HIStalk Interviews Gary Cohen

Gary Cohen is executive chairman and CEO of iSOFT of Sydney, Australia.

iSOFT is a significant global player in healthcare software, but not maybe as well known in the US. I’m interested if you have plans to increase the visibility and presence now that you’ve started with iSOFT Integration Systems.

I think that the US is the process of going through an enormous transformation both in healthcare reform, as we speak, and obviously in relation to some of the effects of the ARRA legislation in relation to how healthcare IT can change the way healthcare is delivered across the US. There is quite a lot of disruption, I suppose, in terms of the US health economy, which is bringing change.

I think that is probably the point I wanted to emphasize. I think that provides significant opening for us, I believe, particularly where we have specialized around socialized healthcare or healthcare that is more distributed rather than just obviously utilized in the hospital, or utilized in a private care facility, or whatever. But the movement of information around that network, whether it’s between the various facilities inside a hospital or the various facilities that can make it to a hospital or may interact with that hospital, such as community and so on.

The architecture and the way in which we have built our latest generation solution, Lorenzo, has obviously been around that socialized healthcare model. I think when you look at one of the requirements for Meaningful Use and a lot the climates for performance-type process; you’re going to need — particularly, as chronic illness processes involve a lot more interaction with many multidisciplinary people in a healthcare environment — solutions that enable that sort of coverage. I think that’s where we do see a significant value.

With that in mind, we think we have a technology that is probably quite suitable for the US environment. Therefore, we do look to the US in terms of increasing our exposure there in a variety of ways.

Can you tell me what areas that you’ll specifically target? Will Lorenzo ever be sold in the US, or will it be strictly integration tools?

The answer would be in the longer term, yes, we will be looking at a way of bringing Lorenzo into the US. It’s no secret that we’ve worked very closely with our partner CSC in the UK program delivering Lorenzo. CSC has made a very significant investment in getting to understand, from an integration and delivery point of view, the benefits of Lorenzo into the market. I think one of the things that we would see is that working with organizations like CSC, we believe have significant benefits to the US market. That is a longer-term plan.

I think that what we need to do is look at what is going to be available over the next 6-18 months that is going to be suitable for the market as against what might be available well beyond that time. I think there are various products and components from Lorenzo because it’s just, if you think of Lorenzo not as a simple solution, but an architecture and as a platform with many solutions, then we are able to reconfigure Lorenzo in a form that is more suitable to some parts of the US health economy. So, ignoring the integration solutions that we have — which we supply already in the US — which aren’t unimportant, but are one facet.

We are looking to build a suite of solutions with that integration engine and Lorenzo applications that might, for example, target health information exchanges, target aggregation solutions, target solutions that are able to provide an umbrella framework around which other disparate systems can be integrated. But at the same time, adopt workflow processes into that rather than simply just adopting an integration solution or adopting a viewing platform, in terms of how you might aggregate solutions up through a portal or whatever. Look at some similar ways that Microsoft is targeting to aggregate solutions, we would see similar ways of moving down that path.

I think aggregation and dashboard-type solutions, business intelligence, solutions that compliment that process; so if we were able to bring some added value into that equation, such as, we’ve got a multi-resource scheduling solution which we have recently added to our suite that would help enable some of these organizations to do things that they’re not doing today. If we can start to surround some of the aggregation and solution into a complex healthcare delivery, I think that we’ll fill a niche that will keep us busy for quite a few months.

Obviously, when you have the add-on or wraparound solutions, then you have to get in front of customers or find partners. What do you think it will take to be positioned to get the word out to compete while the money’s beginning to flow, but there’s a narrow window before it will be gone?

I’m probably a bit more sanguine in the sense that I don’t think it’s just going to be a short-term window. Inevitably, I believe it’s going to be a much longer-term window than people imagined. But there is a window, so let’s accept that. It is going to require probably a few things from us.

One, it’s going to require us to build a reasonable-sized platform in the US in one form or another. That could take a number of forms. That could take a form of — and these aren’t necessarily, mutually exclusive — investing more resources ourselves into the market, which is what we’re doing. We’re building not only what we’ve got around, what would be required in Boston, but we are bringing more and more resources out of our UK facility, our European facility.

With some of the people, rather than basing themselves in Europe; we’re relocating them and basing them in Boston. That’s starting to add some more high-level, intellectual-type fire power to that. We’ve recently recruited a senior operations director from Carestream who was formerly a CTO of Kodak in healthcare. He’s a global position, but based in the US as well. We’re starting to populate that.

Secondly, we are looking at a significant number of partnerships that we can engage within a more meaningful way, both from a distribution point of view as well as a technology point of view. Those discussions are becoming more critical and intense, and we hope to get some significant progress in those in the immediate future.

Three, we’re also looking at acquiring a platform. Obviously, that would in turn mean that we’ve made a more significant position in the US through that platform than we could leverage a lot of our own products and technology in that platform. That’s another discussion. I’m certainly not going into much more detail in that, but they are all on the table for consideration.

I don’t want to press you on the point, but when you said “consider acquisition of a platform,” did you mean a hospital information system or an integration platform?

I think for us, there are two parts to our business model. We have a lot of product outside the US, and many of those products, over a period of time, will be very valuable inside the US market. I’m not saying that they may not need to ultimately get referenceability in the US. You did ask me what else we require, and obviously referenceability inside the US is going to be important for us.

But then secondly, you need to have significant capability from sales and marketing and distribution, and so on, inside the US, in terms of scale. Obviously, that’s something that we’re giving serious consideration to how we achieve that scale from a sales and marketing point of view, and distribution.

The second element is in relation to technology. Most countries have technology that is very country specific because of functionality. If you look at most health information systems on a global stage, whether it’s the patient management system or it’s the financial solutions or whatever, there are certain things that are not ubiquitous and they require very point solutions. There’s no doubt that the US is equally prevalent with its own specific solutions for certain areas.

It may be useful for us to look at ways in which we could either partner or work — whether through acquisition or partnership — with companies that have certain solutions, but don’t have other solutions. That’s one of the things we’re closely focusing on, and those solutions would have to be complementary to our product suite. For example, if there is a hospital information system company in America, that, per se, doesn’t really add a lot of value because we have a lot of value elsewhere in the world, right? Just going and acquiring a HIS solution or partner with someone with HIS solutions wouldn’t necessarily be as complementary as something that might be more synergistic. They’re the sort of things we’re looking at.

How would you grade the progress that’s been made and the value that’s been delivered by the NPfIT project?

That’s a very pertinent question. If we strip all the emotion out it, and the political dramas and the theatrics that go around it, I think you’d have to say there are some parts of the UK program that have been enormously successful — have done very well. Other parts which are in progress, but for which the progress probably has not been as fast and as good as it should have been, from a holistic point of view. If you look at the overall arch, is the program — in terms of its over-arching ambitions and what it’s trying to do — a good program, and is it going to get there? I think the answer will be, absolutely, yes.

I think really, if you take all politics aside, I don’t think anybody would suggest that the program’s going to stop and it’s all going to go backwards; because really, there’ll be a no man’s land and they’ll not have any viable alternatives. By the way, that doesn’t necessarily mean that the end is worth it, but if you look at where they are trying to get toward, what they’re trying to achieve, I think it’s fair to say that the goals and what we set up is, and are, very good.

I think the problems exists that some of the ambitions in the way in which some of the things have been done have been too ambitious and probably haven’t had the necessary capabilities around their systems to do it as fast and at the pace in which the goals that were set by the NHS and by the government at the time and therefore, set forth expectations, in terms of time scales, that meant that it was much more difficult to deliver. Therefore, people could then always refer to the fact, “Well, you promised X on a particular date,” or, “You promised X within a year or two years.” Once you pass that date, you can always refer back, “Well, the program’s late.” The more you say it doesn’t make the program any later, necessarily. It just is late, right?

There’s no doubt that the development of the spines that connect the top and bottom of England together to enable records to be transmitted through the health network has been a very successful development. There’s no doubt that the connections of the primary care facilities onto that spine, and most of the hospital institutions onto that spine, have delivered enormous, potential capabilities in the way healthcare records can be transmitted, as well as the admission and flow of information into hospitals and so on, by doctors.

Thirdly, there is the digitization of radiology and some of the diagnostic solutions, has been very successful. The more difficult part of the program, if you like — and it’s difficult because it is complex, and probably the ambitions to do it — were to put in place the electronic health record solution in each hospital trust. To basically replace all the legacy systems that existed right throughout all those trusts. I think it’s that part of the program where the difficulties occurred. I think it’s that part of the program that probably should have been done in slightly different stages, but it is that part of the program which ultimately will lead to the biggest benefits, and ultimately will lead to a successful outcome. It is on track. It is late. They need to accelerate deployment and they need to accelerate some of the expectations around delivery.

I think the NHS have probably appreciated the complexity a lot more themselves, and have probably reshaped the program and are currently reshaping the program to ensure that it is going to be able to reach some of those goals more quickly. But that’s probably a small snapshot. I’m happy to elaborate if you want me to, but that’s basically a small snapshot.

It seems that in the UK, you can’t separate the politics from the technology. Do you think that there will be similar challenges in the US as the federal government gets more involved in healthcare IT and gets equally ambitious to roll out these huge national projects that are certainly going to involve some uncertainty and some huge expense?

In my opinion, healthcare is a social thing. At the end of the day, part of the problem is that you just can’t leave it to private industry to sort out the problem because it’s so interconnected to the political fabric of a country in one way or other. Whether directly or indirectly, we all contribute to the healthcare budget. You probably don’t really think about contributing to a budget of a large corporation, if you will. Healthcare always has a very large public sector element into it, in some form or other, whether subsidized or for social reasons.

Government does need to get involved, and I think part of the problem is government is never sure how evolve itself. Part of the experiment in the UK, which was probably good and equally bad, is that they got involved, but probably the way they got involved could have been better framed. The UK’s a very specialized thing because use of national healthcare system, principally, and controlled centrally even though it might be distributed through various bodies like NHS trusts and strategic health services and authorities and so on. It’s effectively a centralized controlled system; whereas the US is a far more fragmented, non-centralized controlled system where the central government tries to either help with policy designs and so on, but allows industry to make its way.

I think if the federal government or the national government in the US were to be far more active, in terms of programs and structures, then probably one of the things it would learn from the UK is, perhaps, to ensure that there is far more participation at an earlier stage. There’s far more buy-in, and there’s far more flexibility into the system. You need to have a system that doesn’t just pick winners, but allows the market to pick the winners while at the same time, ensuring that you encourage the market to go out and spend to pick those winners. You might put incentives and rules and programs in place, which is a bit like what ARRA’s trying to do, and then allow the market to do it.

It probably needs to be a bit further along than just where it is at the moment, but I think the more that a government tries to identify itself with one or two parties — even if they are the right parties — then everybody else is disenfranchised and they become enemies. Then they spend their life just chipping from the sidelines, which is fairly what happens in the UK today. It’s much better at the end of the day, I think, to allow the market forces to select that in a way that isn’t necessarily centrally driven, but the programs are centrally driven.

Richard Granger was really hard on NHS vendors, making them compete and telling them they would be replaced. But looking back, there almost weren’t any contractors left and now the government is trying to loosen up the payments because they were too tough. Was there a lesson learned about how hard you can push a vendor?

In my opinion, whether it’s at the smallest end of the scale or the largest end of the scale, you need a partnership for delivery of healthcare solutions of a complex level. You’re not going to a shop and buying a piece of commodity and walking out and you don’t have see the shop keeper again. If that works, or doesn’t, you don’t really have a relationship with the vendor of that software. You just put it in your system. It either works or doesn’t work. You might be pissed off with the vendor, but that’s a reputational issue. You don’t really have a relationship.

Complex healthcare delivery solutions at the level we’re talking about require a very significant interaction and partnership between the providers and the integrators and the government, or the providers of the services — the users. If you don’t have that partnership, and because you dictate terms that become more and more unreasonable, if that partnership starts to get one sided by either side, then basically that relationship starts breaking down as the complexities of the solution, which often requires a lot of flexibility, and as time goes on, changes of understanding of the market and things.

If you look at the UK, this was designed back in 2003, right? I think it got underway in 2004, six to seven years ago. So what’s happened in six to seven years? Requirements have changed. The economic circumstances have changed in governments and so on. If you don’t build in that flexibility in the relationship, then the whole thing becomes… You know, you can’t document it in a contract, so ultimately, the more you put contractual and the more you go one-sided, the more difficulty you ultimately create in that relationship.

There are a lot of observers that are putting a lot of importance on the Morecambe Bay go-live because of the payments that trigger and the deadline that supposedly is out there from NHS. Do you think that’s overestimating the importance of what’s going on there?

Morecambe Bay is going to go live. No one is suggesting that Morecambe Bay is not going live. The go-live in Morecambe Bay — and I really get a bit sensitive about this, particularly because the contractual arrangements — but you’re talking a very technical integration program where a lot of historical data on all systems has to be integrated into the new systems and training has to occur with a lot of people and so on. The last thing you want to do is go live and not have a successful integration.

In any program, or any delivery, if it was slipped today, a week, or even a month, everyone would say, “Well, OK, that’s not the end of the world.” But what happened is that Christine put a date there that was a bit of a mark in the ground for the go-live of Morecambe Bay for Lorenzo, with 1.9, in terms of importance for CSC.

I think leaving aside whatever contractual arrangements CSC has agreed with the NHS or not, the real issue is if Morecambe Bay are happy with the solution, which we know they are, and they have been testing it in their environment now for a number of months, and they’ve also been using the older version of Lorenzo. If the trust has made a commitment to go-live, which we know that it has, the fact it might be delayed by some weeks is leaving aside what contractual arrangements exist between CSC and the NHS because of the payments, that is not in any way a train wreck.

OK, yes, I would have preferred it to happen earlier, but the fact is that we are talking very groundbreaking and new technology at the same time, in a complex integrated trust environment. The one thing I can assure you is that, technically, the solution is working and delivered. So technically, the go-live has occurred in every other environment in the primary care trusts. So, it’s going to happen. I’m sure there’s going to be a fair degree of political emotion around it and rhetoric, for the reasons we’ve discussed earlier.

Of course, your company suffers from that because shareholders look at the uncertainty there and know that you’re a major player and significant part of the revenue and would have some concerns. Is there anything you can do to reassure them, or are they mislead into thinking that it’s that important?

We have to understand, number one, the NHS program represents today, for us, less than 20% of our total revenue. It’s not our total business. It’s a significant part of that business, but we’ve 80% of our business, and actually more than half of the UK revenue has got nothing to do with the national program. We’re quite a major player in quite a number of things, so I want to at least put it in context. But notwithstanding, you’re 100% right. There’s a lot of focus, there’s a lot of attention, and it gets a lot of air play even if it is only 20% of our total revenue because it’s seen to be a major growth engine and potentially, if it doesn’t work very well, a potential risk factor.

The reality is that in some ways, fortunately for me, my year end isn’t up until 30 June, and a lot of the major things and milestones and deliveries are all scheduled to take place between now and 30 June. I am not in any way looking to stress out or think that our investors should be stressing out. But unfortunately, there’s a lot of people who make lots of noise, and sometimes you just have to allow that noise to occur because what can you say other than to let the facts speak for themselves. Sometimes that just has to be the time period.

When you look ahead for five years or so, what are your plans for the company?

I think that we sit on an enormous potential for delivering health solutions, if I could call it, across the health continuum, in that we think that with the pool of intellectual capabilities that sits in our organization, together with the product know-how and technology that we’ve invested in, with what we can potentially create through building upon that. I think that we can be a world leader in healthcare IT and span the globe. Not just in the 40 countries we do today, but in a broader number. But also, be far more significant in some of those countries where we would obviously like to have significant influence, which hopefully must mean — we would like to think — that by that stage we would be a substantial player in the US market.

I think that the opportunity to achieve that means that we will need to grow and hopefully that growth will be commensurate with a very substantial profit returns to our shareholders and those who surround it. That’s certainly our aim, that’s certainly our intention, that’s certainly our desire. I think we’ve got a good team of people around us to help us achieve that. Even though we have challenges at the moment, and we’re not in the US, and also we’ve got the uncertainty around the national program, I think over the next 6-12 months a lot of that, I believe, will be behind us. I think that will really enable the company to propel its success further.

An HIT Moment with … Jeffrey Levitt

An HIT Moment with ... is a quick interview with someone we find interesting. Jeffrey Levitt is chairman and CEO of Precyse Solutions.

What are the key issues involved in moving traditional HIM departments to paperless and EHR-based operations?

Without a doubt, physician adoption. Physicians want to focus on delivering quality care and avoid spending time adapting to a new system or altering their workflow.

There are many issues involved in the transformation to a paperless EHR environment. However, we often receive questions about how to manage the changes that people will have to go through. They must re-think their workflows, processes, and tools that have changed as a result of the investment in the EHR. Many have a hard time giving up things that they understand to embrace change and something new — knowing these new paperless systems may potentially result in job losses in a difficult employment environment.

Coupled with change management tasks are training and conversion issues required under the new systems and workflows. For example, to move to a new dictation and transcription platform or automated coding platform, transcriptionists, editors, and coders must receive additional training and education. At the same time, the basic core HIM functions and processes must continue, otherwise the revenue cycle will be disturbed and billing and collections will be delayed. An efficient and streamlined conversion strategy, reinforced with proven implementation methodologies, is required to minimize disruption while existing HIM employees are learning a new set of systems and procedures.

How can speech recognition be used to turn provider dictation into electronic documentation within the EHR?

Acquisition of data directly from clinicians remains one of the largest obstacles for EHR adoption and information sharing among facilities. This is caused in part by the difficulty of capturing data in a structured format. Many physicians are reluctant to document patient encounters in a structured format directly into EHR systems because they believe it will require more time, more hindrance to their established and desired workflow.

Recently, new technology has emerged with potential to bridge the gap between dictation and structured data entry. Solutions have moved from speech recognition to speech understanding, a more suited concept for the EHR decade, which allows physicians to continue documenting clinical information efficiently via natural language, which is analyzed and processed into a structured narrative in real time. A structured narrative fuses unstructured text; gross document structures like sections, fields, paragraphs, lists; and individual concepts, their modifiers and relationships — all of which are encoded using standard medical terminologies and nomenclatures.

Precyse is pleased to incorporate the M*Modal Speech Understanding technologies in our transcription platform. Utilizing the business logic in our workflow platform and M*Modal’s continuous learning process, speech profiles are established with a new physician’s first dictation, and drafts rapidly improve with continued use. Today, over 80% of our total physician dictations are seamlessly converted into useable drafts, significantly improving transcriptionists’ productivity and providing faster document turnaround. The benefits in accelerating the document generation improves communications between caregivers, can expedite the admissions and discharge processes, and accelerates the billing process to reduce DNFB, to say nothing of the increase in physician satisfaction and adoption.

What coding and documentation issues are currently challenging for HIM departments?

Almost every hospital we encounter has a shortage of qualified coders. Without the ability to code and process charts on a timely and accurate basis, the revenue cycle is disturbed while billing and collections are delayed. At the same time, medical coding is getting more complex because of new medical technologies coming online, changes to the rules of coding and coding specificity as required by MS-DRGs.

Other problems coders encounter are incomplete charts, or documents that do not contain appropriate detail. Because, to a physician, the primary purpose of clinical documentation is continuity of patient care, charts and records are often not prepared from the perspective required for properly coding provided services. With these complexities, the resulting lack of accurate and complete documentation presented to coders can result in the use of nonspecific and general codes. This impacts data integrity and reimbursement and presents potential compliance issues and recovery audit risk.

To mitigate these risks, coders have turned to time-consuming querying to clarify documentation. According to one of our clients, some of their facilities have seen up to 50% of charts submitted to coders result in needing a query back to the physician, further delaying the billing process.

Remedying this problem, many providers have looked to outside help. Experienced coders can be brought in on a contract basis, or even work in a remote setting to ease the burdens on in-house staff. Providers can also contract for coding auditors and educators, and clinical documentation specialists to work directly with physicians to help them understand the difference between clinical documentation and reimbursement documentation.

What tips would you offer for coding audit and compliance?

We urge our clients to invest in training for their coders, and are glad to assist them with the coding education function. We make a vast majority of our internal continuing education materials available to our clients, as well as our de-identified charts for coding practice and education. In those hospitals where we have responsibility for the coding function ourselves, we conduct regular mock audits in addition to our own efforts to identify improvement areas that need to be strengthened in our processes and training. We also build continuous improvement plans into our standard methods of operation. Finally, our Compliance, Privacy and Security Officers spend a lot of time in new colleague orientation and our internal compliance program ensures that we maintain and enhance our own focus on compliance.

How do you see the roles and responsibilities of the hospital HIM department changing over the next five years?

Because more hospitals will be purchasing and deploying more sophisticated EHR systems over the next few years under HITECH, many of the clerical functions will be reviewed and rethought around absence of the assembled paper chart and the introduction of the electronic record. In multi-hospital systems with size, scale and resources, these groups will begin to use the experiences they’ve gained from the regionalization and centralization of their business offices to do the same with their medical records and HIM departments. While there must always be some on-site HIM professionals to handle interdepartmental communications and address physician and patient requests for records, many of the professionals who had formerly been part of the more labor-intensive, paper-based environment at the site of care will find that their jobs have been physically moved to more centralized offices, or to their homes.

Likewise, some of these functions will have been re-engineered for greater efficiency and productivity. We also anticipate the creation of new HIM job categories for many of these workers as we begin to understand how to better extract data from the EHR systems to provide more automated reporting that will be required in our new environment. So, it wouldn’t be surprising to see whole new categories of HIM workers beginning to assist in the preparation of decision support tools, pay-for-performance and other quality reporting information, or aggregate patient information for other uses in the health care system.

It will be a very exciting decade for health care information technology and management, one that will resemble nothing of the past decade. We can thank advancing technologies and mastering new workflows for this anticipated transformation.

News 3/31/10

From Stifler’s Mom: “Re: Medicare. Doctors to take a pay cut. Tricare’s getting cut too.” AMA’s president decries the 21% Medicare pay cut that will hit doctors on April 1. It’s a Catch-22 situation: more patients will be insured under healthcare reform, which will eliminate the need to use hospital EDs for basic care, but the scarcity of primary care docs coupled with reduced payments means those patients will wind right back up in the ED because they won’t be able to get appointments otherwise. As long as Medicare richly rewards procedure docs while stiffing PCPs, there will by the law of supply and demand be way too few PCPs. Just giving everybody an insurance card isn’t going to solve that problem. Let’s hope Don Berwick can blast through the bureaucracy, not only at CMS, but throughout the federal government. If anyone can, I’d say it’s him. Personally, I can’t believe he took the job and I’m sure he didn’t do it to fulfill a long-held hope of becoming a bureaucrat.

From The PACS Designer: “Re: Apple’s iPad release. The wait is over. Saturday will usher in the iPad era for Apple. There will be many reviewers to tell us what they think of their new business and play tool. One of our own, the esteemed Dalai, will give us an early indication of its usefulness when he gets his iPad via a shipper from China and starts to play!” I got Mrs. HIStalk a netbook for traveling and I kind of like that, too. It will fit into a mid-sized purse, weighs next to nothing, has a battery life of over 10 hours, and hops onto a wireless network easily. It’s running Win 7 Starter, is fast, has all the hard drive you’d ever need, and sports the usual array of external ports. The keyboard feels pretty good and the display is just fine. It comes with Microsoft Works, which can read and write Word files, but I’ll hook her up with Google Docs. It’s pretty cool for less than $300.

The Charleston, SC business paper writes up Carolina eHealth Alliance’s project, in which 11 hospital EDs are exchanging information using technology from TELUS Health.

Tressa Springman, CIO of Greater Baltimore Medical Center, writes an article called Improving Clinician Communication that describes that organization’s rollout of the TeamNotes clinical documentation system from Salar, which they integrated with their incumbent EMR. “Too often, hospitals are forced to implement technologies to meet an externally mandated deadline. These are the situations where teams are faced with short-changing the required thoughtfulness of the good design, resulting in a bad system that needs to be reworked. In contrast, I feel very good about our implementation of Salar’s clinical documentation at GBMC, because I feel that we are doing it for the right reasons, at the right pace and in a quality manner driven by a high degree of physician engagement.”

Walt Disney Pavilion at Florida Hospital for Children rolls out GetWell Town from GetWellNetwork, offering patient education, entertainment, and Internet access. The company will announce an agreement tomorrow with Child Health Corporation of America that will make GetWell Town available to its 40 leading children’s hospitals.

East Orange General Hospital announces that it will implement GE Centricity Enterprise. This is an interesting quote: “East Orange General Hospital, under EOGH President Kevin Slavin, started community meetings regularly. In one of the meetings, a GE representative happened to be there and they helped introduce the system to the hospital.” Nice work by the salesperson who “happened” to show up and pitch product at a community meeting. They earned that big commission.

A reader asked me which full hospital information systems a 200-bed hospital with light IT resources should look at. I gave my answer, but I’m curious: what would yours have been? E-mail me your thoughts and I’ll compile them here and share what I said.

A doctor who made $1.5 million writing over 100,000 prescriptions for online “patients” he hadn’t examined gets five years in prison.

A good idea from HHS’s Adoption/Certification Workgroup: put feedback buttons on EHR screens so clinicians can report problems. It’s not a new idea and some systems have them, but they all should if you ask me.

E-mail me.

HERtalk by Inga

From Bad Blake: “Re: Scott Freeman. The former territory vice president at McKesson Physician Practice Solutions, has accepted the role as head of business development for Zynx Health out of Los Angeles.” I see that Scott lists the new job title in LinkedIn, even though someone else is credited with the BD title on Zynx’s website.

From Clareece Jones: “Re: Berwick over CMS. Great news for patient safety.”

Saudi Arabia National Guard Health Affairs wins the Excellence in Electronic Health Records Award for its use of QuadraMed CPR. The award, which was presented at the Arab Health Exhibition and Congress, is given to the healthcare providing making the most innovative use of EHR to reduce error and increase safety and efficiency.

A Connecticut radiologist who was terminated from his physician group accesses a hospital’s computer system and looks at images and personal data for 957 patients. The doctor then allegedly contacted some of those patients and encouraged them to seek service at a different hospital. Apparently after the doctor left the staff at the original hospital, he hacked into the DPAC system using other radiologists’ passwords. The state attorney general is investigating. If I were investigating, the first thing I’d ask is how the heck did the doctor have access to all those passwords.

Eclipsys partners with Rothman Healthcare Research to build Rothman’s Patient Condition Tracker Solution software on the Helios by Eclipsys open architecture platform. The integration will give Eclipsys hospital clients the option to use Rothman’s application in an integrated environment without needing to develop an additional interface.

CPSI’s CPOE, E-Mar, and pharmacy applications achieve “approvable” status from the Ohio Board of Pharmacy. The designation means the software can be installed in Ohio hospitals without further inspection from the Board of Pharmacy.

You can find the list of Thomson Reuters 100 Top Hospitals here. The ratings are based on public information and assess hospitals’ performance in 10 different areas. Thomson Reuters claims that more than 98,000 additional patients would survive each year if those patients received the same level of care as ones treated in Top 100 facilities.

Frederick Memorial (MD) expands its relationship with MEDSEEK to develop a comprehensive eHealth ecoSystem. I believe that is a fancy way of saying that Frederick will be combining its existing MEDSEEK physician portal with a consumer-facing Web site.

eClinicalworks says it has implemented 2,000 providers across 400 independent practices in New York City over the last two and half years. Another 600 providers and 100 practices are in the implementation process.

And in the Midwest, physician network Advocate Physician Partners partners with eClinicalWorks and will recommend eCW’s PM/EMR to its 2,600 independent physicians.

North Florida Surgeons selects Allscripts EHR/PM solution for its 34-provider practice. The practice’s CEO says that a key reason they selected Allscripts was the availability of Allscripts Patient Payment Assurance module to to calculate patient responsible amounts and secure payment authorization prior to surgery. I mentioned this in HIStalk Practice yesterday and the Allscripts folks told me that this particular module, which is offered in partnership with mPay Gateway, is proving to be a big competitive advantage.  I suppose that serves as a good reminder that clinical software is not the only thing providers are worried about these days.

Speaking of Allscripts, the former Healthmatics division president David Bond and ISTA CEO Kernie Brashier join Navicure as VP of sales and CTO, respectively. Less that a year ago Mr. H mentioned that Bond had started a social networking site for teen athletes, which I guess wasn’t as fun as the RCM biz.

The North Hawaii Health Information Exchange (NHHIE) is leveraging Wellogic technology to connect the North Hawaii Community Hospital, the Hawaii IPA, and independent physicians, as well as labs, pharmacies, and other care providers.

The chairman and CEO of MMR Information Systems tells an HIT investment forum that the company expects that by year end, over one million people will use MyMedicalRecords PRH and MyESafeDepositBox services. I just wonder who all these people are, since I don’t know anyone who actually maintains a PHR.

The trustees for St. John’s Medical Center (WY) approve a $1.2 million software purchase to expand the hospital’s EMR system. I believe that St. John’s currently uses McKesson’s Paragon. The local paper was a bit short on specifics, but it sounds like St. John’s plans to add e-MAR functionality.

Mr. H is graciously allowing me to take Thursday off. Best wishes if you are celebrating Passover or Easter this week. I’ll be feasting on malted eggs, and if I’m lucky, a dark chocolate bunny.

E-mail Inga.

Healthcare IT from the Investor’s Chair 3/28/10

March 2010 HIMSS Health IT Venture Fair, a View from the Room

Now that the dust from HIMSS2010 has settled, all the follow-up e-mails sent, and the trinkets and swag carefully filed away, I wanted to delivery my (sorry) overdue thoughts on the Venture Fair that was held on the Sunday before the full festivities got underway. Truthfully, I think Mr. H’s primer on common mistakes was outstanding, but he asked me to share my thoughts from the room and the day in general.

Overall, I think the event was both well done and well organized (though how there turned out not to be enough books which listed the companies and their business summaries was an annoying mystery). I’ll first note that the Venture Fair is primarily sponsored by companies looking to service the attendees, and that’s also how the panels were developed. That’s not necessarily a bad thing, as the would-be entrepreneurs could well benefit from hearing the views of practiced attorneys, bankers or recruiters who can provide critical advice and services to companies of all stages.

A key challenge of the day, however, is that there are really two customers/stakeholders in attendance — entrepreneurs and sources of capital. For the former, I’m sure the three panels were invaluable and I hope they paid close attention to them. For the latter, let’s just say I saw a lot of wandering eyes and smart phones being none-too-surreptitiously used. Financial sponsors were there to see potential investments, and many likely could have been on the panels themselves.

I thought the most interesting and helpful panel was the one that combined entrepreneurs with bankers and lawyers to talk through issues such as types of financing, sources of capital, and how valuations are typically determined. The candor of both the agents (Healthcare Growth Partners) on why or why not to engage them and the entrepreneurs on mistakes they’d made (MEDecision) were thoughtful and sometimes things that can only be learned the hard way (i.e., consider where a potential investor is in their fund’s lifecycle).

A panel discussing legal issues around intellectual property and risk management trended towards the arcane to me (HIPAA galore), but many audience members seemed to find it more relevant. The lunch discussion on how early stage companies can work with the Office of the National Coordinator was also likely helpful for companies interested in dipping their toes into the taxpayer trough for funding.

Bottom line, much of the morning could have been called “An Introduction to Venture Financing 101”, and for most early stage companies, this fairly quick and easy way to gain knowledge about sources of funds, types of investors, use of an agent, and the highly critical difference between terms and valuation (plus the ability to ask questions), was time well spent. I’d encourage entrepreneurs seeking knowledge in these areas to consider attending in the future.

After lunch, with a rousing “Play Ball”, the pitches began. Each company was given the podium and the PowerPoint projector to provide a 15-minute or so introduction to and overview of their business and prospects. Each investor, incidentally, was given a blue dot sticker for their name badges to facilitate the speed dating. After the presentation, the investor left the stage and the room, and in many cases, the swarms of funders followed for outside conversations. I’m sure it was a tough call – “If I follow this guy to impress him and potentially have a call option on funding, do I miss something even better?” I confess I missed a few presentations myself for sidebar chats with friends and colleagues in attendance.

Overall, I have to say the caliber was mixed, as is often the case for events such as this. Rather than comment on all 21, let me hit a few high points directly, a few lower points more obliquely:

• Projections – Show Some Realism. With very few exceptions, the projections were overly aggressive, in some cases approaching absurdity. Yes, I know you’re a growth company, I know investors like to see a “hockey stick” income statement, but in my experience, a bit of realism goes a long way towards establishing credibility. I hope I’m wrong, but I just can’t see the company that projected over $120 million in Year 5 revenues hitting their forecast. Other noteworthy five-year forecasts ranged from $36 million (with 83% EBITDA margins), $42 million, and a company with a product still in alpha reaching $47 million in three years. As Grace said on LA Law, “Goes to credibility your honor”. That said, I actually liked that particular company’s concept and management team.
• · Exit – Be Thoughtful. As a good friend of mine who’s an active banker in the space says, “Where there’s outside capital, there’s a need for liquidity”, and that’s always something both investors and entrepreneurs should bear in mind. This, too, goes to credibility: for example, saying “An investor in [XXX] can expect to see a return of 10 times their investment in three to five years.” Well, maybe they can, depending on the value and terms, but I was surprised to see that very sentence on a page that (as each page did) listed the two sponsoring law firms. Similarly, one company predicted the exit would be via sale to a Fortune 500 HCIT Company. I’ll personally go out on a limb here and say I don’t think McKesson will bite (but again, hope I’m wrong).

Broad Categories – Investors are Careful. Apologies if I sound jaded or am fighting the last war, but I’m sure I’m Little Mr. Sunshine compared to many in the venture community. Here are a few of my views and biases:

• I think the office-based physician market ship has sailed and I’d be loathe to fund a start-up with simply a better mousetrap. I’d want to see significant sales before investing, so friends and family or Angels might be the best road to pursue. Exit will be a challenge. While I maintain EMRs have destroyed more venture dollars than anyone will admit, I confess I’ve been wrong here before (but was right more often).
• I think the RIS/PACS software area is even more difficult. Most of the larger players filled their dance cards during the days when Merge, Amicas, and Emageon were high flyers instead of one small-cap company.
• Maybe I’m missing something, but I’ve yet to see a PHR with a remotely compelling business model. More scarily and interestingly, I’ve yet to meet more than one person who actually uses one. If any readers who use and maintain a PHR for themselves or their family would indicate in the comments section below, I’d be grateful. Incidentally, the concept of sample bias suggests if the readers here don’t, not many random people/patients will.

A Few Stand-Outs. If I had a checkbook, I’d likely want to have a conversation with a few companies. Before naming them, I want to remind readers that: (a) I might have been out of the room chatting with someone or attending to imperatives like coffee, so might have missed the best in show, please don’t be offended if it was you; (b) ST Advisors, LLC has not done business with any of the companies mentioned, but that could change (old banking habits die hard); (c) I’m just a guy with an opinion. I have a space limit of only five so, without further ado and in alphabetical order:

• EDMIS. Despite an absurdly sized booth at HIMSS for a company of its size and focus, I think the ED is an area that needs fixing more than most and point solutions can work particularly well in that environment.
• Logical Images. A unique idea that brings visual diagnostic decision support for clinicians with a subscription model. Projections that appear realistic suggest thoughtful management. Sadly, the company appears to be only seeking strategic investors. I’d pay extra attention to exit, however.
• MedCPU, Inc. Appealing model that “rides on top of existing hospital systems to bring real-time decision support and brings evidence-based medicine to the point-of-care. “ Also a team with a track record, which is always a huge plus in my experience.
• YourNurseIsOn.com. Despite a name that, frankly, reeks of 1999 and projections that I’d dial down, I like businesses that solve a real and difficult problem like the nursing shortage. I saw the company at Health2.0 (where it was also one of the standouts), and like how the story evolves. My primary concern would be around entry barriers (i.e., what’s proprietary about its offering?)
• Prodigo Solutions and Sentient Health. I missed part of their presentations, but I continue to find supply chain and related areas interesting as well. Lots of money floating around, not enough attention being paid, multiple buyers for an exit, and a tendency towards high recurring revenue models all appeal to me.

As ever, thank you for your attention and comments, please drop me a note if there’s a topic you’d like me to address or have questions for Ask the Chair.

Ben Rooks
The Chair

Ben Rooks is the founder of ST Advisors, a strategic consultancy offering long-term and project-relationships to companies and financial sponsors. He earned an MBA in healthcare management from The Wharton School of the University of Pennsylvania, has done healthcare IT equity research, and has worked as an investment banker in over 25 successfully closed healthcare and medical technology transactions valued from $40 to $365 million.

Monday Morning Update 3/29/10

From Lazlo Hollyfeld: “Re: MedPlexus bought by GE. Now granted they likely had a pretty small install base (my bet is 300-350 providers max) but what is going to happen to practices on these ambulatory EMR systems that are inevitably scooped up by larger vendors or more likely left on their own when the tide of HIT stimulus funding inevitably reverse itself in another 18-24 months?”

From In the Cheap Seats: “Re: DocuSys. I hear its was purchased by Merge Healthcare who also bought Eko, a competitive Anesthesia EMR vendor last year. They just finished acquiring Amicas as well.” Not yet announced, but sources tell me the deal for Merge to acquire the Atlanta-based anesthesia systems vendor was signed this weekend. Maybe its tagline was a hint.

From patientsmatter: “Re: Yale-New Haven Health System. I had dinner with an executive clinical leader there last week, where it was said that today the system has three different EMRs in place, but there is a 90% chance they are scrapping them all and choosing Epic.” From my previous reports, it’s almost a done deal if the health system can work out the financial issues.

From Anodyne: “Re: Iowa Health. After more than five years of slogging through a statewide implementation of Allscripts, Iowa Health is changing vendors to the darling, Epic.” Unverified. They were already Epic on the inpatient side, right?

From Consuela: “Re: QuadraMed. Laid of 32 yesterday, mainly accounting and compliance.  Makes sense due to being private and not needing the Sarbanes and SEC stuff and basic accounting functions can be handled by the VC company.” Unverified, but you are right — that would off some relief from the overhead of being a publicly traded company that wouldn’t affect customers anyway.

From Dos Equis: “Re: HIPPA. You have to love that after almost 15 years, Health Data Management misspelled it that way in the survey they sent to readers today.” Not to be overly persnickety, but they also misspelled HITECH right next to it, going lower case for some reason even though it’s an acronym. But it’s probably not the editorial people who created the survey, so I don’t read too much into it.

From UDontKnowme: “Re: Epic’s turnover. The 5% estimate is conservative. Turnover rate, specifically within implementation is well above 5% and is in more to the tune of 15-20%. The average tenure for implementation is about two years. Also, the plan for hiring 500 over the summer is in fact, lower than previous years’ summer hiring plans.”  

From JoseMama: “Re: Peel’s WSJ editorial. It’s valid to critique whether we’re doing enough from a privacy standpoint, but her point of view lacked context. Are your medical records safe on a physical shelf? Or being shuttled around in a truck from facility to facility? And at least when UCLA Medical Center workers looked at Octomom’s medical record, they could track who did it and fire them.”

From Matics: “Re: informatics. You had a post by Indra Neil Sarkar, director of biomedical informatics at the University of Vermont, that ‘There are only about 2,000 to 5,000 of us who are formally certified informaticians.’ Formally certified? Certification in medical informatics does not yet exist. Perhaps he meant postdoctoral trained and/or MS/doctoral degreed?”

  

Picis CEO Todd Cozzens writes an unusually frank criticism of healthcare reform, nearly all of which I find myself agreeing with:

Most of us who live and work in the healthcare world know that something had to be done about the uninsured, the pre-existing condition denial and other key inequalities in our system. What many of us are upset about is that bill that was cobbled together in order to get rushed through ahead of the next election, is not a cohesive, logical plan where increases in care and coverage are met with responsible funding and cost containment. The sum of these parts is an incongruous amalgamation of special interests, one-off provisions, unbridled future costs and somewhere buried deep inside are some good things for patients.

News 3/26/10

From Soft Sales: “Re: Microsoft Amalga. Robert Seliger, former CEO of Sentillion, will take over sales. This was announced internally on 3/15.” Not exactly, but close. Per my Microsoft contact, former Sentillion president Paul Roscoe will lead the sales organization of Microsoft Health Solutions Group, integrating the sales teams of HSG and its recent Sentillion acquisition. Steve Shihadeh will report to Paul. This is quite interesting — obviously Microsoft had a lot more respect for Sentillion than just buying its single sign-on and context management technologies. Putting someone with healthcare sales experience in charge is a good move if you ask me — we’re not talking shrink-wrapped retail sales here.

From UKnowMe: “Re: CSC. Is it putting itself up for sale? Or at least its healthcare biz?”

From All Hat No Cattle: “Re: NIST. Looks like they are still disregarding system usability.” NIST’s Health IT Standards and Testing page outlines its testing programs, none of which appear to involve usability. Of course, there’s already a measure of that: low adoption.

From OhWell: “Re: Epic installs. UKnowMe is right, Epic is selling like mad. Rumor has it that Epic is looking to hire 500+ people by the end of the summer. So much for experienced implementers or even experienced advisors with the time to focus on each install.” People have been saying for years that Epic, like Cerner and everyone else before it, will eventually hit a wall. It hasn’t happened yet, but competitors are hoping they’ll run out of steam. Of course, they aren’t really doing much to give Epic a run for their money, either.

From Mark Moffitt: “Re: HISsies award for service oriented architecture as the most overrated technology. I’m a big advocate of web services, aka SOA, as a catalyst for change in HCIT. That being said, I have to agree with the award above. Vendors may be embracing SOA under the hood, but very few vendors expose services so customers can take advantage of the technology. As a result, the impact has been muted from a customer perspective. Until vendors make services available to customers and other vendors, like: get_data(patient, med_list) or: go_do_something(patient, order, md), the HCIT public will continue to view SOA as an ‘overrated technology.’ I continue to plead with vendors to expose services. Unfortunately, I  get the response, ‘When customers start demanding it, we will provide it.’ Well, I’m demanding it. How many more have demanded it and gotten the same response? Or they offer it but not to customers, only partners that don’t provide a competing product. The push back I hear from vendors is ‘we don’t want to be held liable.’ Really? If I repair my car and install brakes incorrectly, have an accident and crash into another vehicle, is the victim going to sue Ford, or Toyota, or GMC and win? I don’t think so. A simple release agreement that relieves a vendor of liability is all it takes. I’d like to hear from vendors on this topic.”

Inga’s been busy again, as you’ll see tomorrow when she posts our latest executive Q&A series entry. A dozen or so industry executives answered this question: “Now that the ONC has announced the initial grants for Regional Extension Centers, what will be the effect on EHR selection and implementation for both the industry and your company in particular?”

Listening: Luscious Jackson, reader-recommended, all-female pop with hip-hop influences. Defunct for a few years, but I’m pretty crazy about them.

UCSF names Elazar Harel as vice chancellor for IT and CIO, which includes dotted line responsibility for the CIO of UCSF Medical Center, fresh off a failed Centricity implementation.

Dave Garets and Mike Davis, the two top guys at HIMSS Analytics, start their new gigs with The Advisory Board Company on Monday. HIMSS says it will replace them.

Richard Ferrans MD, CMIO of Memorial Hospital of Gulfport (MS) will talk about the Mississippi Coastal HIE in a Medicity Webinar on Wednesday, April 14.

DEA publishes an Interim Final Rule on e-prescribing of controlled drugs (warning: it’s a 334-page PDF). There’s the usual 60-day comment period. I haven’t studied it yet, but if anyone wants to summarize whatever is interesting in all those pages, feel free to send me your thoughts.

Researchers in France begin a project to identify patients at risk for hospital-acquired infections by scanning electronic medical records with a Xerox text mining tool called FactSpotter.

Sisters of Charity Health System (OH) names Robin Stursa to the newly created position of VP/CIO. She was previously at Saint Vincent Health System (PA).

An opinion piece by Deborah Peel, MD of Patient Privacy Rights called Your Medical Records Aren’t Secure runs in the Wall Street Journal.

There is no need to choose between the benefits of technology and our rights to health privacy. Technologies already exist that enable each person to choose what information he is willing to share and what must remain private. Consent must be built into electronic systems up front so we can each choose the levels of privacy and sharing we prefer. My organization, Patient Privacy Rights, is starting a Do Not Disclose petition so Americans can inform Congress and the president they want to control who can see and use their medical records. We believe Congress should pass a law to build an online registry where individuals can express their preferences for sharing their health information or keeping it private. Such a registry, plus safety technologies for online records, will mean Americans can trust electronic health systems.

Bonnie Siegel, formerly of Dorenfest and Hersher Associates, joins HIT executive search firm Sanford Rose Associates.

UC Irvine researchers are developing Telios, a Web-based telepresence system that will offer videoconferencing and remote patient monitoring tools.

Ironic beneficiaries of healthcare reform: offshore business process outsourcers, which are even more attractive when administrative cost-cutting gets serious.

A tidbit from the trial of the former CEO of University Medical Center (NV), accused of squandering $11 million on no-bid contracts: one contractor got $850K for producing a 30-minute PowerPoint describing an IT system the hospital already owned.

Red Hat announces Q4 numbers: revenue up 18%, EPS $0.12 vs. $0.08.

E-mail me.

HERtalk by Inga

Earlier this week, Mr. H mentioned that The Kansas City University of Medicine and Biosciences and its former president are suing one another. A local paper points out that former president Karen Pletz is now better known than she was before the firing. That’s because there are plenty of people (like me) who are drawn to the salacious aspects of the story. On the one hand, we have the medical school, which claims Pletz abused her expense account, racking up $2.3 million in food and travel charges.Then we have Pletz, who counters that she’s a victim of conspiracy, aimed at making her the scapegoat for a board that was paying her a huge salary ($1.2 million a year) and approving hefty entertainment expenses. Someone’s hiding something and it all makes for a juicy trial.

Another not-for-profit hospital system agrees to be acquired and transformed to a for-profit entity. Caritas Christi Health Care says that private equity firm Cerberus Capital Management is buying the six-hospital system for $830 million, which includes $430 million to pay off debt and $400 million on major improvements, such as upgrades to IT systems.

Masonicare Healthcare Center (CT) agrees to deploy MED3OOO’s InteGreat EHR for the physicians serving its facility.

Vanderbilt University Medical Center selects Accelarad’s SeeMyRadiology.com service, giving orthopedic surgeons the ability to exchange medical images in real-time via the Web or a mobile device.

Allocade, a developer of patient flow software, closes a $5 million round of VC financing led by VantagePoint Venture. Allocade intends to use the money to expand operations to meet the increased demand for its On-Cue solution.

The ONC appoints Aaron McKethan and Craig Brammer as the new program director and deputy director of its Beacon communities project. The project will award about 15 grants to non-profit organizations or government bodies to help them achieve meaningful use of their EHRs. McKethan is a research director at the Brookings Institution’s Engelber Center for Health Reform and Brammer is a project director at Cincinnati’s Aligning Forces for Quality.

CareTech Solutions and ForeSee Results announce they’ve formed a strategic partnership to provide CareTech’s hospital clients with an online customer satisfaction measurement and monitoring tool.

ICA vice president John Tempesco is named a Fellow of the American College of Healthcare Executives.

Sermo and athenahealth release results from a Physician Sentiment Index that indicates doctors aren’t too happy with the business of medicine. A couple of the more disturbing findings: 59% of physicians think the quality of medicine will decline in the next five years and 64% agree their clinical decisions are being based more on what payors are willing to cover than what they think is best for their patients. Sermo CEO Dr. Daniel Palestrant explains the results in more detail in this CNBC interview.

March 25th is National Medical Biller’s Day, according to the American Medical Billing Association. Thank you, billers, for keeping the money flowing!

Sixteen Harris County Hospital District employees who were fired for HIPAA violations in November get their jobs back. Hospital district administrators reassessed the intent of the violation and reinstated the workers’ jobs, though no back wages will be paid. The firings occurred after one of hospital’s medical residents was shot in a grocery store parking and became a patient at the hospital. The medical resident survived.

GE acquires MedPlexus, an EMR PM vendor that targets the 1-10 physician practice market. My first thought was why would GE make this purchase given that they already have the Centricity product? However, if I recall my ambulatory EMR history correctly, Centricity EMR is not truly integrated with a practice management product, but interfaces with either the Centricity Practice Solution (the old Millbrook product) or Centricity Enterprise (the old IDX software). MedPlexus, however, appears to be a fully integrated PM / EMR / patient portal solution. It’s also a hosted product, which is possibly a more attractive and affordable solution than GE’s traditional client/server options. And, Centricity EMR has not had stellar KLAS ratings in the last couple of years, so perhaps GE needed a fresh option.

CentraState Healthcare System (NJ) contracts with Design Clinicals to implement MedsTracker patient medication management. CentraState went live December 7th and says they’ve cut medication reconciliation time from about three minutes to one minute 38 seconds.

Dell unveils its Medical Archiving Solution, which is based on its upcoming Dell DX Object Storage Platform. Dell hopes the new technology will appeal to hospitals needing to increase storage for growing EMR and digital imaging systems.

Huntsville Hospital (AL) selects MedAssets’ RCM solutions for claims management and claims audit and resolution.

E-mail Inga.

Readers Write 3/24/2010

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!

Digital Information is Great, but Only if it’s Accurate
By Deborah Kohn

I am a patient at two local healthcare provider organizations that use the Epic suite of clinical information system modules for their base EHR. Both organizations must not yet have installed Epic’s CareEverywhere because currently, the two Epic systems do not talk to one another (or even look / act like one another). But with time, the installation of CareEverywhere should occur at both.

However, the reason I write this article is that either there is a flaw in Epic’s MyChart, the organizations do not know how to correctly configure MyChart, or there remains an important Epic user training issue. When I visit my providers at both organizations, I receive a hardcopy summary of my visit, which I must assume gets generated by MyChart because also I can view the data online via MyChart. Among many items listed on the summary are Current/ Future/Recurring Orders.

1) Orders listed on the summary and in the system cannot be corrected easily by an organization user, even the provider. I don’t know whether this is a user training issue (e.g., how to easily DC or cancel electronic orders that have been performed but, for some reason, not automatically canceled as Future Orders), a system flaw, or a poor implementation of the function. But for one set of lab orders, I was repeatedly asked for lab work to be performed when the lab work was performed months ago and I had the documentation to support this. Unfortunately, it took several handwritten notes and phone calls from me to the provider to finally update and delete the already performed lab orders from the system.

2) If orders listed on the patient’s hardcopy visit summary are incorrect (e.g., numbers of milligrams, duplicate orders, q 4 months not q 2 months, etc.), again these orders cannot be easily corrected by an organization user. That’s because, according to the organization’s users, these orders come from a different “database” than the “real” orders, which are correct in the system, but don’t print to the hardcopy correctly!

3) Either the Epic clinical system does not include or the provider organizations have yet to install or know how to install the following clinical decision support function: Recently, when my provider at one organization ordered a routine TB test, there was nothing in the system to alert the provider that the same, routine TB test was performed at this organization in July 2009. Consequently, this test was repeated in February 2010 at a cost of $398. When I complained about this, the provider organization commented that it is the provider’s responsibility to look back at all the orders in the system to see if a TB test had been performed within the last several years. I don’t blame the provider for not wanting to scroll through several years of past orders to determine this. And I was sorry I didn’t have my “paper” PHR, which I have kept for at least 30 years, with me at the time to double check this.

Now that electronic PHRs and visit summaries are appearing and patients are beginning to “use” (indirectly) organizational EHRs, not only will the organization’s internal users be complaining about system flaws, poor configurations, or outstanding training issues — but external users, the patients and recipients of health information exchanges, will be added to the lists. Consequently, it’s time our industry professionals address the management of the information, not just the technical and operational mechanisms for the sending and receiving of the information. Because it’s great to receive digital PHRs and visit summaries from provider organizations, but only when the information is accurate! Just ask ePatient Dave!

Deborah Kohn is a HIM professional and power user of EHR systems who not only makes sure her analog and digital health record information is correct, but remains dumbfounded that she need not do same with her bank record information.

We Are In the Business of Letting Clinicians Treat Patients
By Jef Williams

While riding the shuttle to my hotel at HIMSS in Atlanta, I overheard two strangers behind me comparing stories of the conference to one another. Their short exchange encapsulated for me both the HIMSS event and the climate in which we are now living. The conversation went something like this:

Woman: “I attended a session today conducted by an IT expert. You won’t believe what I heard”

Man: “Really?”

Woman: “Oh yes. The presenter was talking about successful EMR and IT implementations and actually said, ‘The physicians are the ones who have received the education. They are the ones who treat patients. So they must be the focus of our implementation.’”

Man: “You’re kidding.”

Woman: “No! I was so offended I nearly walked out.”

Man: “That’s ridiculous.”

Whether one agrees with the federal stimulus package and the push toward EHRs, the fact remains that it has created a significant impact on the business of healthcare IT. Clinicians, administration, and IT each play an important role in running the healthcare organization. Administration and IT serve, however, in support roles to the mission of providing an environment that allows clinicians to do what they do best: treat patients.

Over the past decade, the role of IT has grown significantly as healthcare has played catch-up to the most other industries in moving away from paper and manual systems to electronic and automated systems. This shift has had its share of challenges and most organizations can list a number of tragic stories of failed or messy implementations. Difficult workflow, poor user adoption, and meaningless data are all symptomatic of the problem of letting IT professionals make critical decisions sans clinical input regarding system procurement, design, and implementation.

It appears we have not learned our lesson. Introducing federal subsidized funding and reimbursement into the business model of clinical information systems the federal government has shifted focus to management and IT, leaving clinicians in the trailing position. The idea that caregivers come last could not be more backward to the true value proposition of healthcare. This industry is, and will remain, primarily about providing healthcare. No matter how advanced EHRs, widgets, and handheld devices become, patients will continue to measure satisfaction by whether a doctor knows what she’s doing, has the right tools to treat, and that they ultimately are healthy.

So to that presenter at HIMSS, I am not offended. It seems in this climate we have forgotten that we are in the business of letting clinicians treat patients. No EHR, HIS, PACS, eMAR, or any other system can provide better patient care without a doctor reaching out a stethoscope and asking her patient to breathe deeply. We in administration and IT get to play a valuable role in providing the tools and support to help our physicians provide better patient care. But we are just that — support.

Let’s not let the promise of a few dollars and the lure of a few vendor-hosted parties blind us to that fact.

Jef Williams is vice president of Ascendian Healthcare Consulting of Sacramento, CA.

News 3/24/10

From Lee H: “Re: Marshfield Clinic. Bob Carlson is out of the CIO role after just a year. The previous CIO is back for the interim.” Unverified. Bob’s still listed as CIO on the clinic page, but not on his LinkedIn profile. The former CIO was Carl Christensen, moved to CTO last April.

From T. Corolla: “Re: HIStalk. I started reading you the day the blog hit the center column of the WSJ. There are a lot of blogs and there is a lot of criticism of the healthcare industry flung about. I’ve been in it for 35 years and I don’t have time for people who bleat just for the attention. The WSJ article gave you credibility. So I’ve been reading and recommending HIStalk ever since. It has been the single most helpful glimpse into this world. I get sick of the self-gratifying vendor claims and the paid endorsements. I want to know if a product is useful, if the people behind it are honest, capable and knowledgeable, and where it has been deployed. I want to know if promise didn’t pan out. When it is a success, I’d like to know what made it successful. I want to know about what other organisations are doing. I want to be told a straight story. A little humour helps because this is a crazy world and we all need a laugh. You and Inga do that well. What you both do is valuable to me. Thank you for doing it. And thank you for doing it so well.” And thank you for those extremely kind words, which I hesitate to run because it appears immodest, but I conveniently justify it with the rationalization that I’d run them even if they were critical. Since I’m feeling nostalgic, above is my very first HIStalk post from June 30, 2003.

From The PACS Designer: “Re: Windows 7 sales soaring. As we move toward the middle of this year, it looks like Windows 7 is going to be a huge success. The increased sales are from desktop users who want the latest and greatest from Microsoft.” I’m actually running the beta of Office 2010 and it’s pretty good, at least for the minimal uses I have for it. Ever notice that each Microsoft software release goes toward more muted colors? I like that since, taking a cue from car makers (maybe not the best source of inspiration) it makes the old model look gaudy and cheap by comparison. I also noticed that WinXP support ends on July 13, meaning you’d better either be planning to go with Win 7 or to install XP Service Pack 3.

From UKnowMe: “Re: Epic. It seems just about every week I hear about another organization that has selected Epic. How in the world are all of these implementations going to be staffed with experience people? Consulting firms and hospitals are already killing themselves trying to keep up. What will the market look like 3-6 months from now?” Probably about the same — experienced people pitching engagements, newbies actually running them.  

Listening: Brendan Benson, pretty good power pop if you’re in the mood for something peppy. I’m kind of not, so I’ve moved to Nightwish, dark Finnish operatic metal.

The Kansas City University of Medicine and Biosciences and the former president it fired in December exchange lawsuits. They allege fraud; she claims wrongful termination; the lawyers squeal with delight.

Trinity Health (MI) chooses workforce management solutions from Kronos for its 46,000 employees.

It’s Weird News Andy’s moment in the sun, about, as he calls it, “not the sharpest knife in the drawer.” A teenager working in an Internet cafe is assaulted by gang members who accuse him of cheating in a video game. He ends up with a 10-inch kitchen knife shoved completely through his skull, sticking out of both sides of his head. He strolls into the local hospital, where employees thinks it’s a teenage prank with one of those Halloween knives until he collapses. Luckily (or maybe not, depending on your perspective) it didn’t hit anything important and he’s fine. And in a rare double header, WNA says of a boy with a record 31 fingers and toes who’s having some of them removed, “Inigo Montoya must really hate this kid.” I just saw Princess Bride again last week, so I got it right away. Incontheivable!

The State of Massachusetts, drooling at the prospect of federally fueled HIT dollars, will hold the Governors National Health IT Conference on April 29-30 in Boston featuring Governor Deval Patrick, Kathleen Sebelius, David Blumenthal, John Halamka, Marc Overhage, Paul Tang, and Micky Tripathi. Registration runs $350 for non-profit employees and $500 for for-profit. Unfortunately, I expect the HIT benefits listed in the headline above are in order of importance.

The New England chapter of HIMSS will hold its annual public policy forum next Wednesday in Norwood, MA.

iMDsoft gets its first sale in Denmark, with Gentofte University Hospital choosing MetaVision clinical information system for its brand new ICU. The company also announces that Dominion, an IT solutions provider in Spain, will distribute MetaVision in that country.

The fired CEO of University Medical Center (NV) goes on trial, facing charges of giving no-bid contracts worth $10 million to acquaintances. One consulting company had no other clients and was housed in the garage of the owner’s mother. The CEO blamed the computer system for his need to stop providing monthly financial reports, after which the hospital was found to have lost $50 million in the previous two years.

I installed a cool iPhone theme on HIStalk Practice just to make Inga happy, so if you read it on a smart phone, it’s going to be fast and cool. I’ll put it on HIStalk when I get some time. 

BusinessWeek speculates that if Google or Microsoft makes a bid for Nuance as has been rumored, the healthcare operation, which makes up 44% of sales and includes Dragon Medical and eScription, could be split off and sold to an acquirer such as Cerner, HP, or IBM.

A university in Switzerland is examining bodies using a virtual autopsy robot based on MRI technology and topography software, which also makes a copy that can be studied later.

A man is arrested in Australia for posing as an female nurse in suicide chat rooms and persuading at least five people to kill themselves in front of a webcam while he watched.

In the UK, The Guardian claims that the $20 billion NPfiT project is closed to going down in flames, besieged by missed deadlines and flagging support. iSoft’s Lorenzo was supposed to be live this month under threat of replacement.

E-mail me.

HERtalk by Inga

TriZetto Group signs an agreement with 3M Health Information Systems giving TriZetto the right to include the 3M ICD-10 Code Translation tool with several new services for payers under its TriZetto Advantage 10 Services family. Initially TriZetto will integrate the 3M technology in a provider contract modeling service and ICD-10 translation mapping service.

Consulting firms Deloitte, ACS, and CSC hold the largest share of clinical implementation engagements, according to a new KLAS report. When acting as the lead on clinical engagements, ACS, CTG, and Deloitte earned the overall highest performance ratings, winning higher rankings than past leaders like IBM and CSC. In addition to full service firms, companies like maxIT Healthcare and Vitalize were noted for their experience and solid team of skilled consultants.

Newark Beth Israel Medical Center launches an enhanced version of EDIMS EHR in its emergency department. The latest release includes an RCM module, CPOE, and improved physician and nursing documentation tools.

Vitality will rely on the AT&T wireless network for its Vitality GlowCaps product, intelligent pill caps that fit on standard prescription bottles and use light and sound reminders to remind patients to take medications. If patients don’t comply, they’ll receive a phone call or text message reminder.

Lake Region Healthcare (MN) selects Allscripts EHR and PM solution for the 50 affiliated providers at Fergus Falls Medical Group.

The Mayo Clinic enters into a collaboration with VitalHealth Software to develop an EMR specifically for primary care physicians. The technology platform, which will launch later this year as a SaaS offering, is based on several years of development and implementation design within Mayo’s primary care practices. VitalHealth is a joint venture between the Mayo Clinic and the Netherlands-based Noaber Foundation

The Alaska Native Medical Center selects Cerner’s HIS solutions, including registration, scheduling, and CPOE. An October 2011 go-live is planned.

Hudson Headwaters Health Network (NY) adds  athenaClinicals for its 100 providers. Its 12 health centers already use athenahealth’s RCM service.

Psychiatric facility Silver Hill Hospital successfully implements Medsphere’s OpenVista EHR.

Chamberlin Edmonds and Associates introduce PinPoint, a Web-based patient eligibility screening application for hospitals.

East Carolina University’s Family Medicine residency program selects Retasure for retinal risk assessments.

Excellus BCBS awards 48 New York hospitals over $22 million in quality improvement incentive payments. The program targets improvements in clinical outcomes, patient safety, patient perception of care and patient satisfaction, and efficiency.

Disturbing: two armed gunman in Maryland storm a medical office training class and rob 15 students. Tuition was due that day, so each student was carrying $440. Despite the arrival of police and SWAT teams, the robbers got away.

NorthBay Healthcare (CA) implements 250 ZynxOrder evidence-based order sets within its Cerner Millenium CPOE.

Medical ID theft is definitely not funny, but I found a bit of humor in this story. A patient discovers a $12,000 charge on her healthcare credit card for a a liposuction procedure. She never had the procedure, though someone else did using her identity. After contacting the medical practice and police, she waited at the clinic for the impersonator to show up for the next appointment. Do you think she was able to identify the thief by her svelte thighs?

E-mail Inga.

HIStalk 2010 Reader Survey Results

I’m heads-down most of the year trying to keep up with my day job and HIStalk. Once a year right after HIMSS, though, I like to run a reader survey and study the results so that I don’t lose the big picture. The time it takes for readers to fill out the survey is well spent since Inga and I plan the whole next year based on what readers tell us.

In the interest of transparency, I like to share what readers have told me. Here are some tidbits from the 2010 survey.

• The most common age range for readers is 41-50, followed by 51-60. Those groups summed up to 63% of readers. That might surprise some folks who think that only newbies read blogs.
• HIStalk’s readership has a lot of industry experience, with 41% having at 20 or more years and 74% having at least 10.
• Provider employees with IT purchasing influence make up 36% of readers.
• Readers are on the site often, with 38% saying they read whenever the e-mail comes, 23% daily or more often, and 98% more often than weekly. A full 92% said the frequency of new posts is about right, although a few suggested more frequent postings.
• While 63% of respondents get the e-mail blast when I write something new, 37% don’t. I’m a little surprised that folks read without getting the blast since that’s a sure way to be the first to know.
• For the question of the degree to which HIStalk influences reader perception of companies and products, 64% said some and 30% said a lot. Six percent said none at all.
• The most valued HIStalk features are (in order) news, rumors, Inga, and humor. Several respondents volunteered they liked my music recommendations, which I didn’t think to list separately.
• I asked whether readers have a higher interest in companies mentioned in HIStalk. An amazing 85% said yes.
• When asked whether readers were more interested in companies that sponsor HIStalk, 38% said yes.
• I asked about HIStalk’s influence on the industry. 12% said not much, 52% said some, 32% said a good bit, and 4% said a lot. If I were a vendor, I’d spin this to say that 88% of readers say HIStalk influences the industry.
• This is my favorite stat every year: when asked whether HIStalk helps you perform your job better, 82% of readers said yes. I could throw out all the other results and be happy with just this one, especially since it was at 65% a couple of surveys ago and I was pleased enough with that.

I asked what topics I should be covering more of. Some of the themes:

• Usability
• Niche vendors and emerging companies
• Implementation stories and case studies. Some suggested covering these by individual vendors to help others who are making selections.
• Index comments by vendor and/or hospital. I really like that idea. Maybe I should hire someone just to parse out the individual mentions and put them into a database or something.
• Write more about how individual hospitals expect to benefit under ARRA (or how they won’t).
• Get product reviews from real users, verify the submitter’s identity, but then run it anonymously. I really like that idea too.

I asked what one thing I should change. Some comments that represent major themes:

• Readers Write seem like PR pieces. Sometimes they do indeed. Please feel free to post comments saying so since that’s the best method I know to discourage self-puffery under the guise of sharing information. Someone had a good idea – require them to contain at least one negative point about whatever topic they are about.
• Ads take a long time to load on mobile device. Hint: add /PRINT/ to the link and you’ll get the text-only view that should work great on a smart phone.
• Fewer flashing ads. I don’t limit those (yet), but sponsors who want to score points with readers might want to eliminate the animation. This is the most common plea for change.
• Nothing. I like your format – some of the articles are more applicable to me than others, but other readers would pick the opposite. I can sort. Thanks for that. It’s hard to pick out the stories that have the broadest interest.
• More Inga but everyone probably says the same. They do indeed.
• Consistent organization and outlining of the post so I can find the parts I care about faster. That’s hard to do within a single posting given the breadth of topics.
• Open up the waiting list for your HIMSS reception so more can get in! It gets booked up so fast that I always wonder how many people would come if we didn’t have to cut it off. In the mean time, it’s fun to have it be a hot ticket.
• Can’t think of a thing. HIStalk is the best! Thank you.
• I love HIStalk — don’t change! Thank you.
• Shorter reader writes. I keep telling authors to keep it to 500 words if they want to hold reader attention. It’s hard for them to edit their own stuff, I guess, but it would take me a lot of time to do it for them. But prospective authors take the hint – less is more.
• Take a day off! Good idea – I did!
• Several readers said to publish more rumors no matter how wild and unlikely, while others said don’t publish unconfirmed rumors.
• When I first started reading, you walked a line between irreverence and curiosity. Now it seems more like cynicism and disdain. More than anything I’d love to see that curiosity come back. You might be right there. I will work on that.
• Have Monday morning update come out on MONDAY. Great idea, other than my employer would like me to actually do stuff for them on Monday. I usually write it and send it Saturday evening or Sunday since there’s no chance of interesting Sunday news anyway. I could hold the e-mail blast until Monday morning, but readers starting e-mailing me Saturday evening if they don’t get it (which I think is cute, especially when they are worried about me).
• Have something completely new 5 days a week. Long-time readers may remember that I experimented with that in 2005, writing Monday through Friday. It took a lot of time, but even more importantly, one reader was dead on when he told me that HIStalk wasn’t “special” when it hit his inbox every day.
• The world needs more Inga! It really does.
• No more warning about PDF links. That’s certainly easier for me, although if I were reading on a mobile device, I wouldn’t want to click a blind link to some 10-megabyte PDF.
• I would either adapt, add to, or begin an alternative, which includes more weight from the sustainment side. Includes honest opinions, real stories, the truth, about vendors and consultants. I keep coming back to this as an excellent idea.

I then opened it up for any general comments. Here are a few representative ones:

• Keep up the great work! I have no idea how you keep up with everything and then tag it with a great opinion. You make my job easier and and my life more fun! PS: keep Inga around forever!!!
• You do good work and you are very widely read in our industry. I appreciate that you don’t take yourself too seriously. I appreciate that you don’t take rumors too seriously, at least not until there is something to back them up.
• I respect and admire what you’ve been able to accomplish in this industry. Often, I get the news I read on HIStalk 2-3 days before I get it in any other forum! I also appreciate the way you wait to confirm some of the "iffy" news! Thanks and keep at it!
• Not additional thoughts just keep up the fair, honest and direct communication flowing.
• It rocks. Keep it up. At times I get more direct (speak: non-marketing) info than any of the paid research services I use.
• HIStalk has become my lunch reading. You do a great job with it – thank you.
• Good format – its easy to scan and read while listening in on that boring meeting or phone call. Good info overall. As a vendor, I like to see how my software, and my competitor’s, are viewed by the providers and buyers. What are the challenges, the risks they face, what influences how well a product is received and reviewed. For all of us NOT associated with Epic, we are hungry for any insight and help with decoding the provider’s and CTO’s mind.
• Don’t stop doing it – I know it’s a second job for you. HIStalk is the one fact check site I trust to winnow thru the vendor-based marketing crap out there and the big iron IT company’s PR spin. It’s almost as good as a free KLAS analysis.
• I’ve been a follower for a few years now. Stopping by is part of my daily routine, and when it comes to my doing research, HIStalk is on the short list of Internet stoops I hit immediately. I appreciate insight, attitude and opinion free of the general bullshit that tarnishes so many blogs. Keep on doing what you’re doing. I really appreciate it. Seriously.
• Straight forward, no nonsense, sometimes funny, usually very well written, brainy (and probably pretty) female accomplice. What else is there?
• Maybe I shouldn’t admit this, but HIStalk is the only such newsletter I read. I’m in Univ/Hosp research IT (very different from clinical IT), so I don’t relate to a lot of the pure hosp news items – nevertheless, I never miss my daily HIStalk. I think the attraction is partly news, but also that readers can respond anonymously or not – and that you don’t bow and scrape to anyone, esp. sponsors – and I almost always learn something new.
• Nice job as usual … the blog seemingly gets better over time. Great content with professional and humorous delivery … Keep up the great work.
• Keep up the good work. I know how widely it is read. Is there some way to direct writings or advice or commentary specifically to "the workers"? the in the trench folks who I think see all this news and commentary as flying by over their heads far removed from them.
• Love it, thank you for all of the hard work!
• Great blog. I really appreciate the great reporting and knowledge. You’re appropriately suspicious of rumors, and you seem to have a great understanding of what news would be interesting to report. I’m a huge fan and recommend that everyone I know read. (Of course, they all already read you, so I can’t claim to be much of an additive evangelist.) It’s just really, really good. One of two blogs I read regularly (and the other one is a Michigan football blog).
• HIStalk is a great source for breaking information and juicy rumors that come out eventually in the traditional trade rags.
• I am constantly amazed at the breadth of information that jumps out of these pages. I learn more about the industry and movement within it from HIStalk than all the other subscriptions I have. Heck, you have published information about changes within my own company before we were informed of them. The recent articles on EMR allowed me to view the effort through the eyes of various leaders, which was enlightening. I look forward to finding 5-10 minutes to browse the information every day — one of my routines now.
• Just that this is my favorite blog, but I must confess the other blogs I routinely look at are the MTV Jersey Shore and The Real Housewives from Bravo tv.
• To the extent you can bring on more people to write (e.g. more Inga’s and HIStalk Mobile types) – that would be outstanding (and know you’re pursuing this).. and find some way of provoking more CIOs to weigh in… and encourage people to divulge product differentiators and pricing… Thanks again – you’re the highlight of my day and have helped me a better HIT professional by 10x.

Thanks to everyone who took the time to respond.

Monday Morning Update 3/22/10

From kITty: “Re: Detroit Medical Center. Sold to Vanguard Health Systems.” DMC signs a letter of intent to sell out to the for-profit Nashville chain, with the hospital’s CEO saying, “The nonprofit hospital model is killing health care in the city of Detroit.” It will be interesting to see how a for-profit operator can improve a situation in which the local economy is wrecked and the hospital is burdened with charity care. I assume from my long-ago, not fondly remembered experience in working for a for-profit hospital chain that the bean counters will run wild trying to cut costs and manipulate the patient mix for maximal profit, which is of course what for-profit companies do to benefit their shareholders, hopefully not at the expense of their customers (patients).

From mrsoul: “Re: today is Certified Nurses Day. Unlike CPHIMS, you actually have to verify education and experience BEFORE you can take the board exam. Re-certification does take effort and diligence. I am a CPHIMS too; but, I can tell you the RN-BC from ANCC testifies far more effort and experience to my peers. Happy vernal equinox!” Friday, March 19 was the day to recognize certified nurses, including those holding ANCC’s informatics nursing credential. If you are a board-certified RN, a belated happy Certified Nurses Day to you.

Trident Medical System (SC) goes live in the ED with Oacis HIE in a Carolina eHealth Alliance-sponsored program that connects 11 EDs. Trident is Columbia HCA’s hospital group and Oacis HIE connects their Meditech systems with each other and those of MUSC.

John McConnell, who made a couple of kings’ ransoms in selling out Medic Computer System and A4 and then bought golf courses, gets back in the software business. He’s buying a golf club management software vendor. Allscripts probably won’t be buying this one from him.

Parrish Medical Center (FL) claims a 31% reduction in mortality and a 77% drop in non-ICU code blue calls as it uses Clinical Xpert CareFocus from Thomson Reuters in a Six Sigma project involving its rapid response team. The software identifies patients at risk through an ongoing review of meds, results, vitals, orders, and other clinical data.

A few housekeeping reminders: drop your e-mail in the Subscribe to Updates box to your right to be among the first to know when I post something new. The Search box plows effortlessly through the nearly seven years’ of HIStalk to find mentions products, companies, and people. Click the ugly green Rumor Report button to send anonymous news my way, including any attachments. Add your industry events free to the HIStalk Calendar. If you want to look back on previous articles, use the search box or the Archives page. Please remember to support the companies that sponsor HIStalk by poring over the ads to your left occasionally and clicking those that interest you (and the text ads to your right as well). If you want a cleaner, leaner view of a post for printing or mobile viewing, click the View/Print Text Only link at the bottom of it to get a nicely formatted, print-ready version of just the article itself.

Readers generally agree that companies aren’t doing themselves any favors by holding their press releases until HIMSS week, along with everyone else. Make the announcement before the conference, 68% of you said. New poll to your right: what influence does the HIMSS annual conference have on hospital IT buying decisions?

I notice that the visitor count will hit 3 million before long, so I assume Inga is preparing for her usual celebratory pomp and circumstance. She loves watching that counter.

TPD has updated his excellent list of healthcare iPhone applications with many new apps.

The acquisition of QuadraMed by Francisco Partners has been completed.

An interesting perspective from Indra Neil Sarkar, director of biomedical informatics at the University of Vermont College of Medicine, on the role of informatics related to EMRs:

AMIA is making very good headway in this community. There are only about 2,000 to 5,000 of us who are formally certified informaticians. Someone at a medium-sized hospital might have the title informatician, but they are really IT and not informatics. And if there is one term I have an issue with, it’s ‘health-IT,’ it’s the misnomer that we’re stuck with.

Informaticians need IT, but if you ask me to fix something on my computer, I am not a hardware guy. It’s a way of thinking. Many informaticians here fell into the field by accident. I grew up with computers and had strong ideas about the role of computers in microbiology. I am not a physician but I have a lot of interest in medicine. I had the notion I would spend most of my time in the lab using a computer on the side, but I have a dry lab, I don’t maintain a wet lab.

Creating data is not the problem; it’s understanding the data, and that is where AMIA fits in with its history. Its main meeting is more oriented toward electronic health records. This meeting is, ‘Let’s take EHRs and basic bioinformatics for granted. Now what can we do with the data?’

The Las Vegas newspaper reported on confidentiality breaches at University Medical Center a few months back, but this seems to stretching the point: an investigative piece reports that hospital managers don’t have good records of who has keys to the shred bins. The maximum fine for that egregious act: $400. Must have been a slow news day.

CHRISTUS Health engages MEDSEEK to develop its consumer portal and will eventually implement the company’s eHealth ecoSystem.

E-mail me.

News 3/19/10

From Ex-Cerner Guy: “Re: CPSI. I prospected heavily in Mid-Atlantic and Mid-West regions, and can vouch for the need for a CPSI or Intra-Nexus. Quite a few Meditech sites were looking around and they were only getting called back by the McK Paragon types. There is definitely a market and some pent-up demand.”

From Dan D: “Re: Tom Skelton. He has left MED3OOO for another opportunity.” Unverified.

From RJ McMurphy: “Re: putting HIMSS in perspective. Vendors representing half of the hospital HIS/EMR systems in America weren’t even present! If you look at the HIMSS Analytics report in Modern Healthcare for Jan. 2009, you’ll see Meditech with 26.7% market share, Cerner with 12.6, and Siemens with 9.5. That adds up to 48.7%. All three chose to opt out of HIMSS. Basically it’s become a hype circus — no buying influence really happens there. It was more important earlier in the market cycle when PowerPoint was the main operating system for EMR vendors. Now almost all buying is done by peer site reference and Internet data gathering. Organizations like HIMSS, KLAS, Gartner are trying to make themselves more relevant with lots of hype about trends, etc. The world has changed and I laud those three for opting out and saving their shareholders and stakeholders the cash!”

From Doug Dinsdale: “Re: Merge. Dr. Dalai challenges the CEO of Merge to explain why the purchase of Amicas isn’t going to ruin both companies.”

Cerner makes the S&P 500.

A reader sends this picture of a billboard one of his patients asked him about.

Haemonetics extends its $60 million offer for GlobalMed Technologies to give that company time to settle a shareholder lawsuit seeking to block the acquisition.

Tallahassee Memorial HealthCare (FL) chooses Allscripts PM/EHR for its 106 providers and 33 family medicine residents.

Singapore General Hospital wins the Microsoft HUG 2010 Innovation Award for “Best Use of Clinical Records – Inpatient” for its use of Eclipsys Sunrise Patient Flow, which improved bed placement time and reduced overhead.

A Weird News Andy find: a former dentist is accused of using paper clips instead of stainless steel posts inside the teeth of root canal patients, about which WNA says, “Maybe it’s for all those people who use paper to floss.”

More information on the HIMSS EHRA position on meaningful use is here.

McKesson announces a hosted storage option for Horizon Cardiology CVIS, with Cooper University Hospital (NJ) as an early adopter.

Software developed by Boston Medical Center, Northeastern University, and MIT that reduced readmissions by 30% is licensed for commercialization to Engineered Care Inc.

A new iPhone app called iResus walks users through emergency resuscitation, providing a metronome for timing chest compressions.

Nurse scheduling software vendor StaffKnex changes its name to OnShift. They apparently like conjoined words quite a bit.

Everything about this story is sad. A four-month-old Down’s baby dies in the UK after being given a tenfold overdose of the diuretic furosemide. The computerized warning issued to the doctor’s office is overridden by the receptionist. The pharmacist hears the technician questioning the dose with the prescriber, but doesn’t follow up. The neighbors of the parents, convinced they killed their own child, trash their house and steal all the baby’s belongings. Weeks later, the father kills himself by drug overdose. The coroner’s report finally came out this week, four years later, finding that the doctor and pharmacist were at fault.

Revenue cycle vendor Emdeon will acquire management consulting firm Healthcare Technology Management Services for $11 million.

At least somebody likes the proposed meaningful use criteria: AARP and Consumers Union.

Lexi-Comp releases its ON-HAND medical software for the Palm Pre and Pixi.

A KLAS report finds that 20% of smart pump buyers wouldn’t choose their current pump again, although 99% of CareFusion Alaris said they would. Still, the highest rated pump was the B. Braun Outlook.

Meridian Health (NJ) chooses CareAlign from Informatics Corporation of America to deliver an integrated clinical record to five hospitals.

MedFusion licenses LIS, molecular diagnostics, and AP software from Sunquest.

E-mail me.

HIStalk Interviews Mike Cannavo

Mike Cannavo, aka The PACSMan, is founder and president of Image Management Consultants.

Give me a brief history of PACS.

Well, for one, PACS finally works, so that’s a real good start. [laughs] Technology has finally caught up to the promises that were made over two decades ago about PAC systems allowing “any image any time, instantaneously,” although we’ve also become a lot more realistic on how we define instantaneously as well. Customers are also becoming much more educated, although the information they get from vendors is often biased towards a particular vendor’s PAC system. Unfortunately IT has very few resources for information, as most of this as been geared towards radiology.

Why is that?

Until a few years ago, radiology departments – heck, nearly all departments in the hospital for that matter — pretty much operated in a vacuum and made their own decisions. Now with the ultimate goal to have an EHR/HIE established by 2014, IT plays a much more important role in the decision-making process. Radiology still gets to call the shots on what works best for it, because like it or not, PACS still is a radiology-centric system, but IT needs to make sure it works well and plays together well with all the other clinical systems.

There aren’t a whole lot of IT specific resources available, but IT can get educated by going into the radiology community. I’ve had two series on Auntminnie.com titled “PACS Secrets” and “Building a Better PACS” that can be a good starting point. Start with the article titled “PACS and Marriage” and move on from there. It will no doubt bring you and Inga much closer together. [laughs]

Aunt Minnie’s PACS discussion forum is also an excellent resource. SIIM and the AHRA both have some incredible educational resources as well, although you usually have to be a member to access them. Many vendors and even HIMSS have begun virtual education using Webinars, though some are nothing but thinly veiled sales pitches — you have to look very closely at content. I also like Doctor Dalais’s blog as well – he is about a reverent as I am. [laughs]

What about RFPs?

RFPs are dramatically overrated. Now my fellow consultants might hate me for saying so, but a good technical spec that provides the vendor with a baseline to respond to send out to two vendors is about all you ever need. It need not be longer than six to ten pages tops and just needs to outline what you have, what you are looking for, and statements of a similar ilk.

I’ve seen RFPs that read like a New King James Version of the Bible and others that give so little information that they redefine worthless. One of my counterparts actually commented once: “Nothing like a meaty RFP to establish your creds” and I’m thinking, “For whom?” Shorter is always better with an RFP as long as all the information is there. Learn to KISS — Keep It Simple, Stupid.

Interestingly enough, vendors respond to 10-page and 100-page RFPs using the identical templated responses as well. That’s part of the problem we face today. Too many RFPs are being issued and questions are being answered without the right questions being asked orR answered, with the way the vendor answers more important that the question itself. A vendor also isn’t going to rewrite their DICOM conformance statement because you asked for something they can’t or don’t provide. But it is a nice try.

Is writing an RFP a mistake?

Not really, but it has also been my experience with any RFP — be it for a PACS, RIS, VNA, or whatever –  that what you see isn’t always what you get. Asking questions, even multiple choice questions, can still get you answers that don’t really address the client’s needs. A solid contract is much more important than the RFP.

Case in point: I recently had a client who did their own PACS RFP, a rather extensive, exhaustive document literally hundreds of pages long, with over 50 pages dedicated to the archive alone. The system they were buying was exceptionally large, addressed many sites, and cost several million dollars. I was engaged simply to do the contract review for them. When I added contract language relating to the archive being "vendor neutral" and containing nothing proprietary in it, the vendor balked.

We went back to the RFP response the client developed, and while the questions about the archive were properly asked, the way the vendor responded made Fred Astaire look like he had two left feet. Basically while they said they could do it that way they never said they did do it that way — and therein lies the issue — how you interpret a response? That is why I say for the most part, RFPs have very limited value. The contract is what you have to go to court with if need be, and is what needs to be made crystal clear.

Very few customers are also qualified by the vendors as to their readiness for PACS before the go into the RFP process as well. And who pays? The facility, by having to dedicate more internal resources on the project than they need to and also paying a consultant to go over mostly superfluous material. What you see is what you get- recognize that and you’ll save a bunch of time and money.

What if IT ran the RFP process?

It would only make it worse, in my opinion. IT understands IT and radiology understands radiology. This needs to be a team effort with everyone in the hospital working together.

The last project I got involved in where IT was in charge, I was ready to pull my hair out. The person overseeing the PACS evaluation process with IT in charge came to the facility from a Big Six consulting firm and had virtually no understanding of radiology. Process, on the other hand — my God, this person had process down pat. There was constant talk of putting information into this bucket and that silo. I felt like I was living in Hooterville and waiting for Lisa Douglas, Mr. Haney, Sam Drucker, and Arnold Ziffel (the pig) to show up.

We spent nearly a year going through a detailed highly scientific — by Big Six standards — statistical analysis of each of the four vendors being looked at closely, only to have the statistical difference be <0.02% between the top three vendors. I think four points separated them all out of 800+ possible points. But, by God, we did it scientifically. The funny thing was I told the radiology administrator this would happen before we even started, but alas, her hands were tied. This facility wasted over $100K in internal resources internally and nearly a year’s time getting back to their initial starting point.

So, no, IT should not be in charge. Again, this needs to be a team venture.

What are IT’s biggest mistakes relative to PACS?

Where do I start? Probably treating PACS the same way their do every other clinical system, although obviously there is some overlap. Radiologists need to feel comfortable with the workstation operation, so regardless of what IT thinks about the system, if the radiologists don’t like it the way the workstation operates or if they feel it will slow them down, they just won’t use it. And if they don’t use, it then that is just throwing away good money after bad. While no one part of the team should have over 50% vote, in the final decision-making process the system must fit the radiologists so unless you plan on changing radiology groups soon their vote means a lot.

I’ve seen a lot of mistakes made over the years, but thankfully, most were recoverable. One of my favorites was a CIO who insisted on entering into contract negotiations with two vendors at once. I said, “That’s not how it works in PACS” but we butted heads here big time. His thought process was that inviting both to the church it would make each work harder to be competitive.

In the vast majority of cases. this backfires big time. This wasn’t like The Bachelor where Jake had to choose between two of 16 beauties — will it be Vienna or Tenley? — to put a ring on their finger. This CIO wanted to take both to the altar in their gowns, bridal parties and families in tow, with the preacher looking at the groom asking, “Which of these women do you take to be your lawfully wedded wife?” Everyone will be shedding tears, but not everyone tears of joy. And I’ll be sitting there thinking, “Now what do I do now with this toaster and blender I got them as gifts?” That is such a waste of everyone’s time and money, but I, alas, didn’t call the shots.

What did you mean by customers being qualified?

An RFP or tech spec should never be put out on the street unless adequate monies have been both approved for the project and are available for release and a project plan has been developed. Most sites think nothing about putting something on the street as a feeler to test the waters on PACS costs. Unfortunately they either don’t realize (or don’t care) that responding to an RFP costs the vendors anywhere from $4,000-$10,000 per RFP in manpower costs alone. Following it up with on-site visits, customer site visits, etc. adds another $15-20,000 over the project term. So, you’re really looking at $20-30,000 for each RFP that is responded to. If a company has an outstanding track record, they stand to close maybe one out of three RFPs they respond to, so the first $60,000-90,000 of any PACS sales should be considered make-up revenue.

Maybe that explains why $15,000 workstations cost $85,000.

That’s a large part of it, but research and development and software application costs add to that bottom line cost as well. Vendors also need to make a slight margin on the sale too, but that’s all negotiable. [laughs]

Consultants don’t come cheap either, right?

The oats that have been through the horse come somewhat cheaper. [laughs]

There is a plethora of consultants out there today, many whose ink is still wet on the business cards they got at Office Max when they got laid off and figure, “If he can be a consultant, then by damn I can too.” Unfortunately, even the societies that deal with radiology and PACS that are supposed to look out for you don’t. All you need to do to be listed on most of these sites is join their organization or pay a monthly fee to be listed. Now there are disclaimers listed, but who really reads them?

Truth be known, there are less than a dozen of us who do PACS consulting on a full-time basis, not as a sideline business when we’re not out looking for a full-time job with a steady salary. But no one knows who they really are, so we all get a bad name when someone screws up. It’s the same way with IT consulting as well. That’s why I always talk with a client at length about their needs and the project before I even consider an engagement.

Three out of five potential clients who call me get their questions answered within the first hour of a phone call. We do that for free. One out of five potential clients I find I just can’t work with. They want to show me their watch to tell them the time. The remaining one out of five I end up engaging with in a project.

Sounds hard to make money turning away 80% of your prospects.

What we lack in financial input, we make up in volume. Eight customers a day and I can almost pay the phone bill! [laughs]

More than 90% of our end-user business is doing our quick and simple PACS Sanity Check. Most places are pretty sure what vendor they want or at least have it narrowed down to the two they want, so we look at the proposals a client has from the vendors, make sure they are indeed apples to apples comparisons and, if not make, sure they are by having them re-quoted, discuss the pros and cons of each proposal with the client, and then, once the client selects their vendor of choice, we help them with contract negotiations since the contract is unquestionably the most important part of any deal. No muss, no fuss, two weeks and $5K or less and they and we are both done. While all PACS projects are different, most of the things you do are the same and become templated, so why charge people out the wazoo to reinvent the wheel?

Because you can?

Hey now — you calling me a vendor? [laughs]

You’ve worked on a ton of PACS projects. How did they differ?

That’s like asking me how many women I dated in my youth that were different or what makes Inga so special. Why, everything about her, of course. [laughs] The answer, obviously, is all women are different, and while each has their own unique advantages and benefits, each also shares many common traits. The same holds true for PACS. All are different, but not necessarily from a system design standpoint. There are maybe a dozen or so templated system designs that vendors start with and then customize accordingly.

The politics or each site varies widely and is probably the most important issue to address. Frankly, designing a PAC system is like choosing from a Chinese menu — workstations from column A, servers column B, archives column C, etc. Put them together and you have the system design. Making it work is another story, although if you talk to vendors and customers alike, it all works together like magic, just like DICOM is magic and HL-7 is magic. Poof, it all works. Plug and pray, I mean plug and play. [laughs]

The concept of standards is advanced, but the reality is so far from the truth it’s not even funny. DICOM is the most non-standard standard ever developed, so much so that every vendor has to offer their own conformance statement  — this is what we agree to, this is what we don’t. Two vendors can consider themselves as DICOM-compliant, but if they don’t share conformance statements, it won’t work.

IHE, Integrating the Healthcare Environment, is the same way. It’s a great concept, but the execution leaves much to be desired from an ease of implementation standpoint. That is why very few vendors have adopted IHE. Ask around and you’ll see. That is also why VNAs, Vendor Neutral Archives, are growing in leaps and bounds.

It all seems to work at RSNA.

You also saw perfect images at RSNA and software that won’t be available until 2012 at the earliest. Anyone who makes the trek to Chicago knows RSNA is an acronym for Real System Not Available. Seeing it working and knowing what it took to make it work are two entirely different concepts. Yes, it all did work by 10 a.m. Sunday, but rest assured, it wasn’t all plug and play. But we are getting much better.

So PACS implementation schedules aren’t real?

I never said that. Just that implementation schedules are an approximation of when you can expect it to be in, not an etched-in-stone date and time. There is so much that can go wrong that you never expect.

I recall one engagement we did where we lost a month for one 2” hole in a wall. The problem was that none of us knew it was a fire wall. By the time we got the 16 different approvals needed to drill this silly hole, we lost 30 days. There are all sorts of challenges like that. Radiology Information System integrations also have their own set of challenges, requiring the RIS vendor, PACS vendor, and IT department all to be on the same page timetable wise. That almost never happens.

But it could.

When the moon aligns with Jupiter and men finally understand women, then, yes, it can happen, but you stand a better chance of winning the Lotto or Powerball than that happening anytime soon.

Managing expectations is a huge part of PACS. Unfortunately it’s also one of the biggest areas of failure that the industry has nourished.

PACS has been promoted as a cure-all for everything under the sun, but knowing what PACS can and can’t do is paramount to gaining wide-scale, facility-wide acceptance of PACS. Unfortunately there is so much misinformation about PACS that people have a hard time believing the facts.

I go crazy when people say PACS can reduce FTEs. Technically the FTE headcount may be reduced in the film and file room after a period of time, but the overall FTE budget ostensibly will remain the same. If the money coming out of your pocket isn’t different, then what’s the real benefit? The same holds true when people talk about time savings with computed and digital radiography, CR and DR, over analog film. Yes, the imaging process can be reduced by 40-60% over conventional film, but will you see a 40-60% reduction in FTEs or rooms required? No.

In generating a typical 10-12 minute chest film, you save the time associated with film processing and jacket merging, about two minutes on average. All the other processes — getting the patient in the room, positioning them, and even imaging them — remain the same whether analog, CR and DR. Ever been with a geriatric patient? It takes longer to get them in the room and positioned that it does generating the film, and that’s after telling him three times, “Turn to the left Mr. Jones — no, your other left” and then have him ask why he has to have this %&^*% x-ray when his #%^#&^ doctor doesn’t know what the ^&*(%*$ he’s talking about. In my next life I’m going to be a gerontologist. [laughs]

You’re on a roll.

There is massive confusion about CR vs. DR as well, and “pure” digital vs. analog vs. digital conversion. In a properly designed department, the difference between using DR and CR is about 30 seconds per procedure on a bad day. From a price standpoint, however, the differences are huge.

A single, moderate throughput CR reader costing $120K complete can be shared between two rooms, while DR is dedicated to a single room at a current cost of over $300K. $60K cost vs. $300K cost is a no brainer. Don’t have PACS? Even better — stick with film because your equipment cost is probably already fully amortized and we’re not Japan where they pay a premium for images generated digitally. The reimbursement for a general radiographic exam generated in analog or digital form, CR or DR, is exactly the same here in the US and it takes a whole lot of cases at $1.50 a case in film costs to justify either imaging modality on film costs alone.

I hear my detractors now — blasphemy! Burn him at the stake! What about tech costs? My answer: what about them? If you do two procedures per day or 30 procedures per day, one technologist should be able to handle it all. Volume increases? General radiographic procedures are generally declining in most facilities at a rate of 2-5% per year, with CTs taking their place. Even where there is growth, it’s in the low single digits. So why do you even need CR or DR?

There are a variety of arguments for CR in a PACS environment, but for DR to succeed as well, the price point needs to be comparable to CR or at the very most no more than 15-20% higher. Either that or HCFA needs to start reimbursing for digital radiographic procedures over analog, similar to what they are doing now with digital mammography.

You done yet?

Just call me Howard Beale. “I’m mad as hell and I’m not gonna take it any more!” [laughs] Ok, I’m done — for now.

What do you think are the biggest obstacles to future PACs growth?

Probably getting buy-in from all levels in a hospital. PACS is such a complex sale, yet more than 90% of the sales made today aren’t made based on what is the best technical solution for a facility, but based on political decisions. The squeaky wheel syndrome, so to speak.

Such as?

Ah, yes. Another thing no one wants to ever talk about in public, but we all know how politically correct you and I both are, so do I care? [laughs] We can spend days, weeks, months, or years doing technical assessments on a vendor, but if the chairman of the department doesn’t like the vendor you’ve selected, rest assured, it’s not going in. The same can be said for any number of key players on the “team” whose vote equals 51%. I’ve lost many a night’s sleep over situations like this one — not.

If that is the case, why even bother with an RFP?

I’ve asked that same question of my clients and was chewed out recently for asking if putting an RFP out on the streets was a CYA move for them. In hindsight, maybe I shouldn’t have e-mailed it, but … if the decision is made for a vendor already, let’s do a technical spec, send it out to the vendor of choice, and save a bunch of time and effort on our part, not to mention vendor’s time.

People will do whatever it takes to save their jobs.

Thank you for the reminder why I’ve been on my own for the past 25 years.

Are you this blunt with clients?

Clients pay me to provide them with informed, objective information and to get them the answers they need so they can make informed objective decisions. If they elect to make a decision that is politically motivated, that is their choice. I still get paid the same amount.

All I ask them is to give me the opportunity to protect them with a fairly tight contract so that when their choice fails, they have some recourse other than pointing to the consultant. Kevin Costner took the bullet for Whitney Houston in The Bodyguard. I’m not paid that much, nor are most of my clients as hot as Whitney either. [laughs] PACSMan singing: “And eye e eye e eye will always love you.”.

Isn’t it your job is to help them make the right choice?

If you want “the right choice,” call AT&T — I think they own the trademark on those words, although years ago back in 1986 one of my last “real” jobs, where I knew I’d have a paycheck from week to week, I tried to sell an AT&T PACS product called CommView that was anything but the right choice. My job and that of my counterparts is to get them information so they can make the final choice, not I. No consultant worth his or her weight in salt will make a vendor or product choice for the client.

Even if that choice is glaringly wrong?

Even if, in my not-so-humble opinion, it’s a wrong choice. There are no wrong decisions, just decisions whose outcomes you wish might have been different. I’ve dated enough women to know that. [laughs] The only wrong decision in PACS is not making any decision at all and playing catch up for the rest of your life.

I let my sons make most of their own decisions all the time as long as their lives are not in danger. It’s how they learn. Many are right. A few had outcomes that we wish had been different. We then discuss it afterwards what they could have or should have done it differently and what the outcome might have been had we done it differently.

Unfortunately, if you don’t go with what the department chairman wants or someone in administration wants, what was ostensibly the right decision will turn out as the “wrong” decision and can be just as devastating career-wise as blowing $2 million of the hospital’s money on a dead-end PAC system. End users need to take a combination of the Taco Bell and Nike approach — “Think outside the box” and then “Just do it.”[laughs]

Is there a  best vendor?

I wish there was a single vendor who was the best solution for everyone. I’d be working for them now. I wouldn’t last long in a structured environment, but it might be fun to try again.

Most vendors offer fairly solid solutions to customers’ needs. Finding sales reps who can properly articulate what those solutions specific to the client is another story, however. Vendor A’s products may “bring good things to light” but if they can’t articulate how their product meets their needs better than vendor B, vendor B will no doubt get the sale, provided of course that vendor B also has the political support behind them as well. There are no bad vendors or products — just lousy product specialists and sales reps and customers who don’t listen.

And politically correct consultants.

As Curly in the Three Stooges would say, “Why sointenly!!” I’ve had some great discussions with some on the men in my men’s group at church on how Jesus was both politically correct and politically incorrect depending on the situations He was in. I like to think I’m the same way. [laughs]

In this business, you have to believe in God because you’re always calling out His name in one way or another, thanking Him when things go right and invoking His name in so many different ways when things don’t. [laughs]Would you believe I run a sports ministry in my spare time for the past ten years now? If I were to hit the lottery, I’d probably be a stay at home dad with my sons, run the sports ministry full time, and do PACS consulting as a sideline.

News 3/17/10

From Harvey: “Re: CPSI. The small/rural hospital market has been dead money for years. However, the QSII/Opus deal may mark the start of a land grab there. Rumors are that Francisco will either IPO or sell Healthland this year, which tells you that there is demand for assets in this sector. My guess is that almost everything’s for sale in that space, including HMS and the indifferently-managed CPSI. Would love to see an interview with Francisco’s Ezra Perlman. He’s been a major mover and shaker, but rarely discusses HCIT publicly.” I agree (and I would be up for that interview). I overheard conversations at HIMSS about that largely untapped small-hospital market and some interesting players were named as being well positioned, such as IntraNexus.

From ZenSocrates: “Re: McKesson. Mike Myers, the McKesson executive responsible for the Clinical Documentation/Physician Order Entry product and a true pioneer of HIS, has announced his retirement for this July. The concern is that McKesson could not name a successor at the time of the announcement. As a customer, this concerns me greatly!!” Unverified.

From MckHappy: “Re: McKesson. McKesson and Jeremy Chandler are finally implementing the changes they had promised within the Horizon team. Mike Myers has announced his retirement effective July 1. Jim Nemecek is no longer VP over ambulatory. Cem Tanyel from Unisys will be named as the new head of development. Gerry McCarthy will add ambulatory to the physician solution line. The internal release focused on integration and eliminating the politics — errr, I mean development silos. Rumor going around is that portal and ambulatory development will be centralized in Boulder. The ARRA-certified release was shipped on-time to the pilot site last week.” Unverified, but if true, I wasn’t the only one observing the development silos and lack of staff stability.

From William Tell: “Re: HIMSS. I guess from what Lieber says, HIMSS is all things to all people.” An article quotes Steve Lieber as wanting to push into life sciences and payer markets, medical banking, PHRs, and workforce. I can only imagine the confusion as everybody tries to sell something to everybody else at the conferences. And in related world domination news, HIMSS Analytics is now working in Europe.

From Dickie Smothers: “Re: HIPAA. Check out 42 USC 1320d-6, which defines ‘A person who knowingly and in violation of this part … obtains individually identifiable health information relating to an individual …’ The term “person” is defined (in the main part of 1320) as an individual, a trust or estate, a partnership, or a corporation. I’ve read that because the above section applies only for a ‘violation of this part’, it only applies to those otherwise covered by HIPAA (since anyone else couldn’t ‘violate’ the provision). However, the HITECH changes in Section 13409 of the Act seem to broaden the applicability. Don’t think it was effective, however, last Thanksgiving. Nevertheless, a bright federal prosecutor could make a conspiracy charge or bribery charge stick if he/she wanted to. Just my opinion.” This relates to the story I mentioned in which a gossip site supposedly made 6,000 calls to the hospital Tiger Woods was in, trying to wangle his medical records from anyone willing to spill the beans for cash.

From Jack Flash: “Re: athenahealth. This is a very entertaining and insightful interview of a slightly buzzed Jonathan Bush at the HIStalk party. Greatest quote of the interview, on being asked about Healthcare Policy — ‘I love Obama’s package. He looks great.’” Definitely a fun watch.

From Radiology Ralph: “Re: DR systems debut of Unity CVIS. You mean DR Systems does something other than sue other radiology vendors for its ‘416 patent infringement? Go ‘Dominator!’” Just in case anyone doesn’t know the back story, DR Systems filed a slew of lawsuits in 2006 claiming patent infringement of a PACS reading station feature: eRad, NovaRad, Emageon, Fuji, GE, Philips, Siemens, Kodak, and others.

From Stifler’s Mom: “Re: Medicare. Good article on that 21% Medicare cut that happened, then got fixed, while we were partying in Atlanta. I don’t know how many doctors wandering the exhibits halls were leaving their wallets in their rooms, but I would have. Even with the ‘fix,’ if I were a doc, I’d be too nervous and reluctant to be spending any big bucks. No one at HIMSS was talking about a 21% pay cut in their already low Medicare reimbursement!”

From Meaningful Abuse: “Re: HIMSS attendance. If only 30% (~8,357) of the registrants came from healthcare provider setting, where did the other 70% (~19,500) come from? Isn’t this a healthcare setting information technology show? Only 11%(!) of the registrants were CIO/CTOs? Was that 11% of the healthcare provider attendees or 11% of the total registrants? Same question about CEOs… So, who do the vendors want to talk with? C-level decision-makers, not mid-level IT managers or staff. No wonder HIMSS vendors are chafed about the money they have to spend for their chunk o’ concrete.”

Several readers asked about the lyrics to Dr. HITECH’s Meaningful Yoose Rap. They are here and they are excellent.

Now that we’re over the HIMSS hump, I’m interested in doing some new interviews (with provider-siders especially encouraged). Or, your guest articles are welcome (more of those from providers would be especially welcome). I’m finally to the point that I can get to them.

The HIMSS EHR Association weighs in on meaningful use and incentives. That response wasn’t detailed, but it apparently urged simplification, reduced requirements for data collection, and allowing only one document standard.  

Not to be outdone, Markle Foundation has its say on the same topic. Some of their ideas: (a) set explicit health goals; (b) make the quality measures list more focused; (c) add new measures for priority health goals; (d) get rid of the all-or-none approach to incentives to encourage improvement without requiring hitting 100% of the proposed requirements; (e) streamline some of the calculation-heavy functional measures; (f) make electronic reporting requirements simpler; (g) focus on easy measures that improve patient engagement; (h) clarify that a secure download of patient information is acceptable; (h) get feedback into doctors’ hands quicker; and (i) clarify how hospital-based physicians can participate. I think they did a great job with good consensus and I would expect HHS to seriously consider their recommendations since they are less vendor- and product-centric and focus more on patients and providers. Kudos to them.

VA CIO Roger Baker lays it on the line for his IT staff: he’s happy to kill projects that miss deadlines or run into snags. That’s semi-good news for taxpayers, but the shining star of that policy cost a bundle, a failed patient scheduling application that cost $150 million.

In the UK, NHS’s medical director and NPfIT defender resigns his additional role as a director of an NHS software supplier after an anonymous blog commenter brings up the perception of a conflict of interest.

Jobs: EHR Business Systems Analyst (WA), Clinical Exec Physician – Sales Support (GA), Epic Revenue Cycle Manager (FL), Client Training and Support Specialist (MA). Some pretty good jobs are up on Healthcare IT Jobs, so take a look.

Akron General Health System signs an $11 million clinical systems upgrade contract with McKesson, including CPOE and Practice Partner.

A survey finds that 12% of employees knowingly violate IT department policies “in order to get their work done.” The survey appears to encourage outrage at irresponsible users, but IT policies that impede individual productivity in the never-ending quest for risk reduction should probably share some blame.

McGill University Health Centre launches its PHR, Unani.ca.

E-mail me.

HERtalk by Inga

After placing its EHR project on hold for a year, Sutter Health announces plans to spend $400 million and accelerate its Epic implementation over the next five years. Sutter intends to take five of its affiliated hospitals live on its Epic EHR in 2011. The health system has already rolled out EHR to the majority of its physician offices, as well as its Mills-Peninsula Health Services facility.

Preliminary registration numbers from HIMSS10 indicate attendance was up across the board. Professional registration grew 9% over 2009, though the total registration number was only 2% higher than last year.

The deadline to file comments on the latest meaningful use and certification criteria is now past, but not before multiple organizations filed last minute comments. CHIME, MGMA, CCHIT, and the AMA were just some of the many groups to submit public comments before the March 15th deadline.

CCHIT, by the way, says it is suspending any initial or incremental modular testing until it has an accredited Stage 1 ARRA test script to use. A note on its Web site also indicates that CCHIT is “confident” about its prospects for becoming accredited. Meanwhile, Drummond Group reaffirms its desire to be certified as a authorized testing and certification body and is making internal preparations in order to be ready for EHR testing later this year.

Columbia Basin Hospital (WA) agrees to outsource its IT support to Phoenix Health Systems and implement Phoenix’s Total IT Solution service line. The offering includes the implementation of Medsphere’s OpenVista EHR.

Meridian Health (NJ) selects ICA’s CareAlign solution to connect its five hospitals and its affiliated healthcare companies.

After delaying the release its numbers, athenahealth posts a decline in profits and jump in revenue for Q4 and 2009. athenahealth restated its financials going back to 2005 as a result of an internal accounting policy review, initiated by the company, and related to the timing of amortization for deferred implementation revenue. For Q4, revenue grew 33% over 2008’s numbers to $54.4 million. For the year, revenue jumped 38% to $188.5 million. Reported GAAP net income, however, fell 84% to $4.3 million in Q4, compared to $26.8 million a year ago; annual net income fell from $31.5 million to $9.3 million. The $.17/share earnings were in line with analyst expectations.

UMass Memorial Health Care selects Picis CareSuite for its five hospitals.

Wayne State University Physician Group (MI) contracts with NextGen Healthcare to deploy NextGen Practice Solutions. The 540-physician group already uses NextGen EHR.

Holland Hospital (MI) plans to implement the InterSystems Ensemble platform as its enterprise integration engine. The hospital plans to connect multiple systems across the facility and integrate its EMR with affiliated physician groups.

St. Joseph Medical Center (TX) implements Webmedx’s dictation and transcription platform, apparently within three days of a crash of its legacy systems.

Vitalize Consulting appoints Tim McMullen its executive VP of sales. McMullen most recently served as a VP at maxIT Healthcare and was a national VP and partner with First Consulting before that.

HIT consulting firm maxIT and the the medical device experts at Anson Group combine forces. The companies sign a partnership agreement aimed at providing vendors and providers expertise in the implementation of regulated medical devices connected to EMRs. Sounds like great timing, given the recent attention on EMRs and their possible regulation by the FDA.

CareTech Solutions signs a five-year infrastructure outsourcing agreement with Sibley Memorial Hospital (DC).

BCBS of Minnesota makes a bit of a mistake, accidentally publishing a customer’s personal medical information it a handbook for 95,000 members. The woman is now filing suit for the breach of privacy and violation of the Minnesota Health Records Act.  Her attorney calls it “one of the most blatant and egregious violations of medical privacy” that she’s ever heard of.

E-mail a limerick to Inga.

CIO Unplugged – 3/15/10

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

Connected Health
By Ed Marx

One of my favorite preteen games was Connect Four, the vertical checkers game. The objective is to be the first to connect four of your checkers in a row. I often played it with my children when they were young, and inevitably one of them would bump the catcher base prematurely and send all the checkers rolling onto the table and floor. But, oh, the fun we had playing.

I’m now playing a new kind of Connect Four. I am not sure who first coined the term connected health, but I like it. Where my organization has labeled our mobility strategy “mHealth,” we call our connected health strategy “cHealth.”

“But,” you ask. “Is this really a strategy worth my promoting efforts?” What about the whiners and traditionalist? What about the departments that insist on doing things their way?

This is a do or die reality. In Going Mobile, I argued that we must drive mobile computing into our strategies or risk getting lost in backwoods roads and putting our organizations at a serious competitive disadvantage. A twin sister to mobility is connected health.

In his sentinel book “The Innovators Prescription,” Christensen advocates dropping the private-public debate. He says we need to disrupt the way in which healthcare is delivered today. He points out that the way to cut costs is to put care and insurance in the same bed. Emerging models include Accountable Care Organizations (ACO) and the medical home. Each of these requires the four traditional silos—hospitals, physicians, payors, and patients—to break down barriers and act as one entity for the sake of patient centered care.

Essentially, to Connect Four.

Today, healthcare suffers under a fragmented care network. Embedding connected health into our hospital’s strategic thinking and summarily executing that strategy will set future success in motion. And yes, we’ll have to brave those who try to tip the catcher base and disconnect all our checkers. But may we never be the cause of IT atrophy!

Health Information Exchange (HIE), while critical, is not the same thing as “cHealth.” Think of HIE as 1.0, and then bump “cHealth” to 2.0 status. HIE shares some common traits and can create the infrastructure, but “cHealth” disruptively advances the transformation of our healthcare ecosystem. The leader who settles for a business-as-usual attitude is probably stuck in HIE.

Let me give some “cHealth” examples. These are purposefully high level so not to divulge strategies specific to my employer.

Patient Portals
Personal Health Records
Mobile Connectedness
TeleHealth

• Between Physicians
• Between Hospitals
• Between Hospitals/Physicians
• Between Hospitals/Patients
• Between Physicians/Patients

Wellness Programs
Secure Messaging
Home Care
Remote Monitoring
Wireless Monitoring
Education
HIE
Payors

We all understand the fragmentation of healthcare processes and costs in existence today. “cHealth” provides alignment. By executing “cHealth,” we’ll have the connectedness necessary to actualize ACOs and Medical Homes—providing the highest quality of care at the lowest price point—Ultimate value.

Connect Four. Who would’ve guessed that we could learn so much from a kid’s game? Except now the stakes are much higher.

Ed Marx is senior vice president and CIO at Texas Health Resources in Dallas-Fort Worth, TX. Ed encourages your interaction through this blog. (Use the “add a comment” function at the bottom of each 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.”

HIMSS10: Party Like It’s 1999

By Mr. HIStalk

Inside Healthcare Computing has graciously agreed to make this editorial available from its newsletter.

Healthcare is different, everybody says, Well, it sure is when it comes to throwing the excessive bacchanal that is the HIMSS annual conference.

Most citizens are shell-shocked from economic devastation. Most industries are reeling. But at HIMSS, it was 1999 all over again.

Sprawling exhibitor booths are burning electricity like a third-world country! Bring on the big-name entertainment! Cocktail hour in the exhibit hall is just what stressed hospital executives need to make informed, responsible IT decisions!

The most common phrase I heard in the exhibit hall other than Meaningful Use was Ruth’s Chris.

It was a Las Vegas time warp in Atlanta. Everybody slept in expensive hotel rooms and wore pricy clothes and screwed around with party schedules on expensive smart phones and fretted over dinner reservations and wine lists at expensive restaurants. The neon and booth babes were out in force, everybody loaded up on overpriced Starbuck’s coffee, and hired cars and limos lined up to transport captains of the HIT industry and their minions to and from the convention center.

In the back of my mind, though, was my hospital’s ED. I was thinking of the people patiently waiting there, those using it as their primary care provider because they can’t afford insurance. If I randomly chose one of those patients and took them to HIMSS, what would they think of the free-wheeling technology funfest?

I worry that hospital executives have decided that they are far superior in every way to the average patient they supposedly serve. They have more education, make more money, and enjoy life benefits that the randomly chosen ED patient cannot comprehend. When they travel, they travel in style, and thus supposedly struggling community hospitals will reimburse executives for $250 hotel rooms. And when they go to HIMSS, self-sacrifice is hard to find. In fact, so is any mention of real, live patients, many of whom would probably cause the suit-wearing crowd to physically recoil because they don’t look or act like them.

The other irony is that the key element of discussion, the topic that packed the conference rooms, was getting hands on taxpayer money. All those highly paid and highly expense accounted people were getting together to talk about hitting those economically shell-shocked people and companies a little harder in the pocketbook, making the choice on their behalf that their personal income would be better used to fund EMRs through higher taxes.

Maybe the local TV stations should send video reporters to conferences like HIMSS, just to show the folks back home who make it all possible how their healthcare and tax dollars are being spent.

I could be naïve. Maybe the HIMSS spectacle is so over the top that everybody gets the irony. In fact, I bet they were discussing it at Ruth’s Chris.

This editorial is copyright-protected by Algonquin Professional Publishing, LLC., publishers of Inside Healthcare Computing. Please do not copy, forward, or reproduce this material without prior permission. To obtain permission or for more information about Inside Healthcare Computing’s reprint policy, please contact the Customer Service Department at 877-690-1871. Mr. HIStalk’s editorials appear in the subscribers-only version of Inside Healthcare Computing’s E-News Update.

Monday Morning Update 3/15/10

From McMessy: “Re: McKesson report. The author of the report states ‘this channel check is not inconsistent with other checks we have made on MCK and its HCIT products.’ The client in the report indicated that its HERM implementation process started more than a year ago and may take another 18 months to complete. The hospital also said they are currently at HIMSS Stage 6 but that there are about seven Stage 1 criteria that the hospital still does not meet. Ouch!! Another ringing endorsement for HIMSS Analytics! Don’t you need to meet all the Stage 1 criteria before you can get to Stage 2-7?” Not really surprising considering the science fair of wildly different products that share the Horizon Clinicals nameplate, running decentralized development shops for what should be a single product suite, and never-ending employee turnover. But, it works fine in some places and some of their competitors have similar problems.

From The PACS Designer: “Re: HealthVault. Microsoft’s HealthVault application is now ready so that we can create our own PHR along with one for other family members. TPD has posted previously about Microsoft’s Silverlight application which is now part of HealthVault. Also within HealthVault is their Sharepoint application. If you have a Windows Live ID or OpenID you can use either ID to sign up.”

My FDA regulation poll drew quite a few responses, most of which expressed a belief that FDA will indeed step in to regulate healthcare IT in some form. New poll to your right: when a vendor has good news to announce in the weeks before HIMSS, should they announce it immediately, hold it until HIMSS week, or announce afterward? Most vendors hold their news until Monday of the conference, which I think is nuts, but you decide.

Speaking of FDA, it has set up a network of 350 hospitals and asked them to report problems with systems such as CPOE, EHRs, pharmacy systems, PACS, and others under its MedSun medical device safety network, according to a Huffington Post Investigative Fund article.

Inga already referenced Dr. HITECH’s Meaningful Yoose Rap, world premiered at the HIStalk reception at HIMSS, but I’ll embed the video again just in case you missed it. In case you didn’t notice, this was a flawless live performance by Ross Martin, MD, best known until now for his amazing Interoperetta.

And speaking of Inga, she did a marvelous job while I was R&Ring, don’t you think? I never thought I would find someone who could step right in, but we’ve been working together for three years now and she has blossomed wonderfully. I will apologize in advance for the likelihood that I will repeat something she has already mentioned since I’ve been out of touch for a week. Stats-wise, February barely missed setting an HIStalk record even though it was a short month, with 88,057 visits, 120,075 page views, and 5,346 e-mail subscribers. March is trending up. You contributed to those stats, so thanks for that.

As for me, I am rarin’ to go, batteries fully recharged and ecstatic to be back. And listening: Apples in Stereo, Denver-based power pop.

Inga mentioned that I was elated that former HBOC chair Charlie McCall is headed off to prison, which is true. Finally I can quit gritting my teeth when inserting “alleged” in in describing the massive fraud with which his train wreck of a company blighted the industry (although McKesson gets an assist for corporate stupidity in buying him out). It now looks like the decks have been cleared for McKesson to sue him for restitution, which would win them points in my book.

Community Health Solutions of America signs up for MEDai’s Risk Navigator, a predictive modeling suite that identifies high risk patients and tools to manage them.

InterSystems acquires its Italian healthcare implementation partner Prosa.

Former Shands CIO Bill Montgomery is named CIO of Hospital Sisters Health System.

Interesting: when Tiger Woods ended up in a Central Florida hospital, tabloid site TMZ made over 6,000 calls to the hospital within a few hours, dialing every possible number trying to find someone who would provide information. It even offered bribes to hourly workers hoping to get his medical records, the hospital said. It worked — the hospital fired several employees who accessed his records. I’m pretty sure nobody’s HIPAA policies could withstand that kind of attack. Nor am I sure why trying to get someone to violate HIPAA isn’t itself a punishable offense.

I don’t know where Weird News Andy finds this stuff: a Dutch nurses’ union launches a national campaign to remind the citizenry that its members do not routinely provide sexual services to patients. The “I Draw the Line Here” campaign was created after a female nurse observed co-workers offering gratification to a disabled male patient, who then tried to dismiss her because she would not do the same.

CTIA Wireless 2010, in Las Vegas next week, is running an Everywhere Healthcare 2010 track with some good sessions.

Hopefully everybody’s Daylight Saving Time switch went OK.

The Nashville Medical Trade Center, hoping to become a center for healthcare industry events, tried to use the HIMSS conference as a launching pad to get business tenants, but doesn’t seem to have had much immediate success according to this article.

DR Systems will debut its Unity cardiovascular information system this week at ACC.

The unSummit on point-of-care bar coding will be May 5-7 in Atlanta. 

Deborah Peel, MD is the subject of the cover story in Managed Healthcare Executive called Locking down privacy: where do we draw the line? “All 55,000 pharmacies in the United States are data-mined daily, and our identifiable prescription records have been sold for over 10 years. The theft of prescription information is why Congress was persuaded to include the ban on the sale of protected health information in the HITECH bill. I think that the industry is in denial because there is a huge, essentially unknown data-mining industry for health information."

The guys from the Access barbeque team sent over this picture, which has convinced me they should set up the smoker in the parking lot of the Orange County Convention Center at next year’s HIMSS conference. Give a prospect a plate of pulled pork and a beer and he will listed to what you have to say.

E-mail me.

News 3/12/10

HERtalk by Inga

From: Scoopy Sales “Re: Janet Dillione’s resignation. I see HIStalk scooped everyone on this and the ‘news professionals’ are just now reporting the story.” Ha! Mr. H will like that comment. Thanks again to the reader who tipped us off last Friday about Dillione’s resignation as CEO of Sieman’s HIT division.

From: PACSMan “Re: Dillione. I know you had run this yesterday but this confirmation came across just now. The timing is beyond strange- she gives a press conference 3 weeks ago, speaks at HIMSS and even has the damn thing podcast and now eaves to ‘pursue other opportunities’ after 27 combined years at SMS and Siemens. Something gives here- and I bet it ain’t pretty a ’tall….”

From: Mrs. Kravitz “Re: McKesson report.The recent Leerink Swann HC equity research report reads badly for McKesson. After talking to a CIO at a large client base they are pessimistic on McKesson’s ability to get to Stage 1 meaningful use; HEMR and Horizon Clinicals v10.3 still not GA despite representation to the contrary.” I don’t have access to the report. If you have an opinion, chime in.

I noticed that ComputerWeekly also  picked up a reader-supplied rumor, this one about a recent director-level resignation at iSoft. ComputerWeekly actually quoted HIStalk, then added iSoft’s confirmation that Keith Kirtland left for “personal reasons.”

Five Alegent Health hospitals implement Design Clinicals’ MedsTracker for electronic medication reconciliation. The CMO claims that an impressive 100% of the hospitals’ admissions and discharges were reconciled electronically on day two of the go-live.

The ONC publishes its proposed rule establishing two certifications programs to test and certify EHRs. CCHIT will not be granted grandfather status for testing, though they will likely be one of only a few organizations ready and able to qualify under the new program. Organizations wanting to qualify as an “ONC-Authorized Certification Body” for the “temporary” program would be required to submit an application and demonstrate its competency to test and certify EHRs. The temporary program could make it possible for full EHRs and EHR modules to secure certification as early as this summer. The temporary program would expire the first quarter of 2012 and replaced with a permanent program run by an outside certifying organization.

Children’s National Medical Center (DC) plans to implement Streamline Health’s Audit Integrity Manager Solution.

St. John’s Hospital – Eureka (CA) deploys Order Optimizer’s web-based clinical platform, allowing physicians to use evidence-based protocols at the point of care.

I see the folks at EHRtv have begun posting their vendor executive interviews from HIMSS. Dr. Eric Fishman poses some great questions to leaders from Nuance, M*Modal, Allscripts, Eclipsys, and NextGen in these face-paced and engaging spots.

The 17-physician Mountain Region Family Medicine (TN) completes its installation of Greenway’s Prime Patient EMR, with deployment assistance from BCTI and OnePartner.

Detroit Medical Center awards MedQuist a contract for transcription outsourcing services. Medquist will provide ED documentation at six of the health system’s facilities.

Rush University Medical Center (IL) agrees to pay more than $1.5 million to resolve a federal lawsuit. The suit alleges Rush violated the False Claims Act in connection with improperly designed leasing arrangements with several physicians.

DR HITECH live at Max Lagar’s in Atlanta, rapping about Meaningful Use. Doesn’t get better than this!

Weird News Andy sends over this story, which is actually more disconcerting than weird. The NHS, as it continues to create its national database of patient medical records, is suppose to give patients an opt out option before their information is added. Instead, doctors claim the government is rushing the project through and  patient information is being uploaded before  patients have a chance to object. Doctors also claim the government is not adequately educating patient on the database project, nor making the opt out option easy enough for patients to select.

The VA is busy working on Aviva, the next-generation version of its 20-year-old VistA EMR. Aviva is designed to be Web-enabled, modular in design, and capable of easy data exchange with other EMRs. Peter Levin, CTO for the VA, compares the project to “trying to replace a tin can on a string with a cell phone system.”

A former MedAssets contract employee, who used a fake identity to get her job, is accused of accessing the financial information of up to 2,400 patients. UTMB was a MedAssets billing service client at the time and Katina Rochelle Candrick is believed to have gathered social security numbers, dates of births, and credit card information on UTMB patients. Candrick has since been arrested.

In case you missed the actual HISsie Awards presentation, check out the presentation we ran at the reception last week. It’s loaded on SlideShare and apparently the transitions only work if you download it to your system. You’ll want to download it to fully experience the fun – as well as identify the winners and see the pie hit the face of a certain CEO. There is likely some way to post the slide show and have the transitions work correctly, but I am too lazy and too short on time to figure it out.

Provena Health (IL/IN) signs a seven year agreement with ARAMARK Healthcare. ARAMARK will provide clinical technology services for Provena’s six hospitals.

The folks at Surgical Information Systems asked me to let readers know they’ll be at the AORN meeting next week in Denver. If you’re attending, check out their session “Creating a Unified PeriAnesthesia Medical Record to Improve Clinical, Operational, and Financial Outcomes.”

Inova Health System (VA) names Ryan Bosch, MD, FACP, MBA its first Chief Medical Information Officer. Before joining Inova, Bosch worked as Director of General Internal Medicine at George Washington University Medical Faculty Associates.

Stemp Systems earns Preferred IT Vendor status from eClinicalWorks.

The public continues to weigh in with opinions on the latest meaningful use definitions. CMS posted a few additional comments last week and folks are still concerned that the bar is set too high, especially in the early years. The note below questions the exclusion of CPOE in the ED when measuring the total percentage of electronic order entry in a hospital:

The current proposed definition of meaningful use seems to exclude the use of CPOE in the ED as a measure of determining the current percentage of electronic order entry within the hospital setting. That doesn’t make a lot of sense if the purpose of the graduating meaningful use criteria are intended to promote and reward a hospital’s progress in deploying CPOE. Many hospitals will start with the ED to deploy CPOE because of it’s complexity and workflow. The current proposed definition will not recognize those organizations who are making good progress with CPOE simply because they may have started in the Emergency Department. That seems counterintuitive and not within the original spirit of advancing CPOE deployment to 100% within several years. In other words, who cares where an organization starts its deployment as long as progress and total percentages are actually achieved.

Mr. H is back home sometime this weekend. As gratifying as it is to know that HIStalk can stay afloat a few days without him, no one will be happier than me to have him back in charge, especially since he makes HIT so much more fun.

E-mail Inga.