News 5/14/10

From The PACS Designer: “Re: an iPad challenger arrives. While the iPad gets all the press briefings, there’s a similar device called the Notion Ink Adam, brought to TPD’s attention courtesy of a posting by Michelle W. on HIStalk. It looks pretty cool, operates using the Tegra-Android platform, and best of all, it only weighs 1.35 pounds.” The company says they won’t release it until Flash works, which is probably a big mistake since the iPad doesn’t support Flash either and they’re letting Apple saturate the market in the meantime. It’s supposedly coming out in June for around $300, which would be an attractive price point if it works as advertised.

From Ex-Cerner Guy: “Re: Millennium and FDA’s MAUDE database. Not a huge surprise. Orders in Clinicals and FirstNet were designed and written by non-clinicians, with implementation done by non-clinicians. Try to find a Cerner Physician Executive in the field with more than two years under his or her belt. The referenced problem was evident at the Children’s Boston roll-out of FirstNet. From a sales standpoint, we used WYSIWYG-YBLI: what you see is what you get, you better like it.” Unverified.

From NorwichSammy: “Re: William Backus Hospital. Their attempt at digital cardiac access using GE’s Muse has been a big flop. It seems that paper trails are more effective for the clinicians.” Unverified.

From NoSleep: “Re: Hackensack University Medical Center (NJ). They successfully went live with Epic on May 1. It was a big bang cutover of all inpatient units, ED, radiology and several outpatient departments including nursing documentation, mandated CPOE, and medical device integration. Epic Ambulatory EMR and Practice Management will go live starting July 1, including both hospital and private practices in the rollout schedule. Rather than hire additional FTEs or engage consultants to implement Epic, HUMC recruited clinical and operational staff from within the organization, consolidated them within IT, and sent them to be trained and certified by Epic. As a result, the project was implemented on schedule and under budget. HUMC will retain its own in-house staff with expertise to support Epic.”

 

From the desk of Weird News Andy: a guy in Austria missing both arms passes his driving test by using a mind-controlled robotic arm. In England, a transsexual challenges NHS’s decision not to pay for her breast enlargement operation, claiming her female social life isn’t that great and that local street kids are calling her names because she doesn’t look like a woman. WNA editorializes a bit: “So, how many cancer patients won’t get the drugs they need to live so she can feel good about her appearance? How about, oh, I don’t know, paying for it yourself?” Lastly, WNA notices that NHS is using fear to convince patients to opt in to its Summary Care Record, warning them that its propensity to lose paperwork may expose them to NHS errors if they don’t sign up. 

SAP will buy Sybase for $5.8 billion. I hadn’t thought about Sybase for years since its healthcare dabblings have been infrequent and uninspired, but maybe I missed something.

Inga and I are a little behind, as evidenced by folks who are re-sending us e-mails when we don’t respond immediately (connected world expectations are sometimes unreasonable, I’ve noticed). We will catch up, I promise, but it may take a couple of days. Darned day jobs.

Abu Dhabi Health Services Company extends its Cerner deal to cover all applications for all of its areas, including its Lighthouse quality improvement solution.

Housekeeping: check out the Jobs Page. Drop your e-mail address in the Subscribe to Updates box to your upper right to get immediate notification when I write something new. The search box to your right now uses the new search engine I installed, so it covers all HIStalk sites (HIStalk, HIStalk Practice, and HIStalk Mobile.) The “Find us on Facebook” box to your right has adorable pictures of HIStalk readers, but also a link to our Facebook page (which Inga and I are using more often) and the thumb-up icon that gives us a Like when you click (thus temporarily soothing our raging insecurities). And as always, please support our sponsors by perusing and clicking their ads to your left, since they in turn will be motivated to continue supporting HIStalk. Thank you.

McKesson signs a big deal to implement PACS in Ireland.

How to tell you’re a hospital fanboy: when on vacation, you can’t resist following the blue signs to check out hospitals you’ve not seen. I knew a hospital executive who carried an AHA guide in his car and would choose routes that would let him check out all the hospitals along the way. He’s probably still doing it, only now with a GPS.

McKesson shares hit a 52-week high after analyst upgrades, although still below their 1998 (pre-HBOC scandal) prices. Thursday’s closing price was $68.99.

Jobs: Oacis – Clinical data Business Analyst, McKesson HED Consultant, Advanced Programmer Analyst – Interface, Meditech LSS Consultants.

Amcom’s messaging platform now supports Android smartphones.

Genesis HealthCare System (OH) will spend $40 million on an unnamed EMR (it’s Epic, of course, which should be obvious given the price and the fact that nearly every major sale is theirs these days).

Long term care operator Advocat names its IT consultant David Houghton as permanent CIO.

I see that Ed Marx’s first column here generated many comments about HIT vendor relationships. I thought both those who agreed and those who didn’t made their points quite well. Inga is sending out Ed’s PowerPoint as promised to all who commented and provided an e-mail address.

Integrated Document Solutions says it has implemented a cloud-based, RIS-less teleradiology system driven entirely by speech recognition and templates, all within 30 days.

A now-fired hospital employee of Perry Hospital (TX) is being investigated by police after allegedly using a doctor’s password to sign off on mammograms. The hospital has contacted 900 patients to have theirs redone.

A Forbes editorial by PatientKeeper CEO Paul Brient notes that all three technologies covered by Meaningful Use have been around for two decades, failed to hit double-digit adoption, and were avoided because they couldn’t pay their own way.

Odd: several dozen New Mexico residents are surprised to find themselves named as plaintiffs in a lawsuit against the local hospital. Most of them signed what they thought was a petition because a local guy asked them to.

E-mail me.

HERtalk by Inga

Henry Schein promotes Keith Slater to VP and GM of Henry Schein Medical Systems.

Northeast Georgia Health System says QuadraMed’s AcuityPlus nurse staffing management system generated $901,000 in first-year benefits. A 60% improvement in nursing productivity goals saved $659,000 in overtime and contract work and another $241,000 in incentive pay.

Diagnostic imaging provider InSight Services Holdings selects MobileMD’s HIE solution to provide electronic orders and results exchange for physicians.

A CIO involved in an HIS search shared with me his observation that the vendors that spent more time in due diligence gave better demos that met the hospital’s needs. A good reminder that cutting corners in the sales process can cut you right out of a deal.

St. Vincent Health (IN) deploys ZynxOrder to standardize evidence-based order sets. The 19-facility health system built over 350 order sets.

Grinnell Regional Medical Center (IA), Providence Kodiak Island Medical Center (AK), and Union Hospital (IN) are implementing eICU tele-health services from Philips Visicu.

Faith Regional Health Services (NE) anticipates a June 20th go-live on Siemens Soarian.

Medical transcription provider MedQuist releases its Q1 financials, which included a 6.3% decline in revenues to $74 million. Net income, however, grew from last year’s $6.8 million to $7.3 million. The company blames the revenue decline on poor February weather, which it says negatively impacted its transcription volume.

South Nassau Community Hospital (NY) selects the Capacity Management Suite from TeleTracking Technologies to manage its patient flow.

University Physicians Hospital (AZ) will use EmergisoftED for ED patient tracking and nursing and physician documentation.

Richmond Memorial Hospital (NC) is live on Wellsoft’s EDIS.

Here’s an interesting project to watch. SunCoast Health Partners is a joint venture between the SunCoast RHIO (FL) and for-profit partners. Using MedLink’s RHIO Financial Stability Model, SunCoast plans to offer products and services to over 500 practices in the RHIO, betting that providers will need clinical data to support their EHR investment. They expect to generate sales of over $4 million year in the first year and more than $7 million in the next four years.

And from a few of our much-appreciated sponsors, here are some quick updates:

• IntrinsiQ and eClinicalWork partner to integrate IntelliDose with eCW’s EMR/PM solution. eCW will offer the IntelliDose chemotherapy management solution to its oncology practice customers.
• ICA aggregates data from all core clinical systems within the HIE of Montana, which includes seven hospitals and more than a dozen clinics.
• Community & Dental Care, an FQHC in Monsey, NY, selects Allscripts Health Center Solution for its 30 multispecialty physicians.
• maxIT Healthcare announces plans to become an Eclipsys Certified Consulting Partner with Eclipsys, providing installation services for Sunrise Enterprise release 5.5.
• EDIMS and Medit Corporation form a strategic relationship to combine the EDIMS ED system with Medit’s MiRapidAccess registration tools.
• IntraNexus appoints Tom S. Visotsky VP of sales and marketing.
• Medicity announces that its iNexx platform will be generally available August, 2010. It will be free for physicians, allowing them to automate referrals to providers on the platform.
• EHRScope releases the beta version of EHRScope Reviews. End users and consultants can add information to their (free) database, so offer your opinions here.  

E-mail Inga.

CIO Unplugged 5/12/10

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Maximizing Vendor Relationships
By Ed Marx

Vendor management can frustrate even the most elite organization. You can love ’em or hate ’em, but you can’t live without them.

Over the years, I’ve learned to take a proactive approach that allows both the organization and the vendor to achieve their goals while providing maximum benefits for the health system. Here is our simple structure.

Categorize Vendors

First, stratify vendors into four categories. You may find a better framework than what is presented below, but the point is to define how you team up with each vendor. The following categories and principles work for us:

Strategic. Out of hundreds, the vendors that qualify as strategic can be counted on one hand. Elevate these relationships to partnership status at an enterprise level. Consider them health system partners, not merely IT strategic partners. Our C-suite partakes in the selection and then personally invests time in relationship maintenance. Strategic partners identified: transformational, high-dependence, high-cost exposure vendors, and those with whom we wish to increase business. As CIO, I’m the primary relationship manager. I devote my time and energy exclusively to our strategic partnerships.

Tactical. We work with two dozen tactical suppliers. We’re similarly intentional on how we screen and invite these vendors. Tactical suppliers are typically smaller in cost and exposure and are transactional, yet they’re critical to the success of our organization. My direct reports divvy up ownership responsibilities for these important, exclusive relationships.

General. Given the existing business relationship, there’s nothing negative about this category. On average, however, these vendors supply commodities that provide little opportunity to differentiate. Therefore, we spend less time and energy with them. While we expect to maximize this relationship, we continually remind general vendors that maximization will not reach the same level as with strategic / tactical vendors. Our managers and directors own these general vendor relationships.

Emerging. This finite category of vendors has a small initial presence that we expect to build over time due to great potential. Emerging suppliers may come from our tactical or general relationships or may be a net new entrant. My direct reports manage these relationships closely.

Identify Vendors

As a Baldrige-oriented organization, we have a recognized and practiced process by which we discriminate between vendors.

• Supplier scorecards – service metrics, relationship, business model, technology, pricing
• Business technology alignment – opportunity, potential, direction, vision
• Deeper dive – presentations, discussions, research, vision
• Business technology meetings – share process, share strategies, mutuality, outcomes
• Tactical committee review – presentations, price models, benefits
• Strategic committee review – presentations, cultural fit, vision
• Decision – responses collected, responses aggregated, scorecard, decision

Manage Relationships Proactively

Each strategic, tactical, and emerging relationship is managed intentionally and includes formal controls. We also have codified rules of engagement:

• Relationship owners meet quarterly with strategic partners and conduct an annual, formal score card evaluation of both parties
• We arrange meetings between CEOs
• Strategic partners meet collectively once a year to review our organizational and IT strategic plans, working together to develop solutions. We meet offsite at locations that inspire creativity and innovation. This year we met inside Cowboys Stadium.
• We hold monthly follow-up meetings ensure we advance the collaboration.

(click to enlarge)

Next month, I will lead members of our C-suite on site visits to our strategic partners’ corporate headquarters to enhance the executive relationships. My hope is to bring about opportunities that will help fulfill our mission and vision. Although we are unable to devote equal amounts of energy to all suppliers, we do scorecard every strategic, tactical, and emerging vendor annually.

Measure Outcomes

To measure benefits differently for each level of supplier, consider the following: quality of product and service, shared value, maximization of investment, branding, influence, price points, and innovation. Assessed annually, these outcomes are part of the scorecard process as well as topics of discussion among executives on both sides. This forum for transparency and accountability leads to a win-win collaborative approach.

On a practical note

Suppliers persistently seek the CIO’s attention. I wish I had the energy to meet with each one. Having a structure and proactively managing vendor relationships allows me to treat all vendors fairly and frees me up to focus on what matters most.

By concentrating exclusively on our strategic partners, I can ensure that we exploit both investment and commitment. The described process above values vendor interests while optimizing benefits for our health system, clinicians, and patients.

To encourage comments, I will send a generic version of our strategic partnership framework to all who post. The framework contains significantly more detail.

Update: Response to Comments Posted Through 5/14/10

I appreciate the richness of the responses!

A couple of comments. As stated in the post, we work with hundreds of vendors. By definition this implies that we do not have a single vendor solution. There are so many variables to consider and it comes down to the uniqueness of each institution and culture. For us, we have found that a hybrid approach works well. A handful of broad based vendors and BoB. That said, the point of the post was not a position on either but rather the advice that you must maximize your vendor relationships. One way this can be achieved is with structure. It is not a new concept, but it is yet largely unpracticed.

With vendor partnerships, especially with those that are considered strategic, you need to build in formal controls so that the relationship does not go sideways and either party gets scarred. These controls and rules of engagement address things like kickbacks and do not allow for discounts for “talking up vendors”. I touched on this briefly and those of you who left your e-mail, you will get more detail shortly via the generic framework.

In fact if you like what you receive, let HIStalk know and I will send out our very detailed scorecard and review system. It is hard for me to believe that vendors and customers do not sit down together at least annually and score one another. It leads to some tough conversations that are crucial for shared benefit and success. You are what you measure.

I happen to agree with the sentiment that healthcare IT is so far behind and other industries are more customer-centric. You need to read my post Why Healthcare IT Lags.

One of the things we analyze when considering a vendor relationship is the leadership. I believe our strategic partners have had the same CEOs in place for many years. We look for consistency in leadership, so we have not hit the revolving door issue that someone asked about. All of our strategic, tactical, and emerging vendors have made these reciprocal relationships. If they don’t, it is not a relationship and we will end it.

I smiled when I read the comment that our vendor framework is flawed for lack of physician input. I am fortunate to have three physicians in IT and, trust me, they are not shy and I am thankful for this. In fact, they are one of the main reasons we have been so successful with leveraging IT. We have an IT governance council made up of many other clinicians and our C-suite includes an additional three docs.

I am wise enough to know that customer input is a key success factor. I shed my office 15 months ago so I would not become too comfortable. Instead, I spend more time with my customers in their environments. You don’t know me. Keep reading and you will.

You know, I am not sure on the question about inadvertently creating an internal hierarchy based on which vendor you might work with. I can see the point. None of my team has mentioned this as an issue, nor have I seen any behaviors to be concerned with. But I also know that despite my direct team engagement, I can be sheltered. I will need to watch out for this.

So for my IT colleagues, either manage your vendors or be managed. For my vendor readers, if your customer does not have a framework, recommend one. The benefits are mutual. We need one another. I am fortunate to work with many incredible vendors and feel good that we have a fair and equitable framework from which we can build on.

Ed Marx is senior vice president and CIO at Texas Health Resources in Dallas-Fort Worth, TX. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook, and you can follow him via Twitter – User Name “marxists.”

News 5/12/10

From Snoop John B: “Re: Cattails MD. Heard its implementation at Ministry Health has been suspended because of poor upgrade quality.” I asked Ministry CIO Will Weider, who says the implementation has not stopped. Three clinics are live and planning is underway for the remainder. They are reviewing their plans and figuring out how to incorporate Meaningful Use. Will was nice enough to provide a summary:

There have been the usual surprises and unanticipated occurrences. So, this won’t be my first flawless large clinical project. In March the system (it is hosted by Marshfield Clinic) had some stability problems. That may be the source of frustration from your source. It was frustrating for us too, but Marshfield Clinic, led by their CIO, has taken ownership of their problems. We at Ministry are also working through our issues. The situation has improved and Marshfield Clinic has bent over backwards to provide us reports to monitor stability. They are also quickly updating their systems to prevent recurrence of the problems. They have been very transparent in their efforts. I have lots of different clinical system vendors, so I can put Marshfield Clinic’s support in perspective. They are better than most, but admittedly, the bar is not as high as I would like. As you can see, I am not afraid to share the good and the bad (hence the blog name candidcio.com). Our contract doesn’t contain a gag clause like many vendors. So, I will email you directly if our plans change.

From 153 Anecdotes: “Re: FDA’s MAUDE database. Updated with additional anecdotes.” MAUDE is FDA’s database of voluntary reports of adverse events caused by medical devices. There are quite a few reports related to Cerner Millennium, although there’s no way to tell if they were filed by one disgruntled practitioner or several concerned facilities. Some (most?) of the reports involve design complaints rather than actual examples of patient harm, such as: “This cpoe product allows doses to be ordered that are not a multiple-s- of the pill size.”

From Nolo Contendere: “Re: does anyone do background checks? [Name omitted] was recently hired as VP of sales for [vendor name omitted]. Here are links to public records. People are sending this all around, making the vendor a laughingstock.” I’m omitting the names and the links since I don’t want to get threatened, sued, or notified that the guy killed himself or something because I mentioned his crimes (theft, drug possession, driving violations, etc. with some jail time and house arrest). Or for that matter, notified that it’s someone with his name but not the same guy. If it is, he’s bounced around quite a few EMR vendors and has also been accused of stealing leads from competitors a la Glengarry Glen Ross.

From The PACS Designer: “Re: Google search enhancements. Google has made over 500 changes to its search capabilities over the last year. TPD likes one of the new search options that now appears on the left when you first begin your search effort.” I noticed the 3D logo, the left column that allows subsetting the results by source, and some minor redesign. I like it.

Listening: She and Him, musically marginal, but I’m crazy enough about about Zooey Deschanel in movies that I’ll listen to her sing.

Weird News Andy runs across PriceDoc, which he calls “Priceline for doctors” where prospective patients can name their own cash price for specific dental, medical, and vision procedures.

I got a really nice handwritten card from Brittanie Good, marketing director of Enterprise Software Deployment, who thanked Inga and me on behalf of Team ESD for mentioning their new sponsor ad. “We are very excited about our growth and refreshed changes, and we are proud to be a sponsor of HIStalk. We love what you do – keep up the great work!” I’m always amazed and moved that I have such supportive sponsors. I’ve stood the card proudly right beside my monitor.

A New York Times article titled The Agenda Behind Electronic Health Records pits athenahealth’s Jonathan Bush against ONCHIT’s David Blumenthal over the issue of whether HITECH is a cash-for-clunkers program for old-line vendors at the expense of upstarts or the logical way to goose EMR usage among reluctant providers. According to Bush, “Established technology is being given a federally funded new lease on life … Traditional health software now is on Medicare, being kept alive like grandma.” Blumenthal’s comment was that the government had to intervene to correct a market failure, saying, “The market doesn’t reward performance.”

Speaking of athenahealth, the company responds to Dr. Deborah Peel’s HIStalk editorial on athenaCommunity and patient privacy.

Jeff Surges, sales president for Allscripts, is appointed to the board of Merge Healthcare.

Voalté releases a white paper covering the use of smartphones at the point of care.

A medical group that provides services to correctional facilities in 25 California counties chooses eClinicalWorks.

Mac McMillan, CEO of IT security consulting firm CynergisTek, is serving (warning: PDF) as a panelist at a HIPAA conference sponsored by the Office of Civil Rights and National Institute of Standards and Technology that started Tuesday. His session involves OCR’s enforcement of privacy regulations.

Evidence-based protocol platform vendor Order Optimizer forms a strategic alliance with EHR vendor Prognosis Health Information Systems. Prognosis will make Order Optimizer’s protocols and orders available to its customers, along with its SaaS-powered merging engine.

Intuit will buy (warning: PDF) Cary, NC-based patient portal vendor Medfusion for $91 million in cash. Intuit (QuickBooks, Quicken, TurboTax, and Quicken Health) says it will use the Medfusion’s technology to enable patients to communicate with providers, review their health information, and track their healthcare expenses. They also mention the Meaningful Use requirement to give patients access to their records. Medfusion founder and CEO Stephen Malik will become an Intuit SVP and general manager. Allscripts announced a deal to distribute its patient portal a year or so ago.

Vanderbilt chooses Allscripts Care Management for discharge planning.

Nuance announces Q2 results: revenue up 19.2%, EPS –$0.05 vs. $0.02 due to the cost of its acquisition of SpinVox, which converts voice mails into text and e-mail messages.

Cottage Health System (CA) expands its use of Eclipsys applications by choosing the PeakPractice PM/EMR and Eclipsys HealthXchange to link community physicians with its inpatient Sunrise Enterprise system. The HIE product is powered by Medicity.

Northwestern Lake Forest Hospital (IL) says it saved $3.4 million in nurse labor costs through its use of the Kronos workforce management system to reduce overtime and agency use.

Hunterdon Healthcare (NJ) uses InterSystems Ensemble to connect its QuadraMed Affinity HIS to the NextGen PM/EMR of its physician groups.

Twelve hospitals in Australia sign contracts for the Emendo CapPlan capacity planning software. The company plans to enter the US market next year.

Apollo Hospitals, a private hospital operator in India, signs a deal with Cisco to deploy desktop-based telemedicine applications to rural parts of the country.

All Children’s Hospital (FL) will expand its use of GetWellNetwork’s education and entertainment system, courtesy of a donation from a local entrepreneur.

E-mail me.

Readers Write 5/10/10

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

Thoughts About athenahealth
By Deborah Peel, MD

Another misguided, uninformed EHR vendor will discount the price of EHR software for doctors willing to sell their patients’ data!

How is it possible to be so unaware of what the public wants? The public doesn’t want anything new or earth-shattering, just the restoration of the right to control who can see and use their medical records in electronic systems.

Not only is the practice of selling your patient’s data illegal and unethical, but the new protections in the stimulus bill require that patients give informed consent before their protected health information can be sold. So selling patient data without consent is now a federal crime.

Quotes from the story:

• athena’s EHR customers who opt to share their patients’ data with other providers would pay a discounted rate to use athena’s health record software.
• athena would be able to make money with the patient data by charging, say, a hospital a small fee to access a patient’s insurance and medical information from athena’s network.
• Caritas Christi [Health Care] initially launched athena’s billing software and service in October and then revealed in January that it decided to offer the company’s EHR to physicians.
• How many patients would agree to sell their health records to help their doctor’s bottom line AND at the same time put their jobs, credit, and insurability at risk?

Health information is an extremely valuable commodity, so people are always thinking of new ways to use it.

What will athena’s informed consent for the sale of health patients health data looks like? Will athena lay out all the risks of harm? Will athena lay out the fact that once the personal health data is sold, the buyer can resell it endless to even more users? Will athena caution patients that once privacy is lost or SOLD, it can never be restored?

I guess some people are so out of it they do not realize what a barrier the lack of privacy and lack of trust is to healthcare. HHS reports 600,000 people a year refuse to get early diagnosis and treatment for cancer because they know the information won’t stay private. Another 2,000,000 refuse early diagnosis and treatment for mental illness for the same reasons.

Check out slides from a recent conference at the UT McCombs Business School on the subject of patient expectations, privacy and consent.

Deborah C. Peel, MD is a practicing physician and the founder of Patient Privacy Rights.

Thoughts About athenahealth
By Truth Seeker

Um, I think we need to settle down here, folks. I may be wrong, but I believe when athena refers to athenaCommunity and the exchange of information, they are referring to the following hypothetical scenario:

A patient whose primary physician is an athena customer needs to be admitted to the hospital. athena delivers to that hospital a clean, clinically accurate, and up-to-date record of that patient’s medical history and charges the hospital a few bucks. athena is able to charge the primary care physician a lower fee for their EMR service because they are shifting some of the financial burden to the hospital. And intuitively, this make sense for a couple reasons:

The push towards electronic medical records is to enable greater exchange of information and better coordination of care, etc So when athena talks about athenaCommunity, I’m fairly certain that they’re not talking about a sinister plot to share info with hospitals so they can refuse to admit high-risk or expensive patients. (Seriously, the conclusions people draw from articles like this without doing their homework can be completely ridiculous, but I suppose that casting baseless aspersions is just the nature of informed discussion in the Internet era.)

They’re just talking about handing the patient over to another provider and making sure that the new provider has a completely accurate and up-to-date record of that patient’s medical history, and of shifting the financial burden from the handover away from the primary care physician. What a "privacy disaster" … a sheer outrage!

And second, I’m no healthcare economist, but I’m pretty sure that a) the hospital really wants and needs that patient’s medical history and that athena is probably better positioned to deliver it in a more useful format than a lot of their competitors; and b) it’s probably worth a lot more to the hospital than a few bucks. 

I’m not an athena employee or other stakeholder, but I do think that they continue to think of innovative new solutions to problems, bottlenecks, and inefficiencies in the healthcare system. Unfortunately, they seem to have a bulls eye on their backs right now. I for one am happy that we have smart people like Jonathan Bush out there coming up with creative new solutions. 

Why Emergency Physicians Prefer Best-of-Breed IT Systems
By John Fontanetta, MD, FACEP

According to a recent report from KLAS, some hospitals are replacing standalone, best-of-breed (BoB) emergency department information systems (EDIS) with enterprise solutions that are leaving ED clinicians — and often their patients — unsatisfied. Why unsatisfied? Because the clinical functionality in enterprise solutions is both less comprehensive and less efficient for the ED environment and they are just so hard to use.

This report has re-energized the debate over the benefits of the two kinds of systems. IT professionals prefer the seamless interoperability supposedly offered by single systems, but the fact is that many large vendors have simply bought and shoehorned in a separate ED system. The resulting systems have their own interface issues.

Like many of my fellow ED physicians, I have found that a first-class BoB system tailored specifically to the needs of the ED, in our case EDIMS, offers a number of advantages. For example:

• Workflow in the ED is measured in seconds and minutes rather than hours or days. The fewer clicks required, the faster the care. At Clara Maass Medical Center, we can issue complete sets of orders in as few as three clicks, enabling our physicians to be more productive.
• Trying to retrofit an inpatient IT system to the ED is difficult because the ED is just so different from the floors. Customized ED order sets with a linked charge capture system means less delay between treatment and billing, not to mention a more accurate capture of charges, which has dramatically increased our per-patient revenue.
• In the same way, customized alerts that tell the ED staff what they’re forgetting to document cuts back on the number of claims denied due to missing or inaccurate information. At Clara Maass, we have slashed such denials by 75%.

One of the most important things about a good ED system vendor is responsiveness. The vendor should be able to quickly accommodate the ongoing changes in standards and regulations. For example, at Clara Maass, when the H1N1 virus first appeared in 2009, we had templates for recommended care and discharge instructions built into our system by our BoB vendor within 24 hours. And when we decided to create an observation area, they promptly responded with observation-specific templates and order sets and created a secondary note option for the observation physicians.

The EMR system has enabled us to make a number of other improvements in our ED. For example, we have reduced the average patient turnaround time by over 30%. We have boosted the number of EKGs we perform within five minutes of a patient coming through the door from 46% to more than 90%.

Overall, my specialty has been slow to adopt EHRs, not because we don’t see their importance, but because they have a reputation for being unwieldy and unresponsive to the requirements of the ED. With more and more EDs adopting BoB systems that are designed to support ED clinicians’ intricate and demanding workflows, physicians are starting to realize that an EHR can actually be an advantage in our fast-paced environment, rather than a burden. 

CIOs are finding that these BoB systems can offer the same, if not better, integration capabilities than a single, enterprise solution. While many of the HIS vendors are inflexible when it comes to working with other systems, BoB systems have always had to offer integration solutions and many pride themselves on their ability to integrate with almost any system.

John Fontanetta MD, FACEP, is chairman of the department of emergency medicine at Clara Maass Medical Center, Belleville, NJ and chief medical officer of EDIMS.

Digging for Gold in your HIT Applications
By Ron Olsen

Over the past few years, hospitals have focused IT budgets and resources on purchasing applications to enhance their HIS. Many facilities have spent tens or hundreds of thousands — millions for the larger hospitals — on licensing, maintenance, and ongoing professional services.

In the feeding frenzy to continually acquire and implement the latest healthcare information technology, most IT/IS teams are neglecting to ask basic but important questions about their existing applications, such as:

• Are we using the software to its fullest extent?
• Have we turned on every feature we’re currently licensed for?
• Are HIT products meeting the needs we identified when planning the deployment?
• Have we asked users what they’d like to see added to the product, and if so, has that been communicated to the vendor so they can include it in a future version?

Asking questions does not cost anything and end users are usually very vocal about what they’d really like to see software do for them. Their invaluable real-world input is useless if there’s no feedback mechanism, or if your team refuses to incorporate it into product roadmap discussions with vendors.

In a time in which hospitals’ funds are tighter and IT budgets frozen or cut, it’s time to double back and review what products you have purchased and their capabilities. Maybe re-present the product to different areas of the facility explaining existing functionality again, and introducing new features that have been added since the initial implementation. Now that the users have gotten a refresher, they may identify functionality that was not implemented initially and would now prove useful.

Healthcare technology vendors are always eager to showcase new features and theoretical uses for these at sales presentations, but IT/IS admins often overlook “hidden gems” in the software that other hospitals are actually using. If the vendor has a user group, listservs, or an online forum, these are great places to start, not to mention that they cost nothing and consume very little time.

These collaborative tools may enable your team to discover other use cases that even your vendors have not thought of. There are a lot of people in the healthcare IT trenches creating workarounds every day. There may be capabilities within current products to join with other systems within your tool bag to create a new or improved process that is, again, a freebie.

One of the most over-used buzz words in healthcare IT is “interoperability,” a is really a big word that self-important people use to describe data transfer. When thinking about data transfer at a basic level, almost every HIT product can output to a printer. A printer can be easily set up to print to a file. So now you have data in a file format.

Scripting tools can manipulate those files, turning them into almost any format imaginable. With the correct format, data can be transferred to disparate systems, individually or concurrently, via a data stream. This could be a raw text file, compressed zip file, encrypted e-mail file, FTP, or an HL7 file.

This method is easily applied to an enterprise forms management system. If it has a decision engine, you could print a form set from it and then have the engine input the data to a database for audit trails (you should be able to choose the data points). Next, the engine sends the data to a file and launches an application to text the ordering physician that the patient just presented, based on the data in the text file.

If you’re a budget-conscious healthcare IT professional who wants to better meet the needs of your user community, I implore you to take another look at the systems you’re already working with. In my many years as a system admin at a community hospital, getting more out of the tools available to me (instead of just relying on new purchases) helped me deliver more effective tech solutions to my users, positively impact patient service, and keep decision makers happy by saving money.

You, too, have gold nuggets hidden in your existing software. It’s up to you to find and use them.

Ron Olsen is a product specialist with Access.

Monday Morning Update 5/10/10

From MeHere: “Re: Millennium Medical. I used to work for them. I hope there’s a full-scale investigation into their unsavory activities. The IS guy would write up employees for forgetting to encrypt inter-office e-mail.” An unencrypted portable hard drive is stolen from the Chicago offices of the medical billing company in February, exposing the information of 180,000 people. Patients are complaining that they weren’t notified promptly and that the company is not offering the usual free credit monitoring.

From Nothing More: “Re: UPMC. DOH and CMS found ‘easily resolved differences over paperwork.’ I thought that hospital was paperless.” Inspectors find that UPMC did indeed match transplant donor and recipient blood types, but didn’t document properly because the paper form has only one signature line. Doh! And in other UPMC news, it’s on pace to hit $8 billion in annual revenue this year.

From MaxPayneUK: “Re: HC2010 conference. McKesson and Eclipsys were noticed there. Both will focus on the customer base of legacy supplier iSOFT and NPfIT programme player BT/Cerner.”

The Texas Board of Pharmacy hits Parkland Hospital with one of its largest-ever fines ($20,000) for allowing five outpatient pharmacy technicians to steal 370,000 oral doses of drugs in a one-year period. Cases against three supervising pharmacists are pending. The lesson learned is that Parkland did what most hospital pharmacies do — they took drug inventory only occasionally, estimated counts, and didn’t reconcile purchasing records to dispensing records. Parkland says it’s running a perpetual inventory now, always tough to do in pharmacies and ORs.

Meditech’s Q1 results: revenue up 10%, EPS $0.60 vs. $0.48. Very good numbers. I’ve confirmed that Howard Messing will be given both the president and CEO titles, subject to routine shareholder approval in the next few weeks. The company also announces that students at Northeastern University’s health sciences school will use Meditech’s clinical systems as part of their training.

You would expect clinical systems to be a top priority for providers, but I wouldn’t have guessed that portals would score so high. New poll to your right: based on experience, what impact do you think CPOE has on patient outcomes?

Congratulations to the Georgia Tech Flatliners, a team of graduate students that finished first, second, and third at the NHIN CONNECT Code-a-Thon Challenge held last week at Florida International University. The challenge was to create an online format for a Continuity of Care Document that a primary care doctor could use to take calls after hours. Medicity sponsored the team, which as a condition of its participation was required to donate the resulting style sheets to the CONNECT Open Source Community.

An MIT medical engineering student creates print management software and lands his own university as a paying customer for his new startup. The software is Web-based, does not require installation on print servers or desktops, and encourages “community engagement” by matching user groups as rivals to reduce their printing costs.

I appreciate the several companies that have asked about sponsoring the HIStalk reception at HIMSS in Orlando next year. It’s cool to have people thinking about it this early! Anyway, I’ve chosen the sponsor and we’ve already got the venue, entertainment, and menu locked down, just in case you want to mark your calendar now for February 21, 2011 for what will be a memorable blowout. I truly appreciate the companies who support what I do, not to mention the readers who make it worth doing.

Inga and I are writing up the results of the HIStalk Practice reader survey, which I’ll probably run this weekend. My favorite reader comment: “I just absolutely adore Inga.” Who doesn’t? She is entirely adorable.

I forgot to mention that with the rumored but unannounced demise of ADVANCE for Health Information Executives, Texas Health Resources CIO Ed Marx temporarily became a blogger without a home for his CIO Unplugged writings. He’ll be moving to HIStalk this month and I’ve posted all of his previous writings. I’ve tagged them all in their own category, viewable here.

Thanks to everybody who has clicked “like”on the HIStalk Facebook widget in the right column. I’m posting to the Facebook page that Inga created each time there’s a new posting and I’m seeing inbound clicks from it, so I think readers are finding it handy. Click the HIStalk logo or link to go to the FB page.

On the job board: Eclipsys SCM Consultant, Market Research Analyst, Epic Practice Manager. HIStalk sponsors post their jobs for free and can contact me to sign up.

The VA’s VistA Modernization Working Group recommends modernizing the VistA system by moving it to open source and dumping MUMPS as its programming language. The group’s chair says VistA is “outdated and difficult to maintain” and that “we don’t think MUMPS is the answer.” That’s an interesting conclusion given that Epic, Meditech, and other systems are written in MUMPS, a programming language that is almost certainly involved in more US healthcare encounters than any other.

And as I like to do occasionally, allow me to acknowledge Meditech’s Neil Pappalardo, who with colleagues created the MUMPS language and thus the HIT industry in 1966. He’s still my #1 choice of someone to interview, although Judy Faulkner runs a close second (both are MUMPS-made centimillionaires, I should note).

The non-profit Kaiser Permanente’s net income for Q1 was $706 million on operating revenue of $11 billion.

Here’s the danger of announcing one of those sketchy correlation-causation EMR studies: an overambitious headline writer summarizes as, “Doctors: Boot Up a Computer to Save a Life.” 

E-mail me.

HIStalk Interviews Brigid O’Gorman

Brigid O’Gorman is a junior at Connecticut College in New London, CT, majoring in cellular and molecular biology as a pre-medical student. She is captain of the women’s hockey team, a registered emergency medical technician, and winner of a $10,000 Davis Projects for Peace grant for her project to implement electronic medical records in rural Uganda. Connecticut College is contributing $3,000 as well.

While traveling to the airport with a group of Connecticut College students leaving on a medical mission to an orphanage in Kaberamaido, Uganda in the spring of 2009, a drunk driver struck the van in which they were riding, injuring several of the students and killing the trip’s organizer, who would have graduated in 2010, and in whose memory the clinic in Uganda has been renamed to the Elizabeth Durante Medical Clinic.

 
Brigid O’Gorman
Photo: The College Voice

Tell me about yourself.

I’m from Eden, New York, just outside of Buffalo. I live on a farm. It’s really fun, I love it. My dad’s a physician, an internist. My mother has her own flower business.

I went to Nichols School in Buffalo for high school. It’s a private school. I was captain of the women’s hockey team there. I also played soccer and lacrosse there. Then I came to Connecticut College and I’ve been playing hockey here since freshman year. I’m now the captain of the team. I played lacrosse my freshman year, but decided not to do that any more because it was during spring break and I’d rather go to Uganda during my spring break. That was my option and that’s how I got into this whole Africa thing.

Going to Africa has been something I’ve wanted to do since I realized I wanted to be a doctor. I’d always wanted to travel. I’d been to China and Africa was the next place on my list to go. I absolutely love it.

I found out about this opportunity to go in the fall of 2008 through my school. There was a pre-health club meeting which I’m a member of. So I went to this meeting and a couple of girls were up there talking about how they wanted to take a group to Uganda on medical mission. That was like right down my alley. I went to this other meeting and signed up for it and that’s when I got to go last year.

What was it that intrigued you about Uganda?

Nothing in particular. I would have been satisfied to go anywhere in Africa, quite honestly. Uganda is where these two kids started that group to go and they had been there the year before with Asayo’s Wish Foundation. They’re out of Salt Lake City, Utah. They have an orphanage in Uganda.

I ended up going by myself, but what we did last year was go with Asayo’s Wish Foundation. I worked at a medical clinic in this town where the orphanage was. I wasn’t so much interested in children, although that was really a fun experience for me. I worked with a doctor, mainly, and I kind of played around with the kids.

 
Brigid O’Gorman, Uganda 2009
Photo: Connecticut College

What were your impressions from a medical or public health standpoint?

I got to take blood samples and got to look at the malaria parasite under a microscope. It wasn’t powered or anything, but it just had a mirror that caught the sun so it would shoot light up through so you could see it. Obviously technology is extremely lacking. They only had one of those in this medical clinic.

The doctor had one nurse that helped him out. The way it works over there in these clinics is that the doctor just kind of showed up whenever he felt like coming to work, really. He would just, like, show up and people would hear that, “Oh, the doctor’s in his office, so we can go now.” They don’t set up appointments or anything — people just show up and line up outside the office. They just kind of sit outside on the ground, first come, first served. You get there early and keep it and you get an appointment.

He and myself, we got to give them all sorts of medication. I brought over a lot of antibiotics with me that were donated by my father’s office here, so we got to hand out antibiotics. Most of the people had malaria, so we’d have to hand out malaria medication. There was a lot of STDs, so we had to hand out antibiotics for that.

From a healthcare standpoint, they really need medicine. There’s nothing. There’s practically nothing. I’d say the bulk of the supplies they had I brought over with me. That was kind of special just to donate all those things to the people.

Tell me about the grant you got to set up electronic medical records and how you got the idea.

I got the idea because while I was there last spring, whenever the doctor had a patient come in, he would write down their symptoms and ask them questions like, what are you here for? He’d write down their symptoms and what he thought they had and what he was going to prescribe them in this little blue book. It’s just like an exam book that I take my exams in here, so I was like, wow, that’s really weird that I’m seeing these thousands of miles away from my college. It was used to keep their health records in. I thought that was a little perplexing, to say the least.

After he’d fill it out, he’d give it right back to them and say, hold on to it. It would have their past visits to the doctor in it so he could go back and look and see what they last came in for and if it’s any pattern or relation or anything. A lot of the patients didn’t have these, because the doctor gives it back to them, so most of them lose them because they don’t realize how important these things are. They have no concept of staying healthy or this whole medical record system. They weren’t concerned about holding out to this blue book, so it was often that they didn’t have one, which was difficult to try and figure out if this person had a previous medical condition that you didn’t know about.

When we were there, I also worked in the orphanage with about 180 children who didn’t have any medical records either. I kind of built on that foundation of the blue book they were using. I bought blue books there and we started health records for all these children. We wrote down their name and age. A lot of them didn’t know their age because they were orphans, so we’d have estimate their age from their weight or their height. We started that last year and I’m really hoping that it’s continued and people are doing checkups on them and doctor’s visits and things like that.

This was what got me to thinking that they need a more reliable system, I would say. I mean, how are these orphans going to hold on to these little blue books when adults can’t? I thought, I’m a college student and I know about computers, which isn’t that hard to figure out. It’s not that hard to install them. I’ve done it before and it’s simple.

I was planning on using the electronic medical software, hopefully from MEDENT. I haven’t purchased it yet. I know one of the company’s branches is in based out of Buffalo, so I was hoping to talk to them and hopefully get some donations of this system for my computers. One of my dad’s doctor friends has this MEDENT software at his office and I’m going to go see it. I’ve looked at it online and it’s pretty much what I need. I actually need a simpler form of it because I don’t need X-ray scans, I don’t need all the pictures and MRIs they can set up on these systems. I just need patient assessment, patient information, history, just very general, simple things. I’m going to try to work with them and get that going.

I haven’t bought my computers yet, but I’m going to get four of them from Dell. I’ve already talked to them about it. I’m going to have them sent to my house soon and get the medical software installed at my house and set up this whole little system at my house so that when I get to Uganda, I won’t have to worry if something goes wrong with the computers. There isn’t really going to be anyone there to help me, so I’m just going to try to set it up prior to getting there.

I know they have gasoline over there and can power generators. The electricity they have isn’t a lot. They only had one light bulb that actually worked and they ran it on a gas generator, so I figured that would be easy to power the computers. I’d just get a bunch of generators and I could help them power more and have more electricity at this place. That was my original idea. Then I was talking with one of my advisors here from school and she mentioned why didn’t I think about solar panels? I decided to look into the solar panel idea. I learned a lot about them. It sounds a little complicated, but it’s really pretty interesting. It’s not that difficult.

I’ve located a business in Kampala, which is the capital city of Uganda, that sells solar panels and will install them for you. That’s where I’m going to be purchasing my solar panels and I’ll be doing that when I get there. It’s an eight-hour drive from where they are to where I’m going to be, where it’s extremely rural and there isn’t anything around. They’re going to drive them out there and install them for me, which will be great. I hired an electrician already to make sure that the electricity works. I’ve hired a computer technician. These are all native Ugandans, so we’ll see what I get. I’m pretty excited about that.

 
Brigid O’Gorman, Uganda 2009
Photo: Connecticut College

What will your system do?

I’ll have two facilities. One is at this medical center and another is at the local hospital, which is turning out to be a little difficult because this hospital is a government-run hospital and it’s actually from what I’ve heard and found out from people who are working there right now has ended up being corrupt and things are getting stolen, so I’m not sure how much I want to invest in that hospital, but I’m going to give it a try.

My primary facility for this will be this medical center that is on the orphanage property. My plan is to have two computers, one in the patient room when a patient comes in. That will be there for patient visits. The second one will be in another office in the building. That will be for collecting blue books and transferring information from these blue books into the computers. I’m going to have a system where the information is transferred from these blue books to computers, and at the same time, the doctor will be doing his normal patient care. Instead of writing things down in their blue book, he’ll be putting it into the computers, so we’ll probably be tackling two things at once.

I’m bringing printers because they don’t have any form of identification over there. That got me thinking because when I got my driver’s license, you finally have that little card that identifies you. It’s just a huge symbol of who you are to my mind. To make ID cards for these people over there, I really think would have a huge impact on them. I think they would absolutely love it.

We’re going to have webcams to take pictures of each patient, so their information will be in the computer along with their picture so that you can recognize them. The picture and their name will be printed on this card and we’ll laminate it and give it to them. It will all be on the computer, so if they lose it, we can print them out another one.

I was also thinking about making ID numbers for each name, just so that you can enter the number or name either way so the person’s medical files will pop right up. They hand you the card, you type in their number, and you have their medical file immediately sitting in front of you. You know their whole history and you know everything that’s been wrong with them up until now. That’s my goal for those cards — just to give them the thrill of having an identity and something physical to hold on to that says they’re here, they belong here. And also to expedite their gaining of their medical files that are in the computers.

They’re going to be powered by solar energy, so after the initial purchase, so it won’t cost very much, hopefully nothing at all except maybe for maintenance which shouldn’t be too bad because solar panels nowadays are pretty durable.

Part of my proposal, so that the system doesn’t degrade after I leave, is to start training some of the older children of the orphanage. There’s 18- and 20-year-olds living there, so my idea was to start training them on these computers and have a different type of vocational program where I would teach them how to input the information and teach them all about computers and what I’m doing so that they are that much further ahead.

In a country like this, especially in this rural area, having the knowledge to work on computers would be huge for children there. Maybe someday if they wanted to leave that area, they could go and work for the government in Kampala; they could work wherever they want. That’s another piece of my project that I’m really excited about, just to help boost kids up and give them something to do with their lives. 

Elizabeth Durante, 1988-2009, photo overlaid with that of the clinic renamed in her memory
Photo: Asayo’s Foundation

If someone wanted to help you with this project, what else do you need?

I actually haven’t yet bought anything for it. I’ve been trying to concentrate on my school work right now. I’m a junior and I’m taking organic chemistry and it’s not easy, so I’ve been really focusing on my studies right now. I’m not leaving until July 1, so I have a lot of time once school’s over to start getting into it.

I’m going to be needing four computers, two printers, a laminating machine, the solar panels that I’ve already purchased over in Kampala, and any kind of electronic medical record software that I can install on the computers. I’m focusing on MEDENT because my dad’s friend has used it, he’s accustomed to it, and his office likes it, so that way I can get a feel for it from him.

I kind of need everything, but I do have the money for it, so that was really cool and I’m so happy to have this grant.

Other than the fact that the patient carries the record in Uganda, we’re not all that advanced in the US, where your record is in a manila folder on some shelf someplace and people debating whether it should be in a computer instead. What are your thoughts about that?

It’s a debate and there’s a lot of sides to it. I’ve discussed this with my dad because his office runs on those manila folders. They have the hard copy paper and that’s what their patient files are. He has files full of them.

The doctors I go to personally have the electronic medical record software. I work in the ER and that’s what all their systems run on. It’s definitely faster and more efficient, but you also lose the personal aspect of sitting down with the doctor and having them actually writing things in front of you and taking those notes.

It is a difficult debate, but I would have to side with the electronic medical software because it’s permanent and it keeps things safe. The personal aspect of it can be accomplished by doctors actually learning the computer rather than just dishing off information to a nurse or something and having them try to interpret their writing and put it in. If it becomes more familiar to people, it will be really good, but you can’t lose that personal connection between the patient and the doctor. That makes people comfortable and that’s why we’re doctors.

You’ve made time for a rigorous academic curriculum, hockey, and volunteer work. Are the people you know equally involved or are you different?

I never actually thought about that before this whole story started coming out. Recently I was nominated for the Hockey Humanitarian Award, which is given to the best hockey humanitarian student, male or female, from any Division I, II, or III college. That’s what got me thinking that I guess I’m not really normal. I really thought, don’t other people do these things? I really didn’t think it was that uncommon, but apparently it is.

I just do it because I love it. I love to travel. I fell in love with those kids I got to work with last year, so that’s why I really want to go back to this part of Africa. I just really loved the kids there and I’d love to help them.

My pre-med studies are going pretty well right now. Organic chemistry is not easy for me, but it’s OK. My other classes are fine. I’ve been playing hockey since I was four years old. My dad was my coach. That was my first love and I’ve been doing that forever. That got me into school and pretty much filled up my life and who I am.

I found this other volunteering stuff. I volunteer at High Hopes Therapeutic Riding center in Old Lyme. I got there every week once a day, usually Saturdays, for two or three hours. I lead horses around and we help mentally disabled or physically disabled children learn how to ride horses. It’s a therapeutic technique and it’s actually really, really exciting. I love doing that. I started doing that my freshman year and that really got me into volunteering. I coach younger children’s hockey camps and stuff like that in the summer and girl’s lacrosse camps. I like to do all that because I love kids and helping people.

What kind of medical career do you hope for?

There’s so many options. At first, I was thinking I’d like to be a pediatrician because of my experience with these kids over in Africa. That really put me toward that path.

Right now I’m not really looking to settle into a practice anywhere because my primary goal is to get into med school and work with Doctors Without Borders for a few years before I actually grow up or anything. I would love to work with them and travel with them wherever they need help. I would have gone to Haiti in an instant if I were an actual doctor right now.

Then maybe after I’ve had my fill of traveling around and adventure, I’ll settle down and be a pediatrician or maybe a primary care provider.

Does your father approve of your going into medicine?

At first, he didn’t really have much to say about it. He didn’t think that was a choice for me because you really don’t really have a life until you’re out of school, and still you’re a doctor and don’t have a life except for what you do. He wasn’t thrilled about that, but as I’ve been doing these things, he’s really come to see that this is what I want to do. He’ll bring up a topic like, are you doing these things right now and how are your grades and are you ready to do this? He’s really come around. Our entire family thinks this would be great for me, so I’m glad to have the support from them.

What schools are you considering?

Right now what I’m thinking is that my GPA is not exactly stellar. I’m at like a 3.0 right now because of this organic chemistry. Hopefully by the time I graduate I’ll have it up to a 3.3 or something, but medical schools want 3.5 or higher from what I’ve heard.

I’m probably going to do a post-bac program. Drexel has a good program. I think you get a master’s in public health and then they ship you off right into a medical school program from there, assuming you do well on your MCATs and do well in the classes. I’ve been looking at the University of Buffalo. Their medical school is where my father went.

I would like to stay closer to home, just to have that support, but I’m seven hours from home right now in Connecticut. I like that aspect of being away, too. It’s a difficult decision, but I will go anywhere I get in. I don’t really care what part of the country it’s in. I just want to be in med school.

If anyone wants to get in touch with you or offers help, I’ll forward their information to you. And if you have an interest in writing something up or sending pictures, I’m sure people will want to know how you’re doing over there.

First of all, I’d love the help if people would like to help. I have $10,000 in grant money so far and I’m going to be fundraising a little bit more, just to gain a little money for the orphanage itself and try and buy a lot of medications for this clinic that I’m going to be at, because other than this system, they really need the drugs to make everyone healthy again. I’m going to be doing a little bit of fundraising and a little bit of extra money would be helpful.

The electronic medical records software, if anyone comes up with an idea or wants to donate something about that or a simpler version of one of these high tech ones, that would be really helpful.

I’ll definitely get back to you by the end of August or the beginning of September. They actually don’t have Internet where I’m going to be and I’d have to have a lot more money to get it shipped in if I wanted Internet. I am two hours from an Internet site, so obviously my parents aren’t happy since they can’t talk to me very often, but I will be going back and forth from this town to get supplies because there’s basically nothing where I am. It’s just like a store, your orphanage, your clinic, and a whole bunch of homeless people, but I could be able to get in touch with you.

If someone is inspired by your story and would like to make a difference like you have, what advice would you give them?

Do what you love to do. That’s all I’ve been doing. I started out loving to travel, and then that got me out to Connecticut, and then I ended up in China, and then I ended up in Africa and fell in love with a bunch of orphans and taking care of people and volunteering. My advice is just do what you love and follow that because your potential is completely unlimited. Go for it.

News 5/7/10

From Sea Pea Oui Couvert: “Re: say it’s not true. This is not supposed to happen when the entire hospital is wired. Millions spent on EMRs, yet they forget informed consent and then cover up the adverse events.” UPMC’s transplant program is cited by state health department inspectors for violating federal regulations, including failing to document organ and blood matches before transplant procedures were started. The state got suspicious when UPMC reported only one adverse even in a year.

From A Tax’ing Employee: “Re: our CEO at Sunquest. He just moved to Tennessee for what I heard were ‘tax reasons’.’ He has never lived in Tucson for the same reason. Is that fair that he is allowed to live anywhere to dodge taxes and we are not?” Unverified. If it’s my money as a customer or shareholder, I’m cynical about work-from-home CEOs unwilling to relocate to the home office. It’s their call, though, and I’m probably more old school in that regard given today’s virtual organizations.

From The PACS Designer: “Re: iPad’s booming sales. Apple has sold one million iPad’s since the recent launch, the fastest sales results ever for Apple. As we head toward the middle of this year, it will be interesting to see if there will be any waning in the monthly sales figures for the iPad Wi-Fi version now that the iPad 3G version is available for sale.”

Several dozen provider organizations, including AHA and AMA, offer HHS their comments (warning: PDF) on Meaningful Use. They and I agree on the parts we don’t like:

1. The all-or-nothing approach, where you either meet all the criteria or get nothing (actually, I’m OK with that part as a taxpayer footing the bill).
2. The aggressive timetable for complex applications such as CPOE and medication reconciliation that aren’t usually front-loaded in implementation projects.
3. The overall short timeline.
4. The underrepresentation of small practices on the HIT Policy Advisory Committee.
5. The two EDI-related non-clinical requirements for eligibility and claims.
6. The definition of a hospital using Medicare provider numbers.
7. The parts I immediately pounced on when the proposed criteria were published  — manual chart pulls are required to arrive at a denominator for electronic performance metrics, such as the percentage of orders placed via CPOE.

Weird News Andy uncovers a gem: two employees of Olive View-UCLA Medical Center are placed on leave after complaints to Joint Commission that they are running a beauty salon out of the hospital’s NICU. They were giving manicures and eyebrow waxes to co-workers, with one complaint alleging that a doctor “had a French manicure right on the high-frequency ventilator.” WNA also likes this research finding: dark chocolate can protect the brain in stroke patients, which means I’m set in an emergency because I like to keep some of the good stuff (more than 50% cacao) around.

Listening: the new CD from just-reunited Hole. Courtney Love doesn’t do it for me and I was hoping to hate the new music, but the band kicks it even though they’re all suing each other and membership changes hourly. I’ll be playing this quite a few times, I suspect.

McKesson signs an exclusive deal to eventually manufacture, implement, and support the i.v.STATION Robot and i.v.SOFT Workflow Engine from Italy-based Health Robotics. It’s pretty hot stuff.

If you are a nurse, happy National Nurses Week, which started Thursday (happy birthday, Florence Nightingale!) I love nurses (literally, since I married one), so here’s a shout-out to the one group of professionals (both male and female) that hospitals can’t run without. I wrote this in 2003 in their honor, obviously from a community hospital perspective since I was working at one of those instead of an academic medical center at the time:

The only critical people involved in patient care are nurses … My experience is that 80% of patient care is directly influenced by nurses, often via skillfully planted recommendations that allow doctors to believe they thought of it themselves. Your patient satisfaction surveys are almost purely driven by the quality and compassion of your nurses. So is your level of patient safety. Nurses clean up the vomit, hug the babies, keep doctors from killing patients, give the drugs, do the Code Blues, and comfort the families. All the rest of us are hangers-on who look like deer in the headlights on the rare occasions when we stray into an actual patient care area where human triumph or tragedy is unfolding with a nurse at its center … Not too long ago, a hospital was basically a clean building in a peaceful setting (!) where patients could rest and mend. That and nurses were about all anyone needed. Hospital work was charity. No MBAs, no arrogant doctors, no government red tape, no formulary of 5,000 drugs, and no cadre of specialists making large salaries to do small tasks. Oh, and by the way, no computers either. You know what? Life expectancy wasn’t that much different (if you exclude the benefits of vaccinations and reduced infant mortality.) Costs were a lot lower. No one got rich in healthcare. Without all the research, the computerization, the fancy architecture, and the lack of John Wayne "I will not let this patient die" heroics, things weren’t really all that much worse when it came to living and dying. If I’m sick, keep the CEO, CIO, PFS manager, and risk manager out of my room and give me the best nurses you have. When you get right down to it, a hospital is still a clean building with nurses. Everyone else is supporting cast, even if their salaries make them believe differently.

Business Week frowns at hospitals that use technology to determine whether patients can afford to pay their bills. Apparently the business publication does not like the idea that customers may actually be expected to pay for the services they consume. I clicked its Subscribe Now link and, given that philosophy, was shocked to find that their subscriptions are neither free nor payable at the reader’s discretion.

Jobs: Epic Inpatient EMR Manager, Eclipsys Physician Consultant, Senior Applications Analyst – CPOE, Epic Clarity Report Writers.

ONCHIT announces $220 million in grants to establish 15 Beacon Communities that will prove the value of HIT. I don’t exactly get that since the message is that they wouldn’t have bothered without the $15 million taxpayer gift (which doesn’t make a strong case for proving value at all), but I gave up long ago trying to dissect the particular pallets on which taxpayer money is being parachuted down over the countryside into greedily outstretched provider and vendor arms. Even the City of Tulsa gets $12 million in federal money to screw around with electronic medical records and see if anything good happens.

I see that Google now has the Google Apps Marketplace that offers third-party add-ins to Google Docs and relate apps. One I noticed contains administrator tools for rolling out Google Apps to the enterprise.

Maybe the doc-in-the-box trend died and I never noticed: Florida Hospital’s Centra Care walk-in clinics now take online appointments, saying it will significantly cut down on wait times. Meaning that if you just show up, which was the whole point, you’ll sit around like you would in the ED except instead of a seriously injured trauma patient holding you up, it’s somebody healthy enough to have made an advance appointment. That and posting ED wait times to troll for non-urgent patients makes me wonder what the heck providers are thinking out there.

Inspectors from the VA find lots of problems with the brachytherapy program at the Philadelphia VA Medical Center, among them a VariSeed radiation treatment planning PC that was unplugged for over a year despite regular clinician reports that it wasn’t working. It also wasn’t running on the hospital’s secure network and was used by employees to get on the Internet. 

Merge Healthcare’s Q1 numbers: revenue up up slightly, EPS -$0.04 vs. $0.05. Now they’ve got a couple of hundred million dollars worth of AMICAS acquisition debt to service on top of that. 

E-mail me.
 

HERtalk by Inga

From Celtic Fan: “Re: athenahealth. Don’t know if you saw this article about athena wanting to increase its profile to compete better with the HIT Big Boys. Buried in the end of the article is some information on a new product called ‘athenaCommunity.’ Bet the privacy rights folks won’t think much of it.” athenaCommunity is slated to launch later this year, with discounts for providers willing to share patient data with other providers. Hospitals will pay athena a small fee to access patient insurance and medical information. I asked privacy guru Dr. Deborah Peel what she thinks about the idea. Celtic Fan predicted correctly:

This is an ABSOLUTE nightmare—it TOTALLY violates medical ethics and the patients’ rights to privacy — not to speak of Americans’ well-known constitutional rights to privacy. Physicians who go along with that could well violate state licensing laws which often require adherence to the AMA’s principles of Medical Ethics, as well as violate many state laws that REQUIRE informed consent for disclosures of many kinds of information, from genetic tests, to mental health information, to STDs, to addiction treatment information. athena and all the many vendors who coerce doctors to disclose patient health information without consent will have NO liability. Who do you think the patients will sue for violating their privacy? Their doctor, of course, who chose to use an illegal, unethical EHR system. athena will not pay for this massive privacy disaster —their doctor/users will.

British Columbia’s Interior Health Authority begins its Meditech 6.1 migration with technical assistance from Summit Healthcare.

IBM’s Integrated Health Services division launches a multi-year research project to determine how different actions may affect health. Big Blue will combine and analyze data from a wide variety of sources, looking for cause-and-effect relationships. The project will initially focus on childhood obesity.

Kronos reports second quarter revenues of $177.9 million, a 10% increase over last year. EBITA increased 28% to $41.3 million.

Data storage company Iron Mountain urges CMS to consider expanding Meaningful Use guidelines to include subsidies for digitizing paper records. Iron Mountain’s efforts remind me of similar pleas from the transcriptionist organizations, who think digitized transcription records should be recognized in the final Meaningful Use equation.

I’ve yet to venture to the Apple store to actually touch an iPad, though a field trip does seem to be in order. This HIT writer observed a in-store demo, of sorts, where a Genius was educating a group of healthcare providers on a variety of healthcare-specific applications. Sounds like Apple wants to assure a  piece of the healthcare pie.

Clarian Health is changing its name to Indiana University Health next spring, in part to reinforce its partnership with Indiana University and the IU School of Medicine. Clarian owns or is affiliated with more than 20 hospitals and health centers in Indiana.

PatientKeeper presents Oakwood Healthcare System (MI) with its customer innovation award, recognizing the more than 1,000 users (600 of them physicians) who are using the company’s patient portal since its December introduction.

Hospital CIOs rank EMRs and CPOE as their top IT priorities for the next two years. Other high priorities include database initiatives, bar-coded eMARs, and hospital expansion. Among hospital IT managers and directors, EMR was ranked a mere 7th, far below PC refreshing, security initiatives, and CPOE. Another interest data point: the majority of hospitals were either developing telemedicine programs or already had something in place.

Albert Santalo, founder and CEO of the Web-based practice management company CareCloud, is named the Best Up and Coming Technology Innovator by the Great Miami Chamber of Commerce.

York Memorial Hospital (PA) selects Recondo Technology’s SurePayHealth solution for revenue cycle management.

The Texas Health Services Authority hires CTG to help plan the implementation of statewide HIEs.

Here’s a fun fact to share at your next cocktail hour. By 2020, the amount of digital information created within a year will reach 35 zettabytes. If you put that amount of data onto DVDs, they could be stacked halfway to Mars, making them quite inconvenient to access from your couch.

Gartner reports that Dell has gained the largest market share in HIT, making it the world’s largest provider of HIT services in the world. The ranking is based on 2009 revenues generated by both Dell and Perot Systems.

The 130-provider Jackson Clinic (TN) plans to move from its Misys EMR to Allscripts EHR, integrating it with its Allscripts Vision PM.

Siemens Healthcare appoints former Quest Diagnostics VP John Nosenzo to the newly created role of VP of Zone Customer Relations. Nosenzo will manage the company’s national accounts team and all zone general managers.

Odd: a GE Healthcare employee, having dinner with co-workers, is hit by a stray bullet. The 17-weeks-pregnant woman was sitting outdoors when she felt something hit her in the side. When she stood up, a bullet fell out. It came from a handgun fired from a shooting range that was about a quarter of a mile away. Fortunately, she was only bruised and scratched on her abdomen and both she and the baby are fine. An attorney for the shooting club says a member was at fault for shooting at an unapproved target (clearly).

Researchers at Brigham and Women’s Hospital find that using bar-code technology with an eMAR substantially reduces transcription and medication administration errors, as well as potential drug-related adverse events. The hospital documented a 41% reduction in non-timing admin errors and a 51% decrease in potential drug-related adverse events. Naysayers, feel free to send in your comments pointing out that just because A and B happened together, it in no way implies that A caused B or B caused A — as Mr. H always cautions. I’m just glad someone is taking the time and energy to try to figure out if all this technology really does save lives.

E-mail Inga.

HIStalk Interviews Amy Andres

Amy Andres is chair of the Ohio Health Information Partnership. She was interviewed for HIStalk by Dr. Gregg Alexander.

You have a diverse background. What do you bring to the table for OHIP’s (Ohio Health Information Partnership) Health Information Exchange and Regional Extension Center projects?

I know that a lot of people refer to my background working in the health IT industry, both at Allscripts and for CVS ProCare. I did some work for some software development companies.

Honestly, in this particular project, I think the area where I can be most helpful is my background and experience in the public sector. Bringing people together who may have diverse agendas or may be in a competitive situation, or an adversarial situation, and helping them come together for something that’s for the common good for everybody to cooperate in that environment.

I’ve had some experience with that, both at the Department of Education and also at the Department of Insurance. We have a lot of people with a lot of health IT experience at the table, and although I have it, I think the thing that I bring to the table is helping bring everybody together and see what the long-term good can come out of this particular effort.

OHIP is a public/private partnership. Maybe you could explain that give an elevator pitch on what OHIP does.

The thinking when this project kicked off was that there were the two main funding streams from the ARRA funding. One of those funding streams was intended for states to apply for those funds, and that was to support constructing a health information exchange. The other funding stream was designed for the regional extension centers. 

I think the way the feds thought about it originally was they would have this patchwork throughout the country. Not necessarily within state borders, but just throughout the country, there’d be a support system to help physicians adopt EHRs.

The way we thought about it is two-fold. One, it doesn’t seem like a great idea to have one group working on implementing the support mechanism for the physicians and another group building the system that they’ll be connecting to. It really made sense to bring all of those things together. The federal grant requirements allowed for the states to delegate the authority to apply for the HIE grant if they chose to do so.

What we did in Ohio is said, let’s reach out to the different stakeholder groups that truly are going to be the main participants of not only constructing this, but managing it long-term, and let’s all come together under one organization and do this together. For that reason, the Ohio Hospital Association, the Ohio State Medical Association, the Ohio Osteopathic Association, and the State of Ohio started in talks. BioOhio, who was already a non-profit entity and did some work in the space, also came to the table and offered up help to us get started and help us form such a public/private partnership.

Within a few months’ time, we really pulled that together and had those five entities get started with things. Then, in the fall after we applied for the grants and it became clear that we were going to be receiving some form of funding, we expanded to a full 15-member board that includes payers, behavioral health, federally-qualified health centers … We have consumer advocacy perspective, hospital members, and more, just really trying to bring together a diverse group that could not only give us the perspective for decision-making, but really help pull their communities together along with this process.

Are the other Regional Extension Centers (RECs) across the country working similarly? If not, how do they differ?

We’re not completely unique, but pretty close. I’d say the closest organization to us is a group in New York. Other than that, you mostly have the RECs and the HIE grants being made separately. We have had some feedback from some of the other RECs that that’s already starting to cause them some problems.

We’re one of the largest RECs. In most cases, you didn’t have a whole state form as a group. One thing I will mention about the regional extension center side is OHIP originally applied to cover the entire state of Ohio. So did an organization in the Cincinnati area called HealthBridge. HealthBridge covers the Cincinnati region, also part of Kentucky and a southeastern segment of Indiana. So they took their existing marketplace, both an HIE and they do REC-type services. They applied as well.

So what the feds ended up doing is they ended up reducing our grant slightly and awarding HeatlhBridge as well. For Ohio, it was a good thing because we ended up with substantially more funding, so it requires some level of coordination between OHIP and HealthBridge, which is not a problem. We’ve known those folks for years, have worked with them for years, and on a weekly basis have calls to make sure that we’re staying on the same page.

That’s one aspect that’s a little different, but for the most part, having all of one state covered by a REC is not common. Having it coupled with the HIE, I think there’s only one other circumstance. I guess Wisconsin, I believe is also that way. Other than that, it’s split up.

Is this the uniqueness that you mentioned one of the reasons you think OHIP received such a large chunk of the first-round funds?

I get that question a lot. Lots of people ask, “Who do you know in high places to receive this award?” I have to say this wasn’t a lobbying effort. The effort, really, just stood on its own of the model that we presented.

I do think that it helped that the administration found, and the stakeholders on the physician side came together and agreed to use, some funding that was leftover from a previous program to put up as a state match for the federal dollars in a time of a very tight budget. It was unheard of that entities would come up with that level of money for a match. I think that helps, that we were showing that we were committed to it as well.

I think the real reason that the feds gave us such a strong award is I think they see the merit in the model of having all of the stakeholders’ representation groups sitting on the board, and the level of involvement, not just rhetoric, actually, truly becoming involved. I think the feds recognize this is a model that could actually work and be propagated throughout the country. I think that they made a decision to make an investment in this model to see if it works.

EHR adoption and use timetables are exquisitely fast — very accelerated. Do you think that’s going to increase the odds of making bad decisions or failed implementations as the RECs across the country try to roll this stuff out?

There’s no doubt about it. It’s an extremely aggressive timetable. So aggressive, in fact, that some RECs … There’s definitely been some feedback and folks asking to adjust the timetables.

Here’s what personally I’ve observed in working with folks at the federal level. The interest to adjust timetables is not there. That’s going to stay, but what they have done is absolutely worked with us to try to remove the barriers that are getting in the way of getting there.

Although there was a lot of consternation, especially when everybody recognized at the same while we were in Washington that the timetable for this was really two years, not four years, I have to say that all of our board members — our initial five Board members were there — we didn’t have the same heart attack that some of the other folks had because we know our model. If any model’s going to get us there in this time period, it’s the one that we have.

Concerns over hasty decisions? Yes. When you speed up a project like this, that’s always a concern because you don’t have the time to run down every possibility and mitigate every single risk to meeting a successful project. When you’re in that situation, I think what you have to be open to is making adjustments once you recognize that perhaps a path that you were heading down may not have been the perfect path, and be willing to make adjustments as you go.

I think the other thing that’s key when you’re on this type of time period is to be really open and transparent with everybody about the risks of moving at this speed and establish trust with everybody so that when they see that maybe we made a decision that is not helpful in the process, that we’re willing to admit, yep, a change needs to be made and everybody moves on. I think that when you’re working at this pace, everybody’s got to be open and honest with each other and be willing to make adjustments when we realize they need to be made.

Some have expressed concerns that the RECs are not going to be transparent about how they’re making their decisions for choosing their partners, perhaps leaving some EHR vendors to be shut out. How do you address those concerns?

In our particular REC, our situation, we’re using a competitive process. As a matter of fact, that competitive process is going on right now. We’ve just released an RFP for preferred EHR vendors. We don’t know exactly how many we’re going to select, but we do know it will be more than three and probably less than ten. What we’re trying to get to is allowing for a manageable implementation and pricing that’s attractive for physicians right now.

Probably even most importantly, we’re looking for a commitment from vendors to Ohio. Right now, these EHR vendors, I’m sure, are expressing these concerns. They also have a market of the entire country that they’re trying to grab right now. As a group that has responsibility to make sure that this project doesn’t fall apart, we need to know that they’re not going to overextend themselves in our market, and that they’re going to be here. Once they get started here, they need to finish the job here and really be around to support it long-term.

It’s important for us that we work with vendors that are willing to make a commitment. We’re going to hold up our end of the bargain and do some things to support their efforts as well. There will be, absolutely — and there is already underway — a competitive process and several competent individuals scoring those responses to make our selection. If you’re an EHR vendor and you want to operate in Ohio and you’re not one of the preferreds, you’ll still absolutely be able to operate in this market so long as you meet the ONC certification standards. But we feel it’s important to use a competitive process to select a group of vendors that are willing to make a commitment to Ohio.

Are you saying the selection process is a transparent?

Oh, absolutely. Even though we’re not a state entity, even in the state system — which has probably a very high degree of transparency in the process — while the actual competition is going on, that information’s closed because if that information was released during the actual competitive process, it would give people an unfair competitive advantage. But after the process is completed, all of that information will be made public.

Will there be enough qualified people to help with the implementation, support, and training for all these REC projects? What kind of employees are you going to need with what skill sets and where do you think you’re going to find all these folks?

I have to tell you that that is probably, of everything that is happening within this project, that’s the thing that keeps me awake at night the most. The federal government awards grants to help with that over the long term, and in this project long term means three or four years out. That will be wonderful for long-term sustainability of workforce, but the problem that we have is that the mechanism that they contemplated to implement that through the two-year and four-year colleges does not produce a workforce when we need it, which is during this two-year push. We’re going to need it long term, but we really need some of those individuals right now.

When we were in Washington, it became very clear that the timing of that was going to be a problem. So when we got back to Columbus, the first phone call I made was to the Department of Development and the Board of Regents to see if we couldn’t put together a program for Ohio over the summer to produce, at least, the workforce that’s needed for implementation right now. We met with those folks, as well as a federal program that runs through Job and Family Services called the One-Stops. It’s a retraining program.

We’ve got a full team of people from each of the regional partners, from all of the two-year colleges in the state, the Board of Regents, the Department of Development, and the One-Stops. We’re putting together a very intense summer program to train individuals to do the office assessment and workflow support. Then, those individuals will either be employed by the regional partners — the regional entities that are part of our REC — or, they’ll be employed by the vendors. But, we know we need to create that workforce in Ohio. There’s some of that workforce, but not enough to get this job done and it’s a country-wide problem.

As we’re speaking about this, the other thing that we are contemplating is that we don’t want the EHR vendors coming in here bringing people from where they’re headquartered. We really want the workforce in Ohio to be Ohioans, and be people that stay here and support this long effort as systems are implemented. In part of our EHR process when we’re talking about vendors to partner with, one of those requirements would be that they’re hiring Ohioans to do this work. Our role in this is to make sure that there are competent Ohioans to hire for this process.

Every aspect of this project is truly going to have to be a partnership with everybody holding up their end of the bargain. I do, personally, see a lot of jobs being created out of this project. It’s not really something that’s talked about a lot compared to a lot of the other stimulus programs. What more is talked about is the tight timelines and bringing this up, bringing health information exchange structure and EHR adoption up to speed. But, out of all of this, jobs will absolutely be created. We just want to make sure that those jobs go to Ohioans.

A common theme within OHIP is the discussion of community. Why do you see that as being important, and how is the OHIP model addressing that approach?

I think that the OHIP model itself is the epitome of establishing a community around this.

Yesterday I had a speaking engagement with HIMSS. The discussion ended up turning into an hour of questions and answers, in a good way. People were very engaged. They were very excited.

I was there for another hour afterwards just answering individual questions and talking to folks. One woman said to me, “You know, this reminds me of a movement.” She’s like, “This is like you’ve got people coming out of the woodwork looking to volunteer the time and pitch in.” She said, “This truly has the makings of a movement.” When she said that I was thinking to myself, she’s absolutely right.

This is a situation where a lot of people who have wanted this to happen for quite some time see that if this is going to happen, this is it. This is our chance. People on a macro level across Ohio are coming together. What I think we need to make sure happens from this point is that same level of grassroots movement starts to propagate at the individual, local communities level. I think that that is the key to getting this done in not only an aggressive time period, but with less money than truly is needed to ultimately implement this thing. We have to contemplate a different model than the model that’s been used up to this point that, frankly, hasn’t been able to get us there.

The model that not only I believe, but several individuals who are working within OHIP believe, is getting that community level of involvement — getting physicians within their community working together on this and leaning on each other. The idea of bringing together groups of single practices, bringing those individuals together as a cohort and working through this together, it makes it more cost-effective for us to support that effort in that manner. But even more importantly, it gives them a peer group to work with as they’re working through their own problems. Certainly they can identify with each other going through this at the same time. We absolutely think that’s going to be the key to success in this project.

The next step is really bringing those communities together and helping them not only understand where we’re going with this, but understand that there’s support to help their community.

Are there any other points you’d like to bring up?

I guess just the final point, and perhaps I have spoke about it throughout this discussion, but this is one of those situations where you don’t see something like this very often. Where people who normally either are very strong competitors or have very different positions on how they see the world and how the healthcare system should work, or how health information technology should work — to see all of these individuals come together, not just rhetoric, not just the way that they’re speaking to each other, but truly their actions are showing that this is a partnership.

I’d say in my 20-plus-year career, I have never seen anything like this. It’s quite an honor to be involved and to be participating in this. I think a lot of others feel that way, and I think that’s what’s going to bring us to the dedication that’s needed to get this monumental task done on what is a very aggressive timeline. It’s just a pleasure working with folks on this project.

News 5/5/10

From Newsies: “Re: Radianse. The RTLS vendor has filed for Chapter 11 bankruptcy as of April 20.”

From Take the Time: “Re: Neal Patterson. The latest kudos.” Neal makes the Forbes list of best-performing bosses and rightly so: quibbles aside, there aren’t many executives who have transitioned successfully from scrappy startup founder to big-company CEO and kept investors financially happy most of that time. He’s a HISsies pie-in-the-face regular, but if I was investing my money in healthcare IT, he’s the guy I’d trust it with. That’s CERN (blue) vs. the Nasdaq (green) above, just in case you’re a hater.

Eclipsys announces Q1 numbers after Tuesday’s market close: revenue down slightly, EPS $0.09 vs. -$0.02. Shares are up a little in after-hours trading. In other Eclipsys news, E-Health insider reports that the company will take Sunrise Clinical Manager to the UK, offering it to trusts looking for an alternative to NPfIT’s systems.

Dr. Dalai and anonymous contributors document what they say is the end of AMICAS as Merge Healthcare does its best to screw it up after buying it. I’m linking to his main page since he’s running new pieces, so read back a couple of articles for the whole story. It’s big business as usual: layoffs of all the people that made the acquired company successful, forced relocations resulting in resignations, and apparent mothballing of previously sound products. He summarizes with a plea to Merge executives:

Bottom line is this: your actions are destroying AMICAS. If you don’t reverse what you are doing, you have just flushed $250 million down the toilet. Don’t do it to yourselves, don’t do it to the AMICAS people, and don’t do it to me and the other AMICAS customers.

I see that some new jobs have been posted on the HIStalk Job Board, so feel free to cruise over and see if any of them look interesting. Each job lists the number of times it has been viewed at the bottom of the page, so you can see which ones are hottest. I should mention, since a couple of folks have asked, that while everybody can view available jobs, only sponsors can post them.

Small-practice SaaS EMR vendor ClearPractice names pharmacist and former NotifyMD CEO Gary Ferguson as CEO. The company offers its entire suite for $425 per month, including revenue cycle management, help with stimulus funding paperwork, and CMS approval as a preferred provider for patient registry. I don’t know much about the company, so that’s just me reading the press release to you in an authoritative, yet know-nothing voice like a clueless TV news anchor.

A couple of readers e-mailed me noting quotes from both Steve Lieber of HIMSS and David Blumenthal of ONCHIT in which they discounted EHR safety issue reports. Blumenthal called such reports “fragmented” and “anecdotal”, not surprising given the lack of a central, well-publicized reporting mechanism for such problems. One reader also noted that problem reporters are often seen as troublemaking whistleblowers rather than staunch patient advocates, not to mention that some vendors prohibit such disclosure in their contractual language. My response to one e-mail was that we need this industry’s equivalent of the Institute for Safe Medication Practices to take up the banner of centralizing problem reporting and disseminating those reports out for everyone’s benefit. After all, the FDA’s medication safety track record wasn’t very impressive until ISMP got involved. Plus, you would think vendors would prefer that to FDA oversight.

Thanks to new Platinum Sponsor FormFast of St. Louis, MO. The company’s healthcare solutions include forms automation, document management, and workflow automation that help eliminate the paper chase. Specific solution examples include RAC tracking and response, admissions, bar coding, positive patient ID, cancer staging, patient self-service portals, e-signature, on-demand document printing, and importing documents into the EMR and saving the cost of preprinted forms, imprinters, embossers, and labels on the way to becoming paperless. The company is offering a free Webinar on May 25 at 11 a.m. Central, a Forrester Research update on Microsoft’s healthcare strategy called SharePoint 2010: What Value Does It Bring to Hospitals? Three attendees will win an iPad, just in case you’re interested. Thanks for FormFast for supporting HIStalk.

Revenue cycle services vendor Accretive Health sets its IPO price at between $14-16 per share for 13.33 million common shares for a market cap of $1.44 billion. The company had $510 million in revenue last year, which you’d never guess given its crude Web site and the fact that you’ve probably never heard of it except maybe when I mentioned their IPO plans back in the fall.

McKesson’s Q4 numbers: revenue up 2%, EPS $1.26 vs. $1.01, but falling short of analysts’ expectations on both revenue and earnings.

athenahealth CEO Jonathan Bush has told me that he started his internal company blog using HIStalk as a model, so now he’s got a customer-facing version as well. Unlike most CEO blogs, it’s actually interesting and sounds like someone other than a marketing department committee talking.

Smartphone application developer Voalté announces seven new hires.

I’m streaming Netflix like a madman using my new Roku box as a defensive move to Mrs. HIStalk’s usual BBC and dancing shows, so a couple of old movies inspired this week’s guest editorial in Inside Healthcare Computing, an opus I called Healthcare IT Leadership Lessons Learned from R. Lee Ermey. Spoiler: I make a convincing argument that Neal Patterson’s famous “tick, tock” e-mail was cribbed from one of R. Lee’s profanity-laden monologues in Full Metal Jacket. I don’t think a Pulitzer is in my future, but at least I snickered while I was writing it.

All the big hospitals in Madison, WI run systems from next door neighbor Epic, so now they’ve decided to share ED records in a pilot project that runs through July.

Brigid O’Gorman, a Connecticut College pre-med junior and captain of the women’s hockey team, wins a $10,000 grant from Davis Projects for Peace to implement electronic medical records in Uganda. The money will go towards four computers, solar panels to run them, two printers, software, a laminating machine, and an external hard drive. The college will contribute $3,000 to allow her to spend eight weeks there to set it up and help transfer information from the paper notebooks carried by patients into the computers. I like her spirit: “I’m not a wiz at the computer, but I figured I could get a system and teach myself how to input the data before I go.”

Mississippi Baptist Health Systems says it has saved more than $4 million by switching to Symantec for storage, backup, and archiving of its 130 terabytes of data.

This was probably embarrassing: Canadian EMR vendor Medworxx issues a corrected press release about year-end earnings when it notices that the date was given as December 31, 2010 instead of 2009.

A couple of recent journal articles try to peg CPOE and EMRs to mortality and cost, at least in the minds of the headline writers. As I always caution, just because A and B happened together in no way implies that A caused B or B caused A, even though folks looking for someone to agree with their anecdotal beliefs will always drag those articles out as evidence.

Surgeons at Children’s Hospital of Pittsburgh are using a video-over-IP system to monitor progress of cardiac transplant procedures from any VPN-connected PC using a zero-footprint software video player. The Haivision Furnace system lets surgeons know when it’s time for them to jump in to do their part.

E-mail me.

HERtalk by Inga

From Sean Fitzpatrick: “Re: Paul Levy’s lapses of judgment. I’m with you on your observation. It’s too easy to write off the little lapses, which typically reveal underlying bigger ones.” I was glad to see a number of readers agreed with me. Apparently the BIDMC board did as well, fining Levy $50,000 for his “poor judgment” and saying it will also consider his “serious lapse” when determining his next pay package (which is over $1 million now). Board member Patrick Ryan is apparently not pleased with the outcome (not harsh, enough I suppose?) and announces his resignation.

From Madrigal: “Re: Meditech. Thought you’d like to know that Howard Messing has been promoted to CEO (his new title is president and CEO). His previous title was president and COO. Neil Pappalardo’s title is now chairman (it was chairman and CEO)” Unverified, though we heard this report from a couple of readers. The company’s Web site still lists Pappalardo as chair and CEO and Messing as president. One in-the-know person suggests the change means little in the short term and is more of a symbolic shift of official responsibilities.

Lucile Packard Children’s Hospital (CA) reports a 20% drop in mortality rates since introducing CPOE, giving it the lowest rate ever observed in a children’s hospital. Until Packard published its findings, no hospital has been able to show reductions in medical errors and mortality from using CPOE. The hospital, which spent $50 million on its EHR project, attributes its success to a careful and well-planned implementation.

Peninsula Regional Medical Center (MD) selects eClinicalWorks EMR for its employed physicians at the Peninsula Regional Medical Group. The Medical Center will also promote eCW adoption with affiliated community physicians and implement eCW’s Electronic Health eXchange as its interoperability tool.

Pantain Holdings Berhad, a 1,500-bed, 10-hospital network in Malaysia, selects Eclipsys Sunrise Enterprise. John T. Mather Memorial Hospital (NY) also plans to add multiple Eclipsys Sunrise products to create a single EHR across multiple venues of care.

Washington County Hospital (MD) replaces 40 interfaces with Corepoint Integration Engine. The hospital runs Meditech and connects to referring physician offices.

Doctors from Catholic Healthcare West will serve as medical directors for 10 CVS Caremark MinuteClinics in the Phoenix area. The new CVS/Catholic Healthcare West alliance includes plans to eventually integrate EMRs.

The 54 providers at Syracuse Orthopedics Specialists (NY) and New York Spine & Wellness Center choose Allscripts to provide EHR and PM across their 11 locations.

Chatham County Safety Net Planning Council (GA) goes live on its HIE, leveraging technology from Orion Health and Initiate Catalyst Patient Registry.

Mark R. Briggs, the former COO of Carefx, takes over as CEO of HIE vendor VisionShare. He was previously with NaviNet, QuadraMed, and LinkSoft Technologies.

Fort Healthcare (WI) will partner with Cerner to create a connected health community through the use of Cerner Millennium solutions. The hospital, ambulatory surgery center, and specialty clinics will implement more than 20 Millennium products and use Cerner for IT management services.

Senior Lifestyle Corporation selects the selection and hiring solution of Kronos to manage the end-to-end hiring process.

MedLink partners with iMedicor to integrate iMedicor’s information exchange portal with the MedLink TotalOffice program. The combined solution will facilitate secure messaging and clinical data exchange. TotalOffice users will also have access to iMedicor’s ClearLobby drug and medical device information platform.

Healthcare analytics vendor Outcomes Health Information Solutions appoints Gary Velasquez CEO. Former Ingenix CIO Jim Egan is also hired to serve as the company’s CIO.

Ingenix and Health Language, Inc. launch Ingenix Global Code Manager to translate between ICD-9 and ICD-10 coding systems.

Mediware releases Q3 numbers: revenue of $12.8 million compared to $10.2 million last year, net income $891,000 vs. $483,000.

E-mail Inga.

Readers Write 5/3/10

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

Goodbye Data Warehouse and Cubes, Hello AQL
By Mark Moffitt

For the last two years, I have been researching systems to replace the data warehouse used for report-writing in our organization. This effort has been driven by the desire to provide better service to other departments that rely heavily on data reporting for day-to-day operations.

The idea is to push data to users so they can perform in-memory analysis and display of large amounts of data, a system that would replace the current process of requesting custom reports and spreadsheets from the information services (IS) department. The current process requires considerable resources in the IS department and requests can take several days if the number of requests for reports in the queue becomes large.

The requirements for a new system are straightforward, but somewhat daunting:

1. Put data into users’ hands so they can perform business intelligence.

2. The cost of the system, including license, hardware, and consulting, must be offset by the direct costs of shutting down existing systems.

At GSMC we operate Meditech Magic and use a data warehouse for analytics and business intelligence. The data warehouse stores about nine years of financial data in about 650 GB. The data in the warehouse is updated nightly. SQL reports have been developed to provide reporting across the organization.

IS at GSMC is bombarded with requests for new reports. These requests come in the form of specialized requests for data that often require modifying an existing SQL query or writing a new query. The process is iterative that starts with gathering requirements for a report, modifying or writing new SQL queries, generating a report and sending it to the customer.

Typical turnaround times are variable and are highly dependent on the number of reports in the queue to be developed. Best case scenario is four hours, typical is two to four days. Often the customer will, upon review of the report, ask to include or exclude specific data. This back-and-forth typically occurs several times until the report meets the customer’s needs.

The IS department at GSMC has several analysts who spend a good part of their time responding to requests for data. It is a never-ending demand.

We researched the use of OLAP (online analytical processing) cubes to provide data to users. The advantages of cubes is well documented and includes the ability to drill down to details and analyze data in ways simply not possible with reports or spreadsheets. The disadvantage to cubes is that data must first be aggregated. If a user needs data not included in the cube, then the cube must be rebuilt. Also, a data warehouse is required. Finally, building and maintaining cubes require personnel with specialized skills.

About seven months ago, I read on HIStalk about a new company named QlikView. I researched the software and it sounded too good to be true. However, I was intrigued that QlikView doubled revenues in 2008, not an especially good year for selling enterprise software as the national economy was in a major recession.

On the surface, QlikView is a business intelligence solution that consists of a data source integration module, analytics engine, and user interface. QlikView is based on AQL and is completely different from other OLAP tools.

Through AQL, QlikView eliminates the need for OLAP cubes and a data warehouse, replacing the cube structure with a Data Cloud. A Data Cloud does not contain any pre-aggregated data but instead builds non-redundant tables and keeps them in memory at all times. Queries are then created on the fly and are run against the Data Cloud’s in-memory data store.

Under AQL, all data is stored only once, and all data associations are stored as pointers, so a Data Cloud database becomes more efficient at retrieving records than do OLAP databases. A Data Cloud database is also much smaller since records are not repeated through aggregation and its structure never has to change. The architecture allows for a flexible end-user experience because it doesn’t require aggregation or pre-canned queries that try to cover every possible analytical scenario a user can create, unlike data cubes that require both. (1)

Data Clouds run in memory and AQL reduces in-memory storage requirements by about 75% as compared to source data. In-memory Data Clouds can be stored as AQL files for archiving. AQL disk files are 90% smaller than source data. Think of an AQL file like an Excel file where data can be added and deleted and the file saved with different names for archiving purposes.

The price point for the software is about $150,000 (one-time fee) for our health system. Hardware costs are about $15,000 for a server with 98 GB of memory. We expect consulting fees to total $150,000 for a SME in hospital financial data with QlikView experience. We worked with RSM McGladrey on a consulting proposal as they have well-qualified personnel in this space.

If you know much about the BI/Analytics space, you may question the low cost of the software and consulting services. This has everything to do with the AQL model. RSM McGladrey quoted a revenue cycle effort at eight weeks and includes:

• Transfer data from existing systems to QlikView
• Data validation
• Census analysis
• AR analysis
• Insurance contract analysis
• Hindsight analysis
• Train IS staff on data extraction

The revenue cycle statement of work is only one component of the $150,000 quote for consulting services from RSM McGladrey for implementing QlikView at our organization.

The total cost for QlikView at GSMC is $315,000. That will be directly offset by shutting down a data warehouse, savings from using QlikView for analytics versus another system where the cost of consulting services had already been quoted and budgeted, and other savings. We expect additional direct benefits from having deep analytic capabilities with our revenue cycle data.

QlikView has a number or healthcare customers. I believe you will be hearing more about the company in healthcare in the years ahead as they achieve market awareness of QlikView software’s capabilities and price point.

We have not yet purchased the package. If we do, I’ll write a follow-up article on our experience.

1 “Qliktech, IBM Provide New View Of OLAP”, Mario Morejon, Technical writer for ChannelWeb, July 18, 2003, http://www.crn.com/software/18839582

Mark Moffitt is CIO at Good Shepherd Medical Center in Longview, TX.

Humpty Dumpty Leaves Wonderland to Visit Health Information Technology
By Jim Kretz

Suppose I told you that “voting” henceforth would mean you would only be shown a ballot, period. No more selecting your preferred candidate.

Now suppose I told you that your consent to disseminating clinical information did not mean your granting permission, but only your acknowledgement that you saw my information policy — take or leave it. This may remind you of Humpty Dumpty’s scornful assertion, “When I use a word it means just what I choose it to mean — neither more nor less.”

Surprisingly, the insanity of “…use the term ‘Consent’ to mean the acknowledgement of a privacy policy, also known as an information access policy. In this context the privacy policy may include constraints and obligations.” comes from an IHE (Integrating the Healthcare Enterprise) policy paper “IHE IT Infrastructure Supplement 2009” that was taken up  (line 157) by the IT Standards Advisory Committee Privacy Workgroup, April 23, 2010.

The authors of this paper — the American College of Cardiology, the Healthcare Information and Management Systems Society, and the Radiological Society of North America — are not mean-spirited, uninformed, or confused. What could result in their clearly having tumbled into a conceptual rabbit hole?

Jim Kretz is project officer at the Substance Abuse and Mental Health Services Administration of the Department of Health and Human Services. His comments should not be construed to reflect the official position of SAMHSA.

Massachusetts HIT Conference Thoughts
By Bill O’ Toole

I had the pleasure of attending a National Conference hosted by Massachusetts Governor Deval Patrick in Boston last week. The conference was billed as Health Information Technology: Creating Jobs, Reducing Costs and Improving Quality. 

Keynote addresses were provided by David Blumenthal, MD, National Coordinator for HIT and Vice Admiral Regina M. Benjamin, MD, MBA, Surgeon General of the United States. Health IT Policies and Standards were addressed by a panel that included John Halamka, MD (CIO, CareGroup and Harvard Medical School), Marc Overhage, MD (CEO, Indiana Health Information Exchange), Paul Tang, MD (CMIO, Palo Alto Medical Foundation), Micky Tripathi, Ph.D (CEO Massachusetts eHealth Collaborative) with Tim O’Reilly (President, O’Reilly Communications) moderating.  

Another panel discussion on Health IT, Business Opportunities and Job Creation featured leading Massachusetts vendor executives Girish Kumar Navani (eClinicalWorks), Howard Messing (Meditech), Richard Reese (Iron Mountain), Bradley J. Waugh (NaviNet) moderated by Chris Gabrieli (Bessemer Venture Partners).

I could go on and on, but the list would be too long. I mentioned those above to give readers a sense of magnitude and to perhaps share in this small article the profound comfort I felt that "we" are doing this right. Many other highly qualified participants shared their knowledge on all things HIT- and ARRA-related.

What impressed me most was the overwhelming sense of momentum. The stimulus package and its future incentives have so far done exactly what was intended, serving as the spark that has set this massive project in motion. Remaining at the forefront of it all, though, is the goal of better medical care for all. That theme was never lost and was frequently repeated.

As one who until now has found certain parts of most conferences to be extraneous (ok, boring), I felt obliged to inform the far-flung readership of HIStalk that I was extremely impressed with every minute of this two-day conference. If the energy, knowledge, and sincere interest and enthusiasm expressed by those involved in this conference are carried forward to the project at large, then we are truly in for a remarkable change in our industry.

Congratulations to the Massachusetts Technology Collaborative and its Massachusetts eHealth Institute, the Massachusetts Health Data Consortium, and Governor Patrick for organizing this special event. It should serve as the model and be repeated whenever possible throughout the country.

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

Monday Morning Update 5/3/10

From BestofBreed: “Re: Merge Healthcare. Laid off 80+ people Friday.” I heard that from more than one reader. The Amicas acquisition closed Wednesday, so they obviously didn’t waste any time addressing redundant positions. Steamin’ Pyle says rumor has is it that no years-based severance was offered to the expungees, meaning nobody is supposed to get it in the future.

HIStalk sponsors have posted quite a few jobs on the new Job Board, so you might want to check it out. Healthcare IT hiring is definitely picking up.

Sam Patton is named chief quality and regulatory officer of medical device integrator iSirona.

Thirty-nine percent of respondents to my poll said they are personally aware of an incident in which a computer system caused patient harm. New poll to your right for those working in a provider setting: which systems will your organization buy within the next two years?

CHIME sends comments to ONCHIT on EHR certification, expressing concern that certification capacity needs to be adequate to handle the rush of vendors that will be trying to get their products certified at the first opportunity. It also says any program that monitors real-world EHR performance (presumably including any new FDA oversight) should not not be “overly prescriptive”. You’d think CHIME was supporting its 70 big vendor members instead of its 1,400 CIO members with those comments, but that’s the HIMSS model at work.

David Blumenthal, speaking at a Boston conference, says that reports of EMRs causing patient harm have been “anecdotal and fragmented” and should not affect their aggressive rollout.

Sentry Data Systems has an upcoming Webinar on decreasing data center costs by using cloud computing.

Columbia HCA and Solantic founder Rick Scott announces his candidacy to become governor of Florida. His campaign site says things were great at Columbia/HCA when left, but fails to mention that he was fired after the FBI raided its hospitals and the company was charged with the biggest healthcare fraud scandal in US history, eventually costing Columbia/HCA $1.7 billion in fines. His FAQ makes that travesty sound like a valuable lesson learned under fire that makes him a better candidate for public office:

Since I’m not a career politician or a political insider, I’m going to lay it out for you as simply as I can without spin or fancy words. Let me start by being crystal clear about this… I’ve made mistakes in my life. And mistakes were certainly made at Columbia/HCA. I was the CEO of the company and as CEO I accept responsibility for what happened on my watch. I learned very hard lessons from what happened and those lessons have helped me become a better businessman and leader. Lessons I will bring to the Governorship with your support and vote.

An audit finds that University of Iowa Heart and Vascular Center failed to bill patients for $11 million worth of charges in November. Officials claim it wasn’t their new Epic system that was at fault, but declined to speculate further until an investigation is complete.

The usual housekeeping facts: put your e-mail address in the signup box on each site (HIStalk, HIStalk Practice, and HIStalk Mobile) to receive instant updates when we run something new. The “Search All HIStalk Sites” box to your right lets you search all those sites at once. Check out the industry event calendar, where you can also post your event for free. The hideous green  “Report a Rumor to Mr. HIStalk” button lets you send me anonymous, secure information, including any attachments that you might want to include. Please support HIStalk’s sponsors by checking out their ads to your left and clicking on those of interest – Inga and I appreciate their support. And lastly, I thank you for reading, writing guest articles and comments, and making those 3 million HIStalk visits possible by spreading the word. The incredible support I get from sponsors and readers keeps me going through all those after-work nights and weekends when I’m lashed to the keyboard.

The VA says it has figured out the problem responsible for incorrect data displaying when its employees accessed the DoD’s AHLTA system: an interface server change from a single to multiple processors. The description sounds as though it was a transaction timing issue, but that’s just my guess. VA and DoD are back to fax and e-mail for patient information inquiries until a fix is installed.

Carolinas HealthCare (NC) announces several changes in top management, including bringing on Brent Lambert from Carilion Clinic as VP/CMIO.

An ED nurse at Tomah Memorial Hospital (WI) is arrested for using patient information to divert narcotics logged out for 600 patients. The hospital has notified the patients that their information was breached but probably not exposed, other than they were charged for drugs they didn’t receive and will be credited (not that patients usually care since they aren’t paying with their own money anyway, so they probably won’t get a refund).

Shares in athenahealth dropped 18% Friday and bounced off a 52-week low after announcing a surprise Q1 earnings shortfall after the market close on Thursday. One analyst said the company missed expectations in nearly all areas, while another termed its Q1 performance as “disastrous”. Market cap is now under $1 billion.

Odd lawsuit: a woman trying to kick her husband as they walk along a Chicago street loses her balance and crashes through the window of a beauty salon. She admits to have been drinking beforehand, but is suing, claiming the business and building owners knew that drunk pedestrians on their way to or from Cubs baseball games could fall through the window. She’s also suing the hospital that treated her, insisting that a radiology tech stole her BlackBerry and $6,000 worth of jewelry while preparing her for an MRI.

E-mail me.

News 4/30/10

From The PACS Designer: “Re: cloud printing from Chrome. Google has in development a new application that will give Chrome users the ability to send documents to the cloud for printing by a wireless network or cloud-aware printer.”  

From SantaBarbaraLocal: “Re: Santa Barbara Cottage going with Epic. It’s actually Sansum Clinic, which is adjacent to the hospital, that has signed with Epic.” A couple of readers confirmed. That makes more sense than the hospital replacing Eclipsys.

From Brit: “Re: NHS projects in the South. They are being delayed even further because the government bureaucrats are getting cold feet about using Cerner’s Upgrade Center in KC. They have asked BT to build an equivalent center in London, which will push projects out by months and cost the taxpayer tens of millions of dollars more.” Unverified.

Nashville Medical Trade Center gets its first anchor tenant — HIMSS, which will make the facility the year-round home for its Interoperability Showcase. The company developing the $250 million facility says it will try to entice vendors who are HIMSS members to lease space by offering them discounts. HIMSS will now literally be even closer to its high-paying constituents.

Q1 numbers for MedAssets: revenue up 18%, EPS $0.09 vs. $0.03, beating estimates.

Weird News Andy felt bad that I missed the 3 millionth HIStalk visitor, so he “went into my time machine” (which probably means he Photoshopped the above since the next-to-last zero looks a bit clipped) to commemorate the moment.

The National Association of Healthcare Access Management conference starts in Orlando’s Marriott World Center this weekend. The folks from SCI Solutions will offer a Stress Free Zone on Saturday afternoon at 4:30 before the exhibits open, with free drinks and massages.

If you clicked the Like button on the HIStalk Facebook widget to your right, thanks! Inga and I don’t get to know who’s reading all that often, so that’s pretty cool.

Also announced after the market close: athenahealth’s Q1 results: revenue up 33%, EPS $0.01 vs. $0.04. News that spending was up 72% without immediate growth wasn’t taken well by investors, with shares dropping 15% in after-hours trading.

Cerner’s Q2 results, announced Wednesday: revenue up 10%, EPS $0.59 vs. $0.49. Bookings were at an all-time high. Pretty good considering that their hosting services cut into the hardware revenue. New services are mentioned, including running IT departments and revenue cycle services. ProFit finally gets a mention, although not by name, with “great progress” claimed. Oddly, Cerner will resell Pyxis while selling its on RxStation medication dispensing cabinet, also planning to tie into Alaris smart pumps with its medical device hub.

Jobs: Eclipsys Physician Consultant, Soarian Clinicals Consultants, Chief Information Officer.

A flash drive containing information on 25,000 patients turns up missing from Our Lady of Peace, a Kentucky psychiatric hospital. Like everyone else who gets burned, they vow to start encrypting.

The folks from CattailsMD responded to the rumor Alphonso’s rumor from Monday that the project is in trouble and executives have moved on. The leadership changes did occur, with Bob Carlson taking a different role and Paul Olinski retiring, but they say the EMR is now used by more people outside of Marshfield Clinic than within, they just released a dental module for it, and an external customer will implement it using an accelerated go-live process to reach Meaningful Use.

DPS Health, UCLA, and a South African women’s organization announce a study to look at the effectiveness of using text messaging for peer support of people with Type 2 diabetes.

Nuance deploys its eScription computer-aided transcription solution to four NHS trusts in the UK as a pay-per-use SaaS offering.

RTLS vendor Awarepoint announces management changes: the CEO has been replaced, former McKesson executive Ben Sperling is brought in as VP of business development, and former UCSD Medical Center associate administrator and Awarepoint client Thomas Hamelin is hired as SVP of business process improvement.

The CEO of Telus, interviewed on Bloomberg TV, explains the importance of healthcare to the company’s business and why it may pursue telecommunications acquisitions to support it.

Vish Sankaran, manager of the Connect gateway to NHIN for ONCHIT and former Brailer guy at CareScience, resigns. He was program director of the Federal Health Architecture program. His LinkedIn profile says he’s interested in job inquiries, so I’m betting he got one from one of the usual government contractors.

A group offering free clinics staffed by volunteers was founded by Stan Brock, a guy who wrestled animals on TV in Mutual of Omaha’s Wild Kingdom in the 1960s, just in case you were parked in front of the three-channel black and white back then. I like this guy: he decided to leave TV in 1985 “to make people better”. Here’s a snip from a newspaper profile:

Today, Brock has no money, no income, and no bank account. He spends 365 days a year at the charity events, sleeping on a small rolled-up mat on the floor and living on a diet made up entirely of porridge and fresh fruit. In some quarters, he has been described, without too much exaggeration, as a living saint.

The British University in Dubai will host that country’s first national meeting on health informatics on May 5. The one-day program is free.

A Maryland startup will commercialize the Blink lab monitoring software for critical care developed at University of Maryland, Baltimore.

Park Nicollet Health Services will pilot diagnostic software from Zipnosis, a Minneapolis startup run by a co-founder of MinuteClinic. Patients pay $25 online by credit card, take a five-minute automated interview online, a clinician interprets the results, the patient gets an answer back (diagnosis, treatment options, and prescriptions), all within an hour. Park Nicollet will get a cut of the revenue.

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HERtalk by Inga

From NoPollyanna: “Re: mobile healthcare apps. I was searching for information on healthcare systems using mobile marketing — find a doc, directions to office, ED info and wait times. Didn’t come up with much outside of appointment reminders by phone. Is this still just a ‘nice to have’ or is there more happening here?” NoPollyanna is looking for apps that help healthcare systems extend their brands. Suggestions? As for advertised ED wait times, do they have an effect on patients choosing an ED vs. their primary care provider?

From George Stephanopoulos: “Re: EHR implementation blogs. Another to add to your list of ‘EMR journey’ blogs. From the URL, it appears CCMH is implementing the hosted Cerner application suite.” The blog’s author is the CFO at Carroll County Memorial Hospital (MO) and says the hospital is going live in about six months. I had to register on what appears to be on a Cerner-hosted site to request access. I’ve got to hand it to Cerner for figuring out a clever way to get some new leads.

I have been pondering Mr. H’s “so what?" comment in regard to Paul Levy’s "lapses of judgment in a personal relationship.” So, perhaps it does not affect his ability to lead the health system. Then again, what other lapses in judgment might he have had? What future lapses, either his or others, might be brushed under the rug?  Rightly or wrongly, we want our leaders to be role models, at least professionally. An inappropriate work relationship bleeds into the professional world and creates potential for an imbalance (or abuse) of power. I’m not suggesting anyone be fired, but some official reprimand by the board might be appropriate.

Sinai Medical Group (IL) is implementing NextGen’s EHR and PM products and expects to go live in August. Sinai’s faculty group practice includes almost 200 physicians.

HP announces plans to purchase Palm for approximately $1. 2 billion cash. I read the opinions of a couple of pundits who suggest HP was interested in getting its hands on the Palm webOS to run future tablet products.

Billing service provider Healthcare Billing Consultants (PA) selects Sage’s Intergy practice management and analytic tools for their 80 providers.

Medical & Surgical Clinic (TX) commits to Allscripts’ EHR for its 31 physicians.

CareFusion and Cerner announce they will integrate the CareFusion Pyxis systems and Cerner’s CareAware solution. Cerner will also resell the CareFusion Pyxis dispensing technologies to its existing EHR clients,which seems odd since Cerner was offering a competitive product at one time.

Health reform legislation will increase the IT needs for a number of government agencies, including HHS, the IRS, and state and local governments. Job security if you are in IT, I suppose.

GE Healthcare teams up with Ascom Wireless Solutions to launch a wireless, hospital-wide message system that allows clinicians to receive clinical text-messages and alerts throughout their facilities.

Earlier this week I mentioned that we’d like to find a hospital and/or physician office willing to share their EMR selection and implementation journey. I should have explained that a bit better. As opposed to connecting with a entity that has already implemented an EMR, we’d like to find someone just starting the process who would be willing to provide periodic updates. If you have a candidate, let me know.

Ten of the 13 most-considered enterprise business intelligence solutions in healthcare come from industry-agnostic vendors, according to a new KLAS report. Healthcare provider executives ranked Dimensional Insight the top vendor, followed by Information Builders, and McKesson.

St. Joseph’s Regional Medical Center (NJ) deploys Infinitt North America’s Enterprise PACS. Infinitt migrated over 30 terabytes of image and patient data in less than five months.

UNC Health Care (NC) engages MEDSEEK to establish a patient portal that will combine EMR and administrative data from UNC’s Siemens system and its other HIS products.

A NYC grand jury indicts two former executives from New York-Presbyterian Hospital and two contractors for participating in a mail and wire fraud scheme. The hospital officials allegedly received payments and gifts in exchange for awarding contracts to certain companies. The questionable contracts totaled more than $42 million.

A former researcher at the UCLA School of Medicine is sentenced to four months in federal prison for snooping in medical records. The research assistant, a licensed cardiothoracic surgeon in China and a US immigrant, claims he did not know it was illegal to look at the confidential medical files of his co-workers or celebrity patients. He’s now sort of a celebrity, too, since he’s the first person to be sentenced to prison for violating HIPAA’s privacy provision.

Chesapeake Regional Information System for Our Patients (CRISP) selects Axolotl to provide the core infrastructure for its statewide HIE.

Thanks to the Brits, we now have a better idea of the risk factors that predict future professional misconduct by physicians. Doctors who are male, from lower socioeconomic groups, or had academic difficulties in medical school are more likely to be misbehaving doctors.  I think someone needs to do a follow-up study to determine the risk factors that predict misbehaving boyfriends or husbands.

And, thank you Weird News Andy, for referring me to the www.ifshoescouldkill.com website. OMG.

E-mail Inga.

HIStalk Interviews Arien Malec

Arien Malec is coordinator for the NHIN Direct project of the Office of the National Coordinator.

Give me a basic overview of NHIN Direct.

NHIN Direct is a project to expand the set of services that are available on the NHIN, but to expand them in a way that is accessible to the majority of providers. Particularly, the majority of the primary care providers practice in practice sizes of five or fewer. The lingua, the interchange, the health information exchange/interchange for those providers currently is fax. The major aims of this project are to create a set of standards that enable those providers to essentially replace the fax with electronic forms of interchange.

There’s really nothing new in the kind of health information exchange that we’re trying to do. We’re not trying to break new ground so much as standardize existing ground. A lot of HIOs get their start in provider-to-provider or lab-to-provider direct communication. Essentially, what we’re trying to do is standardize that and make it easier to plug in EHRs into exchanges and make it easier for HIOs to develop standard services for that kind of direct communication.

I’d also note that level of direct communication aligns very well with the criteria for Meaningful Use; particularly the requirements to exchange information at transitions in care, as well as receive lab data electronically and provide electronic information to the patients.

How would you characterize the differences between NHIN and NHIN Direct in terms of who will use them and for what purpose?

I’m going to carefully separate NHIN, as in the NHIN Exchange, from NHIN, as in the set of standards and services that are available. There’s some confusion about what’s what.

Both define the NHIN Exchange as the network of networks, as the network in the middle with standards that enables large, national health information organizations to exchange data with each other. A great example of where the NHIN Exchange would be useful is in coordination of care between a provider who’s using a state HIO and a patient treated in the VA system or in the DoD system.

All three of those organizations are, essentially, extraordinarily large IDNs. They are nationwide health information organizations because they cross and transcend state boundaries. That’s the core use case for the NHIN Exchange — coordination of care and information discovery across large, nationwide health information organizations. The core standards that are in use are common standards that can also be deployed within an HIO context, so if I wanted to discover where else a patient has been and what information is available about that patient, I would use the core NHIN services. They’re essentially the IHE interoperability stacks, particularly the XDS, XCA; that stack.

The way that I describe it, I’m going to paint two pictures. Picture one says that I’m a provider who is in an exchange that offers both services and I’m referring to a provider who only gets the simpler kinds of services, the direct services. As a provider with access to both services, when a patient presents, I may do a query to find out where that patient has been seen since the last time I saw them, and discover information with the patient’s consent that helps me inform the care of the patient.

Then at the end of that encounter, I might publish the updated physician information into the repository in the sky for future care providers to discover information. Those are great uses of the NHIN specifications and services.

Then, at the conclusion of that encounter, I want to refer the patient over for care. Let’s say it’s for care that isn’t served on the same EHR, where I can’t rely on the EHR’s capabilities to have the chart available. So I want to push a referral transaction over to, let’s say, the cardiologist. Then at the conclusion of the cardiologist’s care, I really want them to push me an update to what happened to the patient.

That transaction, by its very nature, just doesn’t fit the “publish something in the sky and then grab something from the sky” model. I mean, you could do it that way, but the semantics of that transfer are directional. I want to give the referral over to that provider and that provider expects to receive it in his or her inbox. Same thing for a lab. You might publish the lab to a lab repository in the sky so that all people can have access to it, but the ordering provider wants to get that lab result in his or her EHR directly as well. So you’ve got both publish semantics and push-to-provider semantics.

Pretty much all we’re about at the NHIN Direct project is to create the standards, the specifications for that push-to-address case in ways that allow an HIO or lighter weight organization to be able to provide an address for a provider or for a patient, and for the routing of a transaction to go to that address. So, there’s a lot.

Many of the HIEs created their business models around charging for that type of service. Will they use some aspect of NHIN Direct or is this a replacement or a competitor for it?

A lot of HIOs, I think for very good reasons. It drives a lot of business value. You get started with simple direct services. Nothing that NHIN Direct is doing should, or does, conflict with that desire. NHIN Direct will, hopefully, make those services easier to deploy because there will be a set of standards around them, and EHRs, hopefully, will have their standards embedded within the EHR so it will be easier to get services up and running.

Now if your business model is, “Well, this stuff is hard, and so our business model is to do it because nobody else can and we don’t want any competition and anything that makes it easier to do is a threat to our business model,” then sure, it could be a threat to the business model. I don’t believe that. I believe that making it easier, making it more scalable, actually makes it easier to offer those services at a profit for exchange sustainability.

As I said, I think if you look at the example of successful HIOs, they pretty much all solved this problem at the cost of some blood early on, and they’re able to offer these services. NHIN Direct is going to give them a way of scaling that service offering more, but I don’t think they think it’s a threat to their business. I think if you look again, if you look at the example of HIOs that are up and running and doing well, I don’t think any of them are scared by NHIN Direct. In fact, I think they think of this as something that makes their work easier to do.

What about those EHR vendors that have their own exchanges?

A lot of the EHR vendors — and you can go to the NHINDirect.org website and look at the implementation group to look at the current members of the implementation group and you’ll see a number of the leading EHR vendors out there — many of them are participating in this effort. I can’t speak for them, but if you look at the strategic situation, I think many of them would like to offer a set of value-added services on top of their EHRs for simple connectivity.

Many of them are in context where if you look at the state of HIT in the United States, very few providers operate in a service area where it’s all one vendor and where you can mandate and lock down a single vendor model. So, many of these EHR vendors have customers — oftentimes large health systems — who are asking them to enable interoperability within their products, but also across other products.

I think many of these EHR vendors see this as a way to fulfill their customer’s business needs in a way that is standard, and allows them to offer standardized services. I think the EHR vendors, by and large, have looked at this as an opportunity much more than they look at this as a threat.

John Halamka likes the idea of a health URL where individual data can be pushed. Would this support that, or is anybody working on that?

Absolutely. The notion of an address that you can route information to is a core principle of the NHIN Direct project. In fact, John’s recent blog post describes the work of the addressing working group in NHIN Direct. He’s a participant of the implementation group and he references, explicitly, the health URL concept in the context of what we’re trying to do.

What about privacy and security?

I’m going to back up. If you look at the record locator kinds of transactions — where has this patient been, what information is available about this patient — those are the transactions for which specifications and standards currently exist. There is a significant set of policy issues around that because the information holder is receiving a transaction basically requesting information and needs to decide, on the fly, whether that’s an appropriate information request, and whether the PHI disclosure that’s associated with that is proper and legal. Any of those systems that are up and running have put in place consent models and put in place policy models that ensure that data is only provided when it’s legally appropriate to.

In the set of push transactions that NHIN Direct is all about, the information holder and the initiator of that transaction are one in the same person or organization. The best way to think about the NHIN Direct kinds of transactions is that the data are going to flow, regardless. I’m going to send the summary of care to the provider via fax. I’m going to send it via paper. I’d love to be able to send it electronically.

The legal responsibility is pretty clear for this. It’s the information holder’s responsibility to determine whether the disclosure that they’re making is appropriate. Appropriate is defined by any of the HIPAA exemptions, as well as by explicitly getting patient consent to do the transaction.

What we need to make sure of in the transactions and in the policy framework around health information exchange is that if there is a disclosure along the way, that we know exactly where that disclosure originated from, we know who the legal entity responsible for the disclosure was, and also that we protect the health information and make it secure all along the way so it doesn’t inadvertently get exposed. We’ve got a privacy and trust working group that’s focused on those exact issues.

I think John’s post mentioned that it will be the same framework that’s used by the full-scale NHIN, not a lightweight version.

Exactly, so we’re going to be using TLS on both ends. We’re going to be ensuring that all the data are encrypted in transit. We would recommend that HIOs encrypt it at rest as well, and ensure that they’ve got the appropriate security policies.

The other part of this is that we’re just doing the transaction semantics. We’re just doing the specification. Somebody’s got to take those specifications and run them. The organizations that run them need to run those transactions within a policy framework. That policy framework needs to have much more in it than just transaction-level security rights. You absolutely have to encrypt the data in transit, but then you also have to make sure the exchange has the security policies in place; does security audits and remediation, has good quality assurance policies in place; has good operational controls in place to make sure that … you’ve got to secure the entire system and not just the transactions.

There’s a lot of policy work to be done. We’re closely coordinating the technology work that we’re doing with the policy work that’s being done, both at ONC as well as within the NHIN workgroup and the HIT Policy Committee.

Maybe you can expand on that thought because I’m not sure I understand. What you have is a set of policies and practices, but someone has to actually run it.

Exactly. The metaphor that I’ve used is that you’ve got cake? Cake is good stuff. You want to eat cake. Cake adds value.

We’re not making cakes in the NHIN Direct project. Somebody’s got to run a bakery to bake some cake. What we’re doing in the NHIN Direct project is creating a recipe for cake, and we’re making sure that recipe is well-tested and making sure it works across a variety of settings. That you can use a small bakery or a big bakery to make your cake and the cake’s going to taste just as good, regardless of where you bake it.

But, as an organization, our project is to create a recipe. You’re not going to get any cake from the NHIN Direct project. You’ve got to get your cake from a bakery.

Is there any centrally hosted infrastructure or services?

Not so far as we’ve discussed. There has been some belief — which we’re still going to need to explore this — that there are a couple of potential services that the federal government may end up hosting. One might be a central certification body, as well as a certificate authority to make sure that people who operate on the exchange are carrying correct policy frameworks. That’s the one potential role for the federal government.

They are, essentially, assuring trust. That’s a role that the federal government’s already taking on and is actually legally responsible to take on with respect to the NHIN Exchange, to the extent that the NHIN Direct services get incorporated into the NHIN Exchange. The federal government and ONC have a legal responsibility to create a policy framework for that. That’s one role that the federal government could play.

There are potential other roles the federal government could play, particularly around potentially using some of the information that we have around NTI; as well as that CNS is going to have to have a lot of paying providers for Meaningful Use as a way of making directory services that people might offer more valuable. But, we still have yet to explore or decide on those capabilities.

By and large, the NHIN Direct project will exit with a recipe and not so much with infrastructure.

Do you think the EMR products that are out there will be ready to share data once the platform is available?

With everything else in software, there’s a software development life cycle. There’s a set roadmap on capabilities. What I’m encouraged by is that so many of the EHR vendors are participating in the project and have committed to do real-world implementations. Not necessarily full-scale, real-world implementations, but have committed to doing real-world implementations. That encourages me that by 2011 we’ll have exchange capabilities at a broader scale to support.

What this is all about is supporting providers, both in terms of their obligations to get the money for Meaningful Use as well as supporting providers and patients in the quality and efficiency goals that we’ve set out for the HITECH Act. My hope is that given the participation that we’ve got that we’ll get a good amount of support for providers in 2011.

How would you turn all this technology concept into something that patients would understand? What would you say the outcome would be and when will they begin to see it?

As a patient, what we would hope to see is that a patient has interoperable access. Again, I think John Halamka’s posts on the health Internet address called the health URL are as good a place to start in understanding what this is all about. As a patient, I should be able to get a health Internet address. I should be able to give that health Internet address to my provider and say, “Hey, I want my information posted here.” The provider should say, “OK, no problem. I’ve got all the capabilities for doing that.”

As for when that will happen, I expect it will be in essentially limited operations by the end of this year. I would expect us to be in wider-scale operation by the end of next year.The way that I would judge this project being a success would be the number of providers who’ve got an address.

The other side’s the patient experience. That when I get referred over for care, get treated by a specialist, and then go back over to primary care, that the thing that I expect to happen — which is that specialist knows why I’m there and knows my health information necessary for treating me and that my primary care provider knows what happened when I went to the specialist — that all that exchange has happened behind the scenes with my consent, appropriately.

I think those two outcomes would be the way that I would judge the success of this project. My beliefs and hope would be that we’ve got a decent amount of availability to service it by the end of 2011, and then rolling on to wider scalability in 2011-2012.

What also makes me feel good about this is there are a lot of organizations that can do parts of this, and really all we’re doing is taking the best practices that a lot of these organizations are doing, and saying, OK, that’s great. We know how to do it. We know how to do it, even at scale. Well, we don’t know how to do it and do it interoperably so that you can share information between systems, so let’s focus on that.

Any final thoughts?

I think that if you’re asking about the fact that we’re not hosting, we’re not running any services. I think that’s the thing that people get extraordinarily confused by, and understanding that is real useful.

Another common question that comes up is, “What are you doing about content?” The project itself is focused on transport, but we’re sitting and working with all the other work that’s being done around content to make sure that the payloads that people exchange are interoperable payloads; and all the good work that’s in the IFR to help us constrain down to CCR and CCD, but also constrain down to terminology. We’re relying on that work getting better and more stringent over time so that we can share information, but then we can also understand the payloads.

News 4/28/10

From Harpo: "Re: Halamka’s CEO. Accused of hanky panky with a staff member, but he apologizes and will stay on. Being the most visible and transparent hospital CEO is great, but I didn’t see this on his blog yet." Beth Israel Deaconess CEO Paul Levy admits to "lapses of judgment in a personal relationship" that were first reported to the hospital’s board by anonymous letter. My reaction: so what? He’s human. People sure love to throw those stones.

From Epic Watcher: "Re: Santa Barbara Cottage. Heard from two folks they’re going Epic, although I’m not sure whether inpatient or ambulatory." Maybe someone will report back. I know they’re Eclipsys on the inpatient side and I doubt that’s changing, but you never know. 

From Don Diego: "Re: ADVANCE for Health Information Professionals. Dead." According to the company, they’re shutting it down "due to unfortunate conditions in the market."

From Ex-Cerner Guy: "Re: quick login. Several of my clients experimented with HID Proximity Cards for speed, security, ease of use, and then cost. Speed was instantaneous, security was 100% (they added a fingerprint pad), and ease of use was great. Everyone remembered to bring their ID card and right thumb with them. As soon as the user was more than 10 feet from the workstation, they were logged off. Re-login would bring them to the screen they left. The item that was rated #4 in importance quickly became #1, as the support time and costs became insane due to each non-hospitalist needing a level of customization the facilities were not prepared for. I loved the solution, as did the CIOs and CMOs. CFOs killed it, and probably correctly. Time-and-motion study for typing vs. swiping and pressing did not support the cost model in 2006."

From RedDog: "Re: Northeast Georgia Health System. New CIO and hear the consulting company is leaving as well. A totally fouled up RIS/PACS install in December is the catalyst. Epic is being talked about in the admin suite." Unverified.

From Partial Eclipse: “Re: West Penn-Allegheny. Delaying its go-live of Eclipsys Sunrise because of excessive costs and the shrinkage in CMS payments.” Unverified.

Listening: In This Moment, alt-metal with an angry-sounding female lead who looks like an angelic supermodel.

Texas Health Resources and Children’s Medical Center Dallas will exchange patient information via their common Epic systems. THR also plans to do the same with UT Southwestern and Parkland. 

Macquarie University Hospital in Sydney, Australia and the Australian School of Advanced Medicine will implement iMDsoft’s MetaVision (OR, PACU, and ICU) when the new hospital opens in June.

A new Medicity brief called Key Components of a Successful HIE Strategy covers best practices in deploying a "future-proof" HIE.

McKesson says it will adopt its Paragon HIS for the British market, hoping to offer an alternative to its long-in-the-tooth TotalCare and Star systems for hospitals opting out of NHS-offered systems due to implementation delays.

Speaking of McKesson, it announces availability of 12 new templates for chiropractors for its Practice Partner, Medisoft, and Lytec MD physician systems. Back-crackers get a rebate and the templates for free.

I put a "Find us on Facebook" widget to your right that offers the new "Like" button. Click it and Inga and I will have a tiny bit of our insecurity relieved at least temporarily. You are all so cute in your FB pictures that it makes us proud to have you as readers.

Mike DeSimone joins MedVentive as VP of business development.

The Platinum sponsor-only jobs page is in full swing with 34 jobs posted, so you might want to check those out. Inga will be her usually cheery self in hooking up sponsors to use it as a free benefit of supporting HIStalk.

Neither Inga nor I were home Sunday afternoon to take a screen shot when the HIStalk visit counter rolled over to 3,000,000, darn it. A visitor from Epic was the 3 millionth visitor since June 2003.

GE Healthcare and Ascom Wireless announce plans to tie GE’s patient monitors into Ascom’s VoIP, pager, and DECT handset communication systems.

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From BowerSocks: “Re: giving back. Just wanted to say I didn’t know about the Cerner Diabetes Initiative. We are always looking for great places to donate and I think both the Diabetes Initiative and the First Hand foundation sound awesome.”

Picis implements 53 new US healthcare facilities using its LYNX E/Point revenue management solution for the ED.

Catholic Healthcare East (PA) selects Zynx Health’s evidence-based order sets and plans of care solutions for 18 of its hospitals.

SCI Solutions releases an EMR-enabled version (v6) of its Order Facilitator order management tool. The new version includes the ability to capture H7 order transactions sent from a physician’s EMR to a hospital’s Order Facilitator database.

Oroville Hospital (CA) claims to be the first hospital to implement VistA without the help of outside consultants. The hospital is halfway through the implementation process and is relying on its internal IT group for all customization.

The executive director of the Rochester RHIO says the organization is “no longer an experimental pilot service.” The four year old RHIO now includes participation from 15 hospitals, 866 physicians, and 225,000 patients.

San Juan Regional Medical Center (NM) contracts with Perceptive Software to use the ImageNow document management and workflow system. San Juan will integrate the ImageNow application into its existing Meditech system.

The GetWellNetwork folks tell us they are hosting their  Third Annual User Conference later this week in National Harbor, Maryland. Keynote speakers include The Studer Group’s Brian Robinson and Gerard van Grinsven of  Henry Ford West Bloomfield Hospital.

The Electronic Healthcare Network Accreditation Commission appoints four new commissioners to serve through 2012.

The Alaska EHR Alliance selects e-MDs and Greenway Medical as the “best choices” for the state’s healthcare providers. ACS Healthcare Solutions was the managing consultant for the selection process, which lasted eight months and started from a pool of over 250 EHR vendors.

Thomson Reuters will integrate its Micromedex clinical decision support and CareNotes patient education content within the M2 HCIS.

Beacon Partners is named to the Boston Business Journal’s 2010 Pacesetter list, which recognizes the 50 fastest growing private companies in Massachusetts.

The first of three Thomas Jefferson University Hospitals (PA) goes live on Wellsoft’s EDIS.

Mercy Hospital of Portland (ME) selects Allscripts EHR for its 58 employed providers. The physicians already use Allscripts PM product.

I came across this blog today, written by the CIO of a hospital that’s in the midst of selecting an EMR. So far they have eliminated Cerner and now they are giving Meditech Magic a good look. The post brought to mind something Mr. H and I have discussed a number of times: finding a hospital and/or physician practice that’s willing to share their EMR selection and implementation journey over a period of time. If you’d care to volunteer your insights on behalf of your organization (fame could be yours!), or if you’d like to share any recommendations, please let us know.

Newly posted on HIStalk Practice: the latest question in our HIT Executive series. Check out what several EMR vendors and consultants had to say about the HITECH Act’s short and long-term effects on innovation. Spoiler alert: the answers range from yes to no to maybe.

Thanks to folks at Vitalize Consulting Solutions (VCS) who shared the the news that HIMSS and Modern Healthcare named recipients of their 2010 CEO IT Achievement Awards. The two winners are Peter Fine, president and CEO of Banner Health (AZ), and, David Bernd, CEO of Sentara Healthcare (VA) — and a VCS board member.

E-mail Inga.

Monday Morning Update 4/26/10

From Alphonso: “Re: CattailsMD. The Marshfield Clinic’s CattailsMD project is in serious trouble and may be dead. Senior leadership for the project has been let go or moved to ‘new opportunities’ inside the organization (Bob Carlson and Paul Olinski). Project has gone nowhere for the past few years.” Unverified. I’m not sure why they had a booth at HIMSS or why they would try to commercialize their own product in the first place since that hardly seems core to their mission. Their own use of CattailsMD seemed imperative to them, so I’d be surprised if it’s being allowed to fade.

From Wade Wells: “Re: log on. What’s the fastest, most secure way to log on to PCs in health institutions? We key in our usernames and passwords, but with the rollout of clinical systems and speed being an issue, I’m interested to hear of others’ experiences. Some are suggesting card readers, biometric, etc.” Thoughts?

From Mad Max: “Re: WellPoint cancelling insurance for newly diagnosed breast cancer patients. This ought to be criminal activity. Please keep this story in the public eye and drive those insurance actuary slugs back under the rocks where they belong.” It’s the age-old debate of whether healthcare should be a noble calling or a cutthroat business. It’s in the same vein as to whether Cerner should use its legislative clout to squash competitors – who decides where good business yields to compassionate care? Meanwhile, HHS secretary Kathleen Sebelius asks WellPoint’s $13 million-a-year CEO to voluntarily stop the cancellations, noting that the practice will “soon be illegal” (which obviously reinforces the concept that it’s legal now). The company’s response claims that computer algorithms aren’t used for that purpose, that one patient who complained isn’t a WellPoint member, and that they’ll divulge specifics about her case that proves their side of the argument if she’ll sign a HIPAA waiver.

From The PACS Designer: “Re: iPad review. Another more complete test review of the iPad as a business tool comes to us from InformationWeek’s Fritz Nelson.”

The sponsors-only job board seems to be working fine, so I’ll consider it open for business. It has quite a few job listings already, thanks to volunteers who helped out by testing. This is a lightweight replacement for the job listing topic in the discussion forum. It’s not as fully featured as Healthcare IT Jobs and, unlike that site, it’s open only to HIStalk Platinum and Founding Sponsors (and is free to them).

I gave the iPad a quick grope yesterday. As you’d expect from Apple, it’s very sleek and has great graphics, with a display size that seems perfect for Web browsing or running apps. On the other hand, I’d worry about dropping it since there’s nothing to grab onto. I wouldn’t pay $499 for it since I could buy a full-feature Wintel laptop for less (with a real keyboard and everything). Travelers with computer needs mostly involving entertainment would probably like it, although they’d need to add on a data plan and even then I’d probably stick with an iPhone. Apple is selling a bunch of them even though they don’t really replace anything, though, so I will defer to public opinion.

Thanks to those who responded to my little survey about what hospitals readers are from. I’ve posted the list of organizations (without the job titles). 

Half or fewer doctor will get the HITECH money they expect, said 78% of readers. Only 9% think most of the doctors will get the full payoff. New poll to your right: are you personally aware of a situation in which a healthcare computer system directly caused patient harm?

EHRtv posts over 40 video interviews from the HIMSS conference.

The FDA will step up its oversight of IV infusion pumps, citing 10,000 complaints, 79 recalls, and at least 710 known patient deaths.

McAfee apologizes for its antivirus fiasco that took down computers all over the world, blaming its poor testing. A hospital reader’s comment you may have missed suggests VIPRE Antivirus from Sunbelt Software as a superior alternative.

Brigham and Women’s will freeze hiring and cut its operating budget by 3%, but says those actions are unrelated to the decision by Harvard Vanguard Medical Associates to shift its referrals to Beth Israel Deaconess Medical Center instead. BIDMC implies that its shared EMR access was a key factor in that decision.

An MIT mobile health group says open source mobile platforms are important for affordability and accessibility, making its first choice Google Android and eventually Symbian.

MedQuist completes its acquisition of Spheris.

A problem with the patient verification software used by Australia’s Medicare service causes several hundred errors, the significance of which is disputed. The software vendor had urged the agency to notify the 2,700 affected medical practices in February and March when the problem was found, but the agency declined.

This sounds like something Oracle would do: a formerly free Sun plug-in for Microsoft Office that allows saving documents in OpenDocument Format will now cost $9,000 for 100 users plus annual support, now that Oracle owns Sun.

Odd lawsuit: a Connecticut woman is charged with impersonating a nurse and forging prescriptions for narcotics while employed in a physician’s practice as an RN. Prosecutors say she spent $2,000 to make up a “Nurse of the Year” dinner in her honor from the Connecticut Nursing Association, an organization that she also made up. She sent her boss an invitation on fake letterhead to be a guest speaker at the dinner, which he did.

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News 4/23/10

From Reader: “Re: McAfee bug. Multiple hospitals (U of Michigan, Rhode Island Hospital System, Upstate University Hospital in Syracuse) report being affected by buggy McAfee security release. 1000s of computers down, emergency patients diverted and surgeries being postponed.” I know first-hand since it nailed our place, too, with all kinds of disruptions and “everybody get off the network NOW” emergency messages. McAfee wasn’t much help, being slow to post the problem and a tricky solution. It’s a great time to be a competing antivirus vendor.

From LeapFrog: “Re: Allscripts. I am hearing rumors of a joint GE and Allscripts user conference in June. What does that mean?” Inga tried to tracked this rumor down, reaching the conclusion that a joint meeting is unlikely given the short time frame. However: (a) the Allscripts sales meeting is in June; (b) Allscripts might like getting its hands on an inpatient product like the old IDX one that GE has botched, despite lofty Intermountain partnership announcements; (c) a new Allscripts sales director came from the old IDX group; and (d) GE’s IDX failure might make it happy to get rid of that product. All speculation, but not too far out there as rumors go.

From Dr. M: “Re: Meditech. The iPad runs Meditech using the Citrix connector.” Dr. M supplied the photo above. Another reader cautions that just because apps run in Citrix Receiver shouldn’t be construed to mean that vendors have released specific iPad clients or, until they do, that the Citrix versions are fully usable. The reader says some apps look good and navigation is OK, but typing is slow on the on-screen keyboard.

I’ve confirmed a couple of reader-reported rumors. You’ll Know Who reported yesterday that McKesson Provider Technologies had replaced Sunny Sunyal as president with McKesson Automation’s Dave Souerwine, which was confirmed today on the MPT site. In the Cheap Seats told you on March 29 that Merge Healthcare had acquired anesthesia EMR vendor Docusys, which I’ve finally confirmed through independent sources. Thanks for those reports!

Greenville Hospital System goes live with SabalRx, which routes medication orders to the proper dispensing location and technology based on location. I’ve never heard of Sabal Medical, the press release isn’t very good, and the “About Us” on the company’s Web page doesn’t say who “us” is, so that’s all I know.

Listening: Material Issue, long-defunct Chicago-based power pop.

This sounds like a bad idea: Medical College of Georgia will consolidate management with its hospital and physician group, with the just-hired college president (a doctor and scientist) also serving as CEO of MCG Health. The college’s CFO and CIO may also serve dual roles.

A New York Times article lists the downside of electronic medical records: odd computer placement in the exam room, the need to type instead of listen, an overwhelming amount of information for the doctor to review (like “having a 2-year-old in the exam room”), difficult to use systems that were designed for charging and not treating patients, and the failure of those systems to convey complicated information in an easily understood “story” form.

Another blow to iSoft and NPfIT: northern trusts scheduled to implement iSoft Lorenzo can now opt out and instead run McKesson’s Totalcare instead, courtesy of a new $55 million contract signed last week. Three of the trusts will stick with McKesson Star for some time. Reader UKMaxPaying thinks Cerner may be well positioned to take advantage of the mess and also calls attention to another Lorenzo go-live delay at Morecambe Bay, rumored to have been rescheduled from early May to the end of May.

Sage Healthcare is sponsoring the Texas Health Information Technology Summit, which started Thursday in Dallas. Everything you need to know about the agenda is contained in the prominent explosion-shaped graphic that says, “Learn how to get your $44,000”. I know a handful of the speakers, but not most.

CPSI announces Q1 numbers: revenue up 4.7%, EPS $0.27 vs. $0.37, missing analysts’ expectations and its own estimates.

The Huffington Post Investigative Fund continues its coverage of electronic medical records. In an article on patient harm, it cites 18 voluntary reports to the FDA involving Cerner software, one of which involved a patient death after “an unplanned hospital wide CPOE and electronic record breakdown.” A second article calls attention to a lack of FDA oversight, with its example being a GE Healthcare imaging system that reversed the patient’s image, causing the surgeon to operate on the wrong side. It concludes that a new oversight group might be formed by ONCHIT, with providers held accountable for reporting problems as a condition of receiving stimulus money.

Italian vendor Health Robotics says it’s now the largest American IV robotics vendor after signing 15 new contracts for i.v.STATION, i.v.SOFT, CytoCare, and i.v.Room of the Future as well as some beta contracts with big-name hospitals like Brigham and Women’s, Cleveland Clinic, Duke, and MD Anderson.  

Jobs: Allscripts Consultant, Integration Engineer, Senior Product Marketing Manager, NextGen Consultants.

The Birmingham paper profiles MedManagement, a 110-employee local company that offers advisory services and software, now offering Medicare admission help to hospitals. I like the poster in the background of the CEO photo, titled “Between a RAC and a Hard Place.”

Harvard-affiliated Massachusetts Eye and Ear Infirmary alerts several thousand patients that a laptop containing their information was stolen from one of its doctors who was lecturing in South Korea. They were able to detect it through its LoJack “phone home” feature and determined that someone installed a new OS without the software needed to read the information. They then sent a LoJack command over the Internet to trash the laptop’s hard drive. That’s pretty cool, although they still should have used encryption.

Strange: a British doctor labeled as a “Jekyll and Hyde” drives 800 patients away from his practice in four years by being rude to them during surgeries and focusing on his computer instead of them during consultations. And in this hardly shocking development: his wife, also his practice manager, was equally rude to his employees.

Reuters reports that WellPoint, the country’s largest health insurance company, uses software to target newly diagnosed breast cancer patients for the purpose of finding excuses to cancel their medical insurance.

Ideal Life, a Toronto company, says its wireless home monitoring devices (blood pressure, scales, blood sugar) are the first that are easy and affordable for remotely managing chronic disease, establishing two-way communication between patients and providers that can include motivational messages or tips. That along might not have earned the company an HIStalk mention, but this did: the CEO’s prior job involved the company that sells Teddy Ruxpin and Funoodles.

The outgoing CEO of Sage will get a $32 million parting gift.

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HERtalk by Inga

From NoPie: “Re: Cerner. I am a Cerner employee. I would like to point out that the McKesson Diabetes Initiative posted on the website yesterday is somewhat old news when compared to what Cerner has been providing for free for many years. There is no place I would rather be able to call home for my career. While others may read this e-mail and consider me just another person drinking from the ‘Cerner Kool-Aid’, we really are devoted to promoting a change in what Neal likes to call ‘the middle’ of healthcare.’ How refreshing to find someone from the vendor world who is willing to stand up and say they are passionate about their employer. I happen to like Kool-Aid every once in awhile, as long as it’s made with real sugar. I see on the Cerner Web site details of their Cerner Diabetes Initiative, which pledges to invest $25 million over 10 years for an online diabetes management tool for diabetic children. And, the Cerner-founded First Hand Foundation is a 15-year-old program that provides assistance to children with health-related needs. To date, the foundation has given $12 million in funds to children across 70 countries. Big kudos.

Allina Hospitals and Clinics (MN) selects Language Access Network to provide video language interpretation services to 11 of its hospitals.

University Hospitals (OH) launches Siemens Soarian Financials at Case Medical Center, completing University’s enterprise-wide deployment.

Edwin Miller, formerly with Artromick and athenahealth, joins Curaspan Health Group as VP of product management, along with three new sales executives.

Quality Systems, the parent company of NextGen, shuffles the roles of several executive leaders. Tim Eggena moves from executive VP of NextGen Practice Solutions to the newly created role of executive VP of R&D for NextGen’s ambulatory products. Monte Sandler takes over as EVP of Practice Solutions after serving as NextGen’s VP of account management. Finally, Donn Neufeld is now EVP of EDI for NextGen and QSI, in addition to SVP and GM of QSI’s Dental unit.

Kentucky Governor Steve Beshear announces the official launch of the Kentucky Health Information Exchange (KHIE), which currently connects six hospitals and one clinic. The Kentucky Department for Medicaid Services will also begin data exchange with the facilities.

Robinson Memorial Hospital (OH) selects Eclipsys Sunrise Enterprise as its integrated EMR solution.

Cullman Regional Medical Center (AL) will deploy MedAssets’ revenue cycle solutions for its 145-bed facility.

EDIMS will incorporate Callibra Inc’s Discharge 1-2-3 solution into its ED EHR product.

Harris Corp wins a $72 million contract to update the VA’s billing and collection operations.

University Health System (TX) implements InfoLogix’s HealthTrax mobility solution for its hospital and 20 clinics.

Brandeis University starts an online master’s degree program in health/medical informatics.

McLaren Health Care Corporation (MI) contracts for McKesson Paragon. PHNS will implement six more of McLaren’s hospitals, adding to the two already running Paragon.

Researchers from Henry Ford Hospital release details on their use of electronic medical records during last year’s Detroit Free Press Marathon. Using laptops and a Web sites, medical team members were able to coordinate patient care in real time, as well as help family members locate injured runners. Researchers say the solution also provides data to identify injury patterns and thus improve preparations for other large sporting events. There’s got a be a clever pun to tie the Ford/EMR/road race thing together, but it’s just not coming to me.

Franciso Partners expands its HIT holdings, making a significant capital investment in T-Systems. Founders Woodrow “Woody” Gandy, M.D. and Robert Langdon, M.D will remain on the board, with FP operating advisor John Trzeciak taking over as president and CEO. The company also owns QuadraMed, Healthland, AdvancedMD, and API Healthcare.

EMH Regional Healthcare System(OH) selects Allscripts EDIS for its three emergency rooms.

E-mail Inga.

Readers Write 4/22/10

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

License Rights in Your Software License Agreements
By Robert Doe, JD

Each software license agreement contains a provision which grants specific use rights with regard to the software you are licensing. However, software manufacturers’ standard contract documents may not take into account your organization’s specific use requirements.

As a result, unless your organization has a relatively simple legal structure, you should pay particular attention to this language to ensure the software can be used as you intend it to be used. The extra effort is well worth the time when you consider that without the proper license grant, you may be asked to pay additional, unanticipated fees down the road.

If you don’t alter the standard contract language, typically, the license grant is given only to the legal entity signing the contract. For example, a typical software vendor’s license grant provision might read as follows: “Licensor grants Customer a perpetual, nontransferable, nonexclusive license for the number of concurrent users set forth in Exhibit A to use the computer program listed in Exhibit A (the "Software") at the installation site set forth in Exhibit A for Customer’s internal business purposes.”

In this example, the license grant is given to “Customer,” which is typically defined as the legal entity signing the agreement, which may not encompass all the actual individuals that will use the software. Getting the license rights correct in your contract requires that you know how your organization is structured and who the individuals are that you want to be able to access and use the software, both at the current time and in the future.

If your organization has a parent corporation, or has one or more legal entities that are owned or controlled by your organization or are under common control with your organization, the typical vendor license grant provision will technically not allow any use by the employees of these “affiliate” organizations.

Another example of a situation that is not technically covered in most license agreements is use by contracted providers that are not employees of your organization. In addition, some organizations may have other independent contractors that will need access to the software at various times, such as computer consultants.

With more and more frequency, healthcare organizations are licensing software not only for their own use, but to use on behalf of other smaller healthcare organizations in the community. Similarly, some healthcare organizations are considering re-licensing their systems to smaller organizations at a reduced rate.

In the example license grant language above, use of the software is limited to the “internal business purposes of the Customer.” If the software is to be used, in part, for the benefit of an affiliated or unrelated organization, or re-licensed to such an organization, the license grant will need to be significantly modified to allow for such actions.

When licensing software, it may be worth the extra time to put some thought into how you intend to use the software, both internally within your organization and, if applicable, externally. As part of your analysis, you will need to understand the legal structure of your organization. This information will help you to make sure you have the appropriate license grant in your software license agreements to allow for the use rights you require.

Bob Doe is a founding member of BSSD, an information technology law firm located in Minneapolis, MN.