HIStalk Interviews Andy Smith, Co-Founder and VP, Impact Advisors

Andrew Smith is co-founder and vice president of Impact Advisors of Naperville, IL.

Tell me about yourself and about the company.

Impact Advisors is a healthcare IT consulting firm. We’re dedicated to the provider space. For us, that’s medical centers, academic centers, children’s hospitals, and physician groups. We also do some work in the payer space. 

We’re focused on the technology aspects of both planning and implementation. About a third of our business is associated with planning and assessment work, things like selections, Meaningful Use assessments, long-term strategy, interim management, governance modeling, and mergers and acquisition planning. Two-thirds to three-quarters of our business is focused on implementation work. A lot of our work is around the major inpatient vendors as well as the major ambulatory vendors.

I’ve always worked for a non-profit hospital, so I’m curious. The company has been around not quite five years. How do you go about starting a business in terms of money, research, and effort? How do you know what it takes to build a sustainable business?

Great question. I wish I would have known the answer five years ago. It’s basically School of Hard Knocks. The firm was started five years ago by myself and my brother, Pete Smith. Before that, we had spent 16 and 20 years plus at another consulting organization. For a lot of reasons, it was the right time to start up on our own. 

When we started, we had very modest aspirations. We thought we would just hang our own shingle and do some work.  But very quickly, other colleagues started to call, and clients started to call looking for a different kind of solution. We started to grow and have been growing ever since for the five years.

How do you form that company? That’s a great question. We hired some very experienced people to help us. We outsourced a good bit of our function. We just sort of figured it out. 

In terms of the requirements to get started, I get calls fairly frequently from people that are looking to start an organization. What I tell them is that working for yourself is great and I highly endorse it, but you need to be prepared to learn a lot on the job, you need to be prepared to take a lot less money and maybe not get paid for quite some time, and you’ve got to be willing to take some risk. If you’re willing to do that and you’re smart and your motives are pure, it typically will work out.

Some consulting firms stay small and are happy with that, while others get huge and then hit the wall where they either need to be acquired or grow to the next level. You’re probably at least somewhat surprised that you got as big as you did over that time. How do you see that playing out and what do you look for to challenge you in the next five years?

For us, culture and quality trump growth. We have grown. Our clients have asked us to grow. They’re asking us to do more and more for them to solve more and more complex problems. But for us, we are way more interested in doing it the right way. We resist those growth opportunities where we don’t think they are directly in concert with what we’re trying to accomplish as a firm.

We want to be a world class consulting firm. We want to be the best place for our consultants to work. We want to do really high quality work for our customers. We want to partner with them. We want to take work when we think we can provide it and we want to turn it down when we think that we can’t do the best job possible.

That has been a barometer of our growth. We couldn’t grow much faster than we have. We’ve probably averaged 50 to 70% growth over the five years, but that’s absolutely secondary to doing it the right way.

We’re a culture-based firm. We hire on attributes like work ethic and content knowledge, but almost as important is attitude. We want people that are willing to support each other, that are empathetic, that are client-delivery focused and obsessed, and at the end of the day are somebody that you wouldn’t mind having dinner with. That is the very first gate you’ve got to pass.

Growth has been a very nice outcome. We like growth. Growth means you’re winning. Growth means there is more opportunity for people to move in different directions in their careers. But for us, that is absolutely secondary. We think we still got some track in front of us. We think we can still grow for the foreseeable future and continue to retain our culture.

Consulting companies aren’t always great places to work with all the travel and emphasis on billable time. You’ve won some awards and hired a Happyologist, which I’m sure I made fun of at the time. What are you doing that the other consulting and vendor firms aren’t?

At the end of the day, it really gets down to the Golden Rule. Treat others like you want to be treated. It seems so patently obvious to me. I don’t know why their firms don’t do it, but I think we’re pretty good at creating culture. 

A lot of that comes upfront by making sure we have the utmost integrity during our recruiting process, and that we don’t overpromise during the recruiting process. We’ve got a wonderful recruiter who really is a wonderful gauge of that. It starts right up front at the first meeting and is constant communication through that person’s career. That’s the first thing we do.

Second thing, as you mentioned, we hired a Happyologist. His official title is director of associate satisfaction and culture. I think we’ve done a nice job of culture building. We won some awards. We were  number three in Modern Healthcare’s best places to work this year. We were the highest-rated consultancy in the last two years. We take it very seriously. 

I think we’ve done a historically good job of creating and nurturing culture, but we wanted to hire somebody who is absolutely 24/7 obsessed with how we treat each other and a culture we’re creating as a firm. So we hired our Happyologist, Michael Nutter. He has done a fantastic job over the last year. He’s really responsible for three things.  He is in charge of communication, internal and external. He is in charge of our professional development process or career coaching. He’s also in charge of our culture. 

That’s the intangible, but we do a lot of things around that.  We have our annual retreat, which we call Impactpalooza. Sorry – I think we might have used the name before you did, but we both stole it from Lollapalooza. You know we had an associate pet supermodel contest. We do winter dinners pretty frequently. We just finished a round of holiday dinners. Michael is really in charge of making sure that we celebrate ourselves, so that we celebrate our successes. We pick people up when they fall. That has left a very tangible impression about the firm.

Most of your folks are on the road, so I guess you have to make it bigger than life to make it memorable since you don’t see them often.

It is really hard. To win an award like Best Place to Work is really hard as a consultancy. We have some things going against us. We all travel like maniacs. We’re all pretty Type A-driven people. We’re working really hard at our clients. 

It’s really a family commitment. That’s one of the things we stress when we hire. Hey, this is tough work. You’re away from home, you’re working hard, you got demanding clients, you’re solving really tough problems that they can’t solve on their own. Your family needs to be comfortable with the lifestyle and the amount of work. I’ve actually interviewed spouses that we brought in to the recruiting process just to make sure we’re all in the same page.

You beat out some pretty good competitors to win the Clinical Implementation Principal award from KLAS, especially considering that the company hasn’t been around that long. What are the secrets that companies who might have been the favorites to win aren’t doing?

We pay a lot of attention to clients. We’ve got an executive assigned to each one of our clients. Their job is to make we are paying attention to them.

We are certainly not flawless. We’ve had mistakes. But I think where we are exceptionally good is that if we make a mistake, we always overcompensate. I’ve literally flown across the country to give a client their money back on a job where we did just an average job. Quite honestly, I don’t think we are an average firm; I think we’re an exceptional firm. So I flew across the country, gave the gentleman a check, and lo and behold, a few years later, we’re back there working again. 

Being private and small has allowed us to do some pretty interesting things and to stay really obsessed with overachieving our clients’ goals. I think that’s probably the thing we do better than others.

Who would you say are your most direct competitors?

We deal with the Big Five, the traditional ones. We deal with a number of vendors in the space that have similar profiles to ours. Depending on the job, we could compete with Deloitte or Encore or Aspen. We don’t typically do a lot of staff augmentation roles, so we don’t find ourselves competing with the staff augmentation firms that much. That’s a good business model; it’s just not the model we are in right now.

What we’re really doing is trying to hire the best people. We staff them from the leadership positions on down. It has become an interesting time because our clients are asking us to expand our services and asking us to supply a bigger and bigger footprint in their implementations. We’re starting to move in that direction a little bit, but I don’t think we will ever be a staff augmentation firm. If a client calls us and says, “I need 30 trainers for three months,” we very politely decline or we refer them to some trusted partners.

Opinions seem to vary about how many providers are chasing Meaningful Use money and how many of those are likely to get it. What are you seeing?

It’s absolutely been a catalyst for people to kick off large EMR projects, which has been great. It seems like there’s a bit of a gold rush going on right now. People are really focused on the money and maybe not so focused on the goals that are inherent of achieving the money. I totally get it. There’s money out there to be garnered; you might as well make sure you get it. I am hoping that there may be some tempering of enthusiasm over the next couple of years. All of our clients are very involved in planning for, reporting, and now cashing the checks.

Hospitals seem to be pacing themselves for a sprint, forgetting that after the sprint comes the long run. Do your clients understand that they’ll need more work than just going live, looking 5-10 years down the road to change their business?

I would totally agree. I don’t think as an industry we’re asking that question. What do we do when we get there? 

What we see is the industry is moving so quickly that there is going to be a wave of optimization or a Phase Two of these implementations going forward. We’re very interested in that. We spend a lot of time focusing at what’s next after the next two years. We think that’s going to be the really hot service area. 

We’ve got some methodologies already developed around how to attack that, but quite honestly the market’s not buying that right now. Our industry is really focused on foundational systems at this point, digitizing electronic medical records. After that’s done, I think there is going to be an entire wave of work about, OK, did the data we collect have integrity, what do we do with it, how do we turn it digital information? That’s the analytics – business intelligence wave of technologies we think will be very important in the coming years.

You must be involved in quite a few system selections. What products are hospitals looking for and what factors are driving the decisions they make?

Yes, we are doing a number of selections. I would say the most traditional selection is a system that is looking for a single vendor across multiple disciplines — inpatient, ambulatory, clinical, and rev cycle. It would be great if there was a vendor out there that provided traditional ERP solutions along with those other modalities, but I don’t think we’re there as an industry yet. 

They’ve been frustrated by a best-of-breed approach and the lack of information flowing across their continuum of care. That is probably the biggest driver we are seeing right now.

In terms of the sizeable accounts, is anybody beating Epic?

Not really. They are certainly the vendor to beat in the space right now. They do have a lot of that integration story to tell. They have integrated ambulatory, inpatient, rev cycle, and clinical product, obviously. You probably saw the KLAS reports as I did. They’re winning a majority of selections in the industry right now.

What does that mean for a business like yours? Epic offers their own implementation services and Epic-certified consulting firms are competing for the limited number of certified people.

We are a certified Epic partner as well. There is an incredible demand for a good implementation partners that know that set of technologies. That has been a major growth area for us in the last two years and will probably continue to be one for the next few.

I think we have a very good relationship with Epic. We absolutely challenge them, but I think at the end of the day, what we do is help implement their products more efficiently and to a better outcome. 

I find that we typically provide a lot of leadership, subject matter expertise on their projects, but we’re not backing up the truck, either. We are a small firm. If a client comes up and says, “I would like to outsource my 200-person Epic implementation,” again, we politely decline. But if they come to us say, “Hey, we really need some trusted partners in some key positions to help us implement this more effectively,” that’s right up our alley. That’s where we’re best.

You mentioned that you don’t back down from Epic, but if getting on their bad side resulted in their not approving you as a consulting firm, that would hurt desperately. Do you think companies fear Epic in that way?

I don’t worry about that. I don’t think we really can worry about that. I think at the end of the day, if our intentions are pure and we’re trying to accomplish what’s best for our clients, all the rest is going to work out. That is Epic’s corporate philosophy as well. I find that we’re typically very synchronous in what we are trying to accomplish. It may just be the means to the end.

Having said that, we work very well within their methodology. They bring in an incredible amount of tools and skills to the implementation and I think we complement that very nicely. Our traditional person within Impact Advisors comes with probably a 10-year clinical operations background and a 10-year consulting background. We bring some real-world experience that complements very nicely their products and services, so I think it’s a nice fit. I don’t really worry about challenging them. I worry very much about being an advocate for our clients. The rest tends to work out.

What issue or actions are threatening hospital CIO job security?

Failed implementations are always at the top of the list. If you aren’t meeting the objectives you set forth and you spent tens or hundreds of millions of dollars in the pursuit of, that’s not a good thing. At the end of the day, you need to be able to prove outcomes. Our industry, I would say, has not done that great a job of clearly identifying the return on investment and then measuring it post implementation. 

I think there will come a time where the CIO is expected to say, “OK, we spent $100 million and we achieved a 120 or 200 or 300 million dollars worth of benefit.” That would be the first thing I would worry about. The second thing is no different than any business — overpromising and under-delivering. If you can’t run a tight organization and have a staff that’s focused on client delivery and outcomes, that’s never good as well.

If you look at where the industry is today and where you think it might be 5-7 years down the road, what kind of things do you see?

I think it is going to be an incredibly fun ride. I think the next five years is going to continue to be dynamic and tumultuous. I think that the firms that do best in this industry over the next five years are going to be the ones that  innovate with their clients, that hire the best, that are nimble and agile, that can move with the market. I think we’re good at that. 

It is very difficult to predict what is going to happen over the next five years, but if we stay focused on the objective of good client delivery and helping our clients achieve great clinical outcomes and help them do that as efficiently as possible, we can’t go wrong no matter what happens in the regulatory environment or legislative environment.

Any concluding thoughts?

It has been amazingly fun to grow a company over the last five years. It has been really liberating. I’m very proud of what we have achieved over the last five years. I’m really proud of the culture we have built. I’m really proud of the people we get to work with every day. 

I’m thankful for our clients. We get to work with some of the blue chip clients in our industry. We get to learn from them and help them achieve some great things. It has been a fun ride.

Monday Morning Update 1/9/12

From California Girl: “Re: CareFusion. Has done some executive trimming of late and more layoffs may be in the offing.” Unverified.

From Lucitania: “Re: Gerry McCarthy of McKesson. Confirming that he’s leaving for HealthMEDX to work with Pam Pure again. The internal announcement didn’t give his new role.”

From RS: “Re: Kathleen Sebelius. Op-ed in The Washington Post this evening.” One might quibble with her assessment that the Affordable Care Act is “putting consumers back in charge” by (a) requiring insurance companies to provide an explanation when they increase premiums by 10% or more, and (b) also requiring them to spend 80% of premiums on health care services, which of course still lets them make their big money by investing prepaid premiums until services are actually rendered, which allows them to put their signs on tall buildings and to sponsor sporting events. The problem with reducing healthcare costs is that it would require (a) patients who are conscientious about their consumption of healthcare dollars paid by someone else, which hasn’t worked well historically; and (b) politicians with non-partisan political backbone who are willing to rile big organizations that are loaded with lobbyists and campaign donations, which never happens. And in the way of counterpoint, here’s a comment left on the article:

Tired talking points. Where do I start? Funding was shifted from the Medicare program and the doctor SGR fix was intentionally omitted to make this law "bend the cost curve down", but ACA does nothing to lower costs. Savings were based on finding fraud and abuse, which could have been done in the current system. The rising costs of premiums cited by Sebelius are going to insurance companies who squirrel it away in profits hidden as loss reserves. Any increases in payments for the last 9 years to doctors and hospitals have been lower than the same inflation rate. Her state-based "competition" is dependent on states participating. The "80-20" rule doesn’t apply to AARP plans in exchange for their support. For AARP it is really a 65-30. Lastly if it is so great, why has the administration granted so many waivers to unions and large contributors?

It’s HISsies voting time. I’ve placed the most-nominated entries on the final ballot, which I’ll e-mail out Monday evening. I won’t send an e-mail reminder (since I always get a few complaints about wasting 0.5 seconds of someone’s time to read and ignore the e-mail subject line vs. the five minutes it takes to complain about it), so watch your inbox and check your spam filter if you don’t receive yours. Voting is limited to subscribers to the e-mail update as of this past Saturday morning when I had time to create the ballot e-mail list.

Vince’s HIS-tory this week goes micro – it’s all about the early days of PCs in hospitals. Quite interesting as always, and fun to read of the one example where Apple took a hospital beat-down from the old-guard IBM.

Listening: Veruca Salt, mid-90s, unpolished hard-charging chick rock. And while Mrs. HIStalk and I were having lunch today at the local hipster taqueria, I bet I was the only person there who could identify the music playing over the sound sytem – Portishead’s “Glory Box.” Mrs. H applied minimal effort in pretending to be impressed.

Around two-thirds of readers aren’t buying it when a hospital’s post-mortem on computer downtime claims that patients weren’t harmed as a result. New poll to your right: are business conditions better now than a year ago?

Welcome to HEI Consulting, a new Platinum Sponsor of HIStalk. The KCMO-based company provides expertise all over the world in everything related to Cerner Millennium on both the clinical and revenue cycle sides of the house, including assessments, selection, implementation, workflow analysis, revenue cycle, EDI, CCL scripting, Cerner Open Engine integration, data extraction, and optimization. They offer experienced analysts who have been involved with Millennium implementations worldwide, including in the UK, Middle East, Canada, and of course the US. If you need help with Meaningful use, workflow optimization, ICD-10, give them a call. Thanks to HEI Consulting for supporting HIStalk.

My Time Capsule editorial from five years ago: Happy 2007 – Now Get Back to Work! An extract: “Hospitals, too, get busy after months of letting IT projects lie fallow. No wonder ROI is hard to come by — projects come to a screeching halt because of non-IT staff refusal to get involved during (a) the November to January holiday block; (b) summer vacations; (c) school spring breaks; (d) impending JCAHO or state inspection visits; and (e) local, state, or national conferences involving anyone remotely involved in projects. No wonder implementations take forever – they’re on hiatus half the year. ”

The perennial underperforming and unimpressive Yahoo pays $26 million to secure the services of its new CEO for one year, although that’s a pay cut from that of the previous CEO, who made $47 million in one year before being fired over the telephone. I like Yahoo Finance and I use their e-mail because I like it better than Gmail, but otherwise I couldn’t tell you anything they offer and I don’t really want to know.

John Snyder MD of Mayo Health System in Eau Claire, WI is named as a Mayo MacMillan Scholar. He’ll continue his work with workflow and electronic medical records.

A new Vanderbilt study by Josh Denny MD, MS (above) and Dana Crawford PhD links DNA samples with electronic medical records to examine the genetic basis of hypothyroidism.

CMS takes a bold step to curb high levels of Medicare fraud in 11 states (FL, CA, MI, TX, NY, LA, IL, PA, OH, NC, MO) in allowing RACs to review claims before providers are paid instead of the “pay and chase” standard of pay first-ask later. Orthopedics specialists, as you might expect, aren’t thrilled at that policy, suggesting also that CMS should spend some effort cutting back on direct-to-consumer advertising for free motor scooters and sleep apnea machines, which it says only two countries (the US and New Zealand) allow.

National Coordinator Farzad Mostashari lists ONC’s accomplishments for 2011 and invites comments on the biggest health IT trends for 2012. On his list:

1. Launching Meaningful Use
2. Taking the Direct Project live
3. Releasing the National Quality Strategy to use technology to reduce hospital-acquired conditions, heart attacks, and strokes.
4. Running the Standards Summer Camp.
5. Developing software contests.
6. Issuing grants and curricula for healthcare IT education.
7. Implementing breach reporting requirements as part of HITECH.
8. Launching a consumer e-health program that includes regulations making it easy for patients to access their lab results.
9. Exceeding the enrollment goals of RECs.
10. Measuring the growth in EHR adoption.

Rural doctors in Australia, eligible for $6,000 each in telehealth grants but offered minimal assistance and incompatible software modules, are often just giving up and using Skype instead. According to the president of the rural physician’s association, “In many cases, it works much better than some of the more sophisticated things out there. There is a whole range of technologies and, in establishing video-conferencing, [doctors] are not going to go out and buy some extravaganza of a system, they are going to stick with the simple stuff. Inevitably, there will be shonky players coming into something like this. Doctors have concerns about people putting together hardware and software and calling it a video-conferencing solution.”

E-mail Mr. H.

Readers Write 1/6/12

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

Building a Successful EMR Dress Rehearsal Program: Why it Matters
By Kathy Krypel

EMR implementations are not technology-only projects. They are care process redesign efforts enabled by technology. To that end, it is critical to engage care providers early in the planning and design process and throughout implementation and support. Dress rehearsals, in particular, let them to see how their decisions made during the build process “come to life” prior to actual go-live.

Dress rehearsals are detailed scripted care events that interweave complex processes from various members of the care team with the new EMR technology to simulate real care delivery experiences. There are different approaches to dress rehearsals, so picking the right one depends on the scope of the interactions, risk level, and process complexity. The most common ones are:

• Departmental. Scope is narrow, detail is deep. There are some significant procedures that do not happen frequently, but are so complex that organizations want to develop a dress rehearsal to make sure all roles and possible outcomes are addressed (e.g. transplants).
• Day in the Life. Scope is wide, detail is shallow. Day-in-the-life rehearsals are typically short (less than one hour) to perform and focus on workflows nurses, physicians, and other clinicians follow during their day.
• Integrated. Scope is wide, detail is deep. Integrated dress rehearsals are the most common type and usually last two to four hours. They focus on common workflows with multiple integration points.

The keys to successful dress rehearsals are preparation and participation. When the application teams, site leadership, and super users are fully engaged in both planning and execution, there’s greater buy-in up front, and there are fewer calls to the help desk after go-live.

Questions often come up during the planning phases concerning timing, issues communication, and degree of authenticity. While there’s no one right answer, the following responses to FAQs are based on our experience with successful dress rehearsals:

Timing: “Match timing with approach”

Day-in-the-life dress rehearsals can start as soon as some basic nursing and physician workflow(s) are built and ready for all to see. “Lunch and learn” sessions often offer end users a chance to see and interact with the system prior to go-live.

Integrated and department-specific dress rehearsals should be held as close to go-live as realistically possible. They are led by super users and attendees who have already been through training and practice sessions, so they are familiar with the system. This type of dress rehearsal offers end users one more chance to interact with the system before go-live and to follow their workflow through the care process.

Authenticity: “Keep it real”

Whenever possible, use the equipment and follow workflows accurately. However, make sure all of the pieces work in the dress rehearsal environment. The use of interfacing technology, when working smoothly, greatly contributes to end user confidence. When it doesn’t work, it adds to end user anxiety and impacts confidence in the technology.

Issue Resolution and Communication: “Write it down and follow up”

The dress rehearsal scribe needs to record any questions and concerns, and assign due dates for resolution. Consider using the time at the end to address issues. Often, the needed expertise is already attending/ participating, so problems can be readily resolved and changes approved.

Done at key points during the implementation project, dress rehearsals identify issues early on, so adjustments in technology and process can be made in time to retest and refine. This in turn increases the likelihood of a successful EMR implementation. Equally important, dress rehearsals engage care providers prior to system go-live, mitigating pre go-live anxiety and gaining their buy-in – all critical for achieving Meaningful Use.

Kathy Krypel is a senior associate with Aspen Advisors of Denver, CO.

VNAs and Enterprise Archiving – A Stepping Stone To Healthcare Data Management?
By Tim Kaschinske

At the same time that PACS are proliferating beyond radiology and into other disciplines (such as cardiology and orthopedics, for example), the responsibility for archiving and storing all of this DICOM data is moving away from individual departments (that have traditionally managed these environments) to a hospital’s central IT department. Healthcare CIOs have rolled up their sleeves and embraced the concept of a Vendor Neutral Archive (VNA) or Enterprise Archive as the best approach to managing this data storage challenge.

However, PACS is only one of many systems that a hospital has to manage; and healthcare data encompasses content from all manner of applications, both clinical and administrative. Consequently, a hospital’s storage systems also need to support everything from video to scanned documents to e-mail. Here are just a few of the activities and data types that need to be incorporated:

• Sleep Studies – where EEG and EKG waveforms are captured for brain and heart activity during sleep. Often this data is stored in a proprietary format.
  Endoscopy – where videos of the esophagus, stomach, or colon are captured.
• Scanned Documents – where paper documents that are scanned in and stored as PDF files.
• Laboratory Results – often transmitted using HL7 messages and stored in various formats.

To cope with these many and varied data types, hospitals need a VNA or Enterprise Archive that can deal with more than just DICOM data. In addition, to facilitate data exchange, these archives are adopting the XDS standard for cross-enterprise document sharing.

Over the next 12 months, more CIOs will adopt XDS-enabled archives as a standardized way to store, query and retrieve clinical and administrative content. In facilitating the registration, distribution ,and access across healthcare enterprises of electronic patient records, XDS enables IT to manage and share any document type. It works with DICOM (XDS-I) as well as multiple repositories indexed by a single enterprise registry.

As healthcare storage evolves, the VNA acronym will almost certainly be replaced with something that more accurately describes hospital storage systems. In reality, hospitals are looking for comprehensive healthcare data management. As such, hospitals need to adopt all the best practices typically associated with managing data across the Enterprise, such as:

• Data Protection – providing the ability to store additional copies of data to multiple locations and restore that data in the event of a disaster.
• Multi-media Support  – offering the ability to store and migrate data across different storage devices and media types, all independent of user applications.
• Data Versioning – enabling version control and management of data that can be restored in case of errors or corruption.
• Data Authentication – ensuring that data copied between sites or media types remains consistent and is not corrupted during the copy.
• Business Continuity – for the protection, preservation, and speedy restoration of systems and data during an outage.
• Data De-Duplication – providing the ability to detect multiple copies of identical data and store only one copy with multiple references.

Throughout 2012, hospital IT will be challenged to transform their PACS-centric storage into holistic healthcare data management systems. In the process, they will need to adopt a vendor neutral approach to their hardware and a data-agnostic approach to content. Just what we’ll end up calling it remains to be seen.

Tim Kaschinske is a consultant, healthcare solutions with BridgeHead Software.

2012 New Year’s Resolutions
By Vince Ciotti

Listed in order by their annual revenue, here are Vince Ciotti’s 2012 New Year’s resolutions for each of the leading HIS vendors:

1. McKesson:  Series will be sunset and Horizon announced as the go-forward product. Whoops, I’m sorry, that I meant to say Star is being sunset and Paragon is… oh, never mind!
2. Cerner: “ProFit” to be re-named “LossLeader” and targeted to hospitals whose CFOs and CIOs have a combined IQ of under 25 beds.
3. Siemens: will begin work on a new ERP suite for Invision which will allow them to automatically deduct monthly invoices from the AP system. The new system will be called Invasion.
4. GE: any hospitals that buy Centricity in 2012 will receive a free GE refrigerator for the first 30 patients registered in Centricity.
5. Epic: will sell to 100-bed and under hospitals provided they agree to send all inpatients to Verona for a two-week vacation to learn their EHRs. Epic will send one of its rookies to outpatient’s homes for training, but this will not earn them “good” maintenance rates on their EHRs.
6. Allscripts: will announce the complete integration of all of Eclipsys and Allscripts’ sales brochures, advertisements, PowerPoints, proposals and contracts. Work on disparate data bases and reports to commence in 2013.
7. Meditech: now that the Release 6 implementation line has reached 36 months from date of contract signing, orders are being taken for Release 7.
8. NextGen: announces an integrated solution combining their Opus, Sphere, and Prognosis HIS systems, to be called “Opusphernosis.”
9. QuadraMed: is renaming the integrated version of Affinity and QCPR as “Infinity,” the time it is estimated it will take to complete the project.
10. Keane: NTT wants its money back from Caritor, claiming that Optimum was not fully developed despite the many demos they observed, extensive marketing literature provided, written RFP response attached to the contract, and personal assurances they received from executives.
11. CPSI : is targeting the 500+ bed and up hospital market with a powerful new system that will run on two servers!
12. HMS: their new MedHost ED system is now being offered to hospitals without an ED at a special reduced price during the first quarter 2012.
13. Healthland: is planning a name change to Dairyland to emphasize their Midwest roots, strong service ethic, and diverse industry experience.

Vince Ciotti is a principal with H.I.S. Professionals LLC.

Time Capsule: Happy 2007 – Now Get Back to Work!

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

I wrote this piece in January 2007.

Happy 2007 – Now Get Back to Work!
By Mr. HIStalk

Happy New Year! Considering the alternative, be glad that you were alive and well enough to eat and drink too much over the past couple of weeks. Now get back to work!

You’ll notice your local newspaper, having slyly given many of the real news staff time off for the holidays, is padding out their already-slim editions with time-insensitive material written in advance or copied off the wire services: witless phony New Year’s resolutions for local politicians, tired rosters of the biggest personalities and celebrity deaths of 2006, and pleas for donations to community causes.

I can see why. Healthcare IT news is sparse this time of year, too. No one wants to bring out new products, start implementations, hire or fire people, or make changes in the strategic plan when no one is paying attention (hmm: this would actually be a good time to announce bad news, wouldn’t it?)

If our industry was a sport, the season would begin at the HIMSS conference in late February. It sets the tone for the upcoming year, as companies save positive announcements to coincide with the annual bacchanal. Vendors who make a bad impression at HIMSS will find it difficult to recover throughout the year, with attendees critically evaluating their demonstrations, booth size, staff attire, and cheery spirit or lack thereof. No wonder that even those companies in imminent danger of collapse spend the equivalent of a small country’s gross domestic product on one glorious, go-for-broke HIMSS splash, hoping against odds to get their money’s worth in new business.

Hospitals, too, get busy after months of letting IT projects lie fallow. No wonder ROI is hard to come by — projects come to a screeching halt because of non-IT staff refusal to get involved during (a) the November to January holiday block; (b) summer vacations; (c) school spring breaks; (d) impending JCAHO or state inspection visits; and (e) local, state, or national conferences involving anyone remotely involved in projects. No wonder implementations take forever – they’re on hiatus half the year.

CIOs have plenty of work to do. All those clinical systems projects still need to be finished. Celebrate the completion of major phases with some downtime and reflection, don’t forget to keep pushing at needed process changes and system improvements, and then jump into the next round of work. Clinical systems projects are like painting the Golden Gate Bridge: they’re never finished.

Speaking of clinical systems, if you haven’t yet made a commitment to bedside barcode verification of medications, then now’s the time. Same, too, with tightening up your Pyxis access with biometric security, override vigilance, and double-checked stocking procedures. Your patient safety experts aren’t sitting in IT, so get them involved and listen to their recommendations.

Microsoft has a new operating system and Office version – yay! Users will be upgrading at home, scornfully wondering why your IT department is holding them back in the Stone Age with systems they shamefully underuse anyway. You needed that non-strategic headache, right? At least PC hardware keeps getting cheaper, right about the time Vista will neutralize the benefit by requiring more of it.

RHIOs will want your attention in 2007. Your data, too. Maybe now’s the time to catalog all the electronic data elements you have available and to develop a plan to move important paper-based ones to electronic formats.

If you haven’t already, let one of your computer geeks play around (officially) with Linux, both server and desktop. If you aren’t running it at all now, you will be soon. In fact, you might as well encourage your nerds to bring in whatever compiler, software, scripts, tools, or websites they’re fooling around with because the gap between hobby computing and work computing is narrowing. At least you’ll be able to explain to youthful users why your hospital doesn’t need an official MySpace page.

Stark relaxation means you may need to support a new class of impatient, computer-illiterate users: doctors in private practice and the inconsistent employees they hire. Keep stats to get budget dollars since those support hours have to come from somewhere. It’s a warning you don’t need: office EMRs are going to be hot for the foreseeable future, which means lots of newbies are going to need help.

Lastly, if you’re in management, please make sure to recognize and reward those who work for you. When you get too full of yourself, make a list of which essential personnel would be needed in case of system failure, natural disaster, or clinical emergency. You’re probably not on it.

I hope our industry and all of us working in it have an excellent 2007. If in doubt about a particular course of action, remember WWIWAAP (which you may pronounce WEE-WEE-WAP, since I just made it up): what would I want as a patient?

News 1/6/12

Top News

HHS introduces streamlined rules governing electronic fund transfers from health plans to doctors, which it says will cut approximately $4.5 billion in administrative costs over the next 10 years. The new rules require remittances from health plans to include tracking numbers, making it easier for doctors to match payments with bills.

Reader Comments

From NoVegas: “Re: animated ad. When reading yesterday, I noticed that there are still some animated ads up. I thought they were going away?” A handful of well-intentioned sponsors missed the deadline to switch out their banners, but have assured us their new ads are forthcoming. Meanwhile, join me in a collective “thank you” to those who were happy to comply with readers’ requests to retire the flashing ads.

From Swami: “Re: MedPlus. An RFP posted by New Mexico HIC says they’re exiting the HIE market. Are you aware of their plans?” We asked the company, which provided this response:

MedPlus, the healthcare IT subsidiary of Quest Diagnostics, has made the decision that the company will no longer enhance or further develop the product known as the FirstGateways Clinical Portal or Centergy Clinical Portal. MedPlus continues to satisfy its support and contract obligations to each customer of this product. When all such support and contract obligations expire, however, the product will be permanently sun-setted.

From Birdie Little: “Re: McKesson Provider Technologies. [executive’s name omitted], a 20-year veteran SVP of product management and marketing, is leaving, supposedly to take a small company CEO job. The Horizon fallout had influence.” Unverified, with the name omitted for that reason. Another person reported a similar rumor about the same person, but gave the new employer as HealthMEDX, which former McKesson EVP Pam Pure joined as CEO a few weeks ago.

From The PACS Designer: “Re: Apple’s 2012 launches. The rumor mill from the Far East is heating up again, with info circulating that we may see the launch of Apple’s iPad 3 with the LTE communications upgrade. Since Steve Jobs’ birthday was February 24, the launch may happen then. Later this year, we’ll see the launch of Apple’s iTV, not to be confused with the current $99 Apple TV product.” February 24 would be a lousy date since vendors will be giving away bunches of iPad 2s that very week at the HIMSS conference, just in time for them to be rendered obsolete. That happened last year, as the iPad 2 was released on March 2, a week after the conference. As an alternative, how about the above as a giveaway to Apple fanboys (most of us, I suspect): a creepily lifelike 12” Steve Jobs action figure (that’s an actual photo of the doll above). The manufacturer provides free accessories: two pairs of glasses, a chair, two apples (one with a bite taken out of it), and a backdrop that says “One More Thing.” It goes on sale next month as long as Apple’s lawyers can’t figure out how to shut down a company operating in China.

From Rumble:

“Re: Partners HealthCare. The earth shook in 1994 when MGH and Brigham and Women’s joined to form Partners. Rumor has it that they’re definitely going commercial for their clinical systems – the end of home-brewed. They spent $200M for Siemens ADT before Glaser became CEO of Siemens. Several sources, none official, are confident they’re going Epic. I feel the earth moving again.” Unverified, but I would be shocked if they decided otherwise.

From Roots Fan: “Re: Burlington, VT. Men’s Health just listed it as the #1 Best City for Men, with emphasis on the local hospital’s implementing of Epic, especially MyChart.” The real objective is to sell magazines, and junk stories based on a numbered list (often presented via a lame slideshow) to bait intellectually lazy readers. They’re the literary equivalent of fast food restaurants, providing overly processed, nutrition-devoid fat calories (“The 15 Hottest Actresses You Will Never See Naked On Film” “10 Humor Sites to Make You LOL” … notice they always start with a number to make it clear that minimal mental effort is required to skim them.) I’m not sure having MyChart available is that big of an advantage and Burlington is hardly unique in that regard, but the magazine was mightily impressed, suggesting that doctors just needs your encouragement to implement Epic so you can play with MyChart on your iPhone:

“Our major medical center recently introduced electronic medical records, which will hopefully further boost rates of preventive care,” says Dr. Vecchio. Doctors will soon be able to program preventive-care reminders into patients’ e-records so they never miss screenings. Ask your M.D. about switching to digital records, and then download the MyChart app, which lets you use your smartphone to view your medical file and any screening reminders.

From HIPAA Hound: “Re: doctor’s perspective on end-of-life care. Exactly what I’ve often thought, but never heard much like this, especially from a physician. Adherence to this treatment philosophy would surely save the country billions each year.” I’m glad you sent the link since I read and enjoyed the piece, but forgot where I’d seen it. The gist of the article is contained in a quote from it: “… Doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little.” It argues that doctors are expected to recommend care that they themselves wouldn’t want, with procedures that are not only futile, but painful or degrading. It’s restrained in barely mentions the huge cost taxpayers bear as all the stops are pulled out for Medicare patients in their final days of life, with minimal benefit to anyone.

HIStalk Announcements and Requests

  One of our creative sponsors suggested a new and fun event for HIMSS this year: the HIStalk Booth Crawl. More details will be coming soon, but it’s likely that Crawl participants will have a better chance of winning an iPad 2 than they would hitting it big in the $1 slot machines. If you are a sponsor and have not received details on the Crawl, drop me a note ASAP. Potential players, stay tuned.

  After last week’s getaway in the part of the world Mr. H called “The Land Without Broadband,” I am back in full force. If by chance you failed to peruse HIStalk Practice over the last couple of weeks, here are a few gems you missed. Who to contact to appeal 2011 PQRS or e-prescribing payments. A family practice doctor’s use of social media includes posts entitled, “Are You Smarter Than a Medical Student?” My secret indulgence and 2012 predictions and resolutions. CareCloud adds a director of clinical technologies. Don Michaels offers excellent insight into EMR attestation in 2012 (it’s going to be crazy) and ACOs (the jury is still out.) Dr. Gregg and the percolating e-patient revolution. It just takes a few minutes to be enlightened on happenings in the HIT ambulatory world, so come join the fun.

Over 500 people have signed up for HIStalkapalooza invitations in the first couple of days, so if you are contemplating attending, click here or on the graphic in the upper right column. We always get an interesting mix of executives, unsung in-the-trenches grunts, students, investment people, and semi-celebrities, and this year’s event was designed to encourage them to network (lots of conversation-friendly small spaces, for example, not to mention an open bar.) We’ll close down registration in a few days and e-mailed invitations will follow. It’s only a handful of weeks away, shockingly.

I mentioned that I’m not a fan of year-end industry predictions, given that (a) many of the pundits don’t have the credentials and experience to be making them; (b) nobody wants to look stupid in print, so they predict the obvious; and (c) their predictions are often tediously defended with shallow and unconvincing reasons they believe themselves to be right. Not true of our own Travis on HIStalk Mobile, whose 2012 predictions are specific, bold, and concisely convincing. I like his attitude: “I’ve tried to be specific with some of them, not because I necessarily have any inside information, but because I’ll look good if I’m right and people will likely have forgotten if I’m wrong.”

Listening: reader-recommend Arkells, Canadian semi-hard rockers with a blue-eyed soul sound and strong vocals (think Hall & Oates meets Kings of Leon meets Springsteen.) I’ve listened to the album a couple of times and it’s really good. Nice call by the reader. I’ll definitely be giving it several more listens.

Acquisitions, Funding, Business, and Stock

MedAssets announces that is has paid the $120.1 million deferred purchase consideration due to the former owners of the Broadlane Group as part of the acquisition completed in November.

Frontier Capital invests inHealthx, an Indianapolis-based vendor of health plan portals for patients, employees, and physicians.

Sales

Iowa e-Health selects ACS to implement and manage its HIE.

Summit Medical Group (TN) signs a three-year contract renewal with Zix Corporation for its e-mail encryption services.

The Illinois HIE awards InterSystems a $7.25 million contract to implement its HealthShare HIE technology platform.

North Shore LIJ Health System selects Wolters Kluwer Health’s ProVation Order Sets as its electronic order set solution.

Prognosis HIS announces new sales to Colorado-Fayette Medical Center (TX), Biggs-Gridley Memorial Hospital (CA), Plumas District Hospital (CA) and Shamrock General Hospital (TX).

Mammoth Hospital (CA) will deploy Allscripts RCM services and EHR at its 11 outpatient clinics.

Independence Blue Cross (PA) selects Kony Solutions’ Write Once, Run Everywhere as its mobile application platform.

Mental Health Partners (CO) chooses Stockell Healthcare Systems’ InsightCS RCIM to integrate with the MindLinc behavioral EMR.

Pacific Eye Specialists (CA) selects SRS EHR for its 10 providers.

Doctor’s Medical Center (FL) signs up for Vitera Intergy Meaningful Use Edition for its 23-physician practice.

People

Olathe Health System (KS) hires George Dix as CIO. He was previously with Cape Fear Valley Health System (NC).

Andrew Ziskind MD, previously with Accenture, joins Huron Consulting Group as a managing director in the company’s healthcare practice.

Announcements and Implementations

St. Joseph’s Medical Center (CA) implements PerfectServe’s clinical communication and information delivery system.

Continua Health Alliance and some of its member companies will exhibit personal connected solutions at the International Consumer Electronics Show (CES) in Las Vegas next week. That show outdoes HIMSS in terms of celebrity sighting potential, with Dennis Rodman, Justin Bieber, Snooki, and 50 Cent among the glitterati collecting big corporate paychecks for serving as set dressing for booths.

athenahealth announces that it proactively sought and received a favorable Advisory Opinion from HHS’s Office of Inspector General relating to athenaCoordinator, a fee-based offering that would provide order transmission and coordination services to providers. The opinion clears the way for athenahealth to offer a per-transaction pricing model that charges fees to parties that are exchanging clinical data, but steering clear of anti-kickback statutes.

Government and Politics

HHS announces two winners of its contest to create HIT applications using public data for cancer treatment and prevention. The ONC awarded $20,000 each to the developers of  Ask Dory!, submitted by Applied Informatics, and My Cancer Genome, submitted by Mia Levy PhD, MD of Vanderbilt University Medical Center.

Other

Serbia’s health minister says the introduction of an electronic health card system has turned doctors into scribes, forcing them to fill out forms instead of taking care of patients. He offers a solution: “When a doctor finishes examination, he/she enters data into computer and then takes a health card and fills it in manually. I asked them why not printing the findings and attaching them to the health card. That would speed up the process.”

University of Mississippi Medical Center lays off 115 employees and cuts 90 unfilled positions, saying it’s struggling with increased charity care and coming up with the $80 million it needs to implement Epic.

An Iowa public policy analyst discussing the pre-caucus healthcare climate there says the governor accepted $7 million in federal HIE grants while calling it a government takeover of healthcare. “The practical side of that is that many don’t want the government telling them what to do, and the only way that can happen should this continue forward is by setting up your own exchange, otherwise the feds will set up their own.”

Sponsor Updates

• Free EMR vendor Practice Fusion streamlines its e-prescribing workflow.
• Greenway Medical Technologies and NextGen will join MedAllies at the HIMSS12 Interoperability Showcase to demonstrate MedAllies’ Direct HISP patient data exchange solution.
• Computerworld includes Ugo Mattera, VP of information technology operations at McKesson Health Solutions, in its 2012 class of Premier 100 IT Leaders.
• MED3OOO announces a free webinar regarding its PQRIwizard powered by CECity.
• McKesson introduces its cloud-based supply chain solution to support supports multiple materials management information systems.
• Southern Tier HealthLink (NY) expands its use of Lawson Cloverleaf Hosted HIE.

EPtalk by Dr. Jayne

An article in the Journal of the American Board of Family Medicine discusses barriers to use of formulary information by physicians who e-prescribe. It wasn’t a huge study and the authors claimed it looked at eight practices of varying size and specialty, but a closer look finds the practice size to range from one to four physicians, which I would generally consider to be small practices. Each was using a standalone eRx program. Information was gathered both through observation and through interviews.

Some interesting points. The study included the use of a standalone EHR program, which I bet that made it easier for providers to consider a paper-based workaround. I wonder if the results would have been different if the eRx solution were part of a reasonably robust EHR or if larger practices were reviewed. The researchers had backgrounds in medical anthropology and labor relations, which is certainly an interesting combination.

Although few users were using formulary and benefit references prior to the study, there was a central theme of provider distrust of the electronic resources due to inaccurate data. Providers continued to use paper-based workarounds to find information. Three key difficulties were noted: (a) health plans aren’t required to provide a full set of formulary information; (b) some software packages “normalize” the data, creating groups such as preferred, formulary, or off-formulary which really don’t mean anything; and (c) some payer information is group-level rather than plan-level, which can mean a huge difference in insurance coverage information.

In my market, only 70% or so of the patients have valid formulary information accessible through the EHR despite our attempts to make provision of formulary information a part of our contract renewal process with payers. I agree that the coverage groupings are confusing, but they were confusing in the paper world as well. Personally, I’d like to see some realistic ideas of coverage such as “covered and dirt cheap” vs. “covered but crazy expensive” or even “don’t even think about it.” That would certainly help me be a more Meaningful User.

In addition to immunization and disease surveillance registries, some states are offering registries for Advance Directives, with Virginia being the most recent to head online. I love the idea of patients being able to document what kind of healthcare they want in the event they are no longer able to make their own decisions, and putting it online is a lot more helpful than stashing it in a file cabinet at home or in a bank lockbox. State information exchanges may eventually allow physicians access.

Unfortunate things can happen when patients lose the capacity to indicate their wishes, especially if they haven’t communicated those wishes to family members. Whether you have an online registry in your state or not I, encourage everyone to talk to your loved ones about what you might or might not want done should the situation arise. Some nurses made fun of me when I arrived for an elective procedure (as a sassy 20-something patient) with my advance directive and healthcare power of attorney documents in hand, but I wanted to make sure that in the event of something horrible, it was clear how I wanted my care to proceed.

Speaking of cheery topics, the American College of Physicians recently released its update to its Ethics Manual. The sixth edition features new guidelines that address the issue of cost effectiveness and efficiency in care delivery. Other new or expanded sections include: confidentiality and EHRs; health system catastrophes, social media and online professionalism; pay for performance and professionalism; and patient centered medical home.

Websites like Groupon that offer daily deals are increasingly prone to offer health-care related services. Patients without coverage use the discounts to receive dental care, while others may take advantages of bargains on elective or non-covered services such as Botox or laser vision surgery.

Contacts

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

Acquisitions for Mediware, Cumberland Consulting, and TriZetto

Mediware has announced its acquisition of the assets of Transtem, which sells software for managing adult stem cell collection and transplantation. Mediware President and CEO Thomas Mann said in the announcement, “This is cutting-edge healthcare that is pursuing cures for such large patient population diseases as myocardial infarction (MI), critical limb ischemia (CLI), Parkinson’s disease, diabetes, cancer and many others. Importantly, there is a growing demand for a comprehensive software solution to effectively manage the collection and preparation of the therapeutic cell solutions as well as streamline donor, patient and treatment data management.”

Cumberland Consulting Group has been acquired by members of its management team and private equity firm Tailwind Capital, with participation by investor and former HCA Chairman R. Clayton McWhorter. Tailwind Managing Director Geoffrey Raker said in a statement, “This transaction represents a tremendous opportunity for Tailwind to invest in a proven platform that provides high quality services to a dynamic industry in the midst of an IT transformation. Cumberland has a very experienced management team and is well-positioned for future growth and expansion. We look forward to supporting Cumberland as it pursues future organic initiatives and acquisitions.”

TriZetto announced this morning that is has acquired Medical Data Express, which offers Medicaid and Medicare encounter management software. TriZetto Chairman and CEO Trace Devanny said in a statement, “By acquiring MDE, TriZetto is cementing its ability to offer customers a proven, comprehensive and reliable solution that helps payer organizations meet federal and state requirements for medical encounter data processing. We are committed to continuing to enhance our suite of solutions helping Medicare and Medicaid plans leverage the efficiencies they gain for strategic advantage while maintaining compliance.” 

HIStalk Interviews Robert Musslewhite and Paul Roscoe, The Advisory Board Company

Robert W. Musslewhite is CEO of The Advisory Board Company. Paul Roscoe is CEO of Crimson.

Robert, tell me about yourself and what The Advisory Board Company does.

Robert Musslewhite: Unlike many of your interviewees, I’m not the founder of the company. I was really fortunate to find the company eight years ago after spending some time at McKinsey, and before that, being trained as a lawyer. I immediately realized what a special place this company is. First and foremost, we have an incredible team that’s very engaged and an incredible group of employees that cares a lot about improving healthcare. I think that’s really special.

In terms of what we do, we partner with senior executive teams at over 2,800 hospitals and health systems. We focus on improving clinical, financial, and operational performance. The focus is through this network to identify and service proven, demonstrable best practices, communicate these out to our members, and help them install them to drive performance improvement.

Increasingly, If you look over the past several years, not just through our traditional best practice research, which a lot of our members and member executives know us for, but also through hosted analytic software tools. Most of them have the same format of pulling critical information from hospital IT systems and translating it into key performance metrics, which we load into analytic dashboards that hospital executives and staff can use to drive and hard-wire performance improvement. Today we’re doing this across all key performance areas for the hospital, so things like value-based care, accountable care, physician management, quality, revenue cycle, clinical operation, supply chain, etc.

If you put all that together, we have a deeper and more comprehensive set of services for our members than we had traditionally. That’s a really exciting path for us.

Do you still consider yourself a consulting firm rather than a software vendor?

Robert Musslewhite: No, I think increasingly we consider ourselves a technology company. More than half of what we do is on the technology side today.

I do think the best practice research is such an important part of who we are as a company. It forces us to focus on the practices that matter — what moves the needle in performance, what doesn’t. It forces us to communicate those practices out clearly and think about how to make those practices actionable for hospital executives so they can use them.

If you think about the evolution, as we’ve developed these technology products, it’s based on the insights from the research side and on focusing on helping install best practices and help hospital executives and teams capitalize on the learning that we have on the best practices in a more targeted and tangible way.

The Crimson and Southwind acquisitions obviously expanded your offerings. What’s your vision for the company and what do you see in the future?

Robert Musslewhite: If you think about what’s going on with our hospital and health system members, they’re really at the nexus of transformative change. There’s all kinds of new pressures and imperatives that they’re facing. That’s causing them to change the things they need to do to manage successfully in this environment. It’s pushed up the change to the company.

We’re becoming deeper and more comprehensive in our abilities to partner with hospitals to help them address these challenges. If you go back eight years ago, you would have said we’re a fantastic best practice research provider in helping hospitals understand best practices. Today, we do a lot more to not just help them understand those, but to hard-wire them through technology like Crimson. We also provide services, support, and management services to help  bring those practices to bear on the ground level. That’s what Southwind helps do.

The previous model was more publishing than it was consulting in some ways, where you consolidated best practices and presented them really well. How do you transform from being the best practices aggregator to somebody who’s actually out there solving problems?

Robert Musslewhite: It’s a great question. In some ways, it’s a big change, so there are some operational implications. We have a technology development team. We have an office in India that helps with all the data management and the technology development. There’s a lot that implies about our hiring and recruiting practices and the types of expertise we need to have.

On the other hand, it’s really not a big change at all. We’re still focused on the same thing, which is to help hospitals and health systems understand and use best practices in better and better ways. The metrics and the tools are based on best practice insights. We provide benchmarks across the network of members that we have to help members understand where they fall on their performance, where to focus, and which practices they should be employing to help them improve on that dimension.

Southwind and our other services business provide support when a member needs either physician practice management support or consulting support to embed those best practices and to hard-wire them into their institutions. So from that sense, it really hasn’t been a change at all in terms of our focus in what we want to do help our members.

What are the most pressing issues for your membership and how can you help them in ways that other consulting firms can’t?

Robert Musslewhite: There are obviously a lot of pressing issues out there today. To drill it down to a few is always hard. I would say the number one issue that everyone is facing is the shift in Medicare reimbursement that everyone knows is coming. It creates cost pressure, but it is not the same type of cost pressure that hospitals saw a couple of years ago, where it was “cut, cut, cut” trying to make budget this year.

It’s much more about evolving the business models to be able to manage on a continuing basis what we call Medicare break-even, or success under Medicare margins. That involves bunch of different capability enhancements, from revenue capture to expense management on both on the clinical and on the supply side. Expanding capacity on the right places and improving case mix and top-level growth. There are a lot of different dimensions to that that are driven by the changes that you see in the market today with Medicare and increasingly on the commercial side of reimbursement.

Your work is very targeted to the CIO audience as well. We do a lot of research for hospital CIOs, and what I think is neat there and different is that we focus on the executive suite set of issues and then translate those into what matters from that set of issues and how the CIOs should be responsive there. Rather than just making research that’s targeted for the CIO, it’s in the context of what are the broader health system imperatives and why is that important to the CIO.

Paul, turning to you, give me some background about yourself and then talk about the Crimson product line.

Paul Roscoe: I started my professional life as a lowly management accountant in the British National Health Service many, many moons ago. I’ve been involved in healthcare IT in Europe and in the US for over 20 years.

Prior to the Advisory Board, I was general manager of Microsoft’s Health Solutions Group. I came into that organization alongside Rob Seliger, building the Sentillion business from its infancy and startup phase to the pre-eminent identity access management solution out there in the marketplace that was ultimately acquired by Microsoft.

It was a pretty good decision for me to come to the Advisory Board for many reasons. One, amazing people. Two, as you’re starting to get a sense from and many of our members who’ve experienced our technology first hand every day, an amazing set of technology that the Advisory Board hasn’t historically been known for. A deep sense of commitment to doing the right thing for the membership. All of those combined made it an easy decision for me to come on board and to manage the Crimson business.

When we think about Crimson, we think about it as a Platform with a capital P for aligning hospitals with physicians as they think about the challenges that they’re facing, as they’re rethinking the healthcare network and the reshaping the health system’s role in managing populations of healthcare. Clearly they spend a lot of time thinking about how they should align themselves with physicians.

We created this analytic platform that helps them in a number of different ways. Firstly, a lot of health systems are thinking about how they can secure alignment with physicians, and from that perspective, how they can understand who their most important physicians are, from both the clinical and financial perspective, to target for growth through good old physician liaison outreach or through employment. Given the referral patterns that we see in the marketplace these days, the relationship between docs who are the biggest influencers, and that those the ones that we want to like us and what kind of incentives do we want to build with them. Think of this as like network building — securing physician alignment.

Secondly, clearly you’ve heard this a lot from the people you speak to. The big challenge is how do we work with those health systems and physicians to reduce cost and advance quality? We need to within this domain demonstrate that we can only not only measure physician performance, but frankly not just measure it, but engage with physicians and provide tools that engage our physicians, not just an analyst or a VP of quality. Those are important, but a real change comes from engaging physicians in conversation, looking for the outlier both from a positive and negative perspective, and then finding ways to remediate that to bring that into a high-performing organization.

We think these two things are essential whether you’re in a fee-for-service world or whether you are in a value-based or risk-oriented world.

What we’re now starting to see our members think more about and what Crimson is starting to help them with is the shift from not only maximizing in an inpatient setting, but trying to find ways of transforming ambulatory care. Given the burden of unprofitable patients with chronic conditions, many of our members are investing in – for want of a better description – a medical perimeter around their inpatient facility. The purpose of this infrastructure is to do exactly the opposite from what we’ve done in the past couple of decades – keep those patients out of the hospital; treat them in the ambulatory setting; create the medical homes, care teams, and health coaches, all that good stuff; and invest in ambulatory EMRs and CI programs. That has a huge implication from a technology platform.

The final piece of the puzzle is once you figure out your network, you got the right physicians, you’ve reduced cost, you’ve improved quality, you got a great ambulatory environment — how are we now going to manage populations of healthcare patients? How do we provide analytical tools and competencies to help a provider act in some ways as a payer would, and give them access to technology and data that they typically haven’t had?

Those are the four challenges and the underpinnings of what Crimson has been built to provide on this platform.

You offer CPOE tools. Do you have any tips or best practices to share, or anything to say about the status of CPOE?

Paul Roscoe: From a Crimson point of view, one of the three areas that we’re focused on is how to measure the effectiveness of the order sets that are getting used in CPOE. We’ve built an interesting set of analytics that hospitals are now deploying to help them understand if the evidence that they’re using in their day-to-day clinical practice is actually driving the outcomes and efficiencies that they want it to do.  

Clearly CPOE is being well adapted. There are still opportunities for us to make sure that we are optimizing the delivery of evidence-based medicine. Being able to have analytical tool that allows you to measure that performance across a set of physicians, across a set of hospitals. I think one of the things that’s unique in some ways to Crimson is the ability to benchmark your performance, not only against your peers in your hospital, but on a wide national basis — give me all the neurosurgeons in this particular size of the cohort.

Hospitals are so excited to get a clinical system in place that they often stop at just consolidating the order sets and steering physicians to the center of the guardrails. Will they need to go back now and think about the evidence-based approach and try to not just improve efficiency, but to change practice patterns?

Paul Roscoe: We’re already seeing it. Even the most advanced CPOE deployments that I would put up there in the US have used Crimson to go back to evaluate, now that they’ve got many years of experience under their belt, their performance against those order sets. What they’ve found is that there are significant cost and quality improvements that can come from testing the validity of those order sets, making changes to them, and then reevaluating the performance of it. We’ve seen some quite startling ROI from our members within a year to a year and a half of them deploying Crimson, particularly in an environment where they’ve got sophisticated order sets.

What are some of the IT pitfalls to avoid when working on clinical integration?

Paul Roscoe: From an IT perspective, one of the biggest challenges that you find in the clinical integration environment is that the hospitals are aligning themselves with independent physicians, hence the nature of clinical integration. One of the challenges that many of those hospitals are finding is how do you get good quality data out of the independent practices? You’re aligning yourself with 50 or 60 practices. Each of those practices has different ambulatory electronic medical records, practice management systems with different degrees of interoperability with them. What we have spent a lot our development effort on is building an integration platform that allows us to take this data out of these systems in a very automated fashion.

The second challenge you will find increasingly in a clinical integration environment, how do you link across the continuum? How do you link data that is in the inpatient setting with data that you find in the ambulatory setting? We’ve also set about that problem by building what we call a UPI, Unified Person Index, sort of a mini-EMPI that is right-sized for our use. It allows us to track patients and physicians across the continuum and look at them holistically.

Robert, any concluding thoughts?

In the broad picture, it’s a really challenging time to be a hospital executive. It’s a time of great change, but also a time of great opportunity. From a company perspective, we want to be aggressive in making investments in the improvements and the product rollouts to be sure that we’re right there by our members’ sides in helping them address these challenges. It’s been really exciting to see how big a role Crimson is playing in the market today. The evolution we have planned for Crimson to continue to match what’s going on in the market is very exciting to me. 

When I think of what that means to the Advisory Board, the continued growth is exciting. The innovation it forces us to do is exciting. But at the same time, what I and almost all of our employees would say that they love most about the company is the continued focus on our mission of helping our members. People here get really excited about the prospect of improving healthcare, and to do that in close partnership with a group of executives in a time of pressure and change is tremendously exciting.

Paul?

I think it’s very exciting. It’s also exciting to see the next generation of analytics solutions that we can really impact value and care in the healthcare environment. We’re bringing to market a set of solutions that are very much focused on starting to inflect performance in a real-time environment when the patient is still in the hospital. Analytical solutions can be very valuable when looking historically, but there’s a real opportunity to inflect while the patient’s still in the hospital.

We’re coming out with a set of products that are focused on how we prioritize that information. How do we get predictions of which patients to focus on into the caregiver’s hands at the point of care in a real-time setting? That’s very exciting for me.

2012 Mobile Clinician Voice Challenge 1/4/12

The Problem

Clinicians and their mobile devices are everywhere. Doctors, nurses, and other licensed professionals are interpreting clinical information and making clinical decisions right now using smart phones and tablets, often from locations outside the four walls of the hospital, clinic, or medical practice. They need better ways to interact with these systems beyond tiny keyboards.

The Solution

Give mobile clinicians a voice by speech-enabling your applications, both Web-based and mobile, with as few as two lines of code and in as little as a couple of hours. Free them from the limitations of poking at keyboards that are too small for normal fingertips –let them document on the go using their voice.

Link.

The Challenge

The 2012 Mobile Clinician Voice Challenge offers over $25,000 in prizes for most innovative, speech-enabled healthcare application (Web-based or mobile) developed using the HIPAA-secure, cloud-based Nuance Healthcare Development Platform. The contest runs through February 3, 2012, with winners to be announced at the HIMSS conference.

The Prizes

Full Details

Information is available on the contest page. See the text ad in the right column of HIStalk as well, which will run throughout the contest.

Not a Developer?

Tweet about the contest using @NUAN_Healthcare and #2012mobilechallenge and you’ll be entered in a daily giveaway for contest tee shirts and an iPad 2.

Contest Video

Link.

An interview with Jon Dreyer, senior manager of mobile solutions marketing, Nuance Communications, Healthcare Division


Describe Nuance’s philosophy about the mobile clinician.

The “mobile clinician” is quickly becoming synonymous with the modern clinician. In fact, physician smart phone adoption, which is currently at 72%, outpaces the general U.S. adult population by more than 50%.  And by the end of 2012, mobile device adoption among healthcare professionals is expected to reach 85%.

Whether racing from exam room to exam room or working remotely, mobile access to clinical information and mobile collaboration tools are essential for caregivers. This new breed of healthcare professional is in need of better experience-enhancing technologies, such as speech recognition that is available on any device at any time, in order to be completely untethered, yet still be fully plugged in to interact with and contribute to the care delivery process.

With voice-powered applications becoming common, especially on smart phones, do you see that as becoming a standard for systems designed for clinician use?

Absolutely. Voice will continue to grow as a primary form of input into mobile devices for consumer markets as well as within healthcare. Touchscreen devices with small onscreen or physical keyboards will never catch up to the speed of data entry on a desktop environment. Speech recognition overcomes the challenges associated with touch typing and bridges the gap to provide a ubiquitous experience for all users on all devices and platforms.

Keep in mind that speech recognition software designed specifically for healthcare professionals has been in use for more than a decade. On a daily basis, hundreds of thousands of clinical users across all healthcare specialties rely on the technology to reduce turnaround times, cut costs, and improve the overall delivery of patient care.

Given the dramatic rise in mobile device adoption over the past few years, and its projected growth, it’s only natural that the speech recognition experience clinicians have come to appreciate on their desktop is something that they will expect from their mobile and web-based apps as well.

Give me some cool ideas or apps you’ve seen that would be a good choice to speech enable just in case developers out there need some inspiration.

We have more than 100 partners in our evaluation program today. Healthcare app developers are rapidly embedding secure, cloud-based, medical speech recognition in point-of-care documentation/mobile EMRs, reference and content databases, disease management, clinical trial, pharma, and specialty-specific reporting tools. The applications run on a variety of devices and operating systems that are supported by the development platform, including iOS, Android, Web Browser (Internet Explorer, Safari, Firefox, Chrome), and native desktop applications.

Examples of clinical scenarios and apps that use speech recognition powered by Nuance Healthcare include:

• Mobile EMR access. With speech recognition as part of the workflow, physicians can easily voice document findings and clinical notes without having to return to a workstation or office.
• Interactive patient-side care. Specialists using mobile applications can now visit patients post-surgery and retrieve, as well as document using their voice, all relevant information on their mobile devices.
• Trauma communication and coordination. With specialized, speech-enabled mobile apps, clinicians can capture in their own words the patient story without delay. In a trauma scenario where every minute matters, this streamlined mobile approach helps to speed communication across care teams while expediting prep time for surgery.
• Diagnostic image view and reporting. Radiologists can now access patients’ diagnostic images via their mobile device and dictate reports from anywhere and at any time. The time in which patients receive feedback and care can be significantly shortened.

Do you have any words of encouragement for those who are thinking about entering the challenge?

Healthcare app developers should join the challenge because there’s really no reason not to participate.  Not only is it free to evaluate the Nuance Healthcare cloud-based medical speech recognition technology, but it’s also easy to integrate, deploy, and maintain. It requires minimal development effort (most evaluation partners have their integrations up and running within a few hours of registering) and clinical end users will benefit greatly from having access to medical speech recognition from their mobile and web-based apps.

Contest Notes

• The contest is open to any developer who is a legal resident of the US.
• You can submit multiple entries.
• Apps do not need to be live and/or commercially available.
• Apps do not need to be written specifically for the contest – it’s OK to integrate the speech service into an existing app.

Links

• Contest page
• Press release
• Nuance Healthcare’s ‘For the Health of IT’ blog
• Twitter
• Facebook

QuadraMed Acquires NCR Healthcare Solutions

QuadraMed announced this morning that it will acquire the healthcare solutions business of NCR Corporation, whose products include a patient access kiosk, patient and physician portals, and a payment solution. Terms were not disclosed.

NCR acquired the product portfolio when it bought Maitland, FL-based Galvanon in December 2005.

QuadraMed CEO Duncan James was quoted in the announcement as saying, “This addition to QuadraMed’s portfolio is a logical extension of our existing Access and Identity Management offerings. NCR’s healthcare solutions will improve our clients’ ability to meet the increasing demand for patients to control and self-direct their healthcare experience at hospitals, clinics and physician practices.”

NCR’s healthcare workforce in Lake Mary, FL and Hyderabad, India will become QuadraMed employees on January 5, 2012.

News 1/4/12

Top News

The District of Columbia, armed with $1.06 million in ARRA money, issues an RFP for an HIE technology platform. Bids for the one-year contract are due on January 13. The District decided to support the simpler Direct Project rather than a traditional HIE last year, putting the DC RHIO, which was expecting to get the grant money, out of business.

Reader Comments

From Sunshine: “Re: new hire. Mike Mieure from Sunquest and Misys is the director of IS for Vitera Healthcare.” Confirmed via LinkedIn.

  From Tipsy: “Re: tips for meeting with reporters. Joseph Goedert has some great advice for vendors scheduling meetings with the press. My personal favorite: don’t send your marketing manager to talk to the reporter.”  Mr. H does far more interviews than I do, but I am sure that if anyone attempted to give us a lesson on HITECH basics, we’d be making fun of them later. If you handle media relations for a vendor or PR firm, do yourself a favor and give Joe’s blog post a quick read.

From AnotherDave: “Re: Dr. Jayne’s 1/2/12 post, What Gets Measured Gets Managed. To quote Nick D’Onofrio, ‘You can expect when you inspect.’” Dr. Jayne outdid herself with her post this week, which is getting tweeted and mentioned all over the place. It was informative while being fun to read. She enjoys using reader feedback for future posts, so if you have something you’d like her to write about or comment on, e-mail her.

From Pyorrhea, IL: “Re: a second Judy Faulkner article. Does this include any new information, or is it just the same thing over again?” The first article seemed merely politically biased and sloppy with facts, but the second one by the same author ventures into pure nut-job territory, claiming “a de facto alliance between Epic and the Service Employees International Union” because some of Epic’s hospital customers employ SEIU-organized labor, which is hardly shocking given that Epic’s core customer base is academic medical centers in big cities. I have one positive comment about the article: it was short.

HIStalk Announcements and Requests

  Mr. H seems to have survived without my assistance last week. No surprise, of course, but I like saying it so he’ll take a moment to reflect on how much more fun it is to have me around pinging him with e-mails all day. In my absence, I have noticed almost all our sponsors have now replaced their animated ads, giving the site an almost Zen-like peacefulness (thank you, sponsors.) Now that I am back, Mr. H and I are heads down in our HIMSS planning and are excited about a couple of new fun projects in the works. In addition to the more serious stuff, we are addressing details for the annual Inga Loves My Shoes contest, as well as the crowning of the HIStalk King and Queen for the best-dressed HIStalkapalooza party-goers. I predict an exhaustingly good time will be had by all.

It’s the New Year, so it’s time for HIStalkapalooza signups. Our amazingly gracious, creative, and fun event sponsor ESD has been working tirelessly for months in planning a memorable Las Vegas event for you. It’s at First Food & Bar in The Shoppes at the Palazzo (ESD bought the whole place out for the evening) on Tuesday, February 21 at 6:30 p.m. ESD is a consulting firm, so let’s go over the deliverables. Great food – check. An award-winning bar plus specialty drinks such as the IngaTini, the Mr. H Incognito, and the ESD Activation Sensation – check. Fun contests involving shoes and people dressing up – check. A special performance by Elvis – check. And of course, Jonathan Bush and the HISsies – check and mate. Click the graphic above, the button to your right, or here to request an invitation. If we get fewer requests than we have capacity, then beautiful – everybody who signs up will get an e-mailed invitation. If we’re overbooked (which has happened every year so far, and often quickly), we’ll invite the number of folks we can handle. HIStalkapalooza is held in honor of those involved with HIStalk, HIStalk Practice, and HIStalk Mobile in any way (reader, sponsor, contributor, etc.) and we gratefully acknowledge the support of ESD in making it possible. More to come once we get the signups finished.

Here’s some background about ESD (they didn’t ask me to talk them up, but it’s the least I can do considering they’re paying for HIStalkapalooza.) The Toledo, OH consulting firm provides expertise that includes clinical transformation, go-live support, legacy system maintenance, staff augmentation and training, system optimization, and help with ICD-10 and Meaningful Use projects. Clients often (always?) need healthcare experience and workflow expertise that’s way over the head of freshly minted vendor implementers. That’s where ESD’s expert clinical consultants can save the day, helping CIOs sleep at night by reinforcing their front lines to complete projects, generate ROI, and optimize processes. Founder and President Joe Torti started the company as a solo consultancy in 1990 and has grown it to over 400 clinical IT consultants (nurses, physicians, pharmacists, etc.) and 30 corporate employees. If you’ve been around awhile, you’ll no doubt recognize some of the management team names as I did: Joe Mason, David Tucker, and Dan Oberle, to name a few. ESD not only brings you HIStalkapalooza 2012, but is also a Platinum Sponsor of HIStalk. I greatly appreciate the ongoing support of ESD.

Acquisitions, Funding, Business, and Stock

Chicago-based solar products company SoCore Energy LLC raises $3 million in an equity offering. Among its investors is an investment fund run by Michael Ferro (Merge Healthcare). The company’s chairman and co-founder is Allscripts CEO Glen Tullman. I Googled hoping to find that Epic’s mammoth solar installation used solar panels from SoCore, but nothing came up, dashing my hopes for perfect irony.

Sales

San Jacinto Memorial Hospital (TX) selects PerfectServe’s clinical communication and information delivery platform.

The Premier Healthcare Alliance awards a group purchasing agreement to Authentidate for its Electronic House Call Kiosk and Interactive Voice Response solutions.

Stanford Medical Center (CA), HealthEast (MN), Oakwood Healthcare, and McLaren Healthcare (MI) prepare for the ICD-10 deadline by utilizing OptumInsight’s A-Life Medical computer-assisted coding.

Albany Area Primary Health Care (GA) selects eClinicalWorks EHR suite for its 14 locations.

People

MedQuist hires Michael Raymer as SVP of solutions management. He was previously general manager of Microsoft’s Health Solutions Group.

Announcements and Implementations

Tuomey Healthcare System (SC) partners with Advanced ICU Care to deliver remote tele-ICU monitoring by intensivists and critical care specialists.

Regional Health Services of Howard County (IA) launches Cerner at its 25-bed acute care hospital.

Canton-Potsdam Hospital (NY) begins installation of MEDITECH 6.0.

AirStrip Technologies earns CE Mark certification for its FDA-approved mobile patient monitoring applications, allowing them to be sold in Europe and other areas.

Intelligent InSites integrates the TempSys Fetch real-time locating technology into its RTLS system. The InSites RTLS software solution works with several sensing systems, including active and passive RFID, ultrasound, WiFi, and ZigBee.

Pike County Memorial Hospital (MO) goes live on McKesson Paragon, earning the hospital a story in the local paper.

George C. Grape Community Hospital (IA) will hold a Virtual Ribbon Cutting next week to celebrate the completion of its EHR implementation and Meaningful Use attestation. The 25-bed hospital had to deal with Missouri River flooding through the summer as it accelerated its Meaningful Use timelines as a beta site for Healthland’s Centriq small-hospital EHR.

Government and Politics

Washington’s state prescription database goes live, but previously supportive doctors and pharmacists line up against it when the US Department of Justice tells the state not to expect to get federal money for the $530K annual operating costs. State health officials ask lawmakers to remove the portion of the law that bans charging providers for its use, which would entail yearly per-provider charges of $11 to $15.

In Canada, the leader of Ontario’s democratic party calls for a hospital CEO salary cap of $418K – double the premier’s salary — after hospitals release their compensation contracts following a ruling that they are covered by freedom of information laws.

Other

The US Patent and Trademark Office issues a patent to DR Systems for technology that tracks the resolution (or other parameter) for a displayed medical image.

Indiana University Health Physicians misses its 1,200-physician year-end employment target by 350, with some of the slowdown attributed to physician delays in committing to a common EMR and approving common treatment protocols.

Joslin Diabetes Center (MA) partners with Alliance Health Networks to participate in that company’s Diabetic Connect social network.

Sponsor Updates

• Phoenix Children’s Hospital shares how deployment of the Vocera wireless communications solution has improved communication in its NICU.
• NextGate profiles Hartford Hospital (CT)and its use of  NextGate’s matching technology to identify patients in Connecticut’s HIE.
• Besler Consulting announces the general availability of BVerified Transfer DRG and BVerified IME proprietary solutions.
• Concerro adds VLOG, a video blog option, to its Concerro University client learning center.
• Intellect Resources is holding Big Break New Orleans on January 21, a one-day audition for folks who want to help Ochsner Health System implement Epic as trainers.
• Independence Blue Cross chooses Kony Solutions as its mobile application platform.

The Iowa Caucuses and the Stakes for Healthcare
By Donald Trigg

How should we feel about an anonymous force driving US policy? Does it serve our interests to have a beef-loving sovereign dictating our national conversation? Should a single player carry such outsized influence?

We are talking, of course, not about Mr. HIStalk, but the first-in-the-nation caucuses this evening (Tuesday) in Iowa. And in the less harried first days of the New Year, a moment offers itself for a primer on the quadrennial contest and a short exposition on how it might inform the health policy dialogue this fall.

Forty years ago, an obscure McGovernite orchestrated an early start date for the Iowa caucuses. Four years later, a peanut farmer named Jimmy Carter leveraged a “win” (finishing second to uncommitted) to vault to national prominence, a party nomination, and then the White House. Iowa’s outsized role in the nominating process has been set ever since.

The number of delegates at stake in Iowa toward the 1,143 needed for nomination is modest. GOP aspirants are looking, instead, for what George H.W. Bush in 1980 called the “Big Mo.” In our vernacular, Iowa is not a supplier of choice designation. It is a down select.

Indeed, since 1972, the eventual GOP nominee has finished in the top three in Iowa with only one exception. But unlike the definitively predictive South Carolina primary, Iowa does not decide the GOP nominee. It is the “winnower” of the field.

The mechanics of the caucus process are straightforward. Voters gather in roughly 800 locations, typically in a church basement or a high school gym. After electing a temporary chair and a secretary to record the proceedings, Republicans rise to speak on behalf of their preferred candidate. Then, votes are cast. The results are aggregated and a late evening winner is declared.

If the process is fairly unambiguous, the fate of the six candidates contesting Iowa is less clear-cut. Historically, the GOP has nominated by primogeniture — falling in lockstep behind the next person in line. The 2012 race has been marked from the outset by the absence of an overwhelming front-runner.

Instead, the so-called Exhibition Season has seen a series of volatile swings from candidate to candidate in an elusive search for an alternative to former Massachusetts Governor Mitt Romney. Michelle Bachman. Rick Perry. Herman Cain. Newt Gingrich. Now, we are seeing a late “Santorum Surge” that may put the former PA Senator within striking distance this evening.

It has been said that there are only three tickets out of Iowa. Romney, Paul, and Santorum appear to be clutching them, according to the final Des Moines Register poll. But with 41 percent indicating that they could still change their mind, the Register’s Kathie Obradovich rightly characterized the race as “a moving target.”

The stakes for healthcare are large. David Blumenthal wrote last month in the New England Journal of Medicine, “The 2012 election will be the most important in the history of the health care system.” For all the potential implications in 2013 and beyond, however, the topic has featured only modestly, even comically, thus far.

We had, to the chagrin of public health advocates, Herman Cain advisor Mark Block silently smoking into the camera –reminding us that a 20-something staffer, a video camera, and free time are the campaign equivalent of whiskey, car keys, and teenage boys. We had Romney’s Massachusetts bill, and its common features with the Accountable Care Act, as consistent debate fodder. And we had the criticism of Gingrich amid his Q4 rise for his paid advocacy through the Center for Health Transformation to his vocal backing of Part D in 2004. But neither deep policy substance nor deep debate has featured to date.

One reason, beyond the constraints of the modern campaign, is that the US economy looms so large. An NBC/Facebook poll of early state voters out Sunday put the economy at 59 percent as the top voter concern ,with the federal deficit at 19 percent and with healthcare a distant third at just 11 percent. There is little reason to think that mix will shift this autumn.

The impact of that framing for healthcare finance is that the “second phase” debate will be centered almost exclusively around cost and predominately within the context of the current FFS model. We are headed toward a moment akin to the 1997 Budget Act and it may come as soon as 113th Congress.

But first we will need a GOP standard-bearer. Iowa, “the purest of prairie states,” is an opening step in that drama. It is a good and decent place where Winenrenner properly wrote the politics are “clean and competitive” and, just like HIStalk, “the arena is fair and open.”

Donald Trigg is chief revenue officer for CodeRyte. He worked for then-Governor George W. Bush during the 2000 presidential cycle in Austin, TX. He has traveled to all 99 counties in Iowa, suffering chilly winds and an unsettling amount of chicken fried steak.

Contacts

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

Curbside Consult with Dr. Jayne 1/2/12

What Gets Measured Gets Managed

During the last five years, we have seen significant shifts in how healthcare is delivered and in the way in which different healthcare services are valued. Most of us have realized for quite some time that fee-for-service medicine is clinging to life. Pay-for-outcomes is going to be the order of things from here on out.

Hospitals are no longer going to be paid to ameliorate hospital-acquired conditions or to deliver care to patients who were impacted by preventable harms. Physicians are going to be judged on their patients’ lab data and biometric information rather than the number of visits they bill.

Care will be transformed regardless of how we feel about it, whether it’s by the name Accountable Care, Shared Savings, or Pay-for-Performance. It’s something we all need to get used to.

My colleagues were ringing in the New Year this morning in the time-honored tradition of complaining around the coffee pot. (Most of us were rounding a bit later than usual and I did see a couple of bloodshot eyes.) It seems that many independent physicians, particularly those in small practices, don’t know where to start. (Employed docs are generally confused too, although to a slightly lesser degree.)

I decided to introduce them to Peter Drucker, whose famous statement, “What gets measured gets managed,” should be well understood by now. But let’s just say I was more than surprised by the blank looks in front of me.

Several of the docs didn’t understand that Meaningful Use is going to get trickier as time goes on. Although there are some metrics for Stage 1, many of them are easily achievable with a minimum of work. (Apparently though not as easy as people might think – I’m still stumped by the phenomenon of people unsuccessfully attesting. If you don’t have the numbers, why would you attest? Still waiting for someone to shed light on this.)

Although we don’t have final metrics for Stage 2 and beyond, it’s virtually guaranteed that the bar will be higher and the hoops smaller. In talking with the docs in the lounge, though, many of them don’t have a clue how to approach care metrics – even those with sophisticated software. I’m seeing far too many physicians who are barely using their certified EHRs, who are confused by some of the terminology, or who are hung up on wanting flash and sizzle.

I felt like I was giving a Grand Rounds presentation because our friendly chatter turned into a lecture that I probably could have given CME credit for. Docs don’t seem to understand that you have to know what you’re looking at in order to drive change. It’s not going to drive itself. You have to figure out what you want to work on, then measure it, then work on it, then measure it and work on it some more. Lather, rinse, repeat.

It seems pretty straightforward, but maybe it’s not, so allow me to share some other “secrets” that your docs may not know.

First, don’t get hung up on the fact that your EHR vendor may or may not have a registry or dashboards. Maybe they do and it’s just called something else, or maybe they don’t. One doc I was chatting with was caught up in the fact that he didn’t have his vendor’s dashboard product live yet. He was either under the impression (or in denial – it’s debatable) that he couldn’t start managing care until he had the pretty charts to back up the data. He didn’t like it too much when I called baloney on that one.

Most certified EHRs have at least some minimally decent ability to do reporting. That’s really all you need to start. If you have discrete data, you can report on a wealth of conditions. Prostate cancer screening? Check. Blood pressures? Check. Documentation of advance directives? Check.

You don’t need pie charts to tell you how to care for patients. When your report has blanks on it because you haven’t documented an item for a particular patient – that, my friends, is an opportunity for care.

Second, don’t get baffled by the metrics. Looking at some of the NCQA or NQF or MU measures and how they’re calculated makes my head spin as much as yours does. If you’ve never tried to do quality improvement before, start with something basic.

If it’s important to you to make sure every patient over 50 has a documented cholesterol test, start there. Don’t get hung up in the numbers and managing everyone down to an LDL of 70 or figuring out complicated exclusions. Start with something manageable, such as actually testing everyone. Run reports, do outreach, give it a month or two, then run those reports again and see if you’re making a change.

Third (and this is one of those points where I’m glad I’m anonymous – my CIO is probably spitting his coffee as he reads this) you don’t even have to have an EHR to make a difference. (I think I heard a few vendor gasps out there, perhaps the hissing of the word “heresy,” but it’s true.) You can make tangible gains in patient care without even a single chart pull. If you have a practice management system (that’s a “billing system” to some of you docs) with even rudimentary reporting capabilities, you can find opportunities to deliver care.

How so, you ask? Take an all-too-common diagnosis like diabetes (250.xx in ICD-9 terms.) Run some claims reports. Run a report of patients seen in the last three years with that group of diagnoses codes on a claim (or pick a single one like 250.00 if you’re scared at what you might find) and the date of their last billable visit. Presto! Anyone who hasn’t been seen in the last six months is an opportunity for care. This, of course, assumes that you actually bill the codes you’re addressing at the visit and not just cloning the last visit’s codes, which may or may not have included the diabetes. Primary care physicians are notorious for under-documenting the work they do.

Calculate the percentage of diabetics who haven’t been seen in the last six months and you just created your first metric. (If you passed epidemiology and biostatistics, which you must have to have graduated, you can calculate this. Trust me.) Send some postcards and make some calls (HIPAA-appropriate of course) and get those patients to come to your office for an actual billable visit. Report again in two to three months and see how you did. If you need a graph to show you the results, allow me to introduce you to my friend, Microsoft Excel. But I’m betting the numbers will speak for themselves.

Finally, it’s not just enough to have the data. You have to make it visible to make it actionable. Post your goals and action plans in a visible place in the office. Post monthly outcomes numbers. Celebrate those victories. When the numbers aren’t in your favor, take some time to figure out why and how you can do things differently. Involve everyone in the office. Even if you’re only focusing on a single metric each month, you WILL make a difference in the lives of your patients.

If you don’t believe that what gets measured gets managed (especially if you’re posting it publicly for everyone and their cousins to see) think again. I used to think I was pretty decent with my exercise habits (although it truly is difficult to hit the treadmill with a martini, so I wouldn’t recommend it.) In 2010, I did about 870 miles, which wasn’t totally shabby.

However, a double-dog-dare by some of my staff led to the public posting of our activities, with technical validation courtesy of our friends Garmin and Nike+ to prohibit cheating. (I suppose I could have paid the neighbor kid to jog around with my Garmin on, but that wouldn’t have been very sporting.) We have some serious running junkies on our team, and although I wasn’t delusional about keeping up with them, I felt pretty strongly about being able to beat most of the 20-somethings that populate the cube farm we call home. (Yes, they’re young. Yes, many of them are liberal arts grads. No, we’re not an Epic shop.)

Everyone had to share his or her numbers Saturday night. I almost forgot, so I was frantically uploading with a glass of Bailey’s in hand. I finished respectably with over 1,200 miles, but there’s always 2012:

Just Measure It. Just Manage It. Just Do It.

E-mail Dr. Jayne.

HIStalk Interviews Joe Boyd, Chairman, Encore Health Resources

Joe Boyd is chairman of Encore Health Resources of Houston, TX.

Tell me about yourself and about Encore.

I have been in the industry for just about 30 years. I started my career with EDS on the payer side, working on mainly government-type healthcare — Medicaid, Medicare, and Defense Department-related payer side. I went from there to GTE, and then from GTE to Peat Marwick, all still focused on the payer side of healthcare.

In 1990, I joined Perot Systems and switched over in that point to the provider side. I ran the healthcare division of Perot Systems in the early 90s, from around 1994 until 1997, and then took a general management role for all of North America, which included healthcare. That period with Perot Systems is where I got to know Ivo and a number of the other folks who were the seed group that made Healthlink what it was. 

I left Perot Systems in 2001 and started to do consulting on my own, mainly focusing on working with small to mid-sized companies and largely in healthcare, working with the leadership teams to build the companies. One of the first clients I worked with was Ivo at Healthlink, so Ivo, Dana, and I started working together in 2002.

At some point relatively early, I took the chairmanship there. I was there through the sale to IBM, so I was involved in that process and then stayed on and helped them a little bit after they became a business unit inside of IBM.

When Dana and Ivo decided to create Encore, I was paying keen attention to what they were up to. Early this year, Dana approached me and asked me to join them in an advisory role. I spent most of the year getting up to speed on what they were doing and seeing how they’ve grown. In the last few weeks, they asked me to take the chairmanship role and essentially work with them through a growth period that feels very similar to the growth period I worked with them on the Healthlink side back in 2002 through 2005. That’s how I got here.

Why was the change made and what’s Ivo going to be doing?

It was an opportunity for Ivo to focus on the two things that he likes to do most. One of them is to continue to provide strong input into the vision of the company. I garnered a commitment out of him to continue in that kind of role. Also, to work with our clients and to leverage the relationships that he has in the industry. He’ll be doing a lot of the same things he was doing, but just a lot less involved in some of the day-to-day kind of activities associated with running the company.

What does a chairman actually do?

I’m not sure I can answer that question in the general sense, but what I do in Encore is that I’ve been very focused so far on helping them determine what things they need to put in place to support the kind of growth that they’ve had.

This company has grown from $4 million in revenue the first year to about $20 million last year and we’ll finish close to $43 million in 2011. When I got involved in early March of 2011, we had 125 employees. We have 250 employees now. We need to do some things to focus on supporting that kind of growth and making sure that we can continue to grow and take care of our clients as we have that type of growth. 

I’ll be helping strategically with what the company is doing, working with them on making decisions to put the infrastructure in place to run the company well, and guiding them through the phases of being a small company to being a relatively large company.

Ivo had told me that with Healthlink, he decided at the $100 million revenue mark to turn it over to someone else because it would have taken more money and different expertise to keep it growing. Do you anticipate a similar outcome at a similar point in Encore’s growth?

I don’t think there’s a dollar amount that is important there. I also think that the experience of the management team this time around is such that we can support growing a lot bigger than that. There’s not a magic plan that says that we can only grow to a certain size. I feel very comfortable in this team’s ability to be able to continue to grow and to grow aggressively.

People who start consulting companies often grow them, sell them, then start a new consulting company. What attracts someone to want to run a consulting firm instead of a product company?

I think that there’s a challenge this time around, particularly with Encore, to be more than just a pure play consulting company. One of the things that we focused on from the very beginning is looking at leverage solutions, where we can do two things by putting some methodology and some product in place.

One of them is to extend the knowledge that we have in the company to new consultants who don’t have as much experience maybe or don’t know the culture … a way to make that we have some best practices worked into what we’re doing. But secondly and more importantly is to be able to eventually have, particularly on the analytics side, products that have value independent of the consulting, particularly as clinical information becomes more and more important for decision-making with our clients.

I think we’ll see an evolution of the company to be a lot more than just a consulting company, and a company where revenues aren’t directly correlated to the number of people that you hire and the number of people you have in the company. I think the desire this time around is to have consulting elements to the company, but not be exclusively a consulting organization.

What kind of things do you anticipate that the company might get involved in?

There are two things that where we’ve already started and actually are well down the road on. One of them is a methodology that we call CoreQUEST, which is a discipline around the selection and management of everything from starting an EHR implementation through how you are going to use that kind of information to meet Meaningful Use requirements. If an organization is headed down a path toward becoming an ACO, how you handle that clinical information for decision-making, for what service lines are in which location, what disease management protocols we need to focus on in an area? Eventually if an organization decides they’re going to do their own insurance, how do they underwrite those kind of things? Really starting to use clinical information for decision-making.

There’s also a specific tool called CoreGPS that we’re using right now as a Meaningful Use product to help define how an organization is going to attest to having met Meaningful Use requirements. As the clinical information data becomes more robust, we plan to use that platform for other types of applications that would have use with our clients.

Do you see just growing organically, or do you anticipate that acquisitions will make sense at some point?

I think we’re open to either. From an intellectual property standpoint, we’re focused on building those kind of things organically with our folks and smart folks that we work with or clients, but we might be wise to look at an acquisition or two associated with those aspects of the tool.

When Encore started up, Ivo told me that he really didn’t care if it turned out to be a 30-consultant company as long as the client-base was 100% referenceable and people like to work there, but he would consider it a failure if it got huge and everybody made money but employees and customers weren’t happy. How do you think it turned out in the years since?

I think it’s a touchstone of the company. It’s the only company that I’ve ever been involved with where the beginning of every meeting – and this is true from a team meeting to a board meeting – begins with a discussion of one of the core values of the company, where we move around the room and everyone’s expected to talk about a place in the past week where there’s a good example of that core value being exercised. Then we circle the room again and talk about a particular area where we need to be working on those things.

One of the key components of that is exactly what you said — 100% referenceabilty. But that also extends to the type of people we bring into the company. It extends to what we’ve believe about the way teams should work together. It’s a key part of the way this company operates. The quality of the company will absolutely trump the size of the company at any point in this process. That’s a critically important part of the company.

Some people, probably me included, would say that Healthlink was a pretty special company until it got sold to IBM and they screwed it up. Not intentionally, but because their big company culture didn’t fit with an entrepreneurial consulting firm. Your competitors are being acquired by big companies. Has the dynamic changed?

From my perspective, there are not that many organizations on the field. When I was part of Healthlink, FCG was out there. There were a lot of other companies of a similar size. We were filling a niche that I think largely went away during that period.

What pitfalls did Encore have to avoid to get to this point and then which ones remain between where it is and where you want it to be?

I’m not sure there were pitfalls. There was certainly surprise at how fast the company grew. There was some surprise at how much the prior company brand really accrued benefit to Encore. Ivo told me at one point that he could have gone out and said, “We sell manhole covers,” and a client would have said, “Yeah, that’s great, but we need 15 people to help us with an Epic implementation.” There was a reputation that was built in from the start that I think created growth that they didn’t anticipate at first.

We stressed and we challenged our ability to recruit the kind of people that we want. We have never been willing to compromise the quality of the folks that we bring into the company. Aside from an acknowledgment that we need to spend some time and effort on making absolutely sure that we have the infrastructure in place that not only supports where we are today, but where we want to grow to.

I think that growth has been handled really well. To a large extent, this is probably the most mature startup you’ve ever seen. This is a group of people, including myself, who’ve worked together for 15-20 years. This team really knows how to run a bigger company and knew how to do it from the beginning. I feel like we’re well positioned. Even though we were surprised by the rate of growth, I think we’ve handled that growth very well.

Some clients might just want to deal with a bigger company, while others might just say, “I’m going to call Ivo. I don’t really care who else is out there – I want to work with him.” Do you think that’s unique to healthcare, and what’s the message for companies trying to figure out where they fit in the continuum from “tiny” to “huge conglomerate?”

I’ve been in healthcare for a long time and I also have been involved in other industries. I’ve also worked with some of the larger companies and some of the smaller companies. I think that healthcare — particularly the provider side — has been burned a number of times by large companies that came in and believed it to be similar to other transactional businesses. They don’t recognize that a lot of the makeup of healthcare is institutional and it’s built on longstanding relationships. It’s more collegial than a lot of industries are.

There’s been a tendency for some of those large companies to come in, decide it’s hard, and leave — and leave people in pretty difficult situations. There’s absolute value in knowing that a team is committed to this industry, not only that it’s an industry that they’re interested in, but it’s one where their relationships are more important than making a buck. That commitment to those relationships is critically important. It’s important to Ivo, but it’s important to Dana and to Tom and to myself and to the other leaders in this company.

You have a shockingly long list of current board and consulting activities. Why do you do all those things and how the heck do you find the time to get it all done?

When I left Perot Systems, I made a decision that I wanted to work with companies of a particular size. I also wanted to work in places where I could work with people I enjoyed and where I could make a large impact. I’ve let that guide who I get involved with and I’ve managed my time by limiting that at different points of time.

Right now I’m involved with three for-profit organizations and one not-for-profit. That’s about right for me right now. I’m not doing anything beyond that at this point. The CEOs of all three companies know each other. They’re working on things where I think there’s a lot of value between them. It’s not work when you’re having fun.

For people stuck in jobs they don’t like or that don’t have much of a future, they’re probably thinking, why not just take your suitcase of money and go sit on a beach somewhere? But almost never do people with that level of accomplishment do that. What’s it like to have that option but then to say, “No, I want to keep working?”

That was a soul-searching thing for me. I originally thought that I would do something that was more of a traditional retirement, but I kind of failed at that and decided that it was important to me to stay in touch with what’s going on, particularly in this industry. I did some work with non-healthcare clients. I’ve enjoyed what I’ve learned of a lot of those industries, but my passion has always been in this space. 

It may be that I’m just not a successful retiree. That may be the true answer.

When you look down the road a few years, what do you see as important issues in healthcare IT that people may or may not see coming?

There was an excellent article in The Wall Street Journal by Anna Wilde Mathews on the future of healthcare. She probably summed up my views better than I could possible have done myself.

In a nutshell, I think there are a couple of things. The changes going on in healthcare now have been politicized tremendously. I actually think they’re much more economically based than they are politically based. The requirement to fix a pretty badly broken financial system is going to drive the continued change. It will drive it in the same direction it’s going — quality of care and providing repeatable, successful solutions in healthcare is going to be critically important.

That’s going to drive a necessity to get a lot smarter about gathering consistent clinical data. It’s going to require good analysis of that data. And then really smart people — both client people and people who are external to the industry — working on ways to use that information to improve cost performance and to improve the quality of patient care. I think that’s going to happen. 

The distinction between the payer side of healthcare and the provider side of healthcare is going to continue to blur. Providers are more and more going to try to bring risk management concepts onto the provider side. I think that successful provider organizations are going to have to get sophisticated in managing risk.

The organizations that survive and thrive aren’t going to necessarily look like the organizations that exist today. They’re going to have to change and add some different types of capabilities than what they’ve historically had as part of the mix of what they have to worry about.

What’s happened in the industry right now is foundational. The analytics associated with consolidated clinical, financial, and claims data that position providers to make quality decisions on how to run their business is going to be super important over the next four to five years.

Monday Morning Update 1/2/12

Happy New Year!

Given the lame (and guardedly vague) healthcare IT predictions for 2012 that I’ve seen, written by reporters and other non-combatants, I’ll pass on giving my own. Some of the pearls of predictive wisdom: (a) companies may consolidate; (b) consumers will be engaged; (c) ACOs will be formed and will need analytics; and (d) social networks will be used to encourage good health.

My Time Capsule editorial from this same week of 2006: Can EMRs Sweeten their ROI by Moonlighting as Research Databases? A random sample: “Repurposing that existing information by making it available to those willing third-party customers, even when motivated purely by mission-supporting cash, is at least more beneficial to society than running a McDonald’s or building medical office buildings.”

Thanks to the following sponsors (new and renewing) that supported HIStalk, HIStalk Practice, and HIStalk Mobile in December. Click a logo for more information.

The HIT bubble is here to stay, most readers believe, which must mean it’s not really a bubble in their minds. New poll to your right: when a hospital says having its clinical systems offline for several hours resulted in no patient harm, do you believe them?

We’ll give the HISsies nominations just a few more days before moving on to the actual voting, so this is last call to get your candidates on the ballot. Some obvious choices haven’t been nominated, I should say.

Here’s Vince’s HIS-tory on outsourcing.

Geisinger Health System (PA) says it will not hire smokers starting in February, when job applicants will be required to take a nicotine test.

Reading Hospital (PA) retools its executive team to put clinicians in key roles. The new CEO and COO are nurses, while the new CMIO, chief medical officer, and VP of academic affairs are physicians. The CEO, COO, and CFO all came from the consulting company the hospital had engaged to review best practices. The hospital says it’s also implementing a management process that includes physicians in every decision. Also mentioned is the hospital’s $180 million decision to implement Epic, which the hospital’s board chair says “will explode the quality of care and increase patient satisfaction.”

Cleveland, OH health systems Cleveland Clinic and MetroHealth are sharing electronic patient records and Kaiser Permanente will join them shortly. They’re using Epic’s Care Everywhere rather than an HIE, meaning they can access the records of patients who have opted in from 300 hospitals and 4,000 clinics.

Stanford researchers develop an application that allows technicians to control MRI machines from HP’s TouchPad tablet, which was discontinued within two months of its launch and sold off for $99. The researchers liked it because HP helped them remove its metal parts, a requirement for operating near an MRI magnet.

A British physician advisory group proposes that NHS allow patients to review their own electronic medical records by 2015, including the ability to review physician notes and request prescription refills and appointments online. Expected roadblocks are patient confidentiality concerns, physicians who don’t want patients to see their documentation, and NHS’s potential inability to provide such a service.

A California hospital investigates one of its contracted employees who allegedly posted a photo of a patient’s medical record, including the patient’s name, on Facebook with the comment, “Funny, but this patient came in to cure her VD and get birth control.” Several people scolded the employee on Facebook for violating the patient’s privacy, to which he replied, “People, it’s just Facebook … Not reality. Hello? Again … It’s just a name out of millions and millions of names. If some people can’t appreciate my humor than tough. And if you don’t like it too bad because it’s my wall and I’ll post what I want to. Cheers!”

A man who rear-ended a parked fire truck and then sued the firefighter who saved his life gets nothing in the settlement of his lawsuit. The fire truck was parked in the opposite lane as firefighters were responding to an accident. The driver had a long record of traffic offenses, had been ordered by a court not to drive, was not carrying insurance, and was taking three judgment-altering drugs. He lost control while speeding on the rain-slicked road, crashed into the fire truck, and had to be flown out by medical helicopter. He wanted $300K to settle his suit that claimed the fire truck was parked in his lane, which the crash scene photo appears to show is not the case. The city paid $47,000, of which the man’s children will get $20,000 and lawyers $27,000, claiming it was cheaper to pay the money than the cost of a trial. Since the accident, the driver has been convicted of two additional crimes, one of them a felony that will likely send him to prison.

I’ll have full details on HIStalkapalooza mid-week, so watch for that if you’re interested. Readers always like to guess a company given a tiny section of their logo, so above is your challenge.

Also coming mid-week is information about an application development contest that we’re helping promote. Here’s the story.

One of our sponsors asked us if we had additional promotional opportunities available, i.e. they wanted to buy a featured post or access to the e-mail list. They were running a fun-sounding contest with some pretty cool prizes, right down the alley of HIStalk readers who have written medically related software (vendors or providers alike.) We said no, we don’t do that – all we offer is sponsorships, all sponsors get the same benefits, and we will never make the e-mail list available to anyone. We always turn down requests to provide more exposure for cash.

Inga and I were noodling around on how we might help in a non-commercial way that would benefit someone other than ourselves, so instead of just saying no, we told them, “Make a big donation to charity and we will help get the word out to our readers as long as we can do it our way.” They agreed. We suggested the charity and the dollar amount, to which the company also (surprisingly) agreed.

Receiving the company’s ample donation was Homes for our Troops, a top-rated charity (98.5% on Charity Navigator) that builds specially designed houses for severely injured and disabled veterans who receive them at no charge, with the assistance of donated labor and supplies. Our designated recipient is Marine Staff Sergeant Jack Pierce of Temple, TX, paralyzed from the chest down in his third deployment in Afghanistan when his vehicle drove over a 200-pound bomb, killing two other occupants and severely injuring six. The apartment in which he, his wife, and their young son live is not wheelchair accessible.

I’ll be sending the contest information out around Wednesday.

Time Capsule: Can EMRs Sweeten their ROI by Moonlighting as Research Databases?

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

I wrote this piece in December 2006.

Can EMRs Sweeten their ROI by Moonlighting as Research Databases?
By Mr. HIStalk

I’d never heard of the Clinical Data Interchange Standards Consortium (CDISC) until last week. That’s when that group announced the kickoff of a new interoperability project, this one involving linking EMR systems to the information systems of clinical investigators who are performing drug or disease research.

The audience is researchers, the Centers for Disease Control and Prevention, or registries for patients or disease. The IHE is involved in the testing and will demonstrate the results at the HIMSS conference.

I’m not usually interested in this sort of project. I’ve seen first-hand what an insurmountable effort it can be just to get hospital systems to swap clinical data across the hall, much less with national third parties. Still, this is an exciting indicator of how quickly the now-common idea of interoperability has taken hold. If nothing else, RHIOs have made hospitals think about the value of their patient information and how to exchange it in standard electronic formats.

Getting and keeping drugs and devices on the market is expensive and information-intensive. Several small, highly profitable companies have sprung up to help enlist patients in studies, to do the rigorous paperwork required, and to design research methodologies. Their key commodity is information.

Hospitals have patient information that’s available nowhere else, the kind that arouses researchers and manufacturers that have far deeper pockets. Repurposing that existing information by making it available to those willing third-party customers, even when motivated purely by mission-supporting cash, is at least more beneficial to society than running a McDonald’s or building medical office buildings.

Let’s say your hospital implements a well-integrated, information-rich EMR system that can easily tie together everything about patients from medical history to demographics to procedure history. Suppose you add genomic data to the mix, storing information about family history, lifestyle, and a longitudinal history of disease, treatment, and outcomes. Your patients will benefit, but the information has an equally high value to those third parties trying to assemble or execute big research projects.

Drug companies and device manufacturers need the data that lives in your clinical systems. How else will they be available to target research to a very narrow range of patient types, maybe even those with a rare genomic profile? It could help them identify appropriate research subjects, design post-marketing surveillance, study population-based outcomes, and catalog adverse events. The information you provide could either be de-identified or made available only if individual patients opt in. The benefit to patients is access to a wider variety of treatments and protocols, most likely free to them if tied to a research project.

You wouldn’t just give that information away, of course. Hospital information is far deeper and more detailed than what’s available from any other source, with a wide scale to match. All you need is sophisticated EMR functionality and a relentless push to get every scrap of clinical information codified, categorized, and cross-referenced.

In the movie Wall Street, Gordon Gekko says, “The most valuable commodity I know of is information.” That’s true of clinical data, especially when those who value it can pay. Just don’t sign away too cheaply the rights to your treasure trove of data, even if the interested customer is a RHIO or third party data vendor.

HIT Vendor Executives – Part Two of Two 12/30/11

We asked several HIT vendor executives the following question: Where do you plan to invest your research and development dollars over the next 1-2 years?

Tim Elliott, Founder and CEO, Access

We are focusing on three technologies that every hospital needs: electronic signature, a data bridge between clinical devices and systems and EHRs, and paperless, online e-forms.

The next generation of e-signature not only enables patients to quickly and securely authorize e-form registration packets and bedside consents, but also offers administrators the convenience of a server-based model. A clinical data bridge can capture and standardize output from devices (such as EKG traces and surgery images) and systems (perinatal documentation, COLD feeds, etc), and interface these directly into EHRs – with no paper or manual indexing.

Finally, we’re giving hospitals a way to transform slow, inefficient paper-based processes – such as onboarding, capital requests and physician referrals – into fast, collaborative, paperless ones. Users will be able to access electronic forms from their browser, add attachments, apply digital signatures and send through the proper channels, and to track each stage of the process. Upon completion, a copy of the form is archived in the ECM system and data posted to business and/or clinical systems. With healthcare facilities shooting for full EMRs, we’re doing our part to create technologies that fill the gaps, and are focusing our R&D on removing paper from as many processes as possible.

Ray Dyer, CEO, Acusis

As a clinical documentation solution provider, we continue to look to our customers and healthcare IT market drivers. Given the many transformations underway, driven to a large degree by healthcare provider behavior, we are planning on investing our R&D funding in user intelligence tools including decision support and patient care analytics as well as mobile solutions development. We believe these areas will continue to be driven by customer need and demand, requiring data availability with strong privacy and security provisions. Acusis is poised and preparing to meet these challenges.

Dan Herman, Founder and Managing Principal, Aspen Advisors

Aspen Advisors’ investments will be focused on the expansion of our current services to address the needs of our clients:

• Adoption of EMR technologies and clinical informatics;
• Healthcare reform in support of “accountable care” delivery and financing models;
• Operational integration of Business Intelligence and Data Warehousing solutions to enhance care delivery, improve quality, reduce costs; and
• Improved reliability and cost effectiveness of technology infrastructure through the implementation of structured IT service management processes.

We will continue to invest in the development of structured, repeatable, yet flexible methodologies for planning and assessment, implementation management, and operational performance improvement.

We will also continue our investment in training programs for our consultants, so that our clients will continue to see the consistent application of expertise and delivery of service as our firm continues to grow.

Don Graham, General Manager, Billian’s HealthDATA

Our R&D investment will focus primarily on improving our data on outpatient care, and the better use of social media internally to communicate who we are and what we have.

With outpatient surgical visits now accounting for almost two-thirds of all surgical visits in the US, it is an area that our customers – healthcare vendors – are paying more and more attention to. We in turn must provide them with the data they need to best address this trend, which doesn’t show any sign of slowing down in my opinion.

As for social media, it’s proving to be the most effective way to distribute the news. That includes, of course, healthcare news. We realize that our customers and their provider customers are increasingly using social media as a means of communication and self-education, not to mention public relations and marketing. Patient referrals, good and bad, will have an ever-increasing influence on healthcare-related decisions made by the public, and the public’s migration to social media is obvious.

We, of course, want to be where our customers are, whether that be Twitter, LinkedIn, or blogs like HIStalk, so we’ll be ramping up our social media presence internally to make sure that staff are engaged and conversant in the healthcare discussions taking place online.

Stuart Long, President, Capsule

As the leaders in device integration, we’ve always been in the data business. Yet data needs are rapidly evolving. We are going well beyond the basic connectivity of data into information system(s). Basic connectivity is actually well understood as a necessity at this point; hospitals get that automating the vitals collection process is critical to recovering nursing hours, reducing charting hours and improving patient care. What they really need is better, more useful data to help improve decision making, to alert them to impending conditions faster and to improve the quality and safety of patient care overall.

We’ve reached a tipping point; hospitals are starting to scream “information overload.” Our customers are saying “we get so much data, from so many sources, that we need help sorting through it all; we need it presented in a meaningful way so we can act upon it faster.” We hear them loud and clear and will therefore be investing heavily on data; on how we increase the value of data so we can manage and disseminate the discrete data and communicate additional relevant context and meaning of that data to the right caregiver, at the right time, about the right patient. It’s a tall order and will take a lot of work with our EMR partners as well to make it a reality, but I think we are in the right place, at the right time to make it all happen.

Mac McMillan, CEO, CynergisTek

That’s easy — on the areas of privacy and security representing the greatest challenges for our customers.

We have always prided ourselves on staying out ahead and anticipating the needs of the industry and the needs of our customers in privacy and security. Five years ago, that meant attacking things like data leakage, encryption, and log management/auditing. Today it still involves finding better ways to monitor activity in the enterprise, but it also includes things like securing the cloud, defining managed security services for healthcare, managing the risk associated with the proliferation of mobile devices and medical devices that are not secure, and finding ways to better manage the security requirements with Business Associates.

Healthcare has enough complexity in its environment and more than enough on its plate with HIE, ACO, ICD-10, etc. It needs practical security strategies and solutions that work and are effective at stemming the tide of breaches like we have seen this year. We believe that in order for healthcare to win the battle with privacy and security, it’s going to take an investment in the right technologies and integration of Managed Security Services into compliance programs. We understand that technology alone is not the answer, and so the focus should be on implementation strategies and building the right processes around these technologies that enable them to be successful.

Michael O’Neil, CEO, GetWellNetwork

In recognition of the emerging reality that healthcare will be delivered anywhere and everywhere, no matter what the time, device or location, GetWellNetwork will sustain its investment in innovative Web-based, mobile phone and cable television technologies. When used properly, such technologies will support communication, education and even engagement throughout a patient’s care journey — from the home to the physician office, hospital, imaging center, or pharmacy and back to the home once again.

Platform-agnostic, technology-enabled patient engagement will be indispensable to providers, payers, and vendors as they work collaboratively to reduce hospital readmissions, promote self-care, boost patient and member satisfaction, and decrease cost per case. At GetWellNetwork, we are making significant investment in helping providers fulfill Stage 2 and 3 Meaningful Use requirements, and address the evolving challenges of medical home, accountable care and bundled payments.

Peter J. Butler, President and CEO, Hayes Management Consulting

At Hayes, we plan to invest R&D dollars in our hospital billing compliance software, MDaudit Hospital. It is designed to give auditors access to billing data to support revenue integrity, helping them to eliminate the errors for which CMS routinely recovers payments through its integrity programs such as RAC, MAC, and the efforts of the OIG.

However, we are finding that our clients are increasingly asking us about using this tool for other strategic projects such as ICD-10 documentation improvement, Meaningful Use, and data mining. Therefore, we are exploring related tools to use for these additional purposes. For example, via our recent integration with MediRegs clients can look up diagnosis and procedure codes and documentation requirements while in MDaudit. Additionally, some of our auditors are using MDaudit as a physician training tool on ICD-10 documentation.

Tiffany Crenshaw, President and CEO, Intellect Resources

Intellect Resources is investing in identifying and breeding new talent for the healthcare IT industry, with emphasis on training and go-lives.  In 2011 we debuted Big Break, a high-energy recruiting event designed to select an entire training and go-live teams in short period of time. Big Break is marketed towards individuals with no or minimal healthcare IT experience who have the right attitude, enthusiasm, and potential.  In an intensive one-day recruiting event, job applicants must complete a series of rigorous tests – one-on-one and panel interviews, extemporaneous public speaking, group work and classroom presentation skills – designed to identify only the best training and go-live talent.   

Once selected, Big Breakers complete an intensive course with classroom and hands-on learning, credentialing them in the appropriate EMR. As a result, a hospital system is able to select an entire training and go-live team in just a few days. Because Big Breakers do not typically have prior industry experience, they can often be secured at a fraction of the cost. As a result, hospital systems are able to breed and retain this new talent at a fraction of industry costs in a short amount of time.

Doug Burgum, President and CEO, Intelligent InSites

In our pursuit of improving care while lowering costs, we’ll be investing in three primary areas in the next 1-2 years.

First, one of Intelligent InSites’ most important objectives is to improve caregivers’ ability to spend more time at the patient bedside. To this end, we’ll be continuing our R&D investment in automating non-value-added manual tasks—including EHR data entry and finding available, clean equipment through easy-to-use applications—to give caregivers more time to spend with patients.

Second, as our solution utilizes RTLS and RFID technologies to know the location, status, condition, and interaction of all tracked equipment, patients, and staff throughout the hospital, we collect a massive quantity of operational data, every minute, every day, month after month, year after year. Through our Business Intelligence solution, we help our customers harness this “Big Data” to produce actionable insights critical to making sound and timely decisions, by utilizing flexible, high-impact, easy to create reports.

Third, because real-time data is generated from a wide variety of data sources, and because real-time intelligence can empower multiple healthcare IT systems, we’ll be continuing our investment in our partner ecosystem. We will continue to integrate with the expanding set of RTLS hardware vendors, and we’ll continue to expand our interfaces with EHR solutions, communications platforms, asset management applications, building management systems, and nurse call systems.

We are excited about investing in the future of RTLS, the “magic” of enterprise RTLS software, and helping our customers to truly improve the care they deliver, while simultaneously lowering their costs.

Tom Carson, CEO and President, MD-IT

MD-IT has traditionally developed and delivered software functions that provide or support practical use of technology for physicians and patients, and that will continue to be our focus. Like most vendors, we will keep an eye on Meaningful Use requirements and other market developments, but identifying specific features beyond the near term is tough, as the HIT market is quite volatile at this point.

We expect to see evolving demands as the industry moves from what we think of as effectively an EMR version 1.0 environment to a more mature EMR version 2.0 environment that is more sensitive to the needs of physicians and patients as the primary users of these systems. Certainly near-term efforts will be directed to expansion of our popular mobile functionality that streamlines physician workflows, as well as continued broadening of our interoperability functions that link providers, patients, and payors.

Patrick Hampson, Chairman and CEO, MED3OOO

We are focusing our investments and resources in numerous areas. MED3OOO has committed to focus our knowledge, products and services with a MED360 view of healthcare delivery. We are not like most vendors just supplying systems. Our investments will continue to expand our current operational and technical capabilities and offerings. We will continue to integrate our proprietary systems, and continue our investments in capturing and using data of populations. We will continue to invest in tools that providing information across the entire spectrum of care focused on: efficiencies wherever we can find them, the patient and provider experience, the cost and most importantly the quality of care delivery. We want to be the best partner to providers that is in the industry.

Our investments in point-of-care capabilities will also create a great differentiation for the providers using our proprietary systems. As part of this, we are investing in the area of clinical decision support. “CDS” in an Electronic Health Record can take many forms. It is certainly more than providing guidelines to a provider. We want to focus on the user experience and want to spend a lot of effort with physicians reviewing workflows to determine how CDS can truly add value to the provider and patient when care is being delivered. Our addition of Quippe is just one example of these efforts. Quippe is the state-of-the-art documentation tool in the industry and is the basis of enhanced CDS within our InteGreat EHR offering.

These efforts are also critical to the physicians and hospitals we have partnerships with, but who are on older technologies or legacy systems even though they come from today’s brand vendors. Physicians already have investments in these systems. They too, need these higher level capabilities and they too need knowledge-based solutions. While these systems may be older and not web- based, MED3OOO, as their operating partners we work to provide solutions to improve on the capabilities these older systems just do not have. A system agnostic approach allows us to not just throw them out and waste physician’s precious capital. We try to maintain those systems and it is somewhat like the BASF commercials, “We don’t make things, we make things better.”

Lastly we will continue to expand our significant M3IQ data warehousing capabilities, capturing data from disparate systems, continuing our focus on the promise of combining financial claims and clinical data, and turning that data into actionable, predictable intelligence.

Robert Connely, Senior Vice President, Medicity

We are going through a period of enormous change in healthcare, and it’s clear that healthcare IT will play a critical role in that change. Medicity is focused on a strategy that will enable rapid adaptation to changing requirements while realizing a more cost-effective model that we believe will lead the next generation of information technologies.

Today, we’re building out the underlying IT infrastructure required for tomorrow’s healthcare, including integrating EHRs, building data exchanges, and standing up repositories. We are expanding our analytics capabilities and are involved with developing standards like ONC Direct. 

Many of our R&D efforts are targeted at integrating and improving our family of products. The strategy levers common technology platforms, modular apps, and cloud services. We believe that by porting much of our current functionality into apps designed to run on a platform like iNexx (Medicity’s individual network exchange), we can reduce time to market for new features, control development costs, and provide a greater opportunity to adapt to new needs quickly. 

We believe that technology is evolving to the point that it can adapt to people as opposed to people adapting to the technology.  Towards this end, we continue to invest in emerging technologies and markets.  For example, our efforts range from pioneering pervasive analytics that employ software agents to better analyze information at the source, to enabling consumer platforms to drive better health.  We are also focused on building solutions that leverage payer, provider, and consumer interactions to create more effective care.

Peter Kuhn, CEO, MEDSEEK

MEDSEEK has always been ahead of the curve, developing strategic patient engagement and management solutions that help healthcare executives realize cost savings by improving care collaboration within existing workflows and find new revenue streams by finding and engaging patients. We were among the first to deploy our enterprise solutions to assist hospitals in finding, engaging, activating, and managing patient populations, and we’ll continue to invest in developing those solutions to allow hospitals to better prepare and position themselves in the rapidly changing world of healthcare reform.

Additionally, the strategic use of predictive analytics will ultimately become the market differentiator for hospitals, which is why we acquired Third Wave Research, Ltd, in 2011 and have been working on integrating their advanced predictive analytics expertise into our existing solutions. We will continue to invest in analytics technology that enables our clients to position for patient engagement, wellness and disease management. The rapid adoption of patient portals and the shift away from fee-for-service in favor of outcome- and quality-based reimbursement models will place more emphasis on finding new cost savings and revenue streams. To differentiate themselves from the competition, hospitals must find ways to personalize the patient experience and better manage the patient population. Effectively promoting profitable services to high-value patients and engaging them in wellness programs will influence healthy behaviors to positively impact outcomes.

Jay Mason, CEO, My Health DIRECT

It has been painfully obvious over the years that our solution was a bit ahead of it’s time. While very successful in directing patients to appropriate care settings in an ER, there wasn’t a pressing need to interact “outside of the walls” broadly or routinely. What we have seen in 2011 and see as our chief role moving forward is to serve as a health scheduling exchange. We will continue to invest our R&D in staying ahead of the curve. Today we can provide true Enterprise  Application Integration (EAI) with any willing trading partner via our own platform’s ability to leverage HL7, API, or CRM-based communication protocols.

So the next year will be more of the same for us — creating the integration tools, onboarding methodologies, and consumer engagement services that will allow our clients to redefine the way they interact and guide their patients and members.

Janet Dillione, Executive Vice President and General Manager, Nuance Healthcare

Going into 2012 the pressure is on for healthcare organizations to increase the quality of care delivered while reducing cost and complying with federal mandates. Nuance could not be better aligned to help healthcare organizations succeed in light of such pressures as Meaningful Use and ICD-10 and to ensure that clinical data is created in the most efficient way possible and is built from rich information that can be analyzed and intelligently used to drive broad healthcare enterprise change and improvement.

Over the next 1-2 years, we’ll continue to invest in areas that fundamentally improve the capture phase of clinical documentation, by which I mean empowering clinicians to document anytime, anywhere on any device in the most effective, natural way possible – via voice.  In 2011 we went to the cloud, offering SpeechAnywhere services to development teams across the industry.  Speech-powered clinical documentation is widely in demand and will continue to expand to encompass the complete healthcare enterprise and the mobile clinician workflow.

We’ll also continue to heavily invest and innovate in the area of language understanding and analytics technologies, which make it so clinical data can be extracted from unstructured documents and intelligently leveraged to drive better clinical and business decisions. Through work with 3M, IBM and UPMC, Nuance is making tremendous traction against its mission to transform patient stories into high-value information. Our speech-driven clinical understanding solutions will increase the quality of documentation, improve efficiency and drive better care – all while putting less burden on clinicians.

Todd Cozzens, CEO, Accountable Care Solutions, Optum

I heard someone say the other day that ACO = HMO 2.0 But With Data. It is indeed all about the data. I empathize with health system CEOs who, after spending anywhere from $100 million (average medium size IDN) up to the $3 billion Kaiser spent on installing EMRs in the last ten years that all they really achieved was computerizing paper records. Little has been achieved in actually doing something with the data. That’s what the next ten years is all about.

• Population Analytics: EMRs and the early data warehouses being developed on top of them are good at managing a census – sick people that visit hospitals and doctors. Population Analytics manage entire patient populations across all of their interactions with the health system. EMRs rely mostly on clinical data and some financial data. Population Analytics incorporate claims data, clinical data, financial data and actuarial data across ambulatory, in-patient, post acute and home care. We are in the top of the first inning of the biggest wave of change in our healthcare system any of us will see in our lifetime. These tools are also in their 1.0 versions and will evolve. Optum was almost purpose-built to bring all of these capabilities together into one cloud-based, integrated solution.
• End-to-End (E2E) Financial Efficiencies: Hospitals leak revenue more than any other business in any other industry – with the average health system collecting only 33% of what they actually bill under the current fee-for-service (FFS) system. And on top of this we’re now going to burden hospital finance departments by introducing new fee-for-value (FFV) payments starting with bundled payments and pay-for-performance measures right on up to full risk-bearing entities. In the forward-thinking health systems, we’re seeing the realization that they cannot do this all themselves. Many see FFV as the future so they want their current finance teams to be the experts in the new system. These same health systems are increasingly outsourcing their FFS financial systems to experts who know how to recover lost revenue, realize much higher collection rates and know how to drive cost takeout. We acquired Executive Health Resources to help hospitals drive revenue integrity for the big potential loss area of reimbursable admissions. The Lynx ED coding tool returns an average of $2.5 million lost revenue per medium size hospital. We combined those tools plus others around collections, billing, and Financial Health Record (FHR) to form our E2E solution set and we will invest more in these capabilities in 2012.
• ICD-10: Health systems are so encumbered with Meaningful Use compliance, RAC compliance, and facing the coming huge cuts in Medicare/Medicaid that they have largely been in denial about the impending ICD-10 deadline. With the introduction of up to 155,000 new reimbursement codes and less than 10% of healthcare providers halfway to ICD-10 readiness, ICD-10 could be an insurmountable challenge. We made a large investment in what we believe to be the best technology available to meet this new challenge. Because of the time caregivers will spend hunting for the right code, ICD-10 will actually make the health system much less efficient unless groundbreaking new technologies emerge. The natural language processing technology that we acquired from A-Life is exactly what’s needed to automate this laborious process. We’ve seen tremendous traction for this solution in the last six months and expect that to continue. Our R&D investment has increased so we believe we will keep and extend our technology lead here.
  

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  Paul Brient, President and CEO, PatientKeeper Inc.

  PatientKeeper’s number one priority is to deliver healthcare applications that improve the physician workflow. This means that we save physicians time, we help them provide higher quality care, and we help them get paid for more of the services they deliver.  

  We are still spending heavily in R&D to round out our suite of 13 fully integrated applications. Our near-term focus is to continue to add features to our CPOE product, complete our Medication Reconciliation product, release a next-generation charge capture application, and give our tablet/iPad applications feature parity with our desktop applications. The emergence of the tablet as a “first class” device has been eagerly anticipated by the healthcare IT community for nearly a decade and is finally here.  In fact, we have a small but growing number of our 40,000 users who use their tablet/iPad as their only computing device.

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  Todd Johnson, President, Salar

  While we have always been focused on "the physicians experience," the merger between Transcend Services and Salar has intensified this focus. In the months ahead, we are going to be able to address a physician’s workflow in ways never before thought possible. Understanding all of the external pressures applied to physicians, how remarkable it will be to offer solutions that offer either zero impact on their day-to-day, or better yet, offer drastic improvements to their workflow that they didn’t even realize were achievable? Not only will we be able to satisfy a physician’s interests for time, speed, and efficiency, but we will also be able to free the physicians from those same external pressures. By offering to our hospital customers clinical documentation solutions that meet the needs of coding, compliance, quality, billing, RAC audit mitigation, communication, and patient safety while doing so in a zero impact methodology to the delivery of care, we truly meet the needs of all parties at the table.

  To realize the benefits of this "enhanced physician experience," we will be investing heavily in our web-based platform to complement our existing thick client solutions, natural language processing tools, front end speech solutions, ICD-9 and ICD 10 GEMS mapping solutions, front end computer-assisted coding features, and even an improved workflow for traditional transcription services. We will continue to deliver all of the above through our "have it your way approach," thereby meeting the needs of both our physician users and our hospital customers.

  It’s been a long-time objective of Salar to become the de facto clinical documentation module within a host of HIS systems. We are closer to realizing that objective than ever before. Through some new and unique customer engagements, we will be integrating our platform into industry-standard information systems and, in turn, reaching out to an even broader customer base. The marriage of these solutions and the seamless nature of their delivery are incredibly important to us. Our customers count clicks–and so do we. We will continue to work over the next 1 to 2 years to streamline usability across systems and, ultimately, enhance a physician’s day-to-day experience.

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  Stephen Hau, CEO, Shareable Ink

  Everyone wants innovation, but no one wants to change.

  It is well understood that the healthcare industry must become more electronic and data-driven. However, we also know that change is hard. Market data reveal that, while most clinicians enjoy the accessibility of patient information that EHRs deliver, the majority does not prefer the Windows 95-style “point and click and drop down list” style of documenting that the standard EHR user interface requires.

  We believe that there must be a better way to extract information from a physician’s head without forcing them to become typists, tap a screen or mouse 30 times to create a “cookie cutter” note, or hire prohibitively expensive scribes out of desperation.

  As such, we have begun to invest aggressively in machine learning and natural language processing. Our system does not require user training. Instead, it has begun to learn from clinicians’ handwriting, gestures, and other natural inputs. The ambitious goal is to deliver innovation without requiring clinicians to alter time-tested workflows.

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  Ed Daihl, CEO, Surgical Information Systems

  Our R&D focus supports improving the management of perioperative services, the area of the hospital that continues to drive the financial success of the hospital. A recent survey by SIS shows an increased focus on reducing perioperative costs, with 78% working on cost reduction efforts – a 34% increase since 2010. Additionally,  the survey indicated another shift from 2010 with cost reduction efforts being prioritized over reimbursement concerns. In 2010, 25% of hospitals cited maximizing reimbursements as their top financial concern. In 2011, that number dropped by 56%. We believe that perioperative specific analytics is a powerful tool to help hospitals control costs — their top concern — and will continue to work to improve this management tool.

  Additionally, we see the adoption of anesthesia information management systems as a growth area in the industry. Electronic anesthesia documentation streamlines this process and provides accurate and legible anesthesia records. This equates to significant benefits, such as more accurate charge capture, quality improvement, and allows for the anesthesiologist to spend more time with the patient and less time documenting.  The addition of clinical intelligence with anesthesia analytics provides even more value to hospitals and anesthesia providers by unlocking powerful decision making data to help improve both care quality and financial return.

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  Evan Steele, CEO, SRS

  Over the next couple of years, SRSsoft will evolve to accommodate the acquisition and sharing of increasingly greater volumes of patient health information, as relevant to our specialist and primary care clients.

  We will remain focused on productivity (naturally!) as we evolve our data capture interfaces. This means that user interfaces will be implemented using techniques that are both ergonomic from a personal user perspective and accommodative of the actual workflow that takes place in the clinical office environment.

  We have put into place, and will continue to enhance, our own dedicated platform for data sharing and interoperability. Our Continuity of Care Exchange (CCX) platform manages connectivity and the physical transport of files, while our Discrete Data Exchange (DDX) components handle the import and export of discrete data to and from our system. We will continue to evolve CCX and DDX over the next couple of years to support increasingly higher levels of interoperability.

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  Rick Stockell, President, Stockell Healthcare Systems

  Over the next 1-2 years, Stockell Healthcare Systems will be devoting a significant amount of R&D to ongoing regulatory compliance.  In addition, we will continue our ongoing focus on client business process improvement through the development of advanced analytics and information management solutions.

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  Richard Atkin, President and CEO, Sunquest

  Sunquest is increasing its investment in product development across the board. We now have over 35% of our total resources dedicated to product development and product quality. We will have a particular focus over the next 24 months on developing new functionality in the converging areas of molecular pathology, anatomic pathology, and digital pathology. As a founding Gold Sponsor of the Digital Pathology Association (DPS) and through our partnership with Massachusetts General Hospital, we will be building the next generation of pathology workflow solutions.

  The incorporation of digital images of all sorts into the pathology workflow will drive significant growth, change, and efficiencies throughout our clients’ operations. Sunquest will work closely with our clients to enable them to take advantage of the coming changes in science, medicine, and technology. The ongoing evolution of molecular testing is driving a convergence between anatomic and clinical pathology. As healthcare delivery evolves to a more integrated, regional model and incorporates more personalized data, Sunquest will provide the solutions required to thrive in a new age.

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  Sunny Sanyal, CEO, T-System

  To meet clients’ current and evolving needs, T-System in the next 12-24 months will focus R&D investment on enhancing our emergency department information system, The T SystemEV. Our top three R&D priorities are as follows:

  • Support for regulatory mandates, including Meaningful Use and ICD-10. T-System will seek ONC-ATCB certification for Stage 2 Meaningful Use measures as soon as HHS finalizes the requirements. T SystemEV, already certified for 2011/2012 criteria for Stage 1 Meaningful Use requirements, will be compliant with ICD-10 in 2012, a year before the deadline. Our goal is to give clients maximum flexibility to address clinical, business and regulatory needs
  • Enhance interoperability. T-System will continue to invest and partner with other vendors to ensure that clients can seamlessly connect T SystemEV with disparate inpatient EHRs and other information systems outside the ED.
  • Continue to provide innovative and new functionality. As the care transition hub and starting point for a high volume of patient handoffs, the ED plays a critical role in ensuring the continuity of care. Supporting smooth patient transitions with efficient communication will become even more important as facilities and practices form accountable care organizations (ACOs). T-System will develop solutions and functionality that will help EDs lead the ACO model of healthcare delivery. Additional offerings will continue to improve clinical and financial outcomes that start in the ED and benefit the entire hospital and community.

News 12/30/11

Top News

CSC says it will have to write off almost the entire $1.5 billion it spent trying to install iSoft’s Lorenzo in the defunct NPfIT project in England. The government has apparently declined to give CSC the new scope of work the company had requested. CSC has also withdrawn its financial forecast and stepped up plans to replace its CEO. It posted a loss of almost $3 billion in its Q2 report filed September 30, mostly due to a write-down of goodwill. The company’s market cap is $3.7 billion. Shares are at $23.68, off more than half since the beginning of the year.

Reader Comments

From Zafirex: “Re: hardship exemption for e-prescribing. Looks like so many providers are claiming it that CMS is having difficulties. Wonder how many are truly hardships? I doubt CMS could ever verify since it looks like they’re having trouble even producing a list.” Exemption categories include a practice area with no broadband coverage or that has too few participating pharmacies, practices that applied for Meaningful Use before requesting an exemption, practices that prescribe mostly narcotics that are not eligible for e-prescribing, practices that don’t prescribe regularly, or practices that e-prescribe but not for qualifying visits.

From Search Boy: “Re: searching HIStalk. Thanks for the explanation to King Salmon. Is there a way for retrieved searches to be indexed chronologically rather than as a percentage of keyword match?” I haven’t figured out how to do that. Since the pages are stored in a database, I don’t think the search function can determine the original publish date even though it’s in the title.

From Lilies: “Re: Epic. They’re #17 on the list of 25 oddball job interview questions, with ‘You have a bouquet of flowers. All but two are roses, all but two are daisies, and all but two are tulips. How many flowers do you have?’ There are two distinct valid answers.” Three is the obvious answer (one of each flower) that took me about two seconds to get. I assume the second answer depends on the question not stating explicitly that there are no other kinds of flowers in the bouquet (i.e., you could have two Venus fly traps only, making two a correct answer.)

From Stats Fan: “Re: readership stats. You haven’t given your readership stats lately for me to track.” Good timing since I realized a couple of weeks ago that I’ve been undercounting all along. I had forgotten to add the hit-counting Javascript to the mobile display that you see on iPhones and iPads. That hit me a couple of weeks ago, so I dug around the code and figured out how to fix it, also noticing that a surprising 30-50% of readers use Safari, most of them presumably on iPhones and iPads, which is a lot more mobile readers than I would have guessed. So far for December, it’s 96,250 visits, 148,218 page views, and 22,029 unique people reading (but that’s lower than the real number since I didn’t make the change until the middle of the month.) January and February will be good indicators since the HIMSS conference really pegs the needle on readership. Inga pays a lot more attention to the numbers than I do, so I will await her analysis. Above is where the visitors are from, just in case you are interested. Among cities, it’s Madison, Stone Mountain, Atlanta, New York, and Chicago making up the top five, but the major metro area is Boston with 8.41% of visitors. It’s a 62% male audience, so ladies, tell your friends.

From HIMSS Envy: “Re: HIMSS points. Got me wondering – it would be nice of HIMSS published an annual report for public review. It might not change a thing, but transparency is a powerful motivator. Come to think about it, Mr. H, how about you, too?” I thought HIMSS did a report, but I couldn’t find one. You can get their Form 990 from GuideStar, which always has interesting factoids (like that HIMSS FY 2009 revenue was $44 million and CEO Steve Lieber’s total compensation was $711K). I don’t know what I’d put in an annual report that isn’t already on the About page or contained in the list of sponsors … other than my hospital job, I don’t have any ownership in anything, I have no other income, and I don’t shill stuff like speaking or consulting under the delusion that I have value beyond what you’re reading right here.

From Peds Envy: “Re: tired of writing only good things about Epic. Private practice peds are the worst type of users for Epic. No surprise there. Someone who knows Brown & Toland told me the reaction is 100% unanimous – they hate it.”

From Anonymous Epic Fan: “Re: tired of writing only good things about Epic. Here are a few issues with their implementation methodology and support that even the Kool-Aid drinkers would have a hard time disputing.” Here’s the list from AEF:

• Epic’s implementation planning materials are weak. They have to be re-worked for each new application / scope mix, and after that is done, little to no effort is made by Epic to customize them based on organization specifics. If you want the project plan to be useful and to have sufficient detail, expect to spend a lot of time and effort re-working what gets initially delivered.
• Epic suggests you go live on Model workflows as quick as possible. As painful as it may be, it is definitely better from a cost perspective. Then, you plan to do the bulk of the ‘real’ implementation after getting live. This can/may work if the bulk of the existing documentation / orders workflows are paper based and you are implementing all of Epic’s applications, but this approach is suicide if the existing system being replaced has been customized for the end-users and they are happy with them or if you have to rely on the timelines of other vendors to build/test/implement interfaces and data conversions.
• The Epic Model does not work well for any hospital or outpatient units that are more complicated  then the most typical med/surg units and general practice specialties. Specifically, hospital outpatient departments that bridge the inpatient and outpatient void.
• The Epic Model completely breaks down if you are not implementing all of Epic’s applications and workflows rely on interfaces to/from legacy systems.
• With Epic’s implementation team constantly turning over, being spread across more and more customers, and the increasing pressure to implement faster, attention to detail is lacking. In my experience, they are over promising and under delivering more than they did years ago.
• Time estimates are always low. Everything takes much longer than anyone anticipates. Medication build, consolidating charge masters, cleaning up supply/pick lists, mapping lab components, consolidating multiple sources of payor/plans, cleaning up the provider / credentialing information, getting physicians to agree and sign-off on order set/documentation template content, and working down duplicate patients in your EMPI or mapping data elements for conversions etc.
• Epic implementation tools / deliverables are often shared just before an upcoming trip for when they are to be used. Though effort is made to customize them based on application mix/scope, they never really get updated to reflect the actual workflows discussed and validated early in the process – especially if they differ in any amount from the ‘model’ workflow. The delivered product if very inconsistent from application team to application team and integrated areas/workflows often get overlooked. So just like the implementation planning materials, expect to spend a lot of time re-working these deliverables to make them useful.
• All application teams involved in the implementation are siloed, and in addition, the Epic implementation teams, technical support teams, and development teams are also siloed. This causes issues for organizations live on one set of applications, rolling out another set, and implementing a third set.
• The silos mean that there are application experts, but very few Epic staff have cross-application experience / knowledge and if workflows are interface-dependent, very few have true integration experience.
• Epic’s training only scratches the surface. The true training is the implementation process and go-live. The shorter the implementation timeline, the more unprepared the customer IT staff is to support the applications when they go live – thus the demand for lots of consultants.
• The system documentation is very inconsistent and virtually impossible to search on the UserWeb. Unless you know where to find what you are looking for, you often have to e-mail Epic to ask if documentation exists. I is not uncommon to be sent an ‘unofficial’ document created by a frustrated Implementer not being able to rely on the system administration guides themselves. In fact, all of the implementation documentation / guides were historically written and maintained by implementers, but due to the inconsistency between applications and un-sustainability of keeping it up to date. no implementation documentation/guides exist today.
• Epic’s end-user training materials are great if you are implementing all of Epic’s applications and you are using all Epic model workflows. If anything changes, these are not so great – expect to have to overhaul them.
• Same goes for the testing scripts. An OK start, but definitely not something that can be used out of the box.

HIStalk Announcements and Requests

How Apple wins customers for life: I had a five-year-old, first-generation, 1 GB Nano that I only used for the gym. I heard Apple was recalling a few of them because of some explosion-prone batteries, so I put in the serial number on their Web page and darned if mine wasn’t on the list. They sent a postage-paid Fedex box to return it. Today I got back a brand new sixth-generation, 8 GB Nano, which now comes with a color display, gestures, FM radio with live pause, pedometer/accelerometer, and a bunch of other features, all in a package barely bigger than a watch face (in fact, you can buy a watchband that holds it, turning it into a watch.) It’s super cool, and so is Apple. You did good, Steve Jobs – RIP.

It’s time to wrap up the HISsies nominations soon, so contribute yours now to the blank slate that will be distilled into a handful of choices for the real voting that starts shortly. I’m particularly happy with one nomination for Smartest Vendor Action Taken: “HIStalk sponsors that replaced blinking ads before the deadline.” Well done, and a good observation. My sponsors really are the best – as much as I hated to spring the change on them since it requires work and expense on their end, they’ve been great about it. I’ve enjoyed the nominees for the Beer and Pie categories, as always, and there are some good nominees for the Lifetime Achievement Award.

Speaking of the HISsies, full details and signups will go up next week for HIStalkapalooza in Las Vegas. And also speaking of the HISsies, if you plan to vote (and I hope you do), sign up for the e-mail updates since I e-mail the voting link out to prevent ballot box stuffing that was as rampant as in a third-world dictatorship until I took that step. For that reason, if you aren’t on the list, you can’t vote.

Listening: new from The Roots, which even though I’ve only sampled it so far due to limited time, is just blowing me away. It’s extraordinarily music in the form of a concept album, making it impossible to label as rap, soul, or hip hop even though it includes strong elements of all of those. The accompanying short film is here. Their talent is mind-boggling. Down it goes to the new Nano, which contains only my latest favorites since I intentionally started from scratch: Genesis And Then There Were Three, two albums from Gooder, one from Metric, and Luminiferous Ether by the never-gets-old Zip Tang.

It’s just Dr. Jayne and me tonight as Inga is sojourning in the mythical Land Without Broadband. She will return soon. But in the mean time, Dr. Jayne is doing her usual fabulous job. I’m pretty darned lucky to have two smart, funny, hard-working, and undeniably cute ladies with whom to share the page, don’t you think? I will raise a glass in their honor for New Year’s (probably of Duvel beer since I got some for Christmas and I like it a lot.)

I’m not telling you Happy New Year yet because I’ll be posting a Monday Morning Update this weekend as usual, even if nobody’s around Monday to read it.

Acquisitions, Funding, Business, and Stock

Board members and executives of document management vendor Streamline Health Solutions will buy $400K worth of the company’s stock, news of which sent shares up 9% on Wednesday.

Healthcare alerting system vendor Extension, Inc. announces what it says is record quarterly growth, adding 17 new hospitals in the third quarter and quadrupling its headcount to 40 over the past two years. They might want to budget for a public relations or media person next since this is easily one of the worst-written press releases ever, starting off with a clumsy opening sentence that sounds as though someone whose native tongue was not English (or at least not good English) sweated over it until nothing interesting remained. It doesn’t get better as you read on.

Announcements and Implementations

Tampa General Hospital (FL) goes live on its $120 million Epic system, which works out to $118K per bed. The hospital says $40 million of that was for hardware and software, with the rest going for staffing and training.

Other

Weird News Andy sounds like a fortune cookie in summarizing this story as, “Foot in mouth results in mouth in foot.” A man shows up in the ED with a swollen, infected foot, claiming he stepped on a piece of glass on the beach a couple of weeks before. The beach and timeline part of his story were accurate, but not the glass part: doctors removed a tooth embedded between his toes, lodged there during a beach fight when he kicked his opponent in the jaw while wearing flip flops.

Several readers were interested in John Halamka’s post about his wife Kathy’s newly diagnosed breast cancer. The first of regular updates, posted Thursday, is here. Reading his thoughts and analysis of their situation makes you realize that HIT stuff aside, he’s probably a fine doctor as well, not to mention the kind of supportive partner we would all want if faced with a life-changing diagnosis and gearing up to fight it.

A big health-related software sale you probably didn’t hear about: General Cannabis, which operates the medical marijuana dispensary finder WeedMaps, acquires MMJMenu, whose software for marijuana growers and dispensaries tracks inventory “from seed to sale,” basically an ERP for pot growers. General Cannabis had revenue of $10.4 million in the first nine months of the year and paid $4.2 million last month to buy the Marijuana.com domain.

John Newman, MD PhD, a UCSF physician and legal scholar, worries that medical copyrights will threaten patient care, citing a recent case in which a company offering a licensed cognitive screening tool threatened legal action against a similar but free online tool. The implication is that tools based on published research, which could be anything from a pain scale to a hip fracture risk predictor, could be claimed as proprietary by a fast-moving company. The author speculates that without new forms of copyrights, “… as physicians walk down the hallway interviewing patients, they’re tallying up the licensing fees they need to pay for doing their day’s work, and hospitals are suing each other or making cross-licensing arrangements to manage each other’s intellectual property.”

A power surge caused by monthly back-up generator tests at Aspirus Wausau Hospital (WI) takes all communication and computer systems down for five hours, forcing the hospital to go on ambulance diversion. As is always the case, the hospital says patient safety was never at risk, which you might interpret as meaning that those systems contribute nothing to patient safety. They’re on Epic, I believe, not that the hospital’s Wisconsin location didn’t already make that fairly likely.

GE Healthcare agrees to pay $30 million to CMS to settle a False Claims Act charge that it encouraged hospital and cardiology laboratories to overbill Medicare for Myoview, its form of technetium 99 that shows areas of decreased blood flow in the heart.

Sponsor Updates

• Rockford Orthopedic (IL) announces that 21 providers have successfully attested for Meaningful Use using eClinicalWorks EHR suite.
• Baptist Health Line (KY) receives its third ICARE award from RelayHealth for work with Western Baptist Hospital’s transfer center.
• Paul Rooke, CEO of Lexmark, discusses how the company’s acquisition of Perceptive Software and Pallas Athena puts them in a unique position in his interview with All Things D.
• Health Choice Arizona, achieves a 44% improvement in its completion rate for preventive services pilot program using MyHealthDIRECT.
• AmkaiSolutions will offer revenue cycle solutions from ZirMed to its outpatient surgery provider software customers.

EPtalk by Dr. Jayne

Where have all the drug reps gone? With significant cuts in the budgets for Big Pharma, many reps have been “made available to the workforce,” as they say. It seems hospitals and health systems are hiring former drug and device reps to sell their facilities to physicians. A recent article discusses how they’re using infection data and patient satisfaction scores to drive business rather than the drug pricing and formulary data of yore. In my book, this is just another thing that sucks up valuable time that we need to care for patients, not to mention sucking up budget dollars that could be better spent on those patients.

I wonder how many physicians who refuse to see drug reps also refuse to see these new “physician liaisons?” And how many health systems place rules around having these reps in the office? At some large integrated health systems, policies ban providers from seeing reps or liaisons from any facility or service provider that competes with a system-operated service line. This includes home health agencies, remote cardiac testing providers, reference labs, and the like. Other health systems restrict the hospital privileges of their employees (prohibiting credentialing at competitor hospitals,) so I’m not sure how big of a target pool these new reps have.

Weird News from one of my favorite places: South Carolina sports a giant mound of tires that can be seen from space. At least it’s not burning like the one in my favorite fictional town. But kudos to Lee Tire Company, Inc. of Jacksonville, Florida for waiving the usual fees to shred and recycle the tires in an attempt to clear the 50-acre mess.

Inga and I are well into our pre-HIMSS preparations. As you’re thinking about traveling to fabulous Las Vegas, consider this recent article that discusses continued concerns about backscatter scanners at the airport. Until I read this piece, I didn’t know they had been banned in Europe. As someone who has to wear a badge to track my exposure to radiation in the hospital, I do worry about frequent flyers. Many of my friends who work for vendors fly two to four times a week. There’s enough radiation from just being in a plane, let alone adding to it with scanners. I’d love to see the cumulative dose numbers for some of those flyers. Maybe frequent flyer programs should start issuing radiation monitoring badges with their airlines’ logos as a promotional item.

Each time I sit to write for HIStalk, I’m still amazed to be part of this team. It’s particularly amusing when I’m just reading through my “normal” e-mail and find a mention of us – most recently a blurb from MED3000 regarding Mr. H’s recent piece asking vendor leadership about the biggest HIT-related news items of 2011. I hope I don’t have facial leakage when I see these blurbs (yes, I have a bad habit of multitasking during meetings) because I know I feel like smiling.

Speaking of multitasking, one of my Facebook friends shared another article on docs multitasking during critical procedures. Medical schools are apparently having to actually instruct students to focus on the patient instead of the smart phone. Looking at some of the examples given in the article, it sounds like some IT teams need to revisit the websites they allow users to access. I can’t think of too many medically legitimate reasons to be on Facebook, Amazon, or eBay in the operating room or in the ICU.

I mentioned earlier this month about my inability to keep up with Inga where shoes are concerned. I think I win this round though – I seriously doubt that Santa left a glass slipper filled with Cosmopolitans at her house.

Have a question about managing pesky sales reps, maintaining the perfect poker face, or the best way to garnish a Cosmopolitan? E-mail me.

Contacts

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

CIO Unplugged 12/28/11

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

The Connecters

For six-year-old Herbert, a train ride was nothing new. But this train was different. Cold. Smelly. No seats. Conductors wore helmets, carried guns, and yelled. Shrouded in darkness and smushed between people’s legs, Herbert clung to his mother and aunt. Passengers wept and prayed. Days later, they disembarked at Gurs.

Horrid scarcely described the inhumane conditions in the “relocation” camp. Herb dug through the trash each day, foraging for crumbs. Six months into the torment, a soldier grabbed him and carried him outside the camp gates. The French Resistance, hiding in the night, whisked Herb into the woods.

Dodging armed patrols, they traversed the countryside and came to a convent near Lyon—Herb’s new home. During routine inspections, the nuns would hide him, the only Jew amongst gentiles. A year later, the Swiss underground led him on foot over the Alps into Switzerland, where he found solace in a group home for Jewish boys.

Herb never saw his family again. While he scaled mountains to freedom, they boarded trains for Auschwitz.

After the war, Red Cross officials connected Herb with relatives that had immigrated to the United States years prior. A young adolescent, fluent in French and German, Herb sailed across the Atlantic. Lady Liberty greeted him in the New York harbor. He learned English. Five years later, Herb returned to Germany as an American soldier.

He fell in love with a young fräulein. They had seven children. I am the youngest

At the end of each year, I reflect and give thanks for many things in my personal and professional life. I’m grateful for what I call The Connecters: the beautiful people who held my dad’s hand. From the German guard at Gurs who led him through freedom’s gate, to the hands of the men and women of the underground. For the nuns who loved a boy of a different faith. For the schoolmasters who hid my father in defiance of the law and for the hands of my immigrant uncle who welcomed him into his New Jersey home. They connected my father to his future. In my heart, I kiss those hands.

This year, my gratitude focuses on my personal Connecters — those who helped enabled my then-future career. While hiring me didn’t affect life or death, I am thankful to those who took a gamble on me. Here are my Connecters and what they taught me:

Pastor Rick Olmstead. In a small but growing church, Pastor Rick invited everyone from the congregation who had an interest in leadership to visit his home for a barbeque. He had hoped for gray heads of wisdom, but ended up with four young-in-their-faith sophomore college students. Trusting in a higher power, Rick pushed forward and invested in us. We eventually became part of the team that enabled multi-year, double-digit growth. His exceptional mentoring and leadership formed the foundation of who I am today.

Major Loomis. The Executive Officer of the 244th Army Reserve Engineer Battalion. This officer’s additional duties involved overseeing the Cadet program. As a nervous nineteen-year-old combat medic, I interviewed with him for one of the few coveted Cadet slots. I knew others had interviewed better than I did, but he took a chance and showed me unmerited favor. I went on to become a combat engineer officer. Upon earning the rank of Captain, I served as the battalion motor officer and battalion movement officer. I learned much about organization, leadership, and process.

Mary Hein. She agreed to interview me because she had misread one of my degrees. She thought I had a Masters in Computer Science when in fact it was a Masters in Consumer Science. When I brought this to her attention, she let it pass and continued the interview. I had very little experience to speak of, yet she offered me my first salaried professional position. I cried (not in front of her, of course.) Mary taught me poise, communication, and brand. She helped hone my leadership.

Mike Gogola. I was interviewing for a director of physician relations position when I realized it was actually an IT position. “You have the wrong person,” I told Mike. While I was good at physician relations and marketing, IT was not my forte. To this day, I’m not sure if he was desperate or sincere, but Mike assured me I had the right stuff for the position. He surrounded me with good technical people and I learned on the go. Mike took me with him to networking opportunities and conferences. He taught me project management and IT.

Kevin Roberts. Kevin believed in me before anyone else saw my executive potential. He took a major risk in supporting my bid to become a CIO at a young age and without requisite experience. He shielded me from naysayers as I learned to walk and then run. He pushed me to become increasingly independent, which grew my confidence. He believed in me.

I’m thankful for those men and women who saved my dad and made my life possible. And I’m thankful for the men and women who connected me, took a risk, and enabled my career.

Who are you thankful for? Take time this holiday to let them know your appreciation. But don’t stop there. Ask yourself who you can help connect. When is the last time you took a risk to help an eager wannabe advance?

Leaders are called to Connect.

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