent care centers, and outpatient clinics.

Hello Health raises $10 million in a combination of common and preferred shares and issuance of convertible debentures through its parent company Myca Health.

Sales

CentraState Healthcare System (NJ) chooses Cognizant to develop its ICD-10 transition strategy.

Trinity Health (MI) selects Quest Diagnostics’ ChartMaxx Enterprise Content Management solution.

LifeCare Hospitals (TX) chooses Meta’s integrated HIM and CDI software suite for abstracting/coding and clinical documentation for its 27 long-term acute care facilities.

CMS awards SAIC a contract to provide enterprise remote identity proofing and multi-factor authentication credential services. The total contract value is $78 million, assuming all contract options are exercised.

HMO Simply Healthcare (FL) selects MedHOK’s care management, quality, and compliance software for quality improvement initiatives.

Sacred Heart Health Systems (FL), Piedmont Healthcare (GA), and Orlando Health (FL) sign contracts with QuadraMed for its identity management solutions.

People

KPMG appoints Richard Bakalar (Microsoft Health Solutions Group) to its Global Healthcare Center of Excellence.

CORHIO Executive Director Phyllis Albritton announces that she will step down at the end of March after four years of leading the organization.

Cape Cod Healthcare (MA) promotes Jeanne M. Fallon to VP/CIO.

CareCloud appoints John Hallock, formerly with athenahealth, as VP of corporate communications.

Siemens Healthcare names David Fisher, formerly with the Medical Imaging & Technology Alliance, as VP of healthcare policy and strategy.

Announcements and Implementations

Ochsner Health System (LA) standardizes on the Informatica platform for HIE, BI, and other IS initiatives.

Sentara Princess Anne Hospital (VA) implements EXTENSION’s clinical workflow solutions for nursing staff in its neonatal ICU.

Oakwood Healthcare Dearborn (MI) will go live with an $80 million Epic project in August.

Midwest Orthopaedis at Rush goes live with SA Ignite’s MU Assistant, which documents EHR usage in preparation for assessment.

Delaware Health Information Network announces that all of the state’s acute care hospitals and skilled nursing facilities are participating in its statewide community health record, making it the first state to have all hospitals involved.

New York eHealth Collaborative is accepting presentation proposals through March 23 for its 2012 Digital Health Conference to be held in October.

Shareable Ink announces partnerships with Greenway, NextEMR, and VoiceHIT for its handwriting recognition technology.

Government and Politics

In England, a hospital pilots an analytics service in which drug companies can use the hospital’s de-identified and aggregated data directly from its databases to perform queries and data analysis.

The VA orders worked stopped on its $103 million enterprise service bus that would connect external products to the EHR it’s developing with the Department of Defense. CIO Roger Baker also says the VA is looking for less-expensive alternatives to Microsoft Office, but has no immediate plans to switch.

CMS credits its fraud detection technology for the indictment of a Texas physician and six other people who it claims bilked the government for $375 million of unnecessary home health services. CMS says the physician certified more Medicare beneficiaries for home health service than any other US medical practice, claiming that he recruited them via door-to-door solicitations and visits to the local homeless shelter.

Other

Novant Health (NC) is hiring 150 people with clinical and computer experience as it transitions to Epic.

Weird News Andy extends this story on cosmetic leg-lengthening surgery, which he captions, “Men, grow six inches.” WNA also likes this ink on medical tattoos, including “No CPR” emblazoned on a man’s chest, although the wording WNA suggests for breast implants is not family friendly.

Nuesoft is conducting a survey on attitudes about the transition to ICD-10 and ANSI-5010.

An article in the Minneapolis paper covers the local VA’s use of a virtual ICU to cover hospital ICUs in multiple cities from a single location, which an intensivist there likens to air traffic controllers watching from afar.

Sponsor Updates

• DIVURGENT and Bon Secours Kentucky Health System publish a white paper on implementing an EMR.
• Covisint partners with Anvita Health to add Anvita’s Smart Problem List to its HIE platform.
• Comanche County Memorial Hospital (OK) will migrate from McKesson’s Horizon Clinicals to Paragon HIS.
• ZirMed introduces VeraFund Manager, an end-to-end automated patient/payer solution for healthcare providers.
• CommunityHealth IT (FL) partners with RelayHealth for its HIE.
• Allscripts and MyCareTeam launch a diabetes management system that integrates the MyCareTeam application with Allscripts Enterprise EHR.
• Beacon Partners launches Pillars Project Planner, a Web-based project management and implementation tool that provides organizations real-time access to their projects.
• Nuance introduces two clinical language understanding solutions, Dragon Medical 360 | M.D.Assist and Dragon Medical 360 | QualityAnalytics.
• eClinicalWorks announces Community Analytics, a data analytics solution for communities and ACOs that provides reporting, alerting, and messaging capabilities to manage population health.
• UC Health (OH) expands its use of Streamline Health Solutions in three of its hospitals.
• Central Alabama Health Image Exchange selects MEDecision to deliver its DICOM images and clinical information solution to seven of its hospitals.
• Healthland partners with Imprivata to resell Imprivata’s single sign-on and access management technology.
• Concentra (TX) selects Allscripts EHR to deploy in its 310 urgent care locations across the country. CVS Caremark’s MinuteClinic will transition from its proprietary EMR to AllscriptsMyWay EHR.
• HFMA grants Surgical Information Systems the “Peer Reviewed by HFMA” designation.
• LTC provider NuVista Living (FL) implements the Intelligent InSites RTLS solution as part of its Living Smart Room.
• Trenton Health Team (NJ) selects Covisint as its HIE provider.
• GetWellNetwork says it gained 25 new hospital customers and a 35% increase in live beds for its interactive patient care solution in 2011.
• Healthcare Management Systems (HMS) and Certify Data Systems partner to make Certify’s HIE solution available to HMS customers.
• Microsoft selects Health Language to map patient data within Microsoft Amalga platform.
• Practice Fusion wins top honors for customer satisfaction in the primary care division of the Black Book Ratings
• Imprivata introduces CorText, its secure texting application.
• T-System introduces care coordination technology at the Emergency Nurses Association Leadership Conference.
• PatientKeeper introduces the latest release of its medication reconciliation software.
• Brown & Toland IPA (CA) selects Humedica MinedShare as its analytics platform to assist its 1,500 physicians with Pioneer ACO requirements.
• CynergisTek partners with Iatric Systems to offer Iatric’s Security Audit Manager and Medical Records Release Manager solutions.
• Quest Diagnostics announces a 30-day EHR implementation guarantee to enable bi-directional data exchange between hospitals and ambulatory physicians using the Care360 EHR.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Readers Write 2/27/12

Why Device Connectivity Is Hot Now
By Dave Dyell

Tech-based solutions often enjoy a surge or hot period—a moment in the sun if you will. For those of us in the medical device integration (MDI) space, 2011 felt pretty sunny. For one thing, 2011 was the first year in which KLAS, an independent research organization that ranks health information technology vendors in key market segments, recognized MDI.

In an annual report titled Medical Device Integration 2012: Proven Connections, KLAS detailed the major MDI vendors and their individual strengths, as well as the overall benefit of MDI. For those of us who have worked in the MDI space for several years, recognition from KLAS represented a major milestone.

So why did KLAS add MDI to its list of relevant tech spaces in 2011? Why is the HIT spotlight on MDI now?

One reason is that MDI is a necessary component, or stepping stone, on the road toward achieving HIT initiatives such as Meaningful Use, health information exchange, ACOs, etc. In this way, the rise of MDI has been fueled to a certain extent by the passing of the HITECH Act in 2009.

But I believe that the real momentum behind MDI has another, slightly more organic explanation that is rooted in MDI’s payoff. The promises of MDI—improved clinical efficiency and quality—mirror the promises of other large, federally mandated initiatives. The difference with MDI, though, is that it is a much quicker win. The feedback loop with MDI is shorter than, say, the feedback loop with ACOs.

MDI automates the flow of data from devices directly into the hospital’s clinical information system (CIS) or electronic medical record. This automation (as opposed to handwritten transcriptions and keying) immediately improves clinician productivity as well as data accuracy and availably throughout the hospital.

The aforementioned KLAS report also notes this immediacy. When comparing the benefits of MDI to other HIT initiatives, the report states, “In a simple, more immediate way, some healthcare providers are quietly getting a bump in quality and efficiency through medical device integration systems.”

What does “bump” mean in this context? More than 65% of the study’s respondents reported that MDI saves time and provides the ability to make more informed decisions concerning patient care using the data that MDI makes available.

For the hospital trying to figure out which tech-based solutions to purchase, the KLAS report paints MDI as a solid investment with immediate and future payoffs—a synergy that those of us in this emerging industry have always stressed and will continue to. 

Dave Dyell is founder and CEO of iSirona of Panama City, FL.

Walking Through HIMSS
By Carlos Nunez, MD

Walking the aisles of the exhibit hall and participating in HIStalkapalooza at the world’s largest gathering of healthcare IT professionals and the companies that do business with them led to several interesting discoveries. 

All of the usual suspects were well represented in the exhibit hall (Epic, Cerner, GE, etc.), along with the expected collection of smaller IT vendors and specialty niche solutions (did you know that Rubbermaid makes hospital-grade computer carts?) And, of course, you found companies like IBM, Oracle, and Microsoft that also play in this space.

Coming in to the meeting, it was expected that ICD-10 would be a big topic of focus, but with the recently announced delay in the implementation requirement, that story seemed less relevant. There was also the announcement  that the Stage 2 requirements for Meaningful Use were ready to be published in the Federal Register, but likely wouldn’t be available until after HIMSS. The announcement was big news, but it came too late to have any discernible impact on the conference floor. Finally, the trend toward mobile devices and cloud-based solutions is still grabbing a great deal of attention and booth space.

The trend that was most interesting was the rise and growing prominence of companies exhibiting at HIMSS that – at first glance – may seem out of place. For example, I had a meeting with the folks from Lockheed Martin. Yes, the same Lockheed Martin that makes fighter planes and satellites also has a healthcare business and is now partnering with Johns Hopkins on a patient safety and quality initiative. One of the larger booths in the exhibit hall belonged to a collection of IT and benefits management businesses that were recently cobbled together by one of the major insurance companies. I guess it should come as no surprise that as the American healthcare system continues to grab more attention (and more dollars) than any other segment of the economy, businesses new and old would look for their place at the table.

This trend got me thinking about my own place at HIMSS, and more specifically, where CareFusion should be slotted in the spectrum of industry represented there. To the uninitiated, you might think that CareFusion belongs closer to the Rubbermaid end of the spectrum, especially if you only focus on the “things” that CareFusion makes. What do surgical instruments, infection prevention, or infusion pumps have to do with information technology? However, when you realize those “things” are key components in a portfolio of solutions, many of which are tied together by the very technology that defines HIMSS, you begin to see that CareFusion brings a unique perspective and vision to the HIT conversation.

What became vividly apparent this year at HIMSS is that Healthcare IT today, and the concept of Meaningful Use, is much more than an EMR. It is the information ecosystem that supports every patient encounter. It is the millions of clinical data points streaming from a ventilator or an infusion pump, into a server or into the cloud. It is a medication order entered in a CPOE system, tracked and secured through an automated pharmacy system, and the surveillance engine on a constant vigil for inappropriate medication dosing or signs of infection.  It is new technology designed to make devices and HIT systems talk to one another and provide critical patient data to caregivers when and where they need it, seamlessly across hospitals and systems.

Initiatives like Meaningful Use can sometimes make us forget that healthcare IT is more than just software or the systems we build to collect and store data; it’s how those systems enable us to convert data into useful information to help improve workflow, efficiency, and patient safety. As many providers begin to focus on Stage 2 Meaningful Use requirements, broader concepts like interoperability and standardization will emerge as critical objectives in achieving the desired end goal.

Or as ONC chief Farzad Mostashari, MD, asserted in his keynote speech at HIMSS, “We’re on the right track to make meaningful use of Meaningful Use.” What I saw and heard at HIMSS was a promising acknowledgement of our shared responsibility to improve healthcare. It’s a challenge that’s breaking down barriers between providers, suppliers, and companies of all industries and competencies working to make a contribution. I was proud to represent a company bringing so many meaningful solutions to the table.

Carlos Nunez MD is chief medical officer of CareFusion of San Diego, CA.

Curbside Consult with Dr. Jayne 2/27/12

Over the past several years (and especially with Meaningful Use) there has been a fairly significant shift in the attitudes of ambulatory physicians who are making the leap to electronic health records. The hospital-based physicians (and ambulatory physicians who see patients in the hospital) are a different story. They’re a captive audience who has always been subject to hospital control and who has a long-standing history of adapting to things imposed by various Big Brother entities: the Joint Commission, the hospital’s formulary team, insurance and hospital case managers, etc.

Those physicians have done pretty well adapting to electronic documentation, computerized order entry, and the like while in the hospital. Hospitals have also tended to phase their implementations over the scope of years – deploying in a modular fashion with lab, nursing documentation, CPOE, and provider documentation all done as separate initiatives. Ambulatory docs who dislike the hospital’s conversion have been able to escape back to the relative safety of private practice and cling to their paper charts.

As ambulatory physicians transition to EHR, though, they tend to deploy more rapidly – wanting to get rid of all the paper immediately, but also with a strong drive to keep the revenue stream steady. When I started deploying EHRs some time ago, we worked with early adopters who believed in the promise of electronic recordkeeping and were more willing to staff up, reduce patient load, or work longer hours to realize their goals. These physicians are now mature users who are leveraging their EHRs to achieve advanced Patient Centered Medical Home designations, increase fee schedules through demonstrable quality, and improve patient satisfaction.

On the other hand, there are now thousands of physicians who previously found the idea of the EHR distasteful and feel forced to make the transition. Whether by peer pressure, payer requirements, or the threat of government-related penalties, they’re now implementing and with a significantly different strategy than may be prudent.

More often, I hear of physicians that want to implement a system fast, cheap, and easy. The rest of us who have done this for a while know that it’s very difficult (if not impossible) to do all three. Often these late adopters refuse to follow vendor advice, consultant advice, or frankly anyone’s advice. Convincing them to cut schedules or hire staff is a challenge. Ultimately, it’s the patients who suffer.

As the healthcare market consolidates, hospitals and health systems are looking to “align” (one of my least-favorite buzzwords) with community physicians to ensure profitable referral, ancillary, surgical, and inpatient revenue streams. Many are offering subsidies and other incentives to bring these providers onto EHR systems.

Often these practices don’t actually want to align, but are feeling cornered and desperate. Some have previously turned down acquisition offers from the same hospital and see taking a subsidized EHR as a way to be somewhat protected from burdensome federal requirements while maintaining at least some degree of autonomy. Others simply can’t afford an EHR without the subsidy. A last group is providers who’d like to be acquired but for various reasons aren’t suitable candidates, but hope that alignment (and sending a steady volume of referrals which of course cannot be spoken about) will result in being ultimately asked to the dance.

These physicians often deploy on an existing system-wide EHR. Since they’re late to the game, though, they haven’t been stakeholders in any of the decision-making that’s already occurred and often have less buy-in to the idea of group goals than those users who are actually part of the group.

Another angle is that even though subsidized, these physicians are paying customers with different expectations than employed physicians and different ideas about governance. Of course, this would have been true even if these subsidized physicians were early adopters, but the differences are magnified by them being late in the EHR game and feeling pressured to demonstrate Meaningful Use as quickly as possible.

I still go out on implementations and perform physician training on a regular basis. Until recently, most of the physicians I have worked with have treated me as a respected colleague who could assist them through the difficult transition. Some have even looked at me as some kind of EHR shaman, able to smooth their journey to the other side with mystical wisdom. Of course, there have always been a few docs who were borderline (or overtly) hostile, but they were few and far between and usually we could leverage their partners or peers to moderate their behaviors.

Lately I’ve run into more and more angry physicians who are completely resistant to the idea of the EHR transition even though they’ve agreed to go paperless. Some are passive-aggressive, but others are openly abusive. This manifests in a variety of ways – disruptive behavior, inappropriate comments during training (think middle school students with a substitute teacher), or refusing to be trained at all. I find the latter group the most frustrating because then they can’t figure out why the system is so hard to use and scream the loudest about lack of support.

Looking at the data on how many physicians are actually using EHRs in practice (let alone being robust users) we’re just approaching the midpoint. If what I’m seeing in the field is any indication, it’s only going to get tougher as the last-ditch adopters come through with increasingly unrealistic expectations and correspondingly difficult implementations.

I feel bad for the vendors and for the teams who have to support these folks (mine included.) I feel bad for the physicians who don’t want to transition to EHR and the staff members that have to work with them every day. But most of all, I feel bad for the patients who entrust them with their care. Regardless of what they think about the EHR, the IT team, or the government, I hope the angry docs remember that after all, it IS all about the patient.

E-mail Dr. Jayne.