Monday Morning Update 10/10/11

From Spell Chequer: “Re: HIPAA. I thought you’d appreciate this full-page ad, from an e-guide on HIPAA compliance.” We’re reaping what we sow as a society. It’s considered uncool to correct anyone’s spelling or grammar these days, and thus sloppy mistakes are the rule. Text message writers and tweeters have dumbed down the language the point that it’s barely understandable. What could be more cluelessly arrogant than the implied message, “I’m too important to take the time to spell and write well, so I expect you to translate for me?” As foreign students work endless hours to master English to ensure their future success, ours spend their time butchering it. But even near-illiterates shouldn’t misspell an acronym, especially one in which they claim renowned expertise.

From Major Payne Diaz: “Re: 5010 upgrades. You still need to feed the clearinghouse 5010 data, so the practice management software needs to be updated with vendor code to enact the changes. Then the facility needs to make their modifications – install the new 5010 sub-forms, modify table values, modify the loop/segment data sent for a particular payor. None of these can be performed by the scrubber or clearinghouse. Consider just one – Pay to Provider (rather important, don’t you think?) How would the clearinghouse know this information unless the source system / scrubber values it appropriately? Since when did the clearinghouses get crystal balls?”

From McMessy: “Re: McKesson. Both employees you mentioned left after they got word that Horizon Clinicals is going maintenance-only.” I’ve seen no announcement about Horizon, so if you have, please send something my way to confirm. That rumor keeps floating around (like the one suggesting that MPT is going to be sold,) but it’s all smoke and no fire so far.

I was asked by a book publicist to consider writing about a new book called Your Medical Mind. I did, and it was a somewhat mixed review. It contains good if not occasionally obvious ideas about making medical decisions, but isn’t all that much fun to read, is a bit padded, doesn’t fully answer the question the subtitle asks, and either isn’t clear on its intended audience or fails to engage them on their level. I still like the concepts, though, even if I wouldn’t necessarily invest the time or money to buy the book. I’d like to see the authors (or someone else) turn it into a movement that would probably be more effective on a larger scale. It’s a good conversation-starter, at least.

My Time Capsule editorial this week from September 2006: Drug Rep Gifts Banned – What About IT Reps? A snip: “Having decision-making authority means vendor reps will try to soften you up like gangsters wooing supermodels — with flattery, rapt listening, and a shower of baubles.”

Most respondents to my poll said they follow their employer’s security policies all the time, but of course I didn’t really ask how stringent those policies are (especially those related to encryption of data on portable drives, accessing Web sites and online e-mail accounts from company devices, etc.) New poll to your right: what effect will ACO-type reimbursement models have on quality and cost?

St. Louis-based NextGen reseller KIG Healthcare Solutions is sold to another reseller, GBS Corporation of North Canton, OH.

A jury finds that Teva, Baxter, and McKesson must pay $20 million for selling the anesthetic Propofol in large vials that the plaintiffs say implied the vials could be used for multiple patients. Punitive damages of up to $600 million are being sought. The first two companies (not McKesson) were hit with a $500 million verdict previously in another case. Plaintiffs claimed the companies stopped making smaller vials of Propofol because the larger ones were more profitable; patients sued after contracting hepatitis from a Nevada colonoscopy clinic. The CDC said the infections came from the clinic’s use of Propofol vials for multiple patients, but the defense argued that the infection could have come from improperly sanitized instruments. The clinic’s former owner and some of his employees were indicted on criminal counts that included racketeering, insurance fraud, and patient neglect, but he was found incompetent to stand trial. Since McKesson is a distributor and not a manufacturer, you would expect their involvement to have been limited to filling the orders of its customers. Nearly 300 lawsuits have been filed against Teva, which says it will pay any damages levied against its distributors such as Baxter and McKesson.

Howard Hays, MD, MSPH, acting CIO of the Indian Health Service, testifies in a Senate hearing on that organization’s use of real-time videoconferencing, consultations, patient monitoring, and mobile health. They are providing services such as behavioral telehealth, home blood pressure monitoring for chronic disease management, tele-nutrition, and remote neurosurgical consultations from the University of New Mexico Regional Trauma center. Video of the hearing is here.

A Texas Tribune article covers practice groups in that state that are following new IT-enabled models. Examples: one practice performs all wellness exams in a single visit, answers patient e-mails 24×7, and logs diagnostic results immediately to their EMR. Another offers specialty storefronts, same-day appointments, and valet parking. Kelsey-Seybold Clinic in Houston has 373 physicians in 20 facilities, all with in-house lab and x-ray facilities, uses a single EMR (Epic), has offered an accountable care plan through Cigna for four years. They use the EMR to prevent duplicate tests or treatments and to provide best-practice alerts and preventive reminders. It’s a good reminder that a well-run practice can scale up without needing a hospital to buy it, although most practices are run as small businesses without a lot of business savvy (hint: if your business manager is the spouse of one of the doctors and the IT expert is one of their unemployed nephews, the chances are good that even notoriously inefficient hospitals could run it better).

Great Plains Health Alliance will use $5.2 million in federally guaranteed USDA loans to buy clinical software for 22 rural hospitals.

A Massachusetts state senator introduces legislation that would take away the power of the Massachusetts Historic Commission to restrict the use of land that isn’t listed in the state’s Register of Historic Places. That’s in response to Meditech’s announced plan to take its jobs elsewhere when the Commission insisted that a lengthy archaeological survey be performed before new offices could be built.

The widely decried “Coke and fries” program in Australia in which retail pharmacists would have received computerized reminders to push a particular company’s herbal remedies along with prescriptions has been shut down. The president of the pharmacy guild that came up with the idea is appalled that media coverage was negative. “The idea that community pharmacists would take part in commercial up-selling without regard to their professional standards is offensive to our profession and rejected by the guild.”

Hospital software vendor CPSI pays $102,000 to its employees after a Department of Labor compliance audit finds minor errors in some of its pay rules. CPSI was paying 1.5 times the hourly rate for overtime and a flat fee for being on call over the weekend. The issue involved employees who were already on overtime before the weekend started. The company thought (as did I) that on-call pay is discretionary and not subject to overtime regulations. Of its 1,000 employees, audits found 247 who were affected, with an average payout of $60. As CPSI CEO Boyd Douglas said, there would have been no discussion if CPSI simply shafted its employees like most companies and forced them to take call with no extra compensation.

Cleveland Clinic announces its Top 10 Medical Innovations for 2012, of which two involved healthcare IT: data analytics and mobile apps for physicians. Its just-ended Medical Innovation Summit was like a dream for right-winger capitalists rather than compassionate healthcare advocates, with keynotes by Dick Cheney, Jeff Immelt of GE, and the CEOs of drug and device companies looking for the next bottom line booster.

Oracle settles charges that it overcharged the federal government for software over a nine-year period by not offering Uncle Sam the same discounts that the company’s commercial customers receive. Oracle will pay $199.5 million under the False Claims Act, with the company’s former employee who filed the whistleblower lawsuit pocketing a cool $40 million. Oracle says it followed the rules, but the incidents are so old (1998 to 2006) that it can’t find reliable witnesses and would rather just move on.

Merge Healthcare chooses Dell as its preferred provider of cloud-based computing services, storage, and enterprise hardware. Meanwhile, Chicago Mayor Rahm Emanuel announces that Merge intends to grow its local workforce from 900 to 1,100 over the next two years and install 100 of its Vital Kisoks around the city.

Last month’s arrest of the 17 year-old Matthew Scheidt posing as a physician assistant in a Florida hospital marks the third time he attempted to practice medicine at local hospitals. The earliest documented attempt was in 2007, when the then 13 year-old Scheidt masqueraded as a nurse; he also twice claimed to be a sheriff’s deputy. The Orange-Osceola State Attorney’s Office announced that Scheidt will be procescuted as an adult on two felony counts of impersonating a physician assistant and four felony counts of practicing without a license.

Nuance Communications discloses it has acquired Swype Inc. for $102.5 million. Swype is a provider of alternative keyboard input functions for mobile devices.

We were sent a fun resignation letter that made its way around. The author gave the OK to run it as long as his name and that of the company were removed (although he knows it won’t be hard to figure out which company he resigned from.) He was surprised that his vendor employer didn’t delete it off the e-mail server. Inga and I found him amusing in a Ricky Roma kind of way, so we’re trying to get him to write for us.

Let’s be honest. Resignation letters are usually brief, nice and boring. My goal is to make this none of those things. The only good ones are those accidentally sent out to the whole company where everyone tries to figure out why they got an e-mail about “Frank” who worked here for eight months as an IT consultant in Boise. Good ol’ Frank – he was solid from a technical standpoint, but not so solid at the TO: line of an e-mail.

I thought I might write this as a Top 10 list because that has never been done before … ever. I’m sorry, I have just been informed that I am only able to write this as a Top 7 list. If you want the full Top 10, you will need to wait for the next version – top10.1.1 or Service Pack 2.

And now, the thoughts of a man in a powder blue tuxedo.

10. Keep in touch. Keep in touch is the worst phrase ever. Let’s update that one: “Keep in touch on LinkedIn because I may need a recommendation soon.”

9. The Mothership. I am taking credit for giving the office this moniker, and it has now passed the test because I heard an “executive” use this phrase. I also like to put the word “executive” in quotes.

8. Casual attire. For those of you reading this outside of the Sanctuary walls (no, not that kind of sanctuary, that’s the name of our building), did you know that we can wear jeans every day? There are still some guidelines and I feel some of our IT friends need a little assistance. I have seen so many Canadian tuxedos in the last six months that I feel like I am backstage at a Rush concert.

7. Last season, our softball team was named the Crooked Numbers. It’s a softball term, I guess, but I also think it also describes the reason why we lost so many “executives” a few years ago.

6. Handing in your two-week notice. Other than my current haircut, this was my biggest mistake. I should have said that I am going to consult for all of our top competitors and am building an EHR in my garage so they would have kicked me out right away. Now I had to stay for two weeks to help “transition” someone into my “role” and “drag down morale” with my “shifty eyes” and “rugged good looks.”

5. (This item was not approved by legal, technical accounting, corporate, finance, and/or a gang of angry ninjas.)

4. I will miss many of you. Not all of you of course. But if I had to pick what I will miss most, it is you, free Diet Coke machine. Thank you for early morning wake-ups, late night keep-ups, and mid-day pick me ups. You are the epitome of ICARE.

I have worked here for nearly four years and there are some great people here. I thank them for everything.

Always up for a fried appetizer.

E-mail Mr. H.

Pediatric Office of the Future by Dr. Gregg

Lots of folks are gearing up for (or just gearing down from) their pick of the onslaught of fall HIT and/or healthcare conferences. I know most of you HIStalk fans aren’t pediatric-oriented per se, but I’m guessing that most of you were, at one point or another, children. I’m further guessing that many, if not all, of you appreciate a little humor amidst your techno-serious daily chores.

With these guesses in mind, I asked Mr. H to share the following two video clips with you. They were 100% donated to the 100% non-profit, educationally-focused “Pediatric Office of the Future” (POF) exhibit which I am honored to direct at the upcoming American Academy of Pediatrics-National Conference & Exhibition, Oct. 15-18th, in Boston. These very fun clips were created specifically for our brand new “Tech Talk Theater” by the very good and amazingly-talented folks at Nuesoft. These were all done in house with family and friends, but you’ll swear they hired out!

I can 99.9% guarantee these short “sizzle reels” will bring a smile to your day! (The 0.1% accounts for those incorrigible curmudgeons out there or those who watch just after walking out of a hospital finance meeting.)

Please disregard the blatant “self”-promotion for the greatly expanded POF with our new focus upon all 3 offices where docs work: outpatient, inpatient, and mobile. Disregard, too: our 500% growth; our 31 fantastic sponsors; our brand new “Hospital of the Future” booth; that we’re helping a local free clinic; that we’re giving away low cal ice cream; that we’ve got robots, telemedicine, patient engagement & education tools, cool hospital tech, diagnostic wizardry, etc.; or that we’ve got our new Tech Talk Theater running 28 little 15-minute talks throughout the show with a diversity of speakers on “news, views, & current events from the world of pediatric healthcare technology.”

Did I hear someone say “Emmy”? We’re Tweeting about it at @PedsOfficeFutur.

E-mail Dr. Gregg.

Time Capsule: Drug Rep Gifts Banned – What About IT Reps?

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

I wrote this piece in September 2006.

Drug Rep Gifts Banned – What About IT Reps?
By Mr. HIStalk

Stanford Hospital last week joined the growing number of academic medical centers that prohibit their physicians from accepting gifts from drug company salespeople. The reps aren’t even allowed on campus, except by appointment to conduct product inservices.

Bravo to Stanford. Physicians think they’re too savvy to be influenced by free lunches, rounds of golf, or drug samples, but drug companies know better – subtle bribery works. A $100 staff lunch influences even a $500K a year doctor whose prescriptions for one medical condition might generate thousands of dollars a week of business for the drug company.

I’ve taken my share of IT vendor goodies: junkets, executive dinners, trips on private jets, and one memorable evening spent in an internationally known billionaire’s back yard. Having thereby flouted the rules of propriety myself, I’m qualified to issue my first-ever standards of conduct for CIOs and other provider-side executives.

The most important fact is this: it doesn’t matter whether your acceptance of vendor swag is improper; it matters only that it might appear improper to an outsider, like the attorney of a bid-losing vendor who’s suing you for tortuous interference or the “60 Minutes” camera crew accosting you on your way to drop the kids off at school.

It’s obvious, but if your organization is sending out RFIs or RFPs or is otherwise involved in system selection, accepting anything is unwise. Even speaking to vendor reps is not smart. Don’t let vendors provide free lunches or giveaways to employees attending demos. Vendors shouldn’t pay for your site visits – if you can afford their product, you can spend your organization’s own money on flights and hotels. Spurned vendors aren’t nearly as chummy, I’ve found.

Otherwise, lunches are always OK, whether one-on-one or group. Stuff for the IT department is OK, like shirts, food brought in, or sports tickets. This is the IT version of the unrestricted grants that drug companies offer, where you accept small items without reciprocating and the chance of undue influence is minimal. Corporate ethics people are usually OK with this, as long as the gifts aren’t for the specific benefit of an individual.

On the other hand, it’s never OK to solicit stuff from a vendor: free software from the Microsoft rep, donations for a pet cause, money for a department party, or entry fees for a fundraiser. Vendor strong-arming is tacky.

I also don’t like the idea that vendors buy access to prospects by sponsoring conferences and giveaways for HIMSS and CHIME, but that’s apparently a hopeless cause. It looks like Halloween, except the trick-or-treaters are wearing suits or conscientiously casual golf apparel.

Spouse trips are out. So are ridiculously transparent junkets, phony advisory board conferences, honoraria, or a visit to the German countryside to see your future PACS system being assembled. It’s tempting when all your cross-town colleagues are lining up at the feed trough, but it’s still wrong, don’t you think?

Having decision-making authority means vendor reps will try to soften you up like gangsters wooing supermodels — with flattery, rapt listening, and a shower of baubles. You know what they really want. Surely your integrity is worth enough that you won’t sell it that cheaply, especially knowing that they won’t respect you in the morning.

Book Review–Your Medical Mind

TLC Book Tours asked me to review Your Medical Mind: How to Decide What is Right For You by Jerome Groopman MD and Pamela Hartzband MD. No compensation was provided other than they sent a free copy. I agreed to review the book because I’m a fan of one of the author’s previous books, How Doctors Think.

This book asks a sobering question: can you trust clinicians to always recommend the best course of medical action given your particular personal beliefs and circumstances? Reading it can be uncomfortable. You are reminded that medicine is not quite the pure science that it sometimes seems and that most of us would like to believe. There are few silver bullets.

Physicians and patients each have their own value systems and motivations. They don’t always overlap. The authors urge patients to take control of their treatments, do their own research, and work with their doctors to individualize their treatment to their own satisfaction.

This paragraph from the introduction neatly encapsulates the entire book’s theme (to the point that I wouldn’t necessarily suggest buying the book if you already understand this concept):

Despite many scientific advances, the unsettling reality is that much of medicine still exists within a gray zone where there is no black and white answer about when to treat and how to treat. Often, there are several differing approaches to treatment, each with its own risks and benefits. The best choice for an individual may be anything but simple or obvious.

In other words, with apologies to the 1960s counterculture movement: Question (Medical) Authority, but in a constructive way.

Those of use who work in hospitals get this point since we see examples of it all the time. Doctors sometimes offer patients a single treatment option that they themselves admit they wouldn’t accept for their own family members. Professionals whose opinions differ don’t speak up, figuring it’s none of their business. The book will provide a service if it only gets that point across – nobody knows your body and mind better than you, so you need call your own shots when it comes to medical care.

The opening chapter, called “Where Am I in the Numbers?” urges patients to both understand any numbers presented to them (such as, “This drug causes side effects in x% of patients”). Also, to realize that “stories” from other patients may over-influence the perceptions of both physicians and patients since both tend to believe stories that echo what they already believe (or want to believe.)

The chapter called “But Is It Best for Me?” is slightly critical of evidence-based medicine, the idea that if you read enough scientific literature, every patient can be treated from a cookbook. Its key point is that even those guidelines are subject to bias, only this time that of the people who reviewed the literature to create the guidelines for treating “average” patients.

The book also examines the effect of coping mechanisms. An interesting example is the driven patient who, when faced with a new diagnosis, gets consumed with the idea of researching “the best of the best,” convinced that making the right provider choice can overcome the disease process. Conversely, providers and insurance companies have engaged their advertising agencies to use that belief to bring in new business with feel-good personal stories in ads that suggest everything will be fine if you just call up the particular organization with your insurance card handy.

Other patient decisions are addressed. How do you make end-of-life decisions, and are a patient’s “pull out all the stops” wishes good for the society that bears the economic cost? Do economic formulas such as quality of life indicators really mean anything? Should you choose a doctor who thinks like you, or one who doesn’t?

The authors bring forth critical medical issues, especially since it does so in an economically motivated environment where treatment decisions are often driven by the government, computers, and corporations. Most patients would be surprised to find that they have a voice in even routine treatments, and more importantly, that their voice is essential in achieving the outcomes most important to them as a human being. If everything could be distilled into a formula, restaurants wouldn’t need menus – you would just sit down and let the computer order for you the same meal that everybody else like you gets or that you’ve enjoyed in the past.

Your Medical Mind should start (or augment) a patient-centered movement. Medicine may be a science, but treatment is an art. As much as we’d like to see the body as a set of numbers that can be made to go up and down by drugs and surgery, it’s not that simple. Its message is that everybody (and every body) is different, and you can’t treat the body without the involvement of the mind. As wise doctors have said long before technology, you treat the patient, not the symptoms.

I would probably recommend this book, but with reservation. It’s not especially fun to read, especially if you’re like me and want to cut to the chase like the subtitle suggests (how to decide what is right for you.) The patient stories wear a bit thin, especially when they are broken out into sections separated by chunks of often unexciting citations of other works. It seems to me that the core idea was padded out considerably to justify the price of a full-sized hardcover book (it contains 308 pages, of which 90 are acknowledgments, notes, and the index; the stories sag under the weight of pointless detail). It could have done a better job in distilling all the stories into an action plan for various medical circumstances, such as what to ask before agreeing to surgery or starting on a new prescription. Its readability level is probably too high for the average patient to comprehend.

What I would really recommend, then, is that somebody take these and other patient-centered ideas and turn them into something the average patient can start using now. Most patients will never read the book, and many who read it won’t connect it to an immediate medical decision when the time comes to make one. If the idea is to education patients beyond just selling books (which  few people read these days,) then the message needs to be mobilized in the form of videos, checklists, or how-to pamphlets that can be handed out in medical practices. On the provider side, how about a set of guidelines on how to communicate (both ways) with patients about what’s best for them?

My final thought was this: we’re getting further away from what Your Medical Mind advocates, at least for the average patient seeing the average doctor. Insurance companies and hospital-owned practices don’t want to pay for exploring patient wishes. Doctors get paid for cranking out the encounters and following a corporately-developed, cost-effective treatment formulas. The country is already going broke over healthcare costs, so who’s going to pay for anything more than symptom Whac-a-Mole, where limiting an encounter to ten minutes, getting lab results into the “normal” range, and prescribing from standard treatment algorithms constitutes a medical job well done no matter what the patient thinks?

In that respect, Your Medical Mind is revolutionary. The idea “you’re not the (medical) boss of me” is threatening to the status quo. Doctors and patients have to stay on the good side of insurance companies and the government, where “having insurance” is equated to “having access to healthcare.” If there’s going to be a patient-centered revolution, it will need to be fought behind the closed doors of the examination room, where medicine still what it always was – respectful and honest conversations between doctors and their patients about what’s best for them.

Cerner To Acquire Clairvia

Cerner announced this morning that it will acquire Clairvia, a Durham, NC-based vendor of care coordination and workforce management solutions that are used by more than 400 organizations. Cerner will integrate Clairvia’s Care Value Management suite into its Healthe Intent and CareAware solutions as a comprehensive resource management offering.

”Health care worldwide is experiencing a resourcing deficit that is forecasted to grow dramatically in the next several years," said Jeff Townsend, Cerner executive vice president and chief of staff. "The fundamental supply of staff and other assets simply cannot meet rising patient demand. Clairvia’s predictive models driven by EHR data not only cut costs by aligning the right resource at the right time but, more importantly, optimize patient outcomes. With this acquisition, we are solidifying our commitment to the workforce management marketplace and interoperable cloud-based solutions that focus on providing positive clinical, operational and financial returns for our clients."

The acquisition is expected to close this month and is not expected to have a material impact on Cerner’s fiscal year results. Clairvia President and CEO Beth Pickard will join Cerner with the acquisition.

HIStalk interviewed Beth Pickard last December.

News 10/7/11

Top News

The Cerner Health Conference starts Saturday in Kansas City, with more than 10,000 attendees expected.

Reader Comments

From Tired CIO: “Re: McKesson Paragon. A recent invite was sent to the Paragon user community for a Webinar that will discuss ‘product line updates’ from company executives. This is a first, as far as I know. Also sent was an e-mail blast informing the clients that the support line for Paragon will be re-routed to the HPF division on Friday so that all Paragon employees can attend an off-site meeting (also a first.) It’s looking like there may be something in the works for Paragon.” Unverifed, but that makes a couple of recent rumblings along those lines.

From Joseph Prang: “Re: 5010 upgrades. Most of the 5010 work is being done by clearinghouses, but practice management system vendors are sending daily faxes and e-mails to their customers demanding that they upgrade to be 5010 compliant. Why would practices need to upgrade unless they are submitting directly to a payor or their clearinghouses are requiring 5010 claim input (which none are, as far as I know?) It should not matter. Practices are coughing up big bucks to get their upgrades in, but should be able to submit in Sanskrit if the clearinghouses do their job.” We talked to a couple of other in-the-know folks, who agreed.

From Emmett Hunter: “Re: Cerner. Making an acquisition Friday. Cloud-related.” Unverified.

From Blue Devil: “Re: Todayskick.com. Were you consulted prior to launch?” Brilliant. A site dedicated to showing off your shoes and shopping for new ones. Nope, I wasn’t consulted, which is likely why there appears to be a dearth of sexy pumps. I might have to go through my closet this weekend and upload my Alexander McQueen / Stuart Weitzman / Christian Louboutin collections.

From AtlantaHITGal: “Re: Jay Deady of Awarepoint has hired two employees away from McKesson in what looks like some sort of package deal since both resigned the same day this week. I know McKesson isn’t pleased, but I’m not sure they can do anything to stop the talent exodus that began two years ago.” I omitted the employee names since I didn’t verify their departure.

From Gitane: “Re: Swedish Medical Center alliance with Providence Health Services. In a FAQ document for employees, Epic is mentioned briefly. Document attached.”

HIStalk Announcements and Requests

One more thing to ensure HIT well-roundedness: read HIStalk Practice. This week’s highlights include wine and acrobatics in the MGMA exhibit hall (look for the Medic and IDX booths in the video.) Private companies outshine public ones in the KLAS mid-year rankings of ambulatory EHRs. Navicure readies for ICD-10. Physicians believe that decision support tools and AI will prevent diagnostic errors. Rob Culbert advises on the the right way to subsidize employed physicians. Stay in the know by signing up for e-mail updates. Thanks for reading.

Listening: The Killers, grandiose pop that sometimes sounds like U2, sometimes 80s Britpop, sometimes Muse. The Las Vegas band is hardly obscure: they’ve sold millions of albums, won a slew of awards, and on Independence Day last year, played in a salute to the military on the White House lawn at the President’s invitation.

Inga thinks we should run more stuff about homecare, assisted living, and long term care IT. Neither of us knows too much about it. What do you think? Is there an audience for that and any experts who might help us out?

Jobs on the Job Board: Regional Director of Enterprise Sales, Product Director – Acute Revenue Cycle Solutions, Implementation Project Manager. On Healthcare IT Jobs: Pharmacy Informatics Analyst, Solution Sales Executive – Microsoft HSG, HL7 Interface Analyst, Epic Consultant Manager.

Acquisitions, Funding, Business, and Stock

Navigant acquires Paragon Health, a practice management and consulting firm specializing in cardiovascular practices.

Practice management and billing software provider Kareo, Inc. closes a $10 million equity investment led by Greenspring Associates. Kareo, which has grown more than 100% per year for the past three years, will use the capital to expand its sales and marketing initiatives and to add at least 30 employees by the end of the year.

Wireless asset tracking vendor AeroScout acquires Sentient Health, which offers medical supply inventory management tools.

Sales

PeaceHealth signs agreement through GE Healthcare to upgrade to Streamline Health’s AccessAnyWare v5.1.

Advocate BroMenn Medical Center and Advocate Eureka Hospital (IL) select MediRevv to provide A/R management services.

Ventura County  (CA) enters into a $32 million contract with Cerner to provide EHR to the county’s hospitals.

Children’s of Alabama selects iSirona’s device connectivity solution to deliver data from medical devices to its Allscripts EMR.

People

Aegis Health Group hires William Walker (Medkinetics) as VP of IT services.

Dell names Andrew W. Litt, MD (Litt Healthcare Ventures, NYU Langone Medical Center) chief medical officer for the company’s Healthcare and Life Sciences Services division.

Announcements and Implementations

Merge Healthcare introduces Merge Honeycomb, a cloud-base medical imaging sharing network that is open for use by anyone at no charge.

Iatric Systems earns Surescripts e-prescribing certification for its discharge instructions function that allows prescription routing to retail pharmacies in all states.

Medical Specialists, an Indiana medical practice, uses Shareable Ink and its Allscripts EHR to, in its words, “merge technology and personalized healthcare.”

Verizon Connected Healthcare Solutions and Duke University will collaborate on projects for mobile health and consumer healthcare education, with Verizon providing the infrastructure and Duke contributing people and intellectual property.

Government and Politics

Meaningful Use by the numbers:

• 88,399 physicians and hospitals had signed up for the Medicare program by the end of September; an additional 24,030 registered for the Medicaid program.
• As of September 30, CMS had paid more than $850 million in EHR incentives ($357 million for Medicare and $493 million for Medicaid.)
• Medicare incentive payments have been paid to 3,772 physicians and 158 hospitals.

The Medicare Payment Advisory Commission (MedPAC) votes to endorse a plan to repeal the sustainable growth rate (SGR) formula for Medicare physician pay and replace it with one that keeps rates steady for primary care physicians over the next decade and cuts other physician services 5.9% for three years, then freezes those rates for seven years.

Innovation and Research

A UTMB report looks at the use of telemedicine and the use of mobile and wireless technologies in healthcare. It’s brief, but interesting. The site of its Center for Telehealth Research and Policy has good resources.

Other

Computer Science Corporation (CSC) shareholders file a class action lawsuit against the company over its participation in the UK’s NPfIT project, alleging that CSC deliberately misled them with overly optimistic projections of its ability to deliver, its financial performance, and the viability of the Lorenzo software from subcontractor iSoft, claiming the company knew for years that it was “dysfunctional and undeliverable.”

Plastic surgery for men is on the rise, with facelifts up 14%. Rhinoplasty is the procedure of choice for men, though otoplasty and liposuction are popular as well. Anyone want to venture a guess what surgical procedure remains the top pick for women?

I’ve read a bunch of Steve Jobs quotes in the last 24 hours. Here’s my favorite:

Remembering that you are going to die is the best way I know to avoid the trap of thinking you have something to lose. You are already naked. There is no reason not to follow your heart. Stay hungry. Stay foolish.

I’ve enjoyed watching this excellent video of Steve Jobs delivering Stanford’s 2005 commencement address. It’s like Apple’s products: carefully designed, casually presented, and deceptively simple. The message of finding a job that matches what you love to do is powerful. On death: “I’ve looked in the mirror every morning and asked myself, ‘If today were the last day of my life, would I want to do what I am about to do today?’ Whenever the answer has been ‘no’ for too many days in a row, I know I need to change something. Remembering that I’ll be dead soon is the most important tool I’ve ever encountered to help me make the big choices in life.”

Athenahealth Chairman and CEO Jonathan Bush writes a guest post for Forbes titled Hospitals Might Be Heading Into Trouble, where he likens the “buying binge” and excessive borrowing of hospitals acquiring physician practices to that of Fannie Mae in pushing people into houses they couldn’t afford. He predicts that (a) hospital systems will fail in numbers too big to be bailed out by investors or the government, or (b) hospitals will complete their vertically integrated monopolies and strong-arm higher patient volumes and prices. A snip:

In my ‘hospitals gobbling docs’ scenario, software is the bottleneck to profitability. The supposed enabler of the referrals that the above business model is predicated on, is not working to that end. Why would it be? Software is not a web-native connected system. It doesn’t update when the rules change. Software doesn’t even let you send patients from one hospitals to the next (unless one is owned by the other and using the same server – can you imagine? In this day and age?). In fact, outside of vertically integrated systems like Kaiser Permanente and Cleveland Clinic (and they are highly-specialized solutions) and a few others, you’d be hard-pressed to see any cases where software is greasing the referral wheels. In other words software is mucking up the model.

Weird News Andy channels Buster Keaton in his wordless wry commentary. It’s pretty common to see cemeteries adjoining hospitals in the South, leading to the inevitable knee-slapping quip by one’s father driving the family car, “People are dying to get out of one and into the other.”

A six-year-old boy is treated by a hospital ED for a broken wrist. Three months later, the boy suffers permanent brain damage after being beaten by his mother’s boyfriend, who walks away with two misdemeanor charges and probation. The boy’s father sues the boyfriend and the hospital, claiming the ED doctors should have suspected child abuse from the broken wrist, requiring them to contact authorities. The boyfriend ignores the suit and the hospital prevails in two courts, but another court reverses the decision. This time, the jury finds the hospital negligent and orders it to pay the family $25 million.

Sponsor Updates

• Rockcastle Regional Hospital and Respiratory Care Center (KY) shares clinical data with the Kentucky HIE using the Healthcare Management Systems Connex interoperability platform.
• Nuesoft Technology names Cornerstone University and Colorado College the Fall 2011 winners of its College Health Scholarship program. 
• Merge Healthcare releases an eBook entitled Meaningful Use Guide for Radiology.
• Metropolitan Medical Services partners with iMDsoft to offer the MetaVision Anesthesia Information Management System.
• ZirMed and HEALTHCAREfirst announce a partnership to offer an RCM  solution to home health and hospice care agencies.
• nVOQ and Health Language Inc. will collaborate to deliver the voice recognition solution Say It for Health Care.
• HITEC-LA selects NextGen Healthcare as a preferred vendor.
• Wellsoft receives the highest marks for EDIS solutions in the recent KLAS EDIS report.
• JHIM highlights three hospitals using T-SystemEV to attain Meaningful Use  in the ED.
• EDIMS will participate in the ACEP 2011 Scientific Assembly October 15-18 in San Francisco.
• New Zealand-headquartered Orion Health celebrates the opening of its Paris office with an event at the New Zealand Ambassador’s residence in Paris.

EPtalk by Dr. Jayne

I’m waiting anxiously to hear what the Institute of Medicine has to say tomorrow regarding essential health benefits. As part of the Affordable Care Act, insurers will be required to cover these essential benefits across 10 categories that include professional services, drugs, hospital care, and laboratory services.

The Washington Post feature Wonkblog covered this in an easy-to-read article. I need to be more careful, though, because I was reading this piece while multitasking (aka “not paying attention”) during a Big Meeting and apparently had some facial leakage that might have been perceived as smirking.

My favorite quote is from Tekisha Dwan Everette, director of federal affairs for the American Diabetes Association: “You have to be cognizant that you can’t narrowly include every miniscule coverage option or the whole thing will implode on itself.” I love her use of “implode” and think it’s a perfect descriptor for what we’ll be seeing over the next few years. A close second from National Health Council Vice President Marc Boutin: “As we moved through some of the actuarial analysis, we found that covering everything really isn’t affordable.” Duh. Did they really need to ask an actuary about that, or just a middle school algebra student?

I wonder how many patients will lobby for coverage of the new gray hair prevention pill under development by cosmetic giant L’Oreal? Patients will have to start taking it daily at least 10 years before their hair starts turning gray and then continue taking it for life. I wish I had known about this before I crossed the line into IT administration. I hope they include a Magic 8-Ball to help predict when patients might go gray.

Although many states have already started issuing Meaningful Use checks, providers in the Beehive State can start applying for their piece of the pie starting Monday. For those of you who have forgotten those state nicknames you learned in fifth grade, let me Google that for you: Utah.

Quirky FDA approval: A gel called LeGoo has been approved to temporarily plug small blood vessels during bypass surgeries. It typically dissolves after about 15 minutes, but can be eliminated earlier with application of a cold pack. The FDA wisely warns physicians not to use it on vessels that deliver blood to the brain. Duh #2 of the day.

A new book The Web-Savvy Patient instructs patients facing a medical crisis how to best use the Internet to be an informed patient. Tips include how to tell the difference between good information and poor or vendor-sponsored information. It encourages readers to populate a Personal Health Record to centralize their health information.

Inga scooped me earlier this week with photos from the eClinicalWorks National Users Conference. Although my contacts weren’t as fast with their smart phones, they did deliver the goods. According to my roving reporter, the highlight of the exhibit hall was the Harlem Globetrotters guy and the basketball setup at the Emdeon booth. I know some other meetings are coming up this fall – and I hope to see more submissions from readers. Extra consideration will be given to photos that feature excellent cocktails, costumes, celebrities, or general mayhem. Cerner, AMIA, and NextGen attendees, I’m counting on you!

Contacts

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

Steve Jobs Dies

Apple co-founder and visionary Steve Jobs has died, Apple announced this evening. He was 56.

News 10/5/11

Top News

A former patient files a $20 million class-action lawsuit against Stanford Hospital & Clinics on behalf of 20,000 fellow patients, seeking $1,000 each following a data breach in which patient records were posted on a commercial Web site for almost a year. Stanford has issued a statement blaming co-defendant Multi-Specialty Collection Services, which at the time of the breach was providing collection and billing services.

Reader Comments

From Boot Scootin’: “Re: eClinicalWorks National Users Conference. You should have been at the party. I think you would have enjoyed the dancing and noticed some good-looking cowboy boots.” Indeed, these folks look to be having some fun and the “skirts with boots” look is one of my all-time faves. eCW is entertaining a crowd of 2,700 this week in Scottsdale.

From Rye Catcher: “Re: subcontractor payments. I’m a long-time reader and huge fan. I did EHR implementation work this summer as a subcontractor for one of your sponsors. I’ve done work for them previously and was always paid on time, but haven’t been paid for June and July hours and haven’t worked for them since July. The CEO gives me ever-changing reasons for the delay, telling me four times that the check was in the mail and giving me fake tracking numbers twice. I wonder if your readers have experienced this problem and can offer any tips? I’d rather not take the legal route, but my options are dwindling.” Please leave a comment on this post if you have ideas that can help RC (short of engaging a leg-breaker to get someone’s attention.)

From The PACS Designer: “Re: Apple iPhone 4S instead of iPhone 5. CEO Tim Cook surprised his audience with the announcement that the new features for the iPhone family will be called iPhone 4S. Prices will be $199 with 16 GB of memory to $399 with 64 GB. It will come in a black or white case. A new feature called Assistant adds voice activation capabilities for apps. Transcribing with the iPhone 4S could be a future enhancement for healthcare users when the app becomes available.” A little more horsepower for graphics, GSM and Sprint capability, the Siri personal assistant, eight-hour talk time, and a better camera are the features, but the most significant change may be the lower price (not to mention that the previous models will be discounted as well). Sounds like a comparative disappointment, putting some wind in the Android sails (or sales). Apple shares closed down a tiny percentage. Somehow it all seemed kind of dull without Steve Jobs around, like watching a band play with a replacement lead singer.

Here’s a demo of Apple’s Siri technology. They bought the company for a couple of hundred million last year. There’s a Nuance connection other than Siri uses Nuance speech recognition: the company that formed Siri out of a government research project (SRI International) incubated and IPO’d Nuance at the end of the 1990s.

From Shanana: “Re: HCA. Do you know if they’ve made their decision on Epic or Cerner? Or when they will?” I haven’t heard, but I have readers from there who may provide an update.

From Inga’s BFF: “Re: AHIMA. Here are some shoe pictures!” I get two reactions when I run shoe pictures: the ladies gush and the men accuse me of pervdom. Like most men, though, I don’t know a flat from a pump, but I’ll take my chances in pandering to the women.

From Pathos: “Re: Sunquest’s acquisition of PowerPath. Wonder what will happen to its CoPathPlus AP product?” According to the FAQ (which is marked confidential, but it’s out there on the Web), both products will be supported and enhanced going forward, giving Sunquest a 24% market share. All Elekta employees working on PowerPath will transition to Sunquest and there is an “absolute and clear ‘No Sunset’ policy.”

From Denali: “Re: McKesson Paragon. Heard they’re going to start selling it as just a revenue cycle product. They will still support clinicals. Are they finally admitting that HERM will never be more than a slick PowerPoint?” Unverified. McKesson said they would provide a response from their PR folks, but I haven’t heard back for a couple of days.

From Loop Froots: “Re: HIPAA. Our small healthcare information technology needs to speak with someone about making sure our storage of PHI is compliant with HIPAA and other regulations. We haven’t stored PHI so far, but may need to in the future.” I think Loop is looking for some consulting or advisory help if anyone is qualified and interested. E-mail me and I’ll pass your info along.

From Bomp deBomp: “Re: [provider name omitted]. They’re using an outdated system to rip off the government stimulus money. The system does not allow scanning or viewing images, so they use pieced together applications that are dangerous to patient care. EKGs and x-rays are viewed by different systems and outside reports aren’t available until the patient is discharged. The system is tedious to use, so notes are scant and can’t be followed by other personnel, not to mention that ordering meds and labs is so time-consuming that most physicians do verbal and faxed-in orders. Critical results are hard to find. The lawyers are going to have a heyday, but their physicians will take the brunt of the settlements. Meaningful Use has never been so bastardized.” Unverified.

From Been There: “Re: NPfIT. Having worked for several miserable months on the UK disaster at the very beginning, it was obvious that it would fail. The guy running it had zip, zero, nada experience in health care and didn’t see why that would matter. He was all about writing gotcha contracts with the vendors and ‘holding their feet to the fire.’ Don’t blame it on the docs, blame it on the idiots in charge.” I’ve made that observation previously and it’s a fascinating one: just about every vendor involved got pressured to sign unfavorable contracts, then bailed when it was clear they could be neither successful nor profitable. I don’t know of any precedent where vendors with multi-billion dollar contracts still wanted out and there weren’t really any others qualified to replace them.

HIStalk Announcements and Requests

Posted on Twitter: “#FF @histalk and @IngaHIStalk are great sources of HIT industry scuttlebutt, rumors, and inside knowledge. Also music & shoe ideas too.” What a great 140-character summary.

My doctor’s office now has an electronic check-in kiosk. Very cool. You verify your appointment online, print out a one-page confirmation with a bar code, then when you get to the office, just skip around all the people waiting in line, wave your bar code under the scanner, and take a seat. It’s way easier to use than an airport kiosk and a great way to avoid all the coughing, bleeding, and wheezing folks (and their secretions and excretions) who would otherwise be ahead of you in line.

Acquisitions, Funding, Business, and Stock

Business integration and data management service provider Liaison Technologies closes $30 million in financing to accelerate its growth in the life sciences, healthcare, and HIE markets.

Sales

University Medical Center in Nevada contracts with Interpoint Partners for revenue cycle and clinical products, as well as Interpoint’s 835 denial management software.

The National Cancer Institute’s Center for Cancer Research awards Harris Corporation a $37 million re-compete contract to continue managing data for the center’s clinical research.

Capital Health System, Inc. selects Hayes Management Consulting’s MDaudit Hospital software for proactive risk mitigation.

Carson-Tahoe Regional Healthcare (NV) selects ProVation Order Sets, powered by UpToDate Decision Support, as its electronic order set solution.

Central Illinois Health Information Exchange finalizes a contract with ICA to implement the CareAlign HIE platform.

People

Keith Hagen, former COO of Aperio and CEO of QuadraMed, is named president and CEO of Quantros, which offers quality performance and risk management applications.

Connexall USA appoints Bob Kennedy (Kryptiq) as VP of sales.

Radiologist and former White House Fellow Pat Basu, MD joins Virtual Radiologic as chief medical officer.

The National Quality Forum hires Rosemary Kennedy, the former chief nursing informatics officer of Siemens Medical, as its VP of HIT.

AHIMA elects Kathleen Frawley, associate professor and chair of HIT at DeVry University, as the association’s president-elect for 2012. Other new members to AHIMA’s board include Ann Frischkorn Chenoweth (3M Health Information Systems), Dwayne M. Lewis (DML Consulting), and Melissa M. Martin (West Virginia University Hospitals.)

Ingenious Med names former A.D.A.M president and CEO Mark Adams as its CFO.

Jonathan Goldberg, VP/CIO of St. Peter’s Health Care Services (NY), will hold the same role with the newly formed St. Peter’s Health Partners, which brings together St. Peter’s, Albany Memorial, St. Mary’s, and Samaritan, all in the Albany area.

Announcements and Implementations

Anthelio enters a strategic partnership with MedQuist to implement MedQuist’s clinical documentation services at several of its facilities, also offering the company’s Front-End Speech Recognition and Natural Language Understanding solutions to its clients.

Connecticut Children’s Medical Center preps for its $20 million Epic implementation that will cover both the hospital and its 165 specialty physicians.

HHS, AHIMA, and North Shore Medical Labs (NY) announce a demonstration project to support broader use and adoption of EHRs by providers in underserved communities. AHIMA will provide free HIT training and North Shore will donate EHR software and services through Nortec Software. The project is part of AHIMA’s “HIM Jobs for America initiative,” which supports employment and training opportunities for HIT professionals.

Streamline Health, which has posted losses in recent quarters, announces a new brand identity (logo, Web site, and product names) intended to “represent the Company’s progress as it continues its transformation into an externally focused, high-growth healthcare technology company.” I wonder if my life would be any spicier if I refreshed by brand identity (hair color and new wardrobe) or if, in the end, it would just be a better-looking me with the same old life. Hmm.

The local paper reports that the cost for Kettering Health Network’s (OH) Epic implementation is $100 million. That’s double what network officials said when the project was announced two years ago.

Vocera announces the release of its B3000 Communication Badge, which offers enhanced durability, audio quality, and speech recognition.

Nuance Communications announces a new version of its eScription platform, which includes a streamlined documentation creation process and enhancements to the quality assurance workflow.

RelayHealth adds Blue Button capability to its network, allowing patients to download, print, and share their health information with a single click.

Government and Politics

ONC awards APP Design, Inc. a $1.2 million contract to design ways to help patients understand their choices about how their information is shared, including in an HIE environment. It will result in an e-consent pilot with Western New York’s HEALTHeLINK.

Technology

eClinicalWorks unveils four new products at its National Users Conference this week, including a patient app for Web-enabled devices; Project Scribe, which converts free text to structured data; Project Nimbus, which enables practices to view and update patient data during outages; and eClinicalWorks for the iPad. All will be out by next summer.

Security companies will host a free Medical Device Hacking Summit in Minneapolis next month.

Rock Health opens up the application window to find its next round of startups to accelerate in San Francisco. Applications are due by November 14 and the next group of entrepreneurs moves into its office in January for five months. The above video has entrepreneurs explaining what Rock Health is. Below that are the folks who run it: Halle, Leslie, Clare, and Jess.

Other

From KLAS:  over 80% of providers will use emergency department information systems to help them attest for Stage 1 Meaningful Use, though many products lack required functionality such as medication reconciliation and CPOE. Half of Epic, Cerner and Medhost customers report being ready for MU, but 2/3 of those using McKesson, Meditech, and Picis mention one or more functionality gaps that need to be addressed.

Cherie Lester, an old friend of HIStalk, has an interesting post on her EngageMeHIT blog on how to prepare for a Skype-based job interview. My favorite tip: no pets. If you’ve every been on a conference call with a working-from-home person who doesn’t know how to use the mute button and whose giant-sounding dog barks at every passing vehicle outside, you’ll understand.

A telehealth project in Canada diagnoses and treats dermatology conditions in Africa’s developing countries, expanding the Canada-only Consult Derm to an international philanthropic program called Telederm Outreach.

Weird News Andy cleverly notices that in this case, the mouse really is connected to the computer. Scientists in Israel implant a computerized cerebellum into a brain-damaged mouse, allowing its brain to communicate with its body. If you’re wondering where the scientists happened to find a brain-damaged mouse, you probably don’t want to know more about how animal experiments are conducted.

A hospital staff psychiatrist makes The New York Post for pulling down $516K in taxpayer-paid overtime in addition to his $174K salary, reporting an average of 110 hours per week that also include one four-day stretch of working around the clock.

Sponsor Updates

• Mac McMillian, CEO of CynergisTek, participates as a panelist during the October 5 webcast Health Information Exchange Privacy and Security – Are you Ready?
• SRSsoft partners with Omedix to provide SRS clients with a fully integrated patient portal.
• Mike Smyly, chief business development officer for Inland Northwest Health Services, will co-present with Tim Cromwell from the VA in a National eHealth Collaborative Webinar on HIE leadership and sustainability Wednesday afternoon (October 5) at 1:00 p.m. Eastern.
• Merge Healthcare announces the creation of a clinical advisory board, led by CMO Cheryl Whitaker.
• AsquaredM offers an October 11 Webinar called Applying Value Stream Mapping to the Revenue Cycle.
• Hayes Management Consulting releases a synopsis of the final CMS rule for RACs.
• InHealth Clinical Documentation Solutions joins MD-IT as an MTSO Associate.
• QMACs Inc partners with MED3OOO to offer its physician clients the company’s InteGreat EMR and PM products.
• Brian Levy, MD, CMO and SVP of Health Language Inc., presented an education session on medical terminology and interoperability at this week’s AHIMA convention.
• Medicity’s Kipp Lassetter and McKesson’s Emad Rizk, MD  earn nominations to Modern Healthcare’s and Modern Physician’s list of the 50 Most Influential Physician Executives in Healthcare.
• NextGen Healthcare hosts an October 6 webinar entitled Providing Practices a View into What Matters Financially.
• Concerro will preview its new ShiftPredict schedule modeling tool at the ANCC National Magnet Conference this week in Baltimore.
• SourceHOV signs an agreement with 3M Health Information Systems to make  its outsourced coding resources available with 3M’s suite of ICD-10 products and services.
• San Juan Regional Medical Center (NM) selects Access Universal Document Portal to move perinatal documents from GE Centricity into Meditech.  ‎

Contacts

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

Curbside Consult with Dr. Jayne 10/3/11

Last month I mentioned that the AMA had recently released its 2010-2011 Health Care Trends Report. The report’s “Science and Technology in Medicine” section includes items summarized from other sources, including MGMA data. Surprisingly, MGMA noted that independent practices were “more likely to have fully implemented and optimized EHR systems than hospital-owned practices.”

They noted that nearly 20% of EHR-owning independent practices felt they had optimized use of their systems, while another 50% had completed implementation and were moving to the next stage. In contrast, one-third of owned practices were still in the beginning stages of EHR adoption.

As far as quantifying how many physicians are using the system, only 43% of hospital-owned practices reported that all physicians used the system, where 72% of independent groups claimed that all of their physicians used the system.

I’ve spent a significant portion of my career toiling in the CMIO trenches, including oversight of ambulatory EHR implementation. Although this was largely in hospital-owned practices with employed physicians, I’ve had experience with private practices under hospital-subsidized arrangements as well as truly independent physicians. I’ve definitely noticed a difference in how the two groups do with EHR adoption and have a couple of thoughts on why they’re different.

My first theory involves the idea of free will. In a typical independent practice, the physicians have to come to at least some kind of consensus prior to purchase of an EHR. They’ve often been active participants in the selection process and in determining how a system will be implemented. Physicians may be active in system setup and customization of workflow and template screens.

In contrast, hospital-owned physicians are generally told which EHR they’re going to implement, as well as when and how. There are typically limits on how much autonomy physicians have with workflow, and customization at the provider level is taboo. It may be the system’s way or the highway. It’s always easier to get people to do what you’re asking when they think it’s their idea or when some reward is involved. It’s awfully easy to rebel when someone is trying to force change.

Speaking of reward, my second theory involves having the proverbial skin in the game. Because employed physicians typically have contracts which include the EHR and implementation as part of their employment agreements, they’re not paying much (if anything) out of pocket for the transition. Often employed groups are committed to keeping their physicians’ compensation stable as an EHR is implemented. Those physicians aren’t really incented to rapidly adopt or to change behaviors.

My colleagues who have had to pay their own IT bills (many of whom can also tell you exactly how much they paid for their EHR systems, down to the penny) have a different view of things. Trainers report that independent physicians are less likely to skip training sessions and tend to be more engaged. I’m sure those value-conscious providers know how much they’re paying for training hours and also how much they’ll be hurt if they can’t return to full productivity as quickly as they’d like.

My final theory revolves around the glacial speed of decision-making within hospital-owned practices. Physicians have given up a degree of autonomy (often for good reason – they’re lured by the promise of practicing medicine without having the pressure of dealing with staff, OSHA, CLIA, credentialing, vendors, and other distractions). Decisions are made among multiple levels of mangers, regional administrators, and hospital presidents.

There are often meetings to discuss the meeting before the meeting, not to mention the obligatory meeting after the meeting. Committees (and subcommittees, action groups, and departmental fiefdoms) have to sign on prior to things actually being decided. The ability to move forward with EHR adoption in a nimble fashion is seriously compromised. Each time the cycle repeats, adoption declines.

For those of you in the ambulatory arena, what’s your theory? E-mail me.

E-mail Dr. Jayne.

HIStalk Interviews Deborah Peel MD, Founder, Patient Privacy Rights

Deborah Peel MD is founder of Patient Privacy Rights.

Give me some brief background about yourself and about Patient Privacy Rights.

I never expected to be leading this organization or ever even thought about that. In my younger days, I practiced full time as a psychiatrist and Freudian analyst for a very long time, until it became clear that things were happening in DC that would make effective mental healthcare impossible. Namely, that there were lots of different ideas being floated; for example, the Clinton healthcare initiative. There was a part of it that was going to require everyone’s data from every physician encounter be recorded in federal database.

Fast-forward to the HIPAA privacy rule. That’s what really convinced me of the need for a voice for consumers, because there really wasn’t any. What I’m talking about there is, of course, the change in 2002 that happened under everyone’s radar except for – and this is the is the laugh line – when the 3,000 Freudian psychoanalysts in the nation noticed that consent was eliminated.

In 2004, I started Patient Privacy Rights because there was no effective representation for the expectations and rights that the majority of Americans have for how the healthcare system is going to work. Namely, that people don’t get to see their information without consent. Since founding PPR in 2004, we’ve still been the national leading watchdog on the issues of patient control over information and even internationally. Our power has come because when we came to DC, the other people that were working on privacy, human rights, and civil rights recognized that because of my unique position as a physician and deep understanding of how data flows, that I knew what I was talking about. 

We very quickly got a pretty amazing bipartisan coalition of over 50 organizations. That enabled us to put these issues and problems on the map.

We had some incredible successes in HITECH. Virtually all of the new consumer protections came from our group, including the ban on the sale of PHI, the accounting of disclosures, segmentation, the new requirement that if you pay out of pocket for treatment you should be able to block the flow of that data to health plans and health insurers. We were the ones that worked with Congressman Ed Markey on getting encryption, required stronger security protections, and worked with Senator Snow to get meaningful breach notice into the rules.

All of this work lead to the first-ever summit on the future of health privacy this past summer in DC. The videos and the entire meeting can be seen or streamed online.

If somebody said you had to choose between accepting healthcare IT as it is today or going back to purely paper-based systems, which would you choose?

We’ve never been in favor of going back to paper. Our position has always been there is tremendous technology for privacy and we can have far better control of our information if we implement smart, privacy-enhancing technologies and architectures.

We’ve never been in favor of going backwards, although I do have say, we now know about WikiLeaks and now because of the strong breach notice requirements, it’s appalling how abysmal the security is of electronic records. Actually, it’s looking a lot like paper records are far easier to keep from getting into the wrong hands because there’s only one of them and they’re locked up in a medical records department most of the time.

We wouldn’t make that choice. What we’ve always tried to do is promote systems that give everybody – except the data thieves and data miners – what they want.

I don’t detect any citizen groundswell about the state of healthcare privacy, just organizations doing an occasional biased survey that concludes that the public is extremely concerned or implies that they would be concerned if only they were informed. Is advocacy needed when there have been no events to get the public up in arms?

The public has two minds about this. All the polling shows that they are extremely sensitive about who controls their records and they believe that they should have the control. On one hand, that’s what they believe.

On the other hand, the polls also show they’re extremely concerned about breaches. Large majorities recognize that all these things are going to get broken into. There’s knowledge in some ways and fears about electronic systems. But the key thing is industry and the government have really not recognized how many people are, in Alan Westin’s words, “Health privacy intense.” He’s the guru of polling in health privacy.

At our summit, he presented 20 years of data. The slides are up there for anyone who wants to see. When the polling comes to views about privacy and control of information in the healthcare sector, his findings have been consistent over 20 years — 35 to 40% of the public is privacy-intensive about health information. About other information, it’s 25%. This is a really significant minority.

Even though the public is not yet marching on Washington with pitchforks — and obviously I’m saying that in a joking way — the issues about privacy are simply going to continue to grow. What the industry has really ignored — and I particularly know about because of the patients that I’ve treated for 37 years — is that people will act in ways that endanger their health in order to keep information private. Millions and millions of people. These are not good outcomes. The public knows that electronic systems are far less safe and secure than paper systems.

This is something that has to be faced. There will be people who will choose not to see doctors, who will omit information, who will ask doctors to change diagnoses, who will refuse to get tests, and so on. These are figures from the 2005 California HealthCare famous study that one in eight people does something to try to protect their privacy.

Even earlier figures from HHS in 2000 are troubling. They found that 600,000 Americans a year refuse to get early diagnosis and treatment for cancer because they know the information won’t stay private. Two  million a year — or at least that year –refuse to get early treatment and diagnosis for serious mental illnesses for the same reasons. They know that the information won’t stay private. The same is true with millions of people that refuse to seek treatment for sexually transmitted diseases.

These are not good things. If you look at the military, the Rand Corporation did a survey – I think the book was called Wounded Warriors — that the lack privacy in the military is one of the important reasons that people won’t get treated. There’s 150,000 Iraqi war vets with post-traumatic stress disorder and we have the highest rate of suicide in the military in 30 years. Actually, just this year, we turned the corner that more members of the military killed themselves than were killed by an enemy.

You’ve really, really got to take seriously the fact that people that desperately need help for illnesses and diseases that are very treatable are refusing to get them because the consequences of the information not staying private are too threatening. It’s about two things, mainly – jobs and reputation.

The survey measures their perception, but does their perception reflect reality?

What I’m talking about is the reality — the actual numbers of people who act. My point really is, yes, the polling is off the charts on what the public feels, but the data is in. It’s not just about feelings. It’s about actions people take to protect themselves and their families from job discrimination, reputational damage, insurance discrimination, and the rest.

But it still was self-reported, right?

Well, yes.  These were figures from HHS surveys and from a California Healthcare survey.

As a psychiatrist, your privacy concerns are mostly related to discrimination with regard to employment issues or insurance. Going back to the public’s perception, are there enough occurrences where that’s actually happened that could not have happened with paper medical records?

This issue of discrimination and health information leaking out of the health system is not new because we have health IT. Literally, I learned about this when I hung out my shingle in 1977. The first week I was in practice, a couple of people came in and said, “If I pay you cash, will you keep my records private?”

I was blown away by that. I’d never heard of that in medical school or residency. Nobody talked about that, but these were people who had suffered harm. Again, jobs and reputation. So I said, “Well, sure.”

It’s a very significant issue. Many mental health professionals actually give patients Miranda warnings. If you use a third-party payer, anything you say and do can and will be used against you. Many health professionals will work with people to try to find a fee that they can afford so that they don’t have to have their futures or their children’s futures wrecked.

If patients were allowed to control who can see their medical information, would you be comfortable as a physician making treatment decisions based only on what they want you to see?

As a practical matter, patients still can and do control a lot of what we see and know. I trust what I hear from patients at least on a par, if not more, than what I find in medical records. The history is everything. People are going to withhold information or even lie about it if they don’t trust you. You have to earn patient trust. You get the best information when patients know that you’re really going to protect them and keep their information out of the hands of countless, endless third parties.

I think this is something that physicians and other health professionals – some, anyway – are not going to see coming. As everyone gets their electronic health record – and hospitals are going to get blamed for this too, not just physicians and the practitioners – when they begin to realize how far-flung their data is … that was another thing that came up at the Health Privacy Summit. There’s not even any kind of a data map that can show people all of the places their data goes. It doesn’t even exist. The data gets so far afield. When people see this, they’re going to blame the doctors and the hospitals. That’s not a good thing.

Decisions are made outside the practitioner’s control about who gets that data. At least some EMR vendors believe they own the patient data and can sell it even though that fact may not be clearly stated to patients.

We’ve been pretty actively pointing out that kind of thing. I’m not a lawyer, obviously, but doctors really don’t have a right to sell patient data. That’s one of the reasons we got a ban on the sale of health information into the stimulus bill. Obviously it hasn’t stopped the particular business model of so many electronic health record companies so far, but that was one of the reasons that our coalition worked to ban the sale of PHI without consent.

But as you see, what’s in the federal law and what turns up in regulations is not always the same. That’s a serious problem. I think those contracts will eventually be found to be illegal, just like many health insurers. You probably know about this. You used to get doctors to sign contracts with them with gag clauses, where they weren’t supposed to tell their patients about certain kinds of treatment alternatives. Of course those turned out to be illegal, but that didn’t stop the insurance industry from using them widely for a very long time.

People read about their financial information and Google searches being available to third parties. Do you think they are getting desensitized to the idea that privacy is something they should expect?

No. I think they’re getting more and more rabid about it. You’ve seen lots of pushback, not just in this country, but even more so in Europe, where they have much tougher data privacy and security protection. Google got bit on Buzz. Facebook ended up getting a lot of blowback from their users who believe that they have control over their information. A lot of the controls on Facebook and Google imply that.

I often talk about how people say young people don’t care about privacy. Wrong. I’ve got two teenagers. What’s the premise of Facebook? Some people are my friends and can see things, and others are not.  If you want to think about it this way, it’s an early consent tool. You’re in, you’re out. That’s the new premise of Google Plus, that new circle of friends thing. You have different people that get to know different things about you.

But people really do want control over who sees and uses their information. They feel this very strongly. VCs and other people have begun calling us up and asking what we think about things, because they realize there really are going to be markets for products and systems where people know that they can trust what happens with their information and it doesn’t go anywhere they don’t want it to go.

If you’re one of the good guys in the privacy and confidentiality debate in healthcare, who are some bad guys?

It’s not so easy. It’s not just good and bad.

First of all, there’s a vast number of people who are simply not informed, or they’re well-intentioned and they just don’t know what’s going on. There’s a lot of them. A lot of things happen for that reason.

I also think a lot of the reason we’re stuck with these data-leaking systems is because initially, a lot of the administrative kind of software was imported from other businesses. If you think about this, other businesses don’t have to respect individual privacy in the way that they healthcare system does.

In fact, the difference about healthcare from all other commercial areas — where as you say, we can’t seem to control our data at all – the strongest rights we have to control information are in healthcare. They come from the legacy of Hippocrates. The requirement to get consent is in every ethical code for health professionals from time immemorial. We have extremely strong rights to health privacy despite HIPAA.

One of the slides that I always show is a direct quote from the HIPAA regs that talk about HIPAA is intended to be a floor, and in no way to preempt best practices or stronger privacy protections in state law and medical ethics. Well, what happened to that? HIPAA was never intended to wipe out or preempt state law or anything else.

We’re seeing some movement some beginnings of more movement in ONC to begin to try to put in place the kind of technologies that are a matter of law, like the need to segment mental health and addiction information and certain other kinds of sensitive information — genetic, STDs and so forth. They’re finally starting to spend a little tiny bit of the $29 billion on the things that matter the most to the public.

Publicly visible, high-profile advocates tend to polarize people who either see them as selfless crusaders or shameless limelight seekers chasing personal gain. How do you see your image in healthcare and who agrees and who doesn’t agree with what you do?

In the beginning, I was cast as a very polarizing figure. Everyone saw me as trying to interrupt the $29 billion dollar gravy train, although it didn’t exist until recently. I had some active reporters essentially trying to attack me as a Luddite and stuff. These were people that didn’t even read or listen to what I was saying. It was polarizing in the beginning, but many people really are of good intent.

I think there is a much more mature understanding of the importance of privacy now, as evidenced by the list of top government officials that participated in the first summit on health privacy and the industry people that participated. We had a past chairman of HIMSS,. We had Lisa Gallagher, HIMSS privacy and security officer.  Wes Rishel from Gartner was on the panel. We had top people from this nation, from outside of this nation. We had top government people, top industry people, and advocates and privacy experts in academics who were all taking the question seriously — can we build a system with privacy that’s effective and that works and is reasonable? Can it be done?

There were no catfights on the panels or anything, because everyone there believed this is really an important issue that needs to be addressed. I would say that summit is evidence of me being perceived as – I think at this point – less a polarizing figure than a convener for the people that really want to move this whole effort forward in an effective, responsible, thoughtful way that does not leave the public out and that incorporates what the public expects and what they have longstanding rights to.

Any concluding thoughts?

For me, what’s been really difficult has been the fact that even though the administration — both this one and the previous one — wanted to be inclusive and wanted to have public input, the kinds of financial commitment and staff commitment it takes to actually participate in these government private efforts does not allow the kind of input that’s needed from privacy advocates and experts and academics.

Just speaking for myself and getting back to your point about seeking the limelight for some kind of gain, I have to tell you that I’ve never taken a salary for this. In fact, my family and friends have sacrificed lots of money, lots of time, lots of their own personal efforts to me and to Patient Privacy Rights to enable this to happen. In terms of gain, for me, it’s an honor to work for the public, the people of this nation, for privacy. But in terms of any kind of financial gain, it’s certainly been exactly the opposite.

We are hoping to build on the momentum that started at the summit. We’re going to be putting together several work groups and we’re going to make this an annual event. Patient Privacy Rights is also going to create a new privacy brain trust with leaders in this country and internationally to weigh in on what we can to help move things forward in a constructive way. This nation needs a big counterweight to the many interests that want data without consent, including for-profit research entities, the government, those that sell data, and business analytics kinds of tools with patient data.

This nation and the world needs a group of experts who can provide the kind of credible information on those policy and technology to counter a lot of the one-sided infomercials that come from industry. There’s a real need to hear all sides, so people are coming together under the umbrella of the summit to be able to work together and to have an even more powerful voice than just Patient Privacy Rights and me. It’s a wonderful thing because it isn’t just me who cares about this.

Sunquest Acquires PowerPath Pathology System

Sunquest Information Systems has acquired the PowerPath anatomic pathology information system from Sweden-based Elekta AB for $33 million USD, it was announced this morning in Europe.

Sunquest President and CEO Richard Atkin said of the acquisition, “Sunquest’s commitment to Anatomic Pathology and serving the pathologist has created a natural fit for PowerPath within the Sunquest solution suite. Together, we will have an increased critical mass and expertise to meet the needs of the pathologist in this important and growing market. I am excited to welcome the PowerPath customers into the Sunquest family.”

Elekta, which markets oncology solutions, acquired PowerPath along with IMPAC Medical Systems in 2005. The product was previously sold by IMPATH and Tamtron.

Elekta President and CEO Tomas Puusepp said, “PowerPath is clearly a leading brand in its sector with an impressive customer list of prestigious institutions. However, the synergies between PowerPath and Elekta have been limited and we expect that PowerPath will have good prospects with Sunquest, given their more complementary business"”

PowerPath is supported by 44 US-based employees. Elekta reports that it generates annual revenue of $12 million and is used by more than 450 facilities worldwide that offer surgical pathology, dermatopathology, cytology, and autopsy services.

Monday Morning Update 10/3/11

From Urban Legend: “Re: MediServe. Has acquired rehab scheduling and practice management vendor SpectraSoft.” Verified. MediServe, which offers rehab and respiratory therapy applications, has acquired SpectraSoft, an Arizona-based vendor of systems that include hospital and practice patient scheduling, physical therapy, appointment reminders, and billing.

From The PACS Designer: “Re: iPhone 5 launch. It’s official — Apple will hold its launch for the iPhone 5 on October 4. With this introduction, we’ll be seeing CEO Tim Cook give the presentation instead of Steve Jobs. It will be interesting to see how someone other than Steve does with the new feature presentation for the expected crowd.” Purportedly leaked photos are coming about, above which is one. Most interesting to me will be (a) how Tim Cook does, and (b) how long the fanboy lines are. I expect high demand, reinforcing the obvious – the country’s economic suffering is not universally shared as many folks stand in unemployment and food bank lines, while others clamor in similarly long lines to plunk down cash to replace their perfectly workable cell phones with cooler ones.

From Fed Up: “Re: anonymous comments. I’m disappointed that you gave a company my IP address. I now fear for my job.” I don’t divulge anything I receive to anyone, so it wasn’t me, but the comment you left may have contained enough specifics for the company to take an educated guess on its own. If any organization was pressuring me hard to give them information that wouldn’t be appropriate, the first thing I’d do is post the full details of their request on HIStalk and let the readers decide who’s being unreasonable (that’s a lot of bad PR if the company is out of line.) I will, however, always offer companies the space to rebut comments that are incorrect, and unlike newspapers who bury such comments, I’ll put them right in HIStalk if they keep it concise. Seems fair to me.

From IV Drip: “Re: Health 2.0. The on-stage production is well run by the company employed to do that and incorporates live demos and unscripted comments. The non-stage component is what most people complain about – there is a significant lack of organization in vendor relations and logistics. There’s also the point of reference for vendors – it’s not a bland, measured, vendor-subsidized event with a huge exhibit space where content is determined a year in advance. Attendees love drinking from a fire hose of innovation over a packed two days instead of being exhausted after four days of cattle drive-like trudging around mega-halls and a Las Vegas-like show floor. It’s about networking and meeting new people. They could do a better job with logistics, but if it turns into a vendor brown-nosing type show like HIMSS, I and many other won’t be there.” It’s always a tough trade-off – everybody wants a conference that’s information-driven, off the wall, and fun (and largely paid for by vendors), but with good logistics, decent food, and a comfortable setting. Like most parties, the host’s job is to invite the right people, make sure they are relaxed and happy, and stay out of the way. That’s why I like low-key HIMSS chapter events and user group meetings, but never liked TEPR and was indifferent to last year’s mHealth Summit (bad logistics and not all that fun overall.) I will say that with my ultra-limited event organizing experience (a handful of HIStalkapaloozas, with vendor-provided event planners doing most of the work) you don’t have to sell your soul to vendors to get them to participate. Those involved in my events have been almost insistent that their participation be downplayed even though it was costing them a bundle. I always suggest a little vendor fair area for the sponsor or maybe some giveaways or a short company pitch from the stage, but they’ve always declined. However, I guess when you’re charging as much as HIMSS for exhibiting and putting competitors elbow to elbow in Gladiator Hall, expectations are raised.

New HIS-tory from Vince Ciotti, covering AR/Mediquest. If you’ve been in HIT long enough to remember that company and if you’re going to HIMSS in Las Vegas, put your contact information here to get on Vince’s e-mail list for the get-together he’s arranging there for the pre-1980 HIT’ers.

Listening: new from all-girl Dum Dum Girls, kind of a jangly, upbeat, lo-fi version of The Pretenders with some GoGo’s and spaced out Mazzy Star thrown in.

My Time Capsule editorial from 2006 for this week: For Employees in Uncarpeted Areas, Hide Technology Complexity Like McDonald’s Does, in which I said, “Medical errors, including technology-induced ones, have gotten so bad that some hospitals are actually advising patients to bring along a friend to protect them from staff mistakes. I can’t imagine any other business throwing in the towel and admitting defeat to customers. I’d have just two words for a restaurant waiter who suggests that I watch the cook to make sure he doesn’t poison me: ‘Check, please.’”

Time for me to vent (sorry) about trite words and phrases that spread like the plague from the Internet to the parroting mouths and keyboards of the easily impressionable: “not so much,” “meh,” “totally,” “epic fail,” “it’s all good,“ “just sayin’” and anything in the form of “Best. ____. Ever.” I postulate that these are the same vocabulary-challenged people who pleased themselves to no end in the 90s by cleverly inserting random outbursts of “Not” and “Party on, Garth” at every conversational opportunity and are hopefully embarrassed about it to this day. The Internet, like TV before it, can make you smarter or stupider, depending on how you use it (and a survey of the offerings suggests that the smart money is betting on the latter.)

The majority of respondents think Vista Equity Partners got a good deal in acquiring Sage Healthcare, or at least that’s how I interpret it. New poll to your right, suggested by a reader: do you know and/or follow your employer’s policies regarding device encryption and handling of confidential information like PHI?

University of Texas System chooses CodeRyte for enterprise-wide computer-assisted inpatient and outpatient coding. They will also use the company’s DataScout data mining technology.

Welcome to new HIStalk Platinum Sponsor HealthStream. The Nashville-based company offers innovative learning solutions that enable the training and business objectives of healthcare organizations: patient safety, workforce development, regulatory training, and technology education. HealthStream’s customers include 50% of US hospitals. Its Authoring Center is an open platform that allows content creators to develop and distribute learning modules using the tool of their choice – PowerPoint and PDFs, for example. Competency Center is a competency and performance management solution that hospitals use to create customized performance appraisals and competency assessments. The SaaS-based Learning Center is a learning platform and courseware library that supports 2.4 million active healthcare workers, with 70,000 course completions and 100,000 student log-ins every day from healthcare users. Also offered is a turnkey nurse CE library. Hospitals call HealthStream when they need to improve patient safety, implement quality programs, develop nurse effectiveness, improve compliance, and ensure that clinicians are trained to use new technology and medical devices. Thanks to HealthStream for supporting HIStalk.

Amcom Software’s Messenger middleware earns FDA 510(k) clearance as a Class II medical device. It connects patient monitoring systems to smart phones and pagers, allowing rules-based alert messages to be sent to clinicians.

A Reuters article says that HIT stocks are priced high because of HITECH-spurred revenue growth, but are susceptible for a big fall if Congress gets serious about reining in the red ink and cuts some of the HITECH billions. Specifically named as trading at at a high multiple: Cerner. It’s a pretty shallow article that recites the obvious and, puzzlingly, claims at the end that open source is a big threat to vendors.

Practice Fusion CEO Ryan Howard is profiled in the San Francisco newspaper. He says the company was out of cash and had only 2,000 users at the end of 2008, but has since raised $36 million in financing and signed up 120,000 users tracking 20 million patients in its free EMR. He mentions some company goals: use its customer data for healthcare predictive modeling and create a birth-to-death patient record for patients. The above video, Cracking the Entrepreneur Code, is new and covers some of the same ground about the scrappy startup – he says the company was basically out of business until he got an insurance company check for injuries he received in an auto accident, which he used to make payroll instead of for getting himself fixed up. “When we got funded, I was four years behind on my taxes and needed two root canals. The lesson here: before you go too far down this road, ask yourself what you’re willing to give to pursue your dream.” The first 17 minutes of the video where he’s talking should be mandatory viewing for anyone involved in a startup. It’s fascinating to hear about how in the early days (himself plus three engineers) he did a zero-budget homebrew press campaign to get on the radar of investors.

Greenway Medical Technologies expects to add 400 new jobs and will undertake a $12 million expansion at its corporate headquarters in Carrollton, GA, according to state officials. The company filed for a $100 million IPO a few weeks ago.

MED3OOO (I can never figure out how to spell the name – sometimes they use zeroes like MED3000 and sometimes Os like MED3OOO) puts out a cool video showing their InteGreat EHR running on an iPad with Medicomp’s Quippe. They unfortunately didn’t post the video anywhere that allows me to embed it here, so you’ll have to click the link, but I promise it’s worth it if you want to see an entirely new way for doctors to document. Quippe is undeniably cool and the InteGreat demo is well done. It even contains a bonus in the last five seconds: an Inga quote. I asked if it’s really her on the video since it kind of looks like her in a shadowy way, but she swears it isn’t.

Chester River Hospital Center (MD) was scheduled to go live on Meditech Saturday, replacing QuadraMed Affinity.

Mark Rosenbloom MD, the founder and CEO of electronic clinical reference vendor PEPID, starts an age management practice in Illinois, offering a $995 per month program of lab tests, vitamins, and training sessions.

Two small Long Island weekly newspapers are baffled when all available copies are quickly bought up from vending machines and newsstands, with at least two teams of people grabbing all available copies at or above the cover price. Based on the overlapping stories in both papers, the newspaper strongly suspects friends of a local doctor who was charged with Medicare fraud were trying to keep the story quiet. Jesse Stoff MD was arrested for giving kickbacks to patients after billing Medicare for unnecessary services. He billed Medicare more than $800,000 in one month, tipping the feds off to run a sting operation in which an undercover agent was paid $300 for five visits. The money was delivered in a “kickback room” with a Soviet-style poster warning patients not to talk about the scheme.

The Washington state chapter of the American College of Emergency Physicians sues the state over a new rule that limits Medicaid recipients to three ED visits per year for non-emergency conditions. They have a vested interest since ED docs often bill patients directly for their services. The state’s Medicaid medical director says he had to trim $35 million from his ED budget somehow and only about 3% of Medicaid ED patients are frequent flyers who will be affected, not to mention that up to half of the frequent ED visitors go there seeking drugs. The top Medicaid user in previous audits was a 27-year-old woman who visited EDs 172 times in one year (every other day) complaining of headaches.

E-mail Mr. H.

Time Capsule: For Employees in Uncarpeted Areas, Hide Technology Complexity Like McDonald’s Does

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

I wrote this piece in September 2006

For Employees in Uncarpeted Areas, Hide Technology Complexity Like McDonald’s Does
By Mr. HIStalk

A recent state survey found that El Camino Hospital’s medication error rate nearly tripled after implementation of a supposedly safer, closed-loop type of information technology for medication orders. El Camino, widely recognized as a hospital technology pioneer going back to the 1970s, suffered an embarrassing setback as onsite investigators found actively occurring medication errors that were unknown to the hospital.

Major implementations like CPOE expose serious flaws in an organization’s ability to manage change, to communicate, and to educate — those soft skills often scorned by take-charge caregivers and logical IT types. If El Camino can have problems like these, so can just about any other hospital.

Medical errors, including technology-induced ones, have gotten so bad that some hospitals are actually advising patients to bring along a friend to protect them from staff mistakes. I can’t imagine any other business throwing in the towel and admitting defeat to customers. I’d have just two words for a restaurant waiter who suggests I watch the cook to make sure he doesn’t poison me: “Check, please.“

Walk the uncarpeted areas of the hospital on night shift, where clinicians get dumped because they’re new, working multiple jobs, or desperate to earn shift differential. The variation in practice is shocking to anyone who assumes that policies are consistently followed or that nurse executives speak knowledgably for those folks who toil in the appropriately named “graveyard shift,” where some of the most horrific mistakes are made by tired, under-supported clinicians left to their own devices by the A-team nine-to-fivers. Sometimes they don’t even get computer training because no one wants to come in at 3 in the morning.

Software and medical equipment isn’t designed with these people in mind. Our mental picture of a user is an intelligent, thoughtful person who sits in a quiet room and carefully reads all the screens, labels, and warnings we put in front of them. This paradigm works well in those hospital departments where knowledge management is the key responsibility: laboratory, radiology, and pharmacy, for example. Their employees embrace technology and use it willingly to boost productivity in performing repetitive tasks. The IT track record in those departments is outstanding.

Nurses and doctors don’t work in that world, however, so our efforts and computerizing their work has been spotty. They didn’t go into their professions because they love computers. Much of their work isn’t even all that logical, no easier to computerize than that of a teacher, artist, or mechanic. Rightly or wrongly, how they do things varies by individual or by area, making it highly unlikely that non-personalizable off-the-rack software, as a rigid enforcer of business rules, will ever be fully accepted by those who don’t follow the rules anyway.

For vendors, maybe simpler is better, hiding the complexity like a McDonald’s cash register, where pushing a button with a hamburger picture on it rings up a hamburger. For hospital leaders involved in IT, maybe it’s time to venture out “where the sun don’t shine” – the night shift, uncarpeted underworld of patient care where all of our IT horsepower often fails to protect our patients.

News 9/30/11

Top News

VA CIO Roger Baker says his organization will allow smart phones and tablets on its network starting Monday, with the first batch of 1,000 users swapping out their laptops or BlackBerries for devices running an unnamed OS (Apple). He also says he’d like the VA to develop an enterprise-wide apps store, with some of those apps coming from its recently announced open source EHR project.

Reader Comments

From Matt Holt: “Re: unsubstantiated. C’mon Inga, be nice, or at least reasonable. Keanu’s comment that Health 2.0 was super disorganized? I hear everything from my team — including the three people who didn’t like my write-up of their bios — and I never heard about an argument breaking out about an ad. No one wrote mentioned the fact that we’re the only health conference with more than 120 LIVE demos, that we had two big time health plan CEOs talking directly about technology, that we put the ONC head on stage with seven patients, or that we had 1500 people come – more than 50% up on 2011? Guess next time I’ll have to ask the 20-30 people telling me that Health 2.0 is the best conference they go to that they should e-mail you instead.” Thanks, Matt, for filling in the missing details, although we just ran what an attendee (and sponsor, apparently) sent us. Maybe I am just bummed I couldn’t have been there myself to experience it. Next year.

From High-Heeled: “Re: Error messages. In my role of helping physicians survive and thrive with EHR adoption, some are generally frustrated by the error messages their applications throw up. This is a new error message one of our doctors sent to me and told me it didn’t bother her at all!” Please tell your physician that wine makes me more tolerant as well.

From Lou Reed: “Re: just good enough. Farzad Mostashari is urging the HIT Standards Committee to put out standards that are ‘good enough’ to get started on HIE. In my HIT experience, any link that is ‘just good enough’ handles the core data, but any data outside the norm (such as exceptions, outliers, etc.) gets trashed. Just look at what craziness the open text segments in HL7 cause. Providers will be spending thousands of man-hours trying to sort out this out as they trip over the myriad of exceptions that come up in health care cases. Although I am a firm believer in not letting the perfect be the enemy of the good, there are times when that approach does not fit. This is one. Would he take his child on a plane that is ‘just good enough’?”

From Sorbino: “Re: EHR. Check this KLAS report. Ever heard of PCC – Physician’s Computer Company?” I’ve heard of them, but I was never quite sure what they did (some kind of reseller, I figured). The PCC EHR, which is pediatrics specific, puts up monster KLAS scores. They’re pretty new on the report, though, and there’s often a honeymoon period before the scores start to slip as the company grows, expectations are raised, and an increasing number of users are surveyed. Still, it’s an impressive accomplishment. There’s something to be said for focusing on a particular market segment and excelling in it.

From Just Tennille: “Re: SRS user group meeting. I always feel that I’m among friends there and came home energized. “ I can see where the “energized” part came from – check out the Red Bull and coffee bean chocolates bar. All that’s missing is caffeine IV bags. The SRS developers, lined up for intros and appearing uncomfortable in their seldom-worn and/or borrowed suits, look like they would love to change into nerdwear, ravage the caffeine stash, and sling some code. That’s what you want in a developer, which is why the glad-handing and photogenic sales guys become physically uncomfortable in their presence. I’ve never had an energy drink, but I’ve noticed recently how expensive they are in bars and stores, probably making them even more profitable to their manufacturers than wine or liquor since they don’t have to pay high federal alcohol taxes (Red Bull’s founder is worth $3 billion). I bet they were a hit at the user group meeting.

From Meaningful User: “Re: NY Times on the UK’s HIT fiasco. Blumie toots a different horn now that he’s back using these poorly usable systems.” It’s a fun read, calling NPfIT “a slow-motion train wreck” and asking three experts on whether a similar disaster could befall HITECH, which costs even more than the hugely expensive NPfIT boondoggle. Former National Coordinator #1 David Brailer says the UK ran NPfIT as a giant procurement program, running all over clinicians in the process. Richard Alvarez of Canada Health Infoway says both the US and Canada are taking a different path than Britain in setting standards and outcomes, but not doing the actual implementation. Former National Coordinator #3 David Blumenthal echoed Brailer in saying it has to be a collaborative effort with clinician involvement. You docs who aren’t sold on even subsidized EMRs may have more power than you imagine, or at least Brailer thinks so: “The experience in Britain is a warning to us. The thing that brought them to their knees was the confrontation with doctors.”

From CDMer: “Re: stolen tapes. Another day, another breach.” SAIC says computer backup tapes were stolen from the car of one of its employees on September 14, potentially exposing the detailed health information of 4.9 million military beneficiaries who received care, lab tests, or prescriptions in San Antonio area facilities such as Brooke Army Medical Center.

From Dolphins Fan: “Re: loss of Minnesota PHI. When something like this happens, everyone always points out that it was against company policy. Every healthcare company on the face of the earth has a PHI policy and most have an encryption policy. Unfortunately, for many companies the goal is to put a policy in place to make people happy, but then they fail to enforce it. Execution of a policy, versus simply having a policy, is where you really see how important PHI protection is to a company.”

HIStalk Announcements and Requests

In case you have been too busy following season-ending baseball drama, tracking the latest presidential polls, or watching Dancing with the Stars, here are a few highlights from HIStalk Practice over the last week: Dr. Gregg mulls over Abe Lincoln and HIT innovation. Electronic medical reminders improve care in elderly patients. Younger docs are not necessarily better at EHR than their older peers. MED3OOO serves up education, networking, and fun at its annual user conference. eClinicalWorks sells swag for charity at their national user conference this weekend in Phoenix.  If you have not been a HIStalk Practice regular in the past, I have good news: we are still accepting new subscribers. Thanks for reading.

Welcome to Executive Search Recruiting, supporting HIStalk as a Platinum Sponsor. The Cornelius, NC-based ESR is a boutique search firm (no, they don’t find boutiques, they recruit executives and sales talent) that works with providers, payers, vendors, and consulting forms to bring on partners, principals, directors, sales executives, and consultants, to name a few of the positions they can help with. They’ve worked with companies ranging from startups to Fortune 500 companies, so there’s a 100% chance that they’ve helped an organization similarly sized to yours, offering customized fee structures that include flat fee per hire, retained searches, contract work, and an interesting (low) hourly fee share for billable consultants. The company’s employees average 15 years’ of healthcare experience in executive search, so they know where to find the really good people (hire a bad one on your own and the value proposition becomes clearer.) On the other side of the jobs table, if you’re a high performer looking for an opportunity, check out their current openings and get in touch with Don Calhoun. Thanks to Executive Search Recruiting for supporting HIStalk.

Everybody likes big and/or round numbers, so here are some for HIStalk. E-mail subscribers: 7,546. Likes on Facebook: 1,595. Mr. H connections on LinkedIn: 920. Dann’s Fan Club members on LinkedIn: 1,857. Number of unique readers: 21,350. Number of visits since 2003: 4.56 million. You will make the small round number (zero) of HIStalk full-time employees happy by increasing those numbers where you can. Thanks.

On the Jobs Board: Implementation Project Manager, Epic and Cerner Resources, Director – Product Demonstration Specialists. On Healthcare IT Jobs: HL7 Interface Analyst, Director, Clinical Applications, IT Technical / Product Support Specialist, Epic Consultant Manager.

If you were toiling away in HIT prior to 1980 and want to reconnect with old pals at HIMSS, sign up so Vince can e-mail you details about a little get-together at the HIMSS conference. One reader is hoping for Neil Pappalardo or Octo Barnett from Meditech to attend, but even if they don’t, quite a few interesting folks have already said they’re planning to be there.

Acquisitions, Funding, Business, and Stock

Greenway Medical announces that it is acquiring certain technology assets of CySolutions, a provider of clinical management and EHR solutions for FQHCs and community health centers. Greenway did not disclose the purchase price or the exact technologies it’s buying, but does indicate that CySolutions CEO Bill Young and other development staff members will join the company.

Prognosis Health Information Systems completes its acquisition of Creative Healthcare Systems, a provider of financial management and patient accounting systems.

Sales

Jeff Davis Hospital (GA), a 25-bed Critical Access Hospital, selects Healthland’s Centriq EHR.

Meadowlands Hospital and Medical Center (NJ) chooses PatientPoint’s patient engagement platform for care coordination and revenue cycle management.

Allegiance Health (MI) signs a three-year contract with TrustHCS for its ICD-10 education services and DNFB Assurance program.

Atlantic General Hospital (MD) contracts for Sunrise Clinical Manager from Allscripts. The hospital already uses Allscripts on the ambulatory side.

Blue Cross Blue Shield of North Carolina will spend $15 million to subsidize the implementation of the Allscripts MyWay EHR for 750 North Carolina physicians, with 85% of the cost covered for eligible independent practices and 100% for free clinics, including training and support. BCBSNC will work with the NC Area Health Education Centers to help practices achieve Patient Centered Medical Home status and will also help providers connect to the North Carolina HIE. Allscripts will contribute an additional $8 million to the project.

St. Francis Hospital (CT) executes a three-year agreement with MED3OOO to provide RCM services for its 200 employed physicians.

People

Ryan A. Secan, MD, the former medical director of hospitalist programs at Lowell General Hospital Medical Group and Anna Jaques Hospital, joins MedAptus as chief medical officer.

T-System promotes Erin Estes from director of implementation services to VP and GM of performance solutions.

Announcements and Implementations

Cerner announces the Cerner Reference Lab Network, which requires one standard connection to communicate with all reference labs on the network.

Community Medical Centers (CA) goes live this week on Epic.

CareTech Solutions earns HDI Support Center Certification for its Service Desk IT help desk offering, which it says is the only hospital-specific help desk in the country. The company also just invested $1.5 million to reconfigure and remodel the operation. The press release casually mentions that it’s an “on-shore medical help desk,” meaning that when you call, you’re talking to someone in Troy, Michigan, United States of America.

Scottish charge master vendor Craneware announces financial tools designed for Critical Access Hospitals.

Government and Politics

HHS launches the Comprehensive Primary Care initiative, which will pay primary care practices $20 per beneficiary per month for providing better-coordinated care for Medicare patients. The program calls for participation from private and state insurance providers, requires providers to meet certain quality measures, and will eventually include a shared savings component for participants.

iSoft will provide its Enterprise Management hospital information system to create the Brunei Healthcare Information System, a government project with a goal of creating a single electronic record for every patient in Brunei.

Fujitsu prepares to sue the UK Department of Health for $1.1 billion, saying it’s owed that amount after pulling out of NPfIT in 2008.

Innovation and Research

A hospital in England explains its green IT efforts, which include moving to virtualized servers, replacing desktops with thin client devices, and implementing the NightWatchman power management solution that powers down idle PCs in non-critical areas.

Other

An Atlanta medical practice’s IT specialist pleads guilty in federal court to intentionally accessing the protected computer of a competing perinatal medical practice. Using his home computer, Eric McNeal accessed the system of a former employer, downloaded patient data, then deleted all the patient information from the practice’s computer. He used the patient data to run a direct mail marketing campaign to benefit his new employer. He faces up to five years in prison and a fine of up to $250,000.

Weird News Andy elects not to steal second base in declaring, “I’m not touching this one.” A woman undergoing a swap-out of her breast implants wakes up after surgery to find herself with symmastia, also known as  “uniboob.” She said, “It looked like I had one big breast instead of two,” but the uniboob has since been successfully re-cleaved by another surgeon and the inevitable lawsuit has been settled.

National eHealth Collaborative seeks nominations for its board.

Consumers in Australia complain about the pharmacy association’s plan to push a particular manufacturer’s nutritional supplements when patients pick up their prescriptions. The association’s computer system will remind the pharmacist to tell the patient that the supplements can help mitigate side effects of the prescribed drug. The association’s president is particularly proud of the computer reminders, calling them a “world first for IT-enabled, software-promoted pharmacy sector messages to facilitate targeted recommendations to patients.” The manufacturer’s CEO raised the most ire when she characterized the sales program as a “Coke and fries” upselling opportunity that will boost pharmacy profits. The president of the Australian Medical Association was unimpressed: “I think the evidence for Coke and fries is about the same as the evidence for these products.”

A Denver-area agency ICU nurse is charged with identity theft and theft of medical records after Centura Health discovers he had accessed patient records inappropriately. The complaint against him says he used patient information to sign up for credit cards. His nursing license from another state had already been suspended in connection with a prescription fraud investigation.

A St. Louis-based physician and geriatrician urges the US to emulate the healthcare system of France (#1 in the world vs. the US at #37) and its smart card system. which is really just a microchip ID card that contains no medical information and is required for every citizen over 16 years of age:

The most magnificent component of the French medical system is the "Carte Vitale." This looks like a credit card and is given to the physician by the patient. It is inserted into a computer allowing the physician to review the patient’s basic medical history and is also used for billing the patients visit to the government. The patient thus controls his or her own health records, maintaining privacy.

A family practice physician in Canada, talking to a reporter about the loss of a PHI-containing memory stick from a local hospital, says patients of his own practice are not at risk. “My system is hard copy — paper, and it’s worked for me and many doctors in the city who still use it. It’s awfully hard to lose an entire filing cabinet.”

Thomas Manning, the retiring head of Commonwealth Medicine (a consulting division of the University of Massachusetts Medical School,) will become the state’s highest paid retiree with an annual pension of $347,000 when he retires next year. The organization is under investigation for receiving no-bid Medicaid contracts from the state that cost $138 million per year, but says that’s not related to Manning’s retirement.

Sponsor Updates

• Imprivata reports that the healthcare sector is the leading adopter of desktop virtualization technology, according to a recent cross-industry survey of 477 IT decision makers.
• Wolters Kluwer Health announces that Children’s Healthcare of Atlanta (GA) has selected its ProVation MD software for its GI departments.
• Surgical Information Systems (SIS) becomes an Industry Supporter of the American Society of Anesthesiologists (ASA).
• TeleTracking Technologies announces a free webinar series addressing patient throughput, overcrowding, RTLS asset management, performance improvement, and inter-hospital transfers.
• The executive director of medical operations for Pocono Raceway (PA) discusses how emergency responders are using technology from T-System and Shareable Ink.
• MobileMD introduces its 4DX Connected Health Record, an EHR application for small and family physicians that should be ONC-ATCB 2012 certified in Q4.
• Capsule announces record growth, including the addition of over 90 facilities over the last six months.
• iMDSoft adds Metropolitan Medical Services as a reseller of its MetaVision Suite.
• Billian Publishing launches HITR.com, a HIT benchmarking and social networking community for providers and vendors. The free tool includes customer satisfaction scores for nearly 40 IT systems and 300 vendors.
• CapSite releases a study of the RIS market and finds that 22% of hospitals have plans to buy a new RIS. Sixty-one percent of installed RIS systems are at least five years old.
• HIT consulting firm Care Communications collaborates with Elsevier/MC Strategies to incorporate Elsevier’s ICD-10 transition tools into its ICD-10 readiness and implementation offerings.
• Frost & Sullivan awards Awarepoint its RFID and RTLS Healthcare Competitive Strategy Leadership award.
• For the twelfth consecutive year, CMS extends its use of McKesson’s InterQual Criteria for decision management.

EPtalk by Dr. Jayne

Web sites like Groupon offer discounts on a variety of products and services. A recent article notes that such discounts may be illegal where health care services are concerned. Because part of a patient’s payment is kept by the site, it could be interpreted as violating anti-kickback laws. The American Medical Association hasn’t taken a stand, but two medical boards in Oregon (dental and chiropractic) have banned the practice.

The National Labor Relations Board affirms the right of a physician to terminate an employee for bad-mouthing the practice via social media. However, if multiple employees are collectively complaining regarding legitimate issues, employees may be protected. Timing, audience, and composition are key determinants of whether the speech is protected or not. Better dust off those policies and procedures and make sure social media use is addressed at your practice or hospital.

US District Judge Marcia Cooke has blocked enforcement of a Florida law that restricts physician questions about patient ownership of firearms. For those of you customizing EHR content and intake forms to remove these questions, you’re off the hook.

Accenture is chosen to head efforts to build a national Personal Health Record system in Australia. Orion Health and Oracle are also on the team. The system will include both patient and provider portals.

I maintain admitting privileges at a community hospital that is just now preparing to implement CPOE. I received a hilarious memo from them this week which contained so much worthless consultant-speak that I could have won a round of “Buzzword Bingo” without missing a beat. My favorite part was the discussion of a “cross-functional team dedicated to surveying spaces throughout the facility for process utilization.” I think this is fancy-talk for, “We have to figure out where we’re going to stick all these blasted workstations.” Broom closets, beware!

Sixteen organizations (including vendors, consultants, and advocacy groups) come together to form the Accountable Care Community of Practice. In their own words: “The overriding goal of the CoP is to help enable rapid, effective and efficient adoption and use of Health Information Technology (HIT) by providers implementing new care models in support of accountable care.” In addition to Webinars, they will hold regional forums in Minneapolis, Boston, New York, San Francisco, Seattle, and Austin.

PEPID announces the delivery of the National Drug Code (NDC) database to health IT systems. I’m not a fan of using NDC information for drugs, as it introduces a certain “clutter factor” depending on how vendors utilize it. Although highly specific, NDC codes for a given dose of a particular drug differ based on what kind of packaging holds the drug. As a front-line clinician, I personally don’t care if the pharmacy has 500-tablet stock bottles or 100-capsule stock bottles or which manufacturer it comes from. And don’t forget that generic drugs can have dozens of different NDC codes for the same medication.

I thought of Inga when I came across this business mentioned on a friend’s Facebook page. If it was in my home town, they would definitely get my business. It would also be an excellent name for a woman-owned software consulting firm. Now why didn’t I think of that? I could have probably expensed a number of sassy shoes as a business / advertising expense.

Contacts

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

News 9/28/11

Top News

Two Minnesota hospitals start notifying 16,000 patients that their medical information was contained on a laptop that was stolen. The hospitals blame subcontractor Accretive Health, whose employee left the laptop in a locked car outside a restaurant. The company did not give a reason that its employee had PHI on a personal laptop that was, contrary to company policy, not encrypted.

Reader Comments

From Keanu “Re: Health 2.0 conference. It might be bigger this year, but so far it’s super disorganized (and has been during the lead-up.) I’ve spoken to multiple vendors and sponsors they’ve managed to upset (including us.) I just witnessed a big argument about an ad gone wrong. Signage is lacking and has misspellings. We’ll see how the actual show goes.” Keanu sent a follow-up email, saying the first full day of the show was “semi-organized anarchy,” though better than the initial setup day.

From Jackie Dan “Re: Health 2.0. It’s sort of an interesting meeting and a cross between a mini-HIMSS and a VC startup competition. Everyone is trying to prove they’ve got the next ‘disruptive business model.’ A couple of interesting trends here though, like the whole Dr Chrono/Practice Fusion freemium thing. An insider at Practice Fusion told me that their paying customers are pretty much negligible compared to their purported 100k+ users, although, he still seemed ‘confident’ that they would survive/make money on ad revenue.” I have my own theories on the freebie EMRs and suspect Practice Fusion’s Research Center makes a nice impact to the bottom line.

From Doctor Who “Re: HIStalk resilience. FYI, you guys have significant sway these days. My profile in the Health 2.0 program makes direct reference to a post I made after HIMSS. HIStalk seems to have staying power. BTW, in addition to tons of people vying for money, the Health 2.0 conference is inspiring with some really cool and smart ideas out there. And the reception even included an open bar with Inga-like drinks (coco-tinis, nikita margaritas.)” Glad for the vote of confidence on HIStalk, as I kind of like this gig. HIStalk is over eight years old, so it’s been around for awhile. Bummed I missed the drinks. Next year, Matt.

From Fred Norris: “Re: HIMSS webinar. Got this in e-mail today. Doesn’t HIMSS charge hospitals a bunch to be members so they can benefit from their neutral, unbiased education services? Are they offering equal time to GE, Cerner, Epic, etc.? How can HIMSS claim to run a vendor-neutral annual conference (you have to swear that to be a presenter) and then run this marketing seminar? I’m sure they’re charging Siemens a fortune, so will they lower our annual dues proportionately, or are they just in it for the money like all vendors?” I raised a fuss when HIMSS started shilling its infomercials, but nobody seemed to share my indignation (or maybe they were just not surprised enough to care given the ever-blurring line between HIMSS and other vendors). Like a TV station during election season, HIMSS will indeed offer equal time to all other vendors – at an equal price. I do resent HIMSS passing sales pitches off as education, but that horse left the barn long ago and all you can do is try not to step in the part that’s left.

From NeverEnuf: “Re: Jackson. I thought you’d like this article on executive pay not being sufficient!” The new CEO of financially desperate Jackson Health System (FL), himself a former banker and city manager, gets some heat from the local paper by hiring two $500K executives who also have no hospital administration experience, one an accountant and the other a former IBMer. The CEO says the whole management team is paid well below market rates, which is definitely the case since he himself makes “only” $590K for trying to turn around the ultra screwed up Miami public hospital. That sounds plenty fair for a county official, but you know how hospitals are.

From Viggo: “Re: Thanks for looking over our Web page. I appreciate the favor.” I get quite a few requests for one thing or another: making an introduction, giving an opinion about a potential employer, offering thoughts on a vendor or product. I politely turn quite a few (maybe most) of those down since I don’t have much free time and it gets overwhelming at times (not to mention that much of the time, I’m just as clueless as the requestor and don’t want to just throw something out there implying otherwise.) My decision tree looks like this: (a) is the requestor a friend of HIStalk in some way – a sponsor, a guest article submitter, an interview subject? (b) if not, have I exchanged e-mails with them previously? (I save all my outbound e-mails, so I can tell); (c) is the requestor at least superficially supportive of HIStalk, like by being in the HIStalk Fan Club on LinkedIn or a friend in Facebook? I’ll do whatever I can to support people who support me, but I get more requests than I can handle as an after-work hobbyist (for example, I’m still writing after a crappy and long day at work that was followed by four hours of HIStalk work; my pager is going off; I won’t get to bed for another hour; and six hours later, I’ll the cycle start over again. If you’re waiting on e-mail from me, that’s why.)

From DDLT-AAGL: “Re: Epic. Having Epic installed at all necessarily gives you full access to the server-side code (which is not much use without Epic’s internal-only set of tools for navigating it.) Client (Hyperspace) code is effectively a black box to customers except where APIs are specifically created for custom forms, etc. Numerous server-side programming points allow predefined access at various code entry points — usually this is limited to simple code such as customized text output for a field, etc. But you can do a lot in theory. They draw an absolute line at customers editing any Epic-released code. Pure custom code is (reluctantly) tolerated (as it cannot be prevented by virtue of how Cache works) but discouraged and unsupported.”

Acquisitions, Funding, Business, and Stock

PatientKeeper lands $1.5 million of a planned $3 million debt financing round from a group of nine backers.

CareCloud, a provider of cloud-based PM, EHR, and RCM solutions for physicians, raises $20 million in Series A funding, led by Intel Capital and Norwest Venture Partners.

Greenway Medical Technologies amends its $100 million IPO, noting that it intends to list its shares on the New York Stock Exchange using the symbol “GWAY.”

Telehealth provider Tunstall Healthcare Group will acquire American Medical Alert Corp, a provider of  remote health monitoring and communication services, for $82.3 million.

Sales

HHS awards SAIC a contract to provide full life-cycle operations, maintenance, and enhancement services for its HRSA Data Warehouse. The maximum contract value is $15 million over five years.

The Health Information Network of Arizona (HINAz) partners with  Axoloti Corp (OptumInsight) to create a statewide HIE.

The state of Alaska hires Cognosante to conduct evaluation, technical assistance, and consulting services for the state’s HIE system.

Health Partners of Philadelphia selects MyHealthDIRECT’s Web-based scheduling solution.

Select Data chooses Emdeon’s RCM solutions for its home health customers.

Allegiance Health (MI) chooses TrustHCS to provide ICD-10 training and coding services.

The VA awards HP Enterprise Services a $10.4 million contract to provide a WiFi based RTLS to the VA hospital in Ann Arbor, MI.

People

Kony Solutions appoints Sriram Ramanathan (IBM) as chief technology officer.

Announcements and Implementations

Three Illinois-based health systems and two physician clinics join forces to establish the Lincoln Land HIE, which will utilize Medicity’s exchange technology.

Onslow Memorial Hospital (NC) will activate the second phase of its Meditech implementation next month with the go-live of clinical documentation by  non-physician users. Physician online documentation will start in April 2012.

The hospital authority for Memorial Hospital (GA) approves the $747,125 purchase of an integrated PM/EHR system for physician practices.

Floyd Valley Hospital (IA) begins its $500,000 EMR conversion to Meditech’s Client/Server release.

The American Hospital Association extends its third consecutive, three-year exclusive endorsement of Hyland Software’s OnBase solution as the ECM solution of choice.

Transcend Services releases a front-end speech technology and transcription platform that incorporates template-based documentation tools from its newly acquired Salar division.

MidSouth eHealth Alliance goes live on ICA’s CareAlign 1.0 HIE platform at 16 facilities.

3M Health Information Systems announces the release of its 3M 360 Encompass System, which unites coding, documentation improvement, and performance monitoring by providing auto-suggested codes and real-time clinical documentation improvement prompts.

NoMoreClipboard.com announces cc:me, a new addition to its personal health record service that allows patients to send and receive medical information electronically via the Continuity of Care Document format. They’re most famous for concocting (along with Medical Informatics Engineering) the Extormity fake EMR vendor. A quote from that brilliant spoof:

Generating a return on an investment first requires an investment. The heftier the investment, the more substantial the return could potentially be if there is, in fact, a measurable return. The Extormity EMR Software Suite is built on a proprietary software model renowned for its complexity. This proprietary platform and all of its components must be procured and implemented as a complete package we call the Extormity Bundle (which describes both our comprehensive package and its associated cost) … Planning for this additional infrastructure can be provided by the Extormity Strategic Consulting unit, with implementation provided by the Extormity Solutions and Services Business Unit. These Extormity business units operate in silos, ensuring that you receive and pay for duplicated services.

In Australia, Garner defends a report it prepared for Queensland Health in which health officials requested (and obtained) changes that critics say favored the selection of Cerner for a $180 million statewide EMR project. Gartner highlighted the fact that it considered Cerner the only vendor of a “Generation Three” product (on a five-generation scale, which QH’s ehealth program director wrote is equivalent to “a HIMMS scale of 5”) that is up and running in Australia. Both parties said the change was intended only to call out information already contained in the report, which provided Cerner with no advantage. It doesn’t seem the slightest bit fishy to me, but I’m not looking at it through political goggles like some of the torch-wavers down there.

Government and Politics

In the UK, ministers are considering offering US-based NPfIT contractor CSC another chance (and more money) to get iSoft’s Lorenzo up and running even though individual hospital trusts aren’t all that interesting in trying to implement Lorenzo and NPfIT is being shut down. The newspaper article called CSC “one of the worst-performing IT contractors” for being paid billions of pounds for trying, generally unsuccessfully, to implement Lorenzo, which helped seal NPfIT’s fate. 

Technology

Health 2.0 and Walgreens name Team mHealthCoach the winner of the Walgreens Health GuideChallenge and award mHealthCoach a $25,000 cash prize. mHealthCoach developed a tablet-based application that that displays data retrieved from multiple health and social media sources.

An open source advocate whose medical condition required an implantable defibrillator wants vendors of similar devices to make the source code of their proprietary software available for third party inspection, citing occasional medical device recalls. She admits that even as a programmer she wouldn’t have a clue what she was looking at or wouldn’t have any option other than getting the device or not, but adds, “I don’t want to rely on Medtronics for something as essential as my heart.”

Other

More frequent physician-patient encounters may lead to quicker control of Type 2 diabetes measurements and improve outcomes, according to a study that reviewed the EMR of almost 30,000 patients.

I knew my Starbucks made me happy: an Archives in Internal Medicine report finds that depression risk in women decreases as caffeinated coffee consumption increases.

Most health organizations are underprepared to protect patient privacy and secure data, with over half of health organizations reporting at least one privacy and security issue over the past two years. The most frequently reported violations came from internal sources improperly using PHI.

An interesting Slate article says the highest-paid doctors are the most likely to lose their cushy gigs to automation. Examples cited: technology allows faster reads of Pap smears and mammograms; technology can eliminate the need to get a second radiologist to check a mammogram; and surgical robots help surgeons work faster and allow them to work remotely. A fun quote:

By definition, specialists focus on narrow slices of medicine. They spend their days worrying over a single region of the body, and the most specialized doctors will dedicate themselves to just one or two types of procedures. Robots, too, are great specialists. They excel at doing one thing repeatedly, and when they focus, they can achieve near perfection. At some point—and probably faster than we expect—they won’t need any human supervision at all. There’s a message here for people far beyond medicine: If you do a single thing—and especially if there’s a lot of money in that single thing—you should put a Welcome, Robots! doormat outside your office. They’re coming for you.

Here’s Vince’s latest, Part II on IHC. Have I said I love reading these? You can add to the historical archive by e-mailing Vince.

Marty Gettman, a director at McKesson Provider Technologies in Atlanta working on the CareBridge Services Team, died September 15. He was 49. Condolences can be left here.

A 23-year-old traveling nurse covering for striking and locked-out RNs at Alta Bates Summit Medical Center (CA) kills a cancer patient by accidentally running nutritional supplement through an IV line instead of a stomach tube. Another contract nurse says the 500 replacement RNs were “thrown in” amidst “complete chaos” with only a brief orientation, not that orientation is needed to avoid making a colossal mistake like this by overriding all the safety precautions (like tubing that doesn’t fit the wrong kind of port).  

Sponsor Updates

• Merge Healthcare will incorporate Fovia Medical’s High Definition Volume Rendering (HDVR) across its entire PACS platform. Also announced by the company: speakers at its October 4-7 user group meeting in Chicago include Mayor Rahm Emanuel and HHS CTO Todd Park.
• T-System Inc. honors Ashtabula County Medical Center (OH), Mason General Hospital (WA), Montrose Memorial Hospital (CO), Osceola Regional Medical Center (FL), and PeaceHealth St. Joseph Medical Center (WA) with National Awards for Emergency Department Excellence.
• Iatric Systems’ Patient Discharge Instructions earns Surescripts certification.
• Business Day with Terry Bradshaw will feature The Huntzinger Management Group on the Fox Business Network on October 1.
• Ron Jones, an OptumInsight SVP, encourages CFOs to make the ICD-10 transition a priority in a guest blog post. The company also announces that 30 hospitals will implement its coding solution.
• dbMotion’s Elizabeth S. Willett discusses whether providers should develop an internal connectivity platform or join an externally driven HIE.
• Brad Hawkins, MEDSEEK’s VP of clinical experience, will participate  in this week’s North Carolina Healthcare Information & Communications Alliance Conference and Exhibition.
• Physicians with Kiddie West Pediatric Center (OH) secure stimulus funds using MED3OOO’s InteGreat EHR.
• PatientKeeper presents its Customer Innovation Award for 2011 to Clinical Practice Management Plan (NY) for its extensive and innovative use of PatientKeeper Charge Capture.
• Vocera names William Zerella (Force10 Networks) as CFO and Linda Esperance (MarketTools) as the company’s first VP of human resources.
• Orthopaedic Associates of Wausau (WI) will replace its existing EMR with SRS.
• Memorial Hospital & Health System (IN) subscribes to the CapSite Hospital Purchasing Database.
• McKesson Specialty Health introduces its Innovative Practice Services to help oncology practices improve their financial health through the use of business, technology, and clinical tools.

Contacts

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

Curbside Consult with Dr. Jayne 9/26/11

Last week I talked about the recent government proposal to allow patients direct access to their laboratory results. A certain Mild-Mannered Reporter responded to my call for information from the laboratory vendor side and his remarks are worth sharing:

As an IT manager in a commercial lab that services a state where test results may not be released directly to the patient without specific instructions from the ordering provider, we are just now beginning to think about how we will deal with this new requirement. Our entire Laboratory Information System (LIS) is designed to be provider / client oriented, so modifying our lab result delivery processes will not be a trivial effort.

As I read through the rules as written, a number of concerns pop into my head and refuse to leave:

• Many of our lab results are not patient-centric. As there is no universal patient ID and each of our ordering providers may identify a patient differently, we may have a difficult time locating all of Mary Smith’s results.
• How far back do we need to go? There are CAP retention requirements that we abide by, but not everything is kept online forever.
• We have no idea of what the demand will be. A hundred per day or two per month?
• How will we be required to deliver the results? Your comment about utilizing an electronic portal makes sense, but the current wording seems to indicate that it is up to the patient to define how he/she wishes it to be delivered:

Processing a request for a test report, either manually or electronically, would require completion of the following steps: (1) Receipt of the request from the patient; (2) authentication of the identification of the patient; (3) retrieval of test reports; (4) verification of how and where the patient wants the test report to be delivered and provision of the report by mail, fax, e-mail or other electronic means; and (5) documentation of test report issuance.” [Federal Register: September 14, 2011 (Volume 76, Number 178)] page 56722

Interesting in this wording that encryption is not mentioned when specifying e-mail. Looks like more opportunities for labs and others to accidentally violate HIPAA/HITECH by accidentally disclosing to the wrong party.

I suspect that he lion’s share of the costs will be creating new delivery systems, researching the results, and authenticating the patient. None of these costs can be passed on to the patient — only postage and media costs.

We have always run our business to serve the patients, our physician clients, and our insurance payors. It is a delicate balance to keep everyone happy, but if our clients want us to somehow manage a delay result release and the patients demand immediate access, we may be in the proverbial rock and a hard place predicament.

Now I know that there are a number of states that already require that patients have access to their lab results, so I know that this is all doable, but we need to do a lot of planning to meet this new requirement. For now, I think that we will wait for the final rule before making any major changes.

I should also add that for me, this is not really an issue. My primary care doc publishes the important lab values with his comments on a patient portal for me to see. It works just fine because we have a deal – I don’t try to practice medicine and he doesn’t come down to the lab and tell me how to run my shop.

I’ve always been a fan of The Simpsons, and hopefully some of you are familiar with Lisa’s mentor, jazz musician Bleeding Gums Murphy. (I’m a bit disturbed, though, that when I did a Bing search for ‘image bleeding gums murphy’ it also brought up a photo of former Surgeon General C. Everett Koop.)

Hopefully each one of us has had at least one person in his or her life to fulfill that mentor role. I was lucky enough to have my own Bleeding Gums Murphy for more than two decades. He passed away this weekend, and this is the first time I’ve experienced the relatively new cultural phenomenon of grieving via Facebook. A lot of people think of Facebook as a frivolous time-waster (sometimes I don’t disagree) and many cursed it mightily this week for changing too quickly for our liking. But there’s no doubt that social media have the power to bring people together.

We don’t always have the luxury of having our mentors physically close to us, but it’s been heartening over the last few days to know that when my BlackBerry dings there’s a really good chance it’s going to be someone posting a memory to his Wall. Another friend who studied with him said it best: “I will celebrate his life in memory and mourn only those who never met him.”

In the words of Carole King:

When the Jazzman’s testifyin’ a faithless man believes
He can sing you into paradise or bring you to your knees
It’s a gospel kind of feelin’, a touch of Georgia slide
A song of pure revival and a style that’s sanctified.

E-mail Dr. Jayne.

Monday Morning Update 9/26/11

From My Little Pony: “Re: Epic. They’re recruiting programmers from Hong Kong.” The job posting says Epic is looking for Hong Kong software developers, with paid relocation to Verona. Epic will have a recruiting team in Hong Kong in November. I found the list of solutions the noobs might be working on interesting: genomics and proteomics, telemedicine, creating software that adapts to the individual user, developing next-generation user interfaces, and adding gesture recognition. Epic always resists the idea of outsiders setting usability standards that vendors would be required to follow, but it sounds as though the company has something potentially big in the works. Another version of the same ad is aimed at developers from Singapore.

From Gluteus Max: “Re: Epic being perceived as ACO ready. Epic is good at storing and presenting data, but it’s not good at doing useful things with it. If the ‘Epic Octopus’ business model theory is correct, that’s very much by design. Analytics and data sharing are two of the most important features ACOs will need, so it’s difficult to believe Epic is ‘close to ACO-ready.’” Unverified.

From Verona Notes: “Re: Epic. Now has 266 customers, up from 224 last year and 190 two years ago. Future vision shows Epic is listening to usability criticism, such as software that understands the physician-patient conversation and readies documentation and orders. Unsurprising stock tip: IBM servers dominate competition in internal Epic tests. Amazing logistics for so many people, but starting late=disrespect.” Unverified. There’s that usability thing cropping up again.

From Bea Fragilis: “Re: Epic. To what extent are Epic-certified people allowed to make changes to local hospital code? My sense is that those changes must be minor, documented, and controlled from Verona.” I’ve heard that Epic will let responsible customers change source code and will even provide them with programming standards and documentation to help, although they don’t encourage everybody to start hacking around. I’m interested in that answer as well, not to mention how the customer gets access to the source code (or the extent to which application behavior can be controlled through external hooks).

From MT Hammer: “Re: front-end speech recognition. A new study finds that it results in 800% more errors in patient reports compared to transcribed dictation.” The study, published in the American Journal of Roentgenology, finds that 23% of reports created with front-end speech recognition (i.e., you dictate into a microphone and your words immediately appear on the computer screen) contained at least one major error vs. only 4% of those created from standard dictation and human transcription. Overall, the error rate with speech recognition was eight times higher than with human transcription. Interestingly, speaker accents didn’t make much difference, but imaging modality was a predictor of error rates. I don’t have access to the full text of the article, so I would be interested in radiologist’s analysis (such as the significance of issues defined as errors, why the radiologist didn’t catch the mistakes on the screen when using speech recognition, etc.) Also keep in mind that this compared only two transcription options, with the third being back-end speech recognition like that of the former eScription (now Nuance), which I believe has much higher accuracy since it can consider context and history rather than just pronunciation (similar to what transcriptionists do).

From The PACS Designer: “Re: Windows 8 tour. Microsoft has revealed aspects of its new Windows 8 platform for developers to peruse. Windows 8 will be tightly integrated with a new Internet Explorer 10 using a next generation internet platform called HTML5.”  The problem with pre-iPhone cell phones is that they worked like tiny, underpowered PCs with crappy keyboards. I’m not sure we need the opposite problem – PCs that work like huge iPhones – especially since touch screens are extremely rare in PC-land and the point is lost anyway since you’re either sitting in front of a desktop keyboard or a laptop. My understanding is that Win 8 will have two user interfaces, one for mobile use and one for desktop. MSFT had better make sure not to screw up the latter in trying to pander to those who yearn for an iPhone clone as their primary device.

From King Coal: “Re: HIStalkapalooza. Which night? Looking forward to it with bated breath.” Don’t count on it just yet. The potential sponsor had some venue contracting issues and won’t have enough space  to handle the historically large turnout (and waitlist.) I may end up cancelling it for Las Vegas, leaving you to read your HISsies winners online instead of seeing Jonathan Bush’s one-man show crafted around them (and that I really will miss).

My Time Capsule this week from 2006: The VA Outperforms Private Hospitals in IT Vision and Resolve. An aliquot: “Like a tailor-made suit, VistA was developed to meet the VA’s needs, not those of a vendor’s ‘average’ hospital customer. Just as hospitals talked themselves into buying instead of building (helped along by vendors and risk-averse CIOs,) the industry’s darling turns out to be a homebrew job.”

Reporters and TV stations have gone crazy with their lazy, press release-sourced coverage of the prospect of turning healthcare encounters over to the Jeopardy-winning IBM Watson (most common lame headline: “The computer will see you now”) but readers here weren’t equally impressed with its announced use by WellPoint, with most saying IBM and WellPoint will get the benefit instead of patients and providers. New poll to your right: now that Sage Software has announced plans to sell its healthcare division to Vista Equity Partners, who will benefit most from that transaction?

I’ve enjoyed Vince’s HIStory series immensely, to the point that I suggested that the pre-1980 industry pioneers get together at the HIMSS conference to reminisce (and knowing some of those folks, perhaps tipple a tad). Shelly Dorenfest, Bob Pagnotta, John DiPierro, and David Pomerance are a few of those who have said they’ll be there. If you know them, you should be there, too. Drop your e-mail info on this form and Vince will be in touch. Think of it as a 30+ year class reunion of the College of HIT Hard Knocks.

This week’s e-mail from Kaiser boss George Halvorson talks up the company’s newly won Davies Award win, also mentioning that Kaiser hospitals make up 35 of the 60 HIMSS EMRAM Stage 7 hospitals and that the remaining KP hospitals are all Stage 6. And despite early reports of HealthConnect availability problems, he says KP has won six awards from the Uptime Institute, the only healthcare organization to ever win (although as a counterpoint, that’s data center uptime, and plenty of ways exist to knock users off systems even though the server is chugging along). He also mentions some employee-recommended technology projects that have been funded by KP’s internal innovation fund: an automatic glycemic calculator, a hospital capacity prediction tool, and an SMS appointment reminder system.

Weird News Andy finds this story about hospital drug shortages and the resultant third-party profiteering scary. I’ll elaborate from experience to scare him more. Even if you ignore the possibility of obtaining counterfeit or impure drugs when forced to buy from secondary channels, the patient safety risks with drug shortages are considerable. Product packaging and sometimes concentrations differ from what nurses and doctors are used to, greatly increasing the chance of wrong drug / wrong dose errors. Sometimes the backup drug is therapeutically similar but chemically inequivalent, meaning doctors are forced to use a drug that wasn’t their first choice and one they may not be all that familiar with, making it more likely that something will go wrong. Shortages come and go all the time, so information systems can’t be kept current to steer prescribers to the one currently being used, sometimes requiring IT workarounds that neuter electronic protections such as dose and allergy checking. Those drugs may have similar active ingredients that are still different enough to trigger unexpected drug allergies and drug-drug interactions. My analogy is always this: suppose you’re about to have open heart surgery, but the drugs your surgeon always uses are on shortage, meaning the surgeon will have to compromise with a less-desirable drug that they’ve rarely or never used. You’d be mad at someone for letting that situation occur. The problem here is that everyone involved claims to be innocent and powerless.

On WNA’s slightly lighter side (it involves death, so it’s still not all that light), he captions this story as “Spinal Tap’s drummer?” Coroners in Ireland review the death of a man whose body was found burned in his sitting room, with no damage to the floor on which it rested, no evidence of foul play, and no signs of the source of the flame.  They conclude that he died of spontaneous combustion. A retired pathology professor ruled out divine intervention, saying, “I think if the heavens were striking in cases of spontaneous combustion, then there would be a lot more cases.”

A good article covers the high cost of children’s hospitals, with the Nemours Children’s Hospital (opening next year) in Orlando leading it off. The 95-bed hospital, being built in a city that already has two large and notable children’s hospitals, will cost $400 million ($4.2 million per bed) and was approved by the state only after the well-funded Nemours called in some political favors. Mentioned about high-profile children’s hospitals in general: lack of financial transparency, fast-rising costs accompanied by big executive paychecks and impressive construction projects, big financial war chests, and only tiny amounts of charity care provided. I can say from experience that those multi-million dollar children’s hospital CEOs have the ultimate weapon to keep the donor and political largesse flowing – feel-good happy ending stories of miraculous medical work accompanied by fuzzy-focus, intentionally heart-tugging pictures of adorable babies and toddlers. Your hospital will lose every time if your particular medical miracles involve less Hollywood-like episodic interventions on behalf of elderly patients, the chronically and incurably ill, psychiatric patients, and that particularly colorful stratum of society that shows up in the ED full of street drugs, hostile microbes, and intentionally inflicted wounds.

Don Berwick says CMS administrator is the best job he’s ever had, but he’ll lose it on December 31 unless the Senate confirms him by then. No confirmation hearings have been scheduled.

The New York Times covers telepsychiatry, where patients receive counseling sessions via Skype or specialized Web apps like Breakthrough.com. Says a psychologist, “In three years, this will take off like a rocket. Everyone will have real-time audiovisual availability. There will be a group of true believers who will think that being in a room with a client is special and you can’t replicate that by remote involvement. But a lot of people, especially younger clinicians, will feel there is no basis for thinking this.”

An OB-GYN subpoenas Bellevue Medical Center (NY), demanding a list of every person who accessed the Internet from the hospital on a particular day in 1999. The doctor is trying to find the person who posted defamatory comments about her on a physician review site, claiming she has reason to believe it came from a particular NYU doctor. The hospital says it keeps access logs for only 30 days, but the doctor’s legal team found a computer forensics expert who claims he knows a sophisticated (and undoubtedly expensive) way to bring back 12-year-old records.

E-mail Mr. H.

HIStalk Interviews Michael O’Neil, CEO, GetWellNetwork

Michael O’Neil, Jr. is founder and CEO of GetWellNetwork of Bethesda, MD.

Tell me about the company and about yourself.

GetWellNetwork is a company I started about 10 years ago after a personal cancer experience. We are really focused on one thing — helping hospitals engage their patients and families more effectively in their care. We truly believe that if we do that effectively, the outcomes will improve. This is a company focused on patient engagement. We’ve been doing it for a very long time.

Do you think patients want to be engaged or are they surprised that hospitals would treat them differently beyond just offering a TV in their room?

It really has been evolving pretty significantly over the time that we’ve been doing that. I think the tidal wave of information access for just general consumers — be it for a car you buy or a grocery store you shop in or the healthcare you receive — is so powerful now. To say it’s getting easy would be an overstatement, of course, but we are encouraged every day by how much patients are digging into the information that we provide and want to be involved in their care.

Most of the industry started as modest entertainment providers for antiquated hospital TV systems. How did you come up with the idea of taking the basic on-demand movies and Internet access product and turning it into a two-way communications and education medium?

We let the data dictate our direction. We did have that same core on-demand functionality early on in the company. We were watching the data come across. To be honest with you, the utilization was very low. Your question about do patients really want to be involved … early on, they really weren’t accessing the kind of information that we felt was important to them.

At that point, we were not integrated into the EMR and core systems. We didn’t proactively pull patients in — we let them come in themselves. We really began to change the game five years ago and created a workflow engine called Patient Pathways that lets us take triggers from existing systems and processes and invite the patient into the care process. It has changed radically the impact that we’re seeing.

From the hospital standpoint, the patient is a captive audience for education delivered directly to their rooms. Are hospitals finding that to be effective?

Yes, they are. All of the folks who read HIStalk and are part of this community are pretty bent on the fact that these hospital partners of ours are ferociously measuring whether or not any solution or process they try to implement is changing some of the measures of their care. For us, the measures that we look at are probably fairly natural ones. Does the patient’s perception of the care improve if they’re more involved? What do their HCAP scores look like? You know, pre and post-implementation of this kind of solution.

What do the quality metrics look like? The patients fall less because they’re more informed and involved and educated about the fact they’re at risk for fall. We are measuring data ferociously with our hospitals because they demand it and because we’re genuinely interested in whether or not this thing has efficacy. It’s been a really powerful last two or three years.

Are you seeing impact from healthcare hot topics like Meaningful Use, Accountable Care Organizations, and healthcare reform?

It has been such a powerful catalyst for our whole little industry segment. About a year and a half ago, KLAS picked up patient interactive as a segment, then Gartner picked it up. I would love for us to take credit for that, but we don’t.

We were yelling as loud as we could that patient engagement is a core strategy for performance improvement years ago. We found some incredible hospital provider leaders to take this thing on with a lot of risk. Over the last two years with all these things, Meaningful Use and value-based purchasing and accountable care, patient engagement has become front and center, something they have to do. It has been a great catalyst for us for sure.

Going back to the entertainment category, home TVs have turned into devices that handle everything from broadcast programming to video on-demand and Internet streaming. Is there a large penetration of systems like yours in hospitals, and for those hospitals that don’t have them, are patients disappointed at what’s available to them from their hospital bed for their five-day average stay compared to what they have at home?

Yes. What you just said is coming. The expectations of the consumer, the kind of technology and information access and empowerment in whatever they happen to be going through in a hospital course … there is increased demand to have the kind of access in any environment that consumers have at home or at work or at school. That is certainly is one thing that’s going on. Secondly, the technology to do the kind of things that we do. People expect it now. It’s certainly been a different ramp than it has been in the past.

Hospitals have finally started to take patient satisfaction more seriously. Are you seeing that drive your business?

They are. I applaud these hospital leaders. They’ve been pushing a rock up a very steep hill with wind blowing at their face for a long time. Transforming the patient experience that has been on people’s plates for a decade, but hasn’t always resulted in measured success.

Too often, this notion of patient-centered care was on a poster in a lobby, but there weren’t really solutions to hard wire the patient’s activation into the heart of the care process. That’s really what we’re after.

When we first started the company, the marketing folks at the hospital and the CEO would buy the solution and then throw it into the unit and hope that it would stick. Today, it’s completely different. It is the chief clinical officer, a CMO or a CNE alongside their technology counterpart the CIO, who are saying, “We’ve been charged to do performance improvement. We know patient engagement is an element of that. Let’s go find a solution to help do this in the organization.” It’s really changed 180 degrees for us.

Hospitals I’ve worked at looked at solutions like yours, but always decided they were a tactical “nice to have” that never bubbled to the top. Are hospitals finding that outcomes and the potential for process improvement make your product more strategic?

What you just said is exactly how we lived in this company for about four or five years. To see this kind of thing is to like it. It’s very visual. It’s very high-touch. It’s very patient friendly. We always joke in this company that we’ve never had a bad meeting. 

The fact is, we might have a great meeting and people like the stuff, but to your point, it would be number 12 on a list of 20 things to go invest time in and resources and money in. Too often, we would lose to no decision.

To your question directly, over the last 24-36 months, we are taking all the inbound requests for, “We have budgeted for a patient engagement solution. We look forward to having you come share the work you’re doing”  We lead every single time with, “You’re at 25, not three hospitals that are actually seeing a success. You won’t hear perfect, but you’ll hear that we’re moving the needle on these specific things we go attack.” That’s how we walk through it now.

The bad thing about your success is that you probably have more competitors than you had four or five years ago. What’s your message to tell prospects that your system is better than that of your competitors?

We are attracting competitors. We actually welcome that in one major respect. When we first started the company, we were competing with some of the traditional kinds of hospital TV companies. You asked the question earlier about that kind of functionality, and frankly, we really don’t care who the hospital buys their TVs from. It’s really not about that.

Today, more and more, we’re seeing competition from some of the large EMR companies who have seen this segment begin to grow and are coming at it as an appendage to the EHR and EMR. We’re more focused on how we compare and contrast ourselves with that approach. We feel pretty strongly that patient engagement is more important than just being an add-on to an EMR.

With the 10 years of data and experience and technology we have, we feel pretty confident walking into an environment and saying, “I know you’re going single source for lots of different solutions. When it comes to engaging your patients and families effectively in their care and working in partnership with your nurses, we think we’re doing the very best work in the world in that particular thing.”

Do you consider GetWellNetwork to be content provider or a technology provider?

We’re a technology provider. Most of our platform is based off this proprietary workflow engine. We have 273 live interfaces today across the country. We interface with bedside barcode systems and with RTLS systems and with EMRs and with the café cart in the lobby and the gift shops. We use all these other systems to trigger different events for that patient to engage and activate in. That’s really the technology that we have.

When it comes to content, we’re working with over 25 different content partners. We’ve aggregated tons of content, so that based on what we want the patient to engage in, we just need to make sure that we have the right content that we can put in front of them at the right time based on what the workflows are. It’s really more a technology company than it is a content company.

With the opportunities for education and hospital promotion and third-party ads, I would expect some natural interest in owning that content platform. Do you ever see that there would be a more exclusive partnership or an acquisition, either you acquiring or being acquired to actually control the content channel?

About three years, ago we spent a lot of time in R&D and decided to go attack a certain segment. We thought we could speed adoption by attacking a specific segment in a differentiated way. We did this in pediatrics.

One component of our four-component strategy was to exclusively partner with an organization to produce exclusive content for what we call GetWellTown. We partnered exclusively with KidsHealth, part of Nemours Foundation. They have subsequently produced a library of over 250 pediatric education titles for GetWellNetwork exclusively. It’s been a phenomenal partnership for them as well as for us.

I envision those kinds of things happening for us in different segments, to partner exclusively and/or acquire it if the right opportunity comes along.

GetWell@Home offers information via the Web, cable TV, and smart phones. There’s a lot of opportunity for non-hospital based chronic disease management. Do you think that’s a mechanism by which you’ll be able to get patients interested in managing their own health outside the hospital walls?

We do. I’ll tell you, it’s probably the most exciting thing going on here  on the development side right now.

We develop major new products in a task force model. Usually six or seven of our hospital partners are involved for about 18 months. Russ Branzell and the whole crew from Poudre Valley was heavily involved in our @Home task force. 

We recently launched with them at Medical Center of the Rockies and Poudre Valley Hospital. Our first patients haven been enrolled in GetWell@Home. They’ve done a powerful job in integrating the patient’s involvement, both from an acute standpoint at discharge and then following them home. Really inviting the patient to stay involved in the Poudre Valley Health System’s management of their care.

We never picture patients going to GetWellNetwork.com for their care. We are providing a platforms for those providers who have a trusting relationship to help patients navigate and keep them engaged throughout their journey. It’s been an incredible start this summer. We think this is going to be the most important thing the company’s done in the last five years.

In broadcast or cable TV, it costs a lot to run a specialized channel, but with satellite dishes, it costs very little. Do you see a point where the cost for a “channel” would be so low that you could add a channel specific to a diagnosis or a treatment, so that a diabetic patient could see The Diabetic Channel on GetWell@Home?

We’ve been thinking even more about that. We think not just about a specific channel on a certain diagnosis, but a specific channel for a specific patient.

We’re working a project right now. I can’t give you all the information, but you’ll be the first to know on HIStalk when you actually can announce it. We’re looking at not only using the Web, but also using cable TV delivery to be able to dynamically create personal video-on-demand TV channels for a patient to be able to track their health and to be involved. It will come in their living rooms even when they’re not on a computer.

We think the opportunity is so powerful to attack one of the biggest issues everyone knows, which is that transitions are just not handled very effectively for the patient or family. It’s no one’s fault. It’s just complicated, and we’re not doing a great job at that. We think we have an opportunity to engage people in a very unique way.

Do you think you’ll ever see the point where physicians can leave personal video messages for a patient or use your backbone as telemedicine virtual session platform?

The technology is available today to do that. The way it’s been started early on has been almost from the satisfaction standpoint right now, whereby we can make it very easy for a physician to have one more touch, if you will, with their patients or families. From a perception standpoint, the coordination of care is so, so powerful.

We definitely will move towards doing some more telehealth stuff down the line. We found right now that physicians, for the most part, aren’t yet ready to take that on. Technology won’t be the hurdle there. It really will be organizational readiness. I think it’s coming.

Where do you see the company’s future?

In two major directions. We spent the first eight years working inside the four walls of a hospital and inside the patient’s four- or five-day acute care stay. We see this as a true platform for patient engagement throughout their journey. We’re in the midst of building this platform that can really help providers in the accountable care model elevate the patient activation component of their strategy and really own the fact they can navigate people through them. 

In five years, we will be we will be working as much outside the walls of the building as we do inside.

The other thing that I think we’ll do pretty significantly is we have been asked about 12 or 15 times in the last year to consider doing some work internationally. We’ve held off on doing that just to make sure that we are fulfilling the promises that we’ve made here domestically. We seem to be getting a great handle around that now, so I think also in five years, we’ll be doing stuff around the globe, which we’re really excited about as well.

Any final thoughts?

What you guys do rocks. We read it all the time.  We can’t thank you for all the time and energy you spend doing what you do.