HIStalk Interviews Bert Reese

Bert Reese is senior vice president and CIO of Sentara Healthcare of Norfolk, VA.

You’ve been at Sentara forever. What’s the secret to CIO longevity?

I think the secret is to make sure that the technology is aligned with the enterprise, both the clinical and business initiatives that the company is addressing. So the closer the IT is aligned to the business and the more you are able to deliver on that, the more successful a CIO would be.

Sentara was mentioned recently for developing its own interface from Epic to Picis LYNX. Tell me a little bit about that project.

We were a Picis LYNX customer before we did Epic. The problem that we were trying to solve with LYNX was our inability to code properly in the ED, and therefore, our billings were inaccurate.

What the Picis LYNX software did for us, prior to Epic, was give us the ability to properly code the patient during the visit. We saw that in the old world, prior to LYNX, that we were under-coding, which actually meant that we were understating our revenue potentials from the ED, and from a clinical perspective, not really indicating the proper problem that the patient was being treated for. With the LYNX software, since it’s a logical part of work in ED, it was more convenient for the nurses to code as part of the care process, so it’s worked out very well for us.

We went to Epic, and we wanted to preserve the capability of LYNX, so we developed an interface between LYNX and Epic to allow us to move information from Epic down to LYNX so that they could continue to use the coding software in a convenient way. One of the issues that you have is that nurses and caregivers don’t see coding as value-added to the care process; it’s more an administrative function. So when you want them to do something like that, if you can make it a byproduct of how you treat the patient. Then it’s a lot more convenient and they’ll do it. That’s what we did. It’s pretty straightforward; that’s the real secret sauce is in the Picis LYNX software.

Your EMR project is said to have cost $237 million. How will you measure its benefits?

That’s a great question. So it’s $270 million over ten years. The first thing was we set an expectation that a project of this magnitude goes out over an extended period of time and that you have to set the expectations of the company that they will be spending this kind of money for awhile.

The second piece of it is that when we started the project, we identified 18 major clinical processes that drive about a $35 million-a-year annual return of investment. We have identified those, we have four of our eight hospitals up, and we have seen benefits this year – `09 – at around $16.7 million.

So we know from a dollars-and-cents perspective that electronic medical records do create economic value. If you take that $35 million over the $270 million investment, that’s like an internal rate of return of about 12.3%. That’s a good return of your investment.

The other part of it relates to clinical quality indicators. If you follow the clinical quality indicators and see some level of improvement in clinical quality activity — that is, you see the patients are being better cared for under electronic medical record — then there is that benefit as well.

We have seen great clinical quality. I’ll give you an example of one. In the old world, it would take 137 minutes for the doctor to enter a medication in the hospital before it was administered to the patient. Now, it’s less than five. And there’s tons of stuff on turnaround time and length of stay and things like that.

The key to this — in looking at the return of investment, you look for where there is hunting and gathering of information, i.e., you’re looking for the old paper chart and/or whether there will be hand-offs between one care partner to another care partner. That is where the opportunities are for both economic and clinical quality savings. 

What are your overall impressions of the Epic system and its implementation?

First of all, in the way of background, I’ve got experience with Cerner, Eclipsys, Epic and GE’s IDX/Centricity, so I’ve seen a lot of them. I will tell you coming out of the chute that you can have the best software in the world, but if you do a sloppy install where you support it in an inappropriate way, you’re going to have a failure.

Part of the secret sauce is in the quality of the software. I would say the other part of the secret sauce is in the quality of the local IT staff. Then, the culture of the company who’s adopting the technology.

In the case of Epic, Epic is a superb piece of software. It’s not buggy. It comes very, very clean. They’re a very collaborative company. That makes it easier. It’s less mysterious on the IT side about what it is you’re going to get and what you’re trying to do with the software when you get it fixed, or an upgrade or something like that.

But I will tell you that the responsibility, ultimately, is at the hospital or health system level. They need to make sure they made the right investment in order to have a varsity team to be able to support an application, either in the Cerner, Eclipsys, or an Epic type of venue.

Did you use outsourcing for the implementation?

I used it in an unusual way. In the old world, I was converting from a TDS 7000 to Epic and I had a choice: I could either bring in new staff, or outsource staff to help me with Epic, or I could take my Eclipsys support and give it to an outsourcer — it will move my old staff to learn Epic. 

I elected to do the latter. We hired Perot Systems to commit and run our Eclipsys environment for us while we took our old medical systems team, retooled them on the Epic toolset, and had them support the implementations. Perot is still with us today because we have a couple more hospitals to do on the Eclipsys side, and so they’ve been with me for about five years or so. They do a great job.

How have your IT strategies changed, or have they changed, with the economic climate?

First of all, I want to make a comment. What we’re doing is not about electronic medical records. In our view, in our culture, an electronic medical record — when you have it implemented, most organizations will become a technology-driven company, and our advice is: skate to where the puck is.

The puck is not being a technology-driven company. The puck is going to be when you are a data-driven company, meaning that in order to use the data, a prerequisite is to have the electronic medical record.

When you have the data, the advantage will go not to the organization that has the EMR. It will go to the organization who can convert data to information, to knowledge, to action the quickest both business-wise and clinically.

I’ll give you an example. In the old paper world, I could tell whether you had been in the hospital, whether you had pneumonia, and whether you had an antibiotic administered; but, I couldn’t tell you when I gave you the antibiotic. I can’t tell you the outcome. The outcome would manifest itself. Does it shorten the length of your stay? Did you have more doctors’ office visits at the end of your hospital episode? Because I couldn’t see across the continuum of care.

Now we know when we study the data that when you present with pneumonia in the doctor’s office or in the ED, and the doctor concludes that it’s serious enough that he wants to have you admitted, to onboard the antibiotic as soon as possible. So if I know you’re in the practice or in the ED, and I’m going to send you to the hospital, I’m going to give the antibiotic immediately, because we know that getting the antibiotic onboard will start the curative process, will shorten the length of stay, and shorten the subsequent doctor office visits that are required.

That improves the care for that patient and reduces the cost. You can’t do that without having the data. You can’t do that without having electronic medical record, so that when you decide to tell the care delivery team if you’ve got a diagnosis of pneumonia, "Give the antibiotic now," because you can communicate it electronically to all sites — you can’t do it without that.

So the electronic medical record in our view is, "Welcome to the starting line." It’s going to revolutionarily change healthcare. As it relates to my current level of investment given the current economics, they’re giving us more money. They believe in what I just stated. They believe it’s all about data and the new information that will be created.

So if I was going to summarize it for you: electronic medical records improve quality and make money and they position you for extraordinary opportunities that you’ve never imagined.

You have to have administration that supports that concept?

Yes, absolutely. I think what the role of IT is in the future is that a lot of times, our customers are a rearview mirror. They’re not a guide to the future. So a customer, perhaps, would have never invented the television set, the microwave, the iPhone. It was technologists who invented those technologies and innovations, right?

And so it is the role of technology in the enterprise or in the health system to create a new reality for the company based on the technologies that are available. That’s a big statement. I don’t wait for my administrative staff to create a new reality. I, because I understand the technology, create a new reality on their behalf.

Back to your first question about how it is that you last so long as a CIO in the organization, it’s because I’ve been able to innovate in front of the company to improve what it is that they wanted to do.

Tell me about your internal work with standardization.

You’re right on point. That is part of the secret sauce. If you’re going to report on data, that means that you have to call the same thing the same thing across the enterprise. So a chest bilateral is a chest bilateral, not a chest x-ray. And, more importantly, you have to have the same lab normal values across the enterprise. One pathologist may say with a CBC, "This is a normal value," and another pathologist may say, "That is a different value from the normal limit."

One of the discussions you have to have early on is — what are you going to call things? What will be the standard of practice within the enterprise? So from the Sentara perspective, we are heavily standardized. We took a page out of the banking business back in the late 80s, early 90s where bank mergers took place and went through a heavy standardization. You’ve seen it with stimulus packages and banking consolidations. We took a page out of how they did their conversions and we decided to go that way.

When we affiliate with a new hospital or a doctor’s group, we bring them onto our standards suite with their application. In the case of my eight hospitals, there are no Norfolk General status set screens, there are no Sentara Careplex status screens; there are only Sentara Healthcare status screens. All those hospitals collaborate in what those screen flips look like, which means heavy dialogue, heavy participation, great collaboration, and a lot of fun.

How important are mobile devices for your clinical projects?

Not so much. The biggest extent of mobile devices we have are WOWs, workstations on wheels. Medical staff is not pushed to move them to phones or tablets or anything like that. At the doctor practice level, inside the practices, we experimented with mobile devices and we found, based on the workflow, that the fixed workstation worked best.

Let me describe that for you. If you’re a patient going to one of our doctors and you go into the exam room, you’re normally accompanied by the doctor’s nurse, who then logs on to the system and then enters your problem, enters any of your vital signs, any of your current meds, any changes in your physiology, and brings everything up to date. She then locks the workstation; she bookmarks where she is on your record, and locks it. When the doctor comes in to see you, he logs right on, right where the nurse picked up. So he doesn’t have to reacquire you as a patient, doesn’t have to ask any additional questions. He’s right where she left off, right where his workflow starts.

If he was walking from exam room to exam room with a mobile device, he’d have to log on every time and reacquire the patient. I wade through all the patients I’m going to see that day. And so we found it to be faster if the nurse does her work like she normally would, locks the workstation — he comes in, logs on, and he just picks up right where her summary of the information is and carries on the conversation with the patient. So mobile devices have been interesting for us, but that’s where we are right now.

Anything else that you want to add?

The only other thing I would say around community physicians and electronic medical record — there’s stimulus money out there for doctors that go up on electronic medical record. I would say to the hospitals and the health systems that they have a responsibility to guide that conversation in their communities that they reside on behalf of their community-based physicians. They should become the rallying point, they should become the center of truth, and to help the doctors with the decisions they have to make on the electronic medical record, because they have the capability of doing it.

What I don’t want to have happen is I don’t want a doctor, because he’s anxious about the stimulus money or losing Medicare funding, to make a knee-jerk reaction to a decision. I believe in the theme of better together, and I’d like to have my community doctors as close to us as possible so we can all go there together. And that if we make a mistake, well, we’d all make it together, and hopefully we’d have the power of crowds, maybe we’ll learn from each other.

I would encourage everybody to take on the responsibility of helping to guide the community physicians as to what they should do with the electronic medical record. There is certainly benefit for the hospital, but there’s also certainly a benefit for the patient. If you control the conversation or help guide the conversation, you’ll probably minimize the number of technologies that you have in your community. That means we can start to solve the interoperability problem when you have to hand the data off from a primary care doctor who’s on the XYZ system to a specialist who’s on another system, that the chances of that being done successfully and clinically correct is improved.

So I think the patient benefits, and then ultimately the hospital and the caregivers, because they’re able to have more information in order to care for the patient better. Ultimately, it’s all about the patient.

Readers Write 8/11/09

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

Well, it appears that the only readers writing this week are Gregg Alexander (from HIStalk Practice) and me. Technically, we’re readers too, but it would be nice to have some company up here on the good old Internets. Who’d like to contribute? Anyone? Anyone at all?

BrevIT Revisited
By Mr. HIStalk

Ah, the late, lamented BrevIT newsletter I used to write every Saturday, giddy and dog tired after many hours of writing HIStalk throughout most of the same day. BrevIT was sometimes insightful, often educational, and usually funny (the headlines, anyway). I’m really proud of having done it from mid-2007 to mid-2008, but it took a lot of time and, like most e-mail newsletters, most recipients weren’t reading it even though it had a loyal core following.

I miss it, and if I ever figure out how to do this full time, I’ll bring it back in some form. Or, maybe I’ll roll it into HIStalk in some fashion (I’m open to ideas).

Here’s the index of issues in case you want to read some old ones (odds being that you probably never read it when I was e-mailing them out). Below are some of the headlines I liked as I read back over the old issues. You can probably guess the stories.

• Cerner Announces Millennium for Xbox
• Cerner Slashes Payroll, Stock Price By Dis-Association
• Study: Government’s HIT Initiatives About as Ineffective as Government In General
• RHIO Failure News Slow to Reach Maine, Apparently, as HIE Launches
• Wal-Mart Starts PHR Rollout Quickly After Omnimedix Rollback Special
• Dumped in Dubuque: McKesson Horizons 79
• Hydroelectric Power: VA Facilities Close Due to Data Center Flooding
• Non-World Wide Web: Internet Outage Cuts Off Asia, Middle East
• QuadraMed Curries Little Employee Favor by Offshoring
• Revolution Health Brags That It Has More Freeloader Readers Than WebMD
• Microsoft Bobs in Rough Healthcare Applications Seas
• Allscripts, Eclipsys, WebMD Shares Trampled in Investor Stampede
• Wal-Mart Has a Blue Vested Interest in eClinicalWorks
• HIMSS Fills Orlando with Non-Mouse Ear Wearing Tourists
• Cerner’s Legacy: Taking Yet Another Epic Beating
• Is That Your iPhone In Your Pocket Or Are You Just Glad To See Me, Doctor?
• Looking Up Britney’s Dress Was Free, But 13 Play Dearly for Ogling Her EMR
• Ohio Dots the I in its Standards for Practice-Friendly EMR Contracts
• Cerner Looks to Inhaler to Cure Its Heavy Breathing for Earnings Growth
• Allscripts and Misys Consummate Desperate Lust; Shareholders Hose Them Down
• Data-Selling EMR Vendor Insists on Privacy – For Itself, Not Patients
• McKesson Goes to the Head of the Class (Action)
• Philips Needs Milk of Magnesia After Eating Tomcat
• Survey: Old People Don’t Want to Pay for Health I.T. or Any Damned Thing Else
• Admitted John’s Sidekick Makes it Rain for RHIOs
• UCLA Belatedly Admits Fawcett Leak
• Tricky Dictaphone: Nuance Announces Plan to Acquire eScription
• GE: Imagine Our Stock Didn’t Really Just Tank
• TriZetto Processes Its Biggest Transaction: Selling Itself to Private Equity
• Article: PHRs Are Great, Except for the Untrustworthy Companies Offering Them
• Tick, Stock: Cerner Beats Estimates
• UCSF: So Many Ways to Compromise Patient Privacy, So Little Time
• Allscripts Proves Analysts Wrong with Unimpressive Profits
• HTP Improves its Own Revenue Cycle with McKesson’s Money
• Dollar Menu Choice – One McDonald’s Burger or Three MRGE Shares
• Can You Cure Me Now? Researchers Turn Cell Phones Into Imaging Systems
• Vivalog Vegas: McKesson Rolls Dice on Radiology Case-Sharing Site
• Emageon the Possibilities of a Hostile Board Takeover
• Rardin’ to Go: Merge Healthcare Dumps Suits, Troops, Loot
• California: Doctor Shopping is the One Type of Drug Abuse We Won’t Tolerate
• Leapfrog’s Leaps Not as Giant With One Foot in Mouth
• Eclipsys Announces Good Numbers, Not Just Improved Excuses
• Where’s the Strangest Place athenahealth Made Whoopie? That Would Be H.E. Butt, Bob
• German Re-Engineering: Siemens Corporate Layoffs Whack Hundreds in PA
• MyWay or the Highway? iMedica Gives Misys the Answer: B
• Perot Makes Giant Acquisition Sucking Sound

Cash for Clunkers?
By Gregg Alexander

“Cash for Clunkers”? Hot diggity dog! What a great new idea to adapt into the whole new ARRA/HITECH EHR adoption drive!

I mean, think about it…we’re trying to drive users to EHR adoption, right? We’re hoping to encourage “meaningful use” which could sort of be interpreted as improved mileage, yes? We want every new EHR driver using a system which will participate and share safely on the health information sharing multilane highway, no? And, ultimately, we’d like to see all those non-CCHIT-certified, non-government-approved EHR clunkers off the road, eh?

So, if you read or watch any news lately, you know the auto-selling industry has had a landslide success with the government’s “big bucks for your trash trade-in program” formally known as the Car Allowance Rebate System or CARS. (Cute, huh?) Intended to run until November, the billion dollar budget appears to have been blown in only one week. Talk about end user adoption!!!

Such blazing success should not go unimitated. You want an EHR in every provider pot? Let’s take a lesson and forget the whole 44K reimbursement nonsense. Here’s the new deal:

• First, we pick a catchy name like “Every Human Receives Something” or EHRs
• Next, we choose a cute-ish informal moniker, say, “Moolah for Medicine”
• Third, we decide upon a set of high mileage models worthy of reimbursement … of course, CCHIT-certified systems will likely be the de facto choice.
• Finally, we offer cold, hard, trade-in cabbage to all clunkers out there — those notoriously antiquated non-CCHIT systems and, obviously, anyone still driving the prehistoric pen-and-paper monstrosities.

If $4,500 for a running, drivable, used car inspires sufficient adoption of new, high-mileage models to burn through a billion bucks in one week, I’ll betcha an upfront $44K to turn in old, gas-guzzling EHR junkers or paper-based jalopies for sleek, new, energy efficient health record roadsters will tear through 19 billion greenbacks in two, three days, tops.

Dr. Gregg Alexander is a grunt-in-the-trenches pediatrician and geek. His personal manifesto home page…er..blog…yeh, that’s it, his blog – and he – can be reached through http://madisonpediatric.com or doc@madisonpediatric.com.

Monday Morning Update 8/10/09

Merge Healthcare will acquire MRI software developer Confirma
Continua certifies new personal health devices
Google, Microsoft execs disagree with government’s EMR plans

From Ruppert Breedlove: “Re: Meditech’s latest results. They are trending from high margin (product sales) to low margin (services) revenue that is bringing down profits. Maybe it’s a short struggle while they try to get 6.0 going, or maybe it’s the start of a slow, chronic decline. They are losing a few customers at both ends (Paragon and Epic) and the larger Magic hospitals see a long and winding road that leads to the 6.0 door. Service revenues lag product revenue, so if those flatten and then decline, that would be significant.”

From Cathy Halloran: “Re: Eclipsys Knowledge-Based Charting (KBC). The latest go-live of KBC occurred at North Shore Long Island Jewish Health System in the last three months. It incorporates CPMRC/Elsevier’s evidence-based content within Sunrise Clinical Manager to support the clinical workflow of the  interdisciplinary (nursing and allied health) patient care team. This content and design was endorsed by enterprise-wide  NSLIJ interdisciplinary teams including physicians with the goal to use KBC to advance practice at the point of care. NSLIJ teamed with the CPMRC for Transformational Services and with Eclipsys for implementation services. There are two hospitals live right now, the  children’s hospital and a large academic/tertiary hospital. As we continue to  implement KBC across NSLIJH, the tools and content will support evidence-based  care and practice.” Cathy is VP of clinical systems at NSLIJ.

From Bulbs: “Re: GE. GE has a warranty on Meaningful Use and, unlike NextGen’s, it doesn’t specify ‘to use our BEST EFFORTS to keep a general released version of the Software in compliance’. It actually says it WILL meet compliance with certifying bodies, although they have carved out Enterprise stating they will use ‘diligent efforts’.” GE’s warranty text is here. The penalty, though, is only a credit (not refund) of six months’ of support fees, which isn’t much consolation if you’ve bought licenses, hardware, and implementation services (all from GE, the warranty specifies). My advice would be to forget the boilerplate and insist on your own contract language, backed up by more significant penalties. And, while customers are semi-guaranteed that GE’s product will be certified, most of the Meaningful Use obligations will fall on them, not their vendor (e-prescribing, getting quality results, keeping data in electronic form, etc.) I’ve got a UL-approved electric saw, but I’m still not prepared to build a house.

From Fed up with Zynx pricing: “Re: evidence-based nursing. With the recent acquisition of Provation, WoltersKluwer is now a reasonably priced alternative to Zynx for evidenced-based order sets and the recently released care plans. We were able to negotiate a substantial savings compared to Zynx when we bundled in the UpToDate product that Wolters also offers.”

Here’s what you thought about NPfIT in my previous poll: big success (3%); big failure (51%); somewhere in between (27%); don’t know and don’t care (19%). New poll to your right: will more EMR vendors promise their prospects future CCHIT certification or Meaningful Use compliance?

Allscripts will add 125 new jobs in Raleigh.

I couldn’t resist looking up Ken Kizer’s 11 acronyms: MD (medical doctor), MPH (master of public health), FACEP (Fellow of the American College of Emergency Physicians), FACPM (Fellow of the American College of Preventive Medicine), FACOEM (Fellow of the American College of Occupational and Environmental Medicine), FAMT (Fellow of the American College of Medical Toxicology), FAACT (Fellow of the American Academy of Clinical Toxicology), FAAMA (Fellow Academy of Medical Administrators), FACPE (Fellow of the American College of Physician Executives), FRPH (Fellow of the Royal Society for Promotion of Health), and FRSM (Fellow of the Royal Society of Medicine). He’s one busy “fellow”, apparently, since he’s also board certified in six medical specialties.

Listening: reader-suggested Silversun Pickups, LA indie with an all-too-rare female bass player. 

The Seton Law people say that HITECH improves requirements for breach handling, holds business associates directly accountable to the government, increases enforcement of violations, strengthens “minimum necessary” restrictions, improves accounting of disclosures, and prohibits sale of PHI. On the other hand, personal health record vendors like Google and Microsoft are not specifically included, so they can still use, disclose, and possibly sell the health information of patients, leaving consumers no choice but to accept their privacy promises. 

Speaking of Microsoft, it’s taking heat after a report found that 90% of the ads displayed when searching for prescription drug information on its Bing search engine led to unlicensed pharmacies, many of them providing illegal offshore counterfeit drugs.

Girish Kumar Navani, president of eClinicalWorks, is interviewed in The Journal of New England Technology and is asked excellent questions. He predicts the stimulus impact to eCW will be only 20-25% and will take 5-6 years to evidence itself. Asked if he wants to take the company public: “No. There is no question about it. There’s no way I would kill my freedom to be shackled by reporting to Wall Street every quarter … I think going public is like the hangover after a night out. You really feel good about it the day you go public, and then after that it feels like a hangover — and it never stops.”

A North Carolina business paper covers local companies that have added HITECH-inspired services (EMR hosting, order management, patient communication) to their physician product list.

The C. difficile bacterium killed 248 people in Scotland last year and was involved in the deaths of another 517, leading a public health official to urge use of an electronic bed management and infection tracking systems to combat the problem.

A new RFP tender from NHS: an order communications system.

Continua Health Alliance certifies three new personal health devices for connectivity and interoperability: a blood pressure cuff, scale, and glucometer.

Cleveland Clinic CEO Toby Cosgrove says healthcare reform “may end up making the problem substantially worse” if all it does is make insurance more widely available, adding that “the conversation has morphed from health-care reform to insurance reform.” Unfortunately, we’ve let those terms become synonymous.

Interesting results from the President’s Council of Advisors on Science and Technology this past Thursday and Friday in Washington. Attending were CTO Aneesh Chopra, ONCHIT head David Blumenthal, and our own John Glaser. According to the excellent recap by nextgov, Google CEO Eric Schmidt told them that the administration’s health IT system will keep hospitals using outdated databases in a Web-centric world, stifling innovation. He, of course, humbly suggested using Google Health and then snipped when Blumenthal told him the national system will share some information with PHRs. “Giving me a summary … is not the same thing as giving me the record." Microsoft’s Craig Mundie advised the administration to worry more about metadata and information lookup instead of specific EHR applications, but Blumenthal told him that’s not possible because stimulus funding was tied to EHR adoption (which seems more and more to have been a big mistake – you pay for a house, not for a pile of boards and a promise, to continue my construction analogy from above). He also admitted that we’re way behind Scandinavian countries in EMR usage (not to mention overall health and healthcare value). 

South Florida HIE and Community Health Alliance, two dormant and broke RHIOs that never got much of anywhere, regroup to chase stimulus money. They’re arguing that it makes sense to give them the cash instead of using it to “reinvent the wheel”, which I almost buy given today’s prevalent bail-out mentality (crappy car makers, criminally greedy financial institutions, and market-failed EMR vendors and RHIOs … hey, it’s only taxpayer money).

GE paid $50 million in fines and $200 million in legal fees to make SEC book-cooking charges go away, but it was a corporate embarrassment nonetheless, “like a professional baseball player revealed to have been dabbling in steroids”, Forbes says (while also pointing out that the SEC is mighty blustery about going after GE considering they missed major scandals like Bernie Madoff’s). Other articles I’ve read said that Jeff Immelt panicked because he was about to break a long string of profits under Jack Welch as the new CEO and maybe created a culture of fudging the numbers. A former GE executive says he was told, when he advised another executive that results were coming in light, he was told he was “taking those accounting courses way too seriously” and to “just reverse a few journal entries.” 

St. Vincent Indianapolis Hospital is experimenting with letting UPMC’s neuropathologists perform live biopsy readings via TeleNeuropathology, in which the Indianapolis neurosurgeons follow along as UPMC’s pathologists control a robotic microscope in the OR and inspect its images over an Internet connection.

Merge Healthcare will acquire Confirma, a Seattle-based MRI software developer, for $22 million in stock. I thought those Merrick people were obnoxious when they took Merge over a year ago, but they are doing everything right, including the eTrials acquisition last month and a stock price run-up of 16 times its 52-week low.

Kaiser Foundation Health Plan and Hospitals had a fair Q2: revenue was up a little, but net income was way up on lower non-operating losses (investments, I’d guess). It lost 36,000 members, but surely that’s related to higher unemployment. HealthConnect got a big mention in the announcement.

Winner of the Highest Potential Startup Idea at IPhoneDevCamp: Nurse Brain, a patient dashboard that nurses use to log their activities and then hand off to the oncoming nurse at shift change. Brilliant.

An HUC at St. Francis Hospital (WI) gets her job back after an arbitrator finds that termination was too severe a penalty for violating HIPAA laws in using the hospital’s medical records to locate her estranged son. The son filed a hospital complaint when he received a birthday card from her, claiming the only way she could have gotten his address was from hospital records.

The former director of interoperability and standards at HHS says the Nationwide Health Information Network needs to be scrapped because it’s obsolete, but there’s time because “I have not seen in the stimulus where the NHIN is being advanced.” David Blumenthal responded that HNIN is important and a work in progress.

HIMSS keynoter Dennis Quaid is on the big screen in GI Joe: The Rise of Cobra as General Hawk. How does a movie about a generations-old doll translate to the big screen? “Big, brainless action and bad acting,” said one critic. Others:  “Whoever said Dennis Quaid was set dressing in this film was absolutely right … every line he delivers sounds as if he’s reading it right off the page” and “Dennis Quaid has apparently been assigned to look gruff and bark orders.” Roger Ebert gives it 1.5 stars and, in the biggest Dennis insult of all, doesn’t even find him worthy of mentioning. Despite the pans, it’s pulling in big box office, at least until word gets around.

E-mail me.

News 8/7/09

From Wade Welles: “Re: evidence-based nursing. Do you know of any product in the market similar to Zynx Care, Milliman Guidelines, or McKesson InterQual?” I’ve heard of MCAP, which might be worth a look. Sunrise Knowledge-Based Charting from Eclipsys looked pretty good last time I checked quite some time ago. The floor is now open for suggestions.

From Sally Apizza: “Re: Todd Park. Todd’s appointment as CTO for HHS makes perfect sense. He is one of the most sincere, honorable people in the industry and, while the money he made building athena is nice, he is clearly focused on fixing the healthcare system. Besides, he has way too much energy to stay retired at 35.”

From Wes Jeeter: “Re: magazines. They are doing blogs and interviews. Like yours, only way not good.” I’m flattered in that imitation sort of way, especially since I’m a toiling-after-work amateur competing against companies and full-timers.

From The PACS Designer: “Re: cloud basics. Smaller institutions can benefit from good content on the Web. InformationWeek has a Plug into the Cloud blog that continually posts the latest in trends when it comes to cloud computing concepts.”

From The Queen: “Re: TPD. Would it be possible for TPD to please, please stop referring to himself in the third person?” It’s possible, but of unknown likelihood. Mr. HIStalk will leave that up to him since it’s his brand.

QuadraMed announces Q2 numbers: revenue down a little, EPS -$0.04 vs. $0.05. Severance payouts for two departed executives were largely responsible for the loss.

Eclipsys also moved into the red in Q2: revenue was down slightly, EPS -$0.07 vs. $0.15, missing revenue estimates by a large margin and guiding lower for the fiscal year. CEO severance was part of that loss, too.

Listening: reader-suggested Muse, pop-progressive that sounds kind of like the best parts of Queen. They’re doing a big stadium tour starting next month as the opening act for U2.

Streamline Health Solutions names board member Jonathan Phillips as board chair, replacing Brian Patsy, who will continue in his CEO role. Jon is founder of Healthcare Growth Partners and has supported HIStalk as a sponsor nearly from the beginning, also sharing his expertise in some interviews that turned out to be eerily accurate about the HIT vendor marketplace.

Merge Healthcare, seemingly back on the right track after some long and ugly struggles, announces that its PACS product has been integrated with Epic at HealthPartners. Shares have nearly tripled in three months, with market cap back to a respectable $235 million.

Speaking of Merge, it says it will “unlock the vault” on its internal imaging software tools, making them available to the commercial market as toolkits.

Salesforce.com takes a minority equity position in free EMR vendor Practice Fusion, also announcing the use of Salesforce.com’s cloud infrastructure for Practice Fusion’s new PHR, due out in November.

The military releases an independent report (warning: PDF) reviewing the design plans for the “world-class medical facility” that will replace Walter Reed. On the IT side, it worries about infrastructure planning (fiber and wireless) and EHR issues such as interoperability and usability. Most interesting is the highly practical definition of “world-class medical facility” in Appendix B, which calls for Stage 6 of the HIMSS Analytics EMRAM and state-of-the-art technology for knowledge management and unified communication. A fine job, but no surprise given those involved, including Ken Kizer of Medsphere (with a record-breaking 11 credential acronyms after his name) and Orlando Portale of Palomar Pomerado Health.

A reader is looking for technical experts who have experience with the Touchworks data model. E-mail me if you are interested.

AHRQ will provide a Web site generating application that allows organizations to publish hospital quality and utilization data.

Mississippi Medicaid will offer beneficiaries an EHR and e-prescribing system from HIE provider Shared Health.

EHRtv filmed last week at the Orlando Allscripts ACE09 meeting.

Speaking of Allscripts, several more uncreative law firms have filed suits against the company that are identical to the ones already filed by their legal competitors, i.e. the same “material misrepresentation” charges that don’t stand a chance at lining legal pockets unless certified as class action. The stock went down and is climbing back nicely, but naturally anyone who lost money must have been a victim of something other than market conditions or their own bad decisions. At least we still lead the world in something: resource-wasting lawsuits.

Epocrates gets a nice plug from US CTO Aneesh Chopra: “There is not a doctor I know who hasn’t downloaded a copy of Epocrates. It’s accessible and they use it on their Treos and iPhones."

China’s Ministry of Health is getting expert opinions on EMR standards, hoping to use electronic records to save money.

Jobs: Account Executive, Practice Partner Consultant, Lead Pharmacy Informaticist, Project Office Manager, CFO/VP Finance, Director of Marketing. Lots of winners here. I might apply.

Memphis startup Provider Health Services, which puts doctors and nurse practitioners in nursing homes, is using EMRs as a core strategy to manage costs and reduce provider paperwork.

Local police are mad at Rhode Island Hospital for refusing to give them details about a suspected homicide victim’s injuries, citing state privacy laws. Disclosure to police is allowed only in cases involving gunshots and abuse of children and the elderly, the hospital says. Police called out an exception that allows it if the information could help law enforcement.

Massachusetts, which has most expensive health care in the country, wants to replace the fee-for-service model for all providers with a capitated payment (although they avoid calling it that to prevent memories of bad HMOs).

Children’s Hospital of Philadelphia gets recognition for its Pediatric Knowledgebase, which provides dosing guidance, therapeutic drug monitoring, and medication usage research. It can be customized to work with EMRs.

IT solutions vendor PC Mall announces the formation of a dedicated healthcare division. 

This gripes me too: a husband and wife get their annual physicals, taking care to get blood work at an in-network hospital. They got a bill for $1,700 after the fact — the in-network hospital had sent their blood off to an out-of-network lab. The hospital told them it was their job to figure out which lab the hospital uses, later sending collectors after them. I had the same problem with my own hospital’s ED doc – the hospital’s insurance didn’t cover their own ED doctor services because they contracted ED coverage out to another company. How the heck are hospital patients supposed to figure that out in an emergency? And what alternative do they have anyway?

AMICAS reports Q2 numbers: revenue up 73%, EPS -$0.19 vs. $0.00, and guides revenue up. The stock jumped 15%, now having nearly tripled since December.

Somehow hearing Fannie Mae say this while asking for another $10.7 billion in taxpayer bailout money because of their bad mortgage investments makes me nauseous: “We are dependent on the continued support of Treasury in order to continue operating our business.”

UnitedHealthcare will make Quicken’s health expense tracking tool available to 700,000 of its enrollees, with plans to roll it out to 20 million people by the end of the year. Or, you could just download it here.

E-mail me.

HERtalk by Inga

From Worried: “Re: healthcare reform. Consider this: over the next three months, more than 700 post offices will be reviewed for possible closure. Don’t know about you, but the last time I had to go to the post office, I stood in line forever. Rates continue to rise and the quality of service doesn’t come close to Fedex. Hmm … does anyone seriously want this same government to run our healthcare system?”

From Robe 411: “Re: ARRA vendor guarantees. With all the talk about how IT vendors can get hospitals to Meaningful Use, is anyone aware of any guarantees vendors are stating should they be selected? For instance, are they promising in writing to be CCHIT certified by a particular date or promising to have a capability gap filled by a certain date?” Robe 411 posted this now on the HIStalk Discussion Forum, in case you missed it. I’d be interested in hearing what companies are doing. I do know that NextGen has a money-back guarantee program that includes a promise that the “solution that will always evolve to meet the standards and certifications for federal stimulus reimbursement programs of interest to physicians using NextGen Healthcare products.”

Eclipsys names former Trinity Health CEO Judith C. Pelham to its board of directors.

Cardinal Health elects current executive George Barrett chair and CEO, just in time for its August 31st spinoff of CareFusion. The company also announced a $500 million stock buyback plan and appointed Glenn Britt, chairman and CEO of Time Warner Cable, to its board.

Twitter suffers a denial of service attack Thursday, making the service unavailable and leaving users like me confused about alternate ways to waste time. Meanwhile, Facebook was suffering its own performance issues, possibly also due to an attack or maybe because of extra traffic from all those Twitter-deprived folks.

SRS announces that the 12-provider Chestnut Hill Cardiology (PA) has selected the SRS hybrid EMR for its practice. We mentioned this on HIStalkPractice and included a photo of the office. EMR_guy sent us this note: “I saw the building and immediately recognized it even though I haven’t lived in Chestnut Hill in 12 years. When I was a kid (a long long time ago) the building was originally a fast food burger place (fitting that it is now a cardiology practice). The place was call Gino’s and they had great burgers and shakes.” We are happy to inspire trips down memory lane. Mr. H, being a sucker for nostalgia and reader happiness, tracked down the photo above that should really take you back.

Maryland state officials agree to fund up to $10 million over the next five years to build a statewide HIE, getting the money by adjusting hospital reimbursement.

Picis enhances its ED PulseCheck solution with the embedding of First DataBank Drug Data File Plus. Picis has long supported access to Cerner Multum Vantage Rx Database, but with the addition of FDB, now covers 95% of what hospitals use.

Perot reports a 3% increase in profit for the second quarter despite an 11% decline in revenues. Perot says tighter cost controls helped earnings to rise to $31 million, compared to $30 million last year. New contract signings decreased 48% to $135 million, but have totaled $1 billion over the last year.

PeaceHealth (OR) selects ProVation MD software for procedure documentation and coding. Meanwhile Provation vendor Wolters Kluwer Health introduces its ProVation Care Plans solution, which allows interdisciplinary care teams to customize care plans and create education programs and guidelines.

AT&T agrees to extend special pricing to VHA member hospitals and non-acute care organizations. The contract allows VHA members to obtain “competitive” rates on AT&T wire line services, including local, long-distance, and toll-free services, plus audio and video conferencing.

Consumer Reports, the granddaddy of rating services, offers patient satisfaction ratings on more than 3,400 hospitals. The Consumer Reports Health Ratings Center rates the overall patient experience, including doctor and nurse communication, room cleanliness, and hospital staff attentiveness.

Healthcare Management Systems launches a new online bill pay service, providing hospitals the alternative to send electronic bills and receive payments online.

athenahealth reports its second quarter results, which included a 9% increase in profit compared to a year ago. The company reported $3 million in profit ($.03/share) and revenue of $46.7 million (a 42% increase.) athenahealth attributes the positive results to better sales, including an increase in athenaClinicals EMR users from 498 to 1,034 providers. Results were in line with analyst expectations, yet the stock price has fallen the last two days. Go figure.

A British GP receives a formal warning for downloading pornography at his surgery computer. The General Medical Council said the actions don’t meet the standards required of a doctor, but “are not so serious as to require any restriction on his registration.” Got to love those Brits and their sense of humor. I know people who have been fired for far more frivolous dalliances.

AMICAS second quarter results: revenue of $23.5 million compared to $13.6 million last year; net loss of $6.6 million compared to last year’s $97,000 loss.

Darn. Why didn’t I think of this?

E-mail Inga.

HIStalk Interviews William Hersh, MD

William Hersh, MD is professor and chair of biomedical informatics at Oregon Health & Science University, Portland, OR.

How many informatics people is it going to take to support projects launched due to HITECH?

I’ve actually not sat down and penciled that out. I published some research last year using the HIMSS Analytics database, which is an admittedly imperfect source of information, that moving everyone to Stage 4, which was CPOE and clinical decision support, would require another 40,000 people on top of the 109,000 or so that are presumably already working in health IT if you extrapolate.

One of the big questions, though, is the role of people who do informatics. The HIMSS Analytics database focuses more on IT. There’s a growing recognition of people who work in informatics, who work at that intersection between IT and healthcare, and are working with IT but in more of an informatics role, a focus on information. The estimates there vary. Chuck Friedman, who is now David Blumenthal’s deputy, came up with a back-of-the-envelope calculation of about 13,000. Don Detmer, the former president of AMIA, said it’s probably more like 50 to 70,000, but probably somewhere in that ballpark for the informatics people.

We’ve got a lot of people in the industry who learned on the job when there wasn’t any formal training available. What results will we get by using the formally trained people?

There are many ways to learn things. I don’t have a degree in informatics myself. A lot of fields begin with people who blaze a trail. They pick things up, learn things on the job. That’s probably, when we’re talking about industrial scale health IT, not practical. Plus, there is a growing base of knowledge that many of those trailblazers learn.

I think the world is changing and there’s going to be more of a need, just for efficiency reasons, to train people, to give them the knowledge and skills. The old-timers kind of learn that through the college of hard knocks, but to really scale things up is going to take more formal training.

There are so many ways to get training — ANCC certification for nurses, 10×10, graduate certificate programs, full-fledged undergraduate degrees, and graduate degrees. What are the disadvantages and advantages of all of those credentials compared to what the market needs?

I think the market will probably sort itself out. People ask me, “Will I need to have a credential to work?” And at least in this point in time, the answer is no, but that could change in the future, just like anything in our economic system. The value will be what people put in it.

There may be a time in the future when people go to apply for a job and potential employers might look at a group of resumes where one person has some formal knowledge that’s been validated by some sort of certification process, as opposed to someone who has just learned things on the job, and that may tip the scales.

If the people are otherwise equal, if the person has been in the job for 20 years, that may tip the scales the other way. So I think it will sort itself out over time.

Informatics is a profession but with different roles, such as a nurse who sits in front of a screen and builds order sets all day all the way up to a physician who is an architect for an entire system, yet each could call themselves an informatician. Is there a need for more granularity in what people are doing with their credentials rather than which credentials they have?

Yes there is. The reality is, in some ways the informatics field has some similarities with an MBA. People typically don’t come into an MBA program with a business degree. They come from all walks of life. I know of a couple of physicians who have MBAs who’ve gone on to management jobs in healthcare.

What I always tell people is that informatics is a very heterogeneous field. There are many different kinds of things and there are many heterogeneous pathways into the field. There are many heterogeneous pathways into jobs, although usually the job that you do is somewhat a function of your background. So for example, it’s pretty unusual to see a CMIO who’s not a physician, or at least who’s not a clinician, but typically a CMIO is a physician.

But there are other jobs, such as managing an EHR implementation, that are more suited for someone who has knowledge of healthcare but who isn’t necessarily a clinician. And it’s also a jobs-in-between, like the nurse who creates order sets or order entry screens and things like that, like you mentioned.

A physician colleague I know was in the OHSU graduate certificate program and said it was hard, with a lot of statistics and epidemiology. Is there a presumption that there is a base set of knowledge that would be more typically found in a physician?

I’m actually kind of surprised to hear that. In our graduate certificate program, they don’t — for example, like they have to for our master’s program — take a statistics course. I guess it depends on how you’re defining statistics and epidemiology.

Our certificate program, and I think in a lot that are forming, is focused on giving people the knowledge of informatics in terms of what you do with information to improve healthcare, to improve its quality, safety, etc., and then how you go about implementing systems to be able to capture and use that kind of information.

There’s not a massive amount of statistics and epidemiology in our certificate program. I don’t have the exact numbers in front of me, but about 50% in our program are physicians. Of the remaining 50%, about 25% are in healthcare professions like nursing and pharmacy. The other 25% are from everything else, with probably the majority of which is IT. We do get a fair amount of people with IT backgrounds who want to learn more about healthcare to be able to apply it.

Going back to your other question, “Do people need to be trained?” We actually have a lot of people who are already in CMIO kinds of jobs and then realize that they need to learn more informatics and enroll in our program. I chuckle about it sometimes because that’s not usually the way you go learning about a field — after you’ve gotten your job. You wouldn’t send a surgeon off to residency after they started doing operations.

If you’re reporting to a hospital executive, they probably don’t know anything about informatics enough to say, “Yes, I want my person to have a certificate, if not a degree”?

Yes, it’s true. This is still a new field that is sorting itself out. Another problem related to what you’re describing is that HR departments know very little about it, although spending time talking to more and more forward-looking healthcare organizations, the HR departments are starting to learn about the value of this.

There’s a local hospital here in Portland, Providence Health Systems, and they are doing a lot of effort, mostly internal development, but more appropriate, like sending people off to learn more, but also developing internally an informatics cadre, if you will.

It seems like the ideal appetizer for the training would be the 10×10 program, which you were involved in that early on. How does that fit in now and is it going to meet the goal of 10,000 people by 2010?

The 10×10 program was started when AMIA was looking to have some kind of e-learning option. They had talked to some vendors and it would have been prohibitively expensive. We actually already had a broad-based course in our program here.

So I suggested to the AMIA people, “Why don’t we just take this course? We can repackage it as more of a continuing education course.” That’s how it came about. AMIA turned it into a sort of a program that let other universities offer 10×10 courses and so forth.

We won’t hit 10,000 people. In fact, there have been 750 people who have done the 10×10 course. But the main reason why we won’t hit the 10,000 people is that 10,000 people haven’t come forward and said, “We want to do this.” But about 750 have, and we have some published data saying that people find the experience worthwhile.

The way we’ve structured the 10×10 course here is that since it is essentially equivalent to our introductory course. People who do the 10×10 course can then get credit for the introductory course in any of our graduate programs, even all the way up to our PhD program. The graduate certificate program consists of eight courses, one of which is that course, so then they have to take seven more.

10×10 is a broad-based and intensive but introductory experience to informatics. I don’t know if anyone will become a high-end informatician unless they have loads of experience just with that one course.

The tough thing about establishing a credential is that you’ve got to market it to employers. Do you think vendors, given their emphasis on “just get stuff in and installed”, maybe don’t really care too much about the theoretical nature of informatics and are never really going to embrace a credential?

We’ve had vendors who have sent some of their folks. Some of the big vendors have sent a few of their folks to learn about it. I agree, vendors are focused on getting your systems up and running.

I wouldn’t call 10×10 a theoretical course because it’s pretty practical, these issues with implementation, with standards, with quality measures, and things like that. I mean it’s definitely an academic course, but it’s actually not highly theoretical.

We don’t know for sure, but at least half the people get their tuition paid by their employers. Typically, hospitals will send people, sometimes universities, and again, we have had a number of vendors who have sent some of their staff.

I think it would be a great course – obviously, I’m biased — for vendors to just get a bigger sense of the marketplace. With all the expectations of the stimulus package, the vendors are going to have to be a little — you probably know this as well as I do — more cognizant about standards and interoperability, because it’s going to be expected of them, whether they really deep down want to do it or not.

What do you think HITECH is going to do in terms of innovation?

I think that if we define Meaningful Use at a reasonably good level, a level that most people can hit, and we make interoperability a big part of it, that will drive the vendors in a way — I mean, I remember 15 years ago when people were saying, “Should I demand of my vendor that they speak HL7 Version 2?” It was really customers that drove that, and I think it’ll be the same way. 

It’ll be customers and the Meaningful Use guidelines, at least around things like interoperability, that vendors say, “If I want customers to be able to meaningfully use my EHR system, we’re going to have to do this interoperability thing whether we deep down want to do it or not.” I think it’s important for people to know what the issues are around interoperability standards and so forth which are the kinds of things that we teach in courses like this.

Maybe that’s part of the reason programs haven’t picked up — vendors aren’t really developing a lot of new products. Are people with all this formal training going to be disappointed when they go to work for a vendor and realize they won’t get to design a lot of fun new stuff and re-architect systems that have been on the market for 20 years?

That’s actually hard to know. We have about 250 alumni already in our program. That’s not 10×10; those are actually certificate or master’s program. A small number of them work for vendors.

I think they probably have mixed feelings about their job. It probably varies from vendor to vendor in terms of what things people get to do. Of course, you might get a job with an innovative vendor, but you might get stuck on some project that you really don’t want to do anyway.

But I think one of the good things — maybe I’m a little idealistic about this — but if we come up with good, achievable definitions of Meaningful Use, that we can get the vendors or companies … I’ve never worked in the private sector but I certainly know a lot of people in the private sector, and at the end of the day, you’ve got to make a profit. But if we set the motivations for the vendors right, then hopefully we can make them do the right thing and keep their feet to the fire, just like some of the hospitals and physicians will have to be kept to the fire, too, in terms of implementing things that are Meaningful Use.

You were involved with clinical data sharing before it was a hip thing to do. What’s your vision of where it should go?

I think we need to be realistic about it. We need to recognize, for example, that the kinds of things we can do with clinical data sharing, when we have good, quality data to do it — quality measurement, for example — is a great thing. I don’t think anyone is opposed to it in principle, but the question is, can we get good enough data and meaningful quality measures and act on them?

I think that a lot of times people think that just because data is in electronic form that that means that you can do anything with it, like it’s the gospel. The reality is that, for clinicians in the trenches, high quality data is not their top priority. Usually their documentation is what stands between them and their getting home for the day.

I think we need to focus on trying to develop ways to help clinicians to get the best data in the systems so we can do things with it like quality measurements and health information exchange, all the kinds of stuff we talked a lot about now, but all that depends on as good a quality of data as possible. I also think we need to be realistic in what we can and cannot do.

Is it skewed toward having physicians input their own information to create all this quality data that someone else gets to use?

Speaking as a physician, although I actually don’t do patient care these days, I sympathize with a physician when someone ends up imposing an extra hour onto their day in terms of entering data.

This is where I think the research comes in. How can we find ways to get the highest quality data and not increase the cost of getting it? If it truly takes an extra hour a day of physician time, ultimately we’re going to pay for that, and I’m not sure if the healthcare system or the payors are willing to do that.

I think we need to find ways of getting as good a quality of data as possible, but I think physicians are going to have to change their ways a little bit, too, and recognize that they can’t just scribble things, that we need a certain standard of quality for data. I think this could be a role for physician specialty societies — groups like ACP, AAFP that have initiatives — looking at these sorts of questions, like how do we get the best data without taking an inordinate amount of time?

Is it the right step to shoot the government’s wad on putting out electronic medical record systems that didn’t take advantage of any of that research and say, “Look: type or use a mouse, it’s up to you, but that’s how it goes in”?

There’s definitely a risk in what we’re doing. On the other hand, we need to be bold and make it happen, just like healthcare reform. There’s going to be no perfect healthcare reform because we have so many different competing interests, but I think we’ve got to do something because the status quo is not acceptable.

The same thing is true when it comes to information. We need to be bold, but again, I know there’s been a lot of arguments about what should and should not be in Meaningful Use, but I think that it’s a good bar that most people with the right amount of effort can hit. That’s what we ought to aim for.

What technologies that aren’t necessarily mainstream now that can make a difference?

You know, it’s funny, because when I talk about informatics, I often times say, “We can’t be too focused on technology; we need to be focused on information.” I think it would be technologies that help people enter high-quality data, so maybe there will be some kind of role for some things like speech recognition with real-time transcription, or data entry interfaces that have structured interfaces but don’t completely box you into choosing this checkbox or that checkbox.

Whether that’s going to be handheld devices — they’re obviously portable and convenient, and they’re wireless now. On the other hand, they have tiny screens, and things like typing on them are very difficult.

So it’s hard to predict which technology — again, I think the focus should really be on what we want to do. To me, the most important issues in informatics are getting high-quality, standardized, interoperable — I’m actually less concerned about interoperable applications. Those will come if you have interoperable data.

We really need to accelerate trying to standardize clinical data and obviously make it available with obviously all the security protections and so forth, but across applications. The rest of the interoperability, and also things like health information exchange and quality measurements, will come from that. 

My last question, elicited from your previous answer — and this is an A or B answer only, there is no “all of the above” — is informatics about technology, or is it about people and organizations?

Unhesitatingly about people and organizations. That’s an easy one. [laughs] I mean, it’s what you do with the technology. You can’t be ignorant of the technology; you have to understand it and be facile with it, but informatics is about people and organizations, basically improving healthcare and improving people’s health.

And your programs focus on it in that way rather than about technology?

Absolutely. You can come here or online or whatever, and learn a lot about technology and get involved in projects that do a lot with technology, but at the end of the day, it has to have some value to health or healthcare, making people’s lives better. We emphasize that. I think that most informatics programs emphasize that point of view.

I think one thing that’s happened in the last few years is that the informatics field has kind of matured a little bit and recognized its role. Again, I don’t want to say that technology’s unimportant, because it’s very important, but it’s what you do with it that’s more important. I think that informatics has kind of recognized its role in that realm.

Any other comments?

Obviously I have a little bit of a bias toward the academic/education side of the field, but I do think that there is growing knowledge in this field and that people benefit from knowing it. That’s one of the roles that academic programs are going to play. I actually believe that informatics will mature as a profession as a result of that knowledge.

No matter what happens with ARRA, the trajectory was already to increase the use of health IT and I think that will continue, probably accelerated through ARRA.

News 8/5/09

From Sweet Duck: “Re: Philips. Starting RIF this week. Some will be notified this week, most next week.”

From Former Misys: “Re: interesting lawsuit.” It’s the usual securities fraud lawsuit that inevitably results when share price drops even temporarily, one of many filed by “corporate wrongoing” attorneys Izard Nobel LLP, this time against Allscripts. Another was filed against Allscripts by fellow corporate heel-nippers CSGRR, which has filed hundreds of similar suits (I’m not kidding – I broke out of their Web page navigation structure to get this folder of suits filed, of which company names starting with A alone take up three pages). I get several of the class action notices every month for one company or another since my IRA is in a “wrap fund” that trades a lot, but I thrown them straight to the trash unopened because I’ve long since learned that (as in life in general) the only benefit invariably accrues to the lawyers on both sides.

From The PACS Designer: “Re: Scribd. Another collaboration Web site you might want to checkout is Scribd. It’s a place to form a group to discuss a specific subject or event. TPD came across this site when viewing a cloud computing use cases white paper, and the open cloud manifesto (OCM) website, which also may be of interest to HIStalkers.”

From Bob in Accounting: “Re: Huron Consulting Group. Wow.” Shares of Chicago-based Huron Consulting Group dropped 75% on Monday after an audit uncovered what looks like suspicious accounting, the company announced it will restate three years’ of results, and most of the company’s executive team resigned (Holy HBOC, Batman!). They did a bunch of healthcare acquisitions over the years: Spelz & Weis, Wellspring Partners, Aegis Advisers, and Stockamp. Huron was founded by a bunch of former consultants from Arthur Andersen, the scumbag, fee-obsessed company that let Enron and HBOC happen as their see-no-evil auditors. I know there are at least a couple of folks who work there who read HIStalk, so hang in there. The sins of the suits usually hit the peons hardest.

Speaking of Huron, here’s an ironic story lead from a 2004 WSJ: “Down the road and across the river from Arthur Andersen LLP’s old 28-story headquarters in Chicago, a firm set up by some of its former employees is hoping to become a beneficiary of the spate of accounting scandals that helped cause the collapse of the once-venerable audit firm. Huron Consulting Group Inc., a financial and legal advisory firm founded by former Andersen partners during the company’s death spiral in 2002, is set to go public with a $115 million stock offering by the end of the year. Its specialties include "forensic" examinations of companies with accounting blowups. That is, its consultants drill deep into particular accounting areas to figure out what went wrong, often working with audit committees and their law firms.” If they were Andersen, they would hire themselves as external auditors.

From Kit Kittredge: “Re: Todd Park as HHS CTO. What do you think about that?” Brilliant, although I’m shocked that they could get him since he doesn’t need the paycheck and seemed to be enjoying semi-retirement and starting up Maria Health (apparently now Ventana). I’m surprised HHS went outside the usually bureaucrat farm system to get someone so notable from private industry, especially since athenahealth is about as opposite as you can get from the COBOL-loving civil servants unimaginatively carrying out tedious political decrees involving the most arcane and mind-numbing financial transactions. You have to admire him for giving up cushy family time to get into a government grind with little to gain in money or reputation, knowing that entrepreneurs don’t easily morph into DC lifers. I e-mailed him today and he promises to interview here again once he’s settled in.

Speaking of Todd Park, ABC News e-mailed after finding his interview here, asking to use the picture I had run (which came from athenahealth, who gave their OK to them, which I now see has been picked up by Modern Healthcare). I see they are running it now in a story quoting a watchdog group’s spokesperson as saying TP “played the campaign finance system well” in donating to Obama’s campaign and expressing concern that his recusal on issues germane to athenahealth would hinder his effectiveness. I’d strongly disagree on the former: you’d have to be an incredibly idealistic multi-millionaire to want a wonky beltway CTO job, so I’m pretty sure he’d otherwise have rather have kept his ATHN shares. On the latter issue, I suppose it’s a theoretical risk, but since he has to sell his shares and give up his board position, he wouldn’t have much motivation. I’d rather have this situation than the ever-present ones where influential public servants quit to sell their influence to the private companies they formerly regulated.

Fred e-mailed the Allscripts internal e-mail announcing that field engineering services will be outsourced to DecisionOne in October. “DecisionOne is the right partner because they are expert at hardware installation and repair and have been in this business for the past 50 years. They have high standards and their employees will be trained and certified to the same standards as our employees. More importantly, they are committed to retaining the majority of our employees.” Sounds like a win all around, although hiring on with a new outsourcer is always traumatic for the affected employees (hopefully Allscripts put in the contract that nobody gets let go for some period of time). Outsourcing non-core business under carefully defined terms often works well.

A reader sent over the Boston Business Journal article featuring eClinicalWorks President Girish Kumar Navani, who founded the company with his brother-in-law and cousin, all three of whom live in houses next door to each other. Doing EMRs was their third idea after a golf course tee time app and a hotel reservation system. I like it that he’s cheap like me: the article mentions that he didn’t like the $90 walk-up rate he was quoted at a rental car counter, so he whipped out his laptop and made an online reservation for a $19.95 rate.

And I swear this is coincidental because I forgot to mention it Saturday until Inga reminded me: eClinicalWorks has signed on as  Gold Sponsor of both HIStalk Practice and HIStalk, which I appreciate even more now that I know how much Girish hates wasting money. I was super impressed when I interviewed him in 2006 and 2008 because he seems like an absolute straight shooter whose physician practice systems were forcing dramatic changes in the EMR marketplace. He said the company was doing $60 million in revenue in the 2008 chat, but that BBJ article pegs it at $100 million now. He had this to say about the much-watched New York project: “New York is not just about implementing an EHR, it’s about demonstrating that you can improve quality of care. Then, it’s all about expanding that to connect into the local RHIOs. There’s another level and degree of integration that’s big in the city – connecting with their school health program, with their immunization registries. You’re now talking about a truly digital healthcare system.” I’m really honored that he always takes my calls and e-mails, like when he hastily arranged a telephone interview on his way to the airport the day news of the eCW-Sam’s Club distribution deal broke, allowing me to get the details to you just a couple of hours later and before anyone else. Thanks to eClinicalWorks.

Listening: Keane, sweeping pop-rock, mostly piano and soaring harmonies. If you’ve seen the gazillion ads for the final season of Monk, that’s their song Time to Go playing. Excellent all around.

We’re working on an interview with the CEO of the unnamed HIE vendor that has been the subject of reader speculation. If you have information or questions we can use, send them my way.

The RN Pocket Guide is offered as a $19.99 iPhone version. Nice.

Brigham and Women’s gets an $8 million research grant to strengthen Rwanda’s health centers, including expanding its EMR to cover all patients instead of just those with HIV/AIDS and TB.

I’m sure Kathleen Sebelius is relieved that HIMSS issued a press release supporting her HIPAA security enforcement responsibility change to the Office of Civil Rights, then pitching HIMSS products and its self-nominated involvement in CMS’s work just two paragraphs later.

NHIN vendor MEDNETWorld.com announces that it will offer the Voluntary Universal Healthcare Identifier from Global Patient Identifiers, Inc. (that’s former Gartner guy Barry Hieb and former HIMSS VP Liddy West).

eHealth Ontario makes headlines for financial excess again, although support or criticism seems to follow party lines. One SVP consultant was paid $58,000 plus another $10,000 in expenses for just 21 days of work, later upping the average to $76K per month and billing for his nightly glass of wine. The CEO and board chair stepped down in June over no-bid contracts, of which $16 million were issued. Courtyard Group got $10.5 million of those, billing several of its executives (some of them believed to have political connections) at $393 per hour.

This Information Week article says CIOs should embrace Twitter because it’s “driving significant business value” and not “solely the province of professional goofballs and teenagers.” Case in point: Mayo Clinic, which announced a disease study on Twitter, checked to see who re-Tweeted it, and then e-mailed some of those people copies of the embargoed study so they could blog about it.

RealMed is named the exclusive practice clearinghouse for Adventist Health System.

E-mail me.

HERtalk by Inga

eHealth Ontario names its third new CEO in three months. Rob Devitt is stepping in until the end of the year as the board searches for a permanent CEO.

MedMatica Consulting Associates announces the availability of its HISAssist service line, which offers EMR implementation assistance such as go-live support, on-demand service desk support, and remote analyst and report writing assistance.

TrialX will release an iPhone application that gives doctors and patients the ability to search for various clinical trials. Could be cool to play with next time I’ve self-diagnosed myself with some life-threatening condition.

Durham, NC internist Esther E. Poza, MD joins TSI Healthcare as the company’s chief medical officer, tasked with leading the company’s efforts help physicians adopt EHRs.

The Hospital of Central Connecticut signs an agreement with AMICAS for its PACS, Reach, and RadStream solutions.

Merge Healthcare announces net income of $400,000 for the quarter ending June 30th. This compares to a $18.2 million loss during the same period last year. Second quarter 2009 revenues rose more than 15% to $15.4 million. Merge also announced a new contract with the Center for Diagnostic Imaging, a 51-center network based in Minneapolis. And, Allscripts selects Merge Healthcare’s Cedara WebAccess software application to “image enhance” Allscripts EHR solutions. The Cedara WebAccess portal will provide users a zero-footprint method of distributing medical images and reports.

MedAssets releases its second quarter 2009 earnings report, which included a 37.5% increase in net revenue over 2008. Total revenue was $84.2 million; net income was $2.2 million vs. last year’s $1.6 million loss.

Sac-Osage Hospital (MO) is likely not alone in its financial struggles or its desperate hope to win federal monies. The 47-bed facility, which bagged an 0.065 on the seven-point HIMSS Analytics EMRAM scale, is borrowing $1 million to purchase an EHR, apparently solely to hope to qualify for $3 million in ARRA funding. Says the CEO: “We wouldn’t have gone to an electronic health record at this point and time, because we just don’t have the cash to do it. We’re taking a risk that we’re going to be able to meet the criteria and get some of this stimulus money to help offset the cost … If that doesn’t happen, we’re shutting it down.”

A new KLAS report reiterates the struggles of small critical access hospitals wanting to adopt healthcare technology. Challenges include the limited number of vendors serving that market segment, inadequate functionality, and low CPOE adoption. Cost is also noted as a barrier.

Meanwhile, Randolph Medical Center (AL) completes an 18-month transition to Healthland EMR. To fund the project, the 25-bed hospital received a $1.2 million Critical Access Hospital Health Information Grant from HHS.

DOD introduces an online mental health system for its service members and their families. The TRICARE Assistance Program allows members and families speak via webcam with a licensed counselor at any time.

JPS Health Network (TX) anticipates a net loss in its new fiscal year, yet its proposed budget includes $152 million for an upgrade to existing computer technology. Adding a system-wide EHR accounts for $44 million of the budgeted funds.

An ultrasound tech from Jackson Memorial Healthcare (FL) pleads guilty to selling confidential medical information. The tech was paid $1,000 a month to capture details on patients involved in accidents, gunshot wounds, and stabbings. A third party then sold the information to a lawyer suspected of soliciting patients to file personal-injury claims. Details on at least 26 patients were compromised over a two-year period.

Despite of a weak economy (or because of it?) women continue to spend money on plastic surgery, particularly to enhance their professional marketability in a tight job market. In fact, the American Society of Plastic Surgeons finds that about 3% of working women have already undergone a cosmetic surgery they considered a career investment. Botox use was up 8% in 2008 and the use of hyaluronic acid was up 6%. The volume of tummy tucks and breast implants fell 9%, however. Draw your own conclusions.

I’m lobbying Mr. H to send me on assignment to do some investigative reporting. The Mexican government is offering free health insurance for tourists staying in city hotels. The plan will pay for medical care for any disease or accident, including ambulance service, hospital accommodations, prescriptions drugs, and emergency dental care. Sounds like a perfect time to visit if one needs emergency mammoplasty or the like. The offer comes on the heels of a 50% decline in tourism since the first outbreak of swine flu.

E-mail Inga.

Readers Write 8/4/09

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

HIE: To Be It or To Do It
By Kipp Lassetter, MD

Since the start of the ARRA-generated deliberation over the definition of meaningful use, health information exchange (HIE) has become one of the healthcare industry’s hottest buzz terms. Yet ask what this crucial term means and you may have trouble pinning down a consistent response.

HIE has typically been viewed as a synonym for a regional health information organization (RHIO). However, as the industry has evolved, the real-world use of the term has expanded, making HIE a notoriously gray area. Distinguishing between an HIE as an entity and HIE as an action is key to resolving this confusion.

An HIE-as-RHIO — like CalRHIO or the Delaware Health Information Network (DHIN) — is a regional entity run by a third-party, neutral organization with a fixed governance structure. But in its broader sense, HIE is an action and an objective that applies more broadly within the care community to any hospital, health system, and physician practice pursuing health information exchange.

In the realm of this broader definition of HIE-as-an-action, hospitals, health systems and RHIOs share the common goal of exchanging healthcare information with their affiliated physicians, laboratories, member hospitals, payers, other ancillary service providers, and with patients directly.

In fact, hospitals, health systems and RHIOs can use the same technology to ensure the acquisition of data from disparate systems across dispersed care locations and publish that information to data consumers. With a sufficiently robust HIE technology, these data consumers — including providers, payers, hospitals, and patients — can, in turn, publish information to the network, producing a bi-directional exchange of actionable health information.

It is important to pay attention to this distinction between the concepts of HIE as an entity and HIE as an action, i.e. organizations like RHIOs and the act of exchange itself. If HIE is a requirement for demonstrating meaningful use, does the government declaration refer to HIE as an entity (an HIE organization) or does it refer to the action (the exchange of health information)? Though this may appear to be a purely semantic argument, the distinction becomes relevant when selecting a health information exchange solution.

If a vendor promotes its product as an HIE solution, does that mean the solution provides health information exchange only within the four walls of the hospital? Or is it also capable of connecting to broader state, regional, and/or national health information exchange platforms? The latter aligns best with the government’s current explanation of meaningful use.

Per the federal HIT Policy Committee’s revised recommendations for meaningful use, the capability to exchange health information is required where possible in 2011. Also, significantly, participation in a national HIE is required by 2015. This clarification suggests that hospitals and health systems should ensure that their HIE solution delivers two levels of capabilities — providing data exchange within the organization and then seamlessly connecting to broader HIE platforms.

Kipp Lassetter, MD is the CEO of Medicity.

Office of Civil Rights and HIPAA
By Deborah Peel, MD

 

This could be scary. These are the people who responded to the over 40,000 complaints of privacy violation citizens sent to them by having DOJ investigate and penalize a handful of individuals for identity theft.

On the other hand, most privacy complaints were for disclosures of PHI that do not violate HIPAA because there is nothing much left in it to violate. HIPAA was gutted in 2002 and virtually every player in the healthcare system (all CEs and BAs) was granted the right to use and disclose every American’s PHI without consent for TPO. People are outraged to learn that when others decide to use, disclose, or sell their PHI, it is no longer a privacy violation because the Bush Administration removed the key consumer protection in the HIPAA Privacy Rule.

Once HIPAA was gutted and over 4 million CEs/BAs can decide when to use and disclose our data, there was not much left to protect consumers. Ensuring the security of health databases and software is very critical, but alone, without consumer control over PHI, is not enough to make systems trustworthy.

HIPAA is an exposure rule now; HITECH did not restore the patent’s right of consent at the federal level. But, the right to health privacy still exists in Constitutional and common law, so complaints about privacy violations sent to OCR have to be dealt with via the state and federal court system instead, which is almost impossible for an individual to pursue. HITECH did authorize state AGs to enforce HIPAA, but again, the key enforcement that patients want is the right to control use and disclosures of PHI, which do not violate HIPAA, but do violate medical ethics and Constitutional and common law.

Looks like OCR will now enforce security requirements and will eventually make the rules to ban sales of PHI (they will go through a rulemaking process and propose amendments to HIPAA, so HIPAA will comply with the ban on sales required by HITECH).

Again, OCR has not met the public’s expectation of being the watchdog for their interests.

Deborah Peel, MD is a practicing physician and a board member of Patient Privacy Rights.

The PACS Designer’s Review of Meaningful Use Concepts
By The PACS Designer

With the American Recovery and Reinvestment Act of 2009 (ARRA) allocating funding for Healthcare IT solutions to promote meaningful use of software solutions, TPD thought it would be  good to review how it can be accomplished meaningfully.

We’re all aware of the controversy surrounding CCHIT-certified EMRs  and what they can bring to the adoption of usable software for physicians without significantly impeding their daily work routines. While obtaining the CCHIT certification draws attention for the vendor to their product offerings, it doesn’t guarantee that using their EMR will bring new efficiencies to your practice. The reason is there’s much more to the implementation than the a standalone certified EMR solution.

First, when installing an EMR solution, you need a central database location to store patient data for further clinical use in daily activities. Typically the EMR vendor supplies a data storage location for its software only. This causes another silo to be created with limited functionality ,thus hampering its expansion for other data collection activities (i.e. lab results and other data parameters). If the EMR solution comes with a data port to receive and send data, then some progress is possible for further integration efforts for the practice.

When it comes to measuring meaningful usage, it should be viewed with a broad spectrum of daily activities beyond the clerical function that is present in most EMRs.

One early benefit of an EMR that physicians can utilize is the e-prescribing function. If the EMR software has an export function, you will be able to forward your prescriptions to the appropriate pharmacy, thus eliminating the need for giving the patient a paper copy and/or faxing it for the patient. Also by using electronic forwarding for prescriptions, you are beginning the meaningful use process which should prove that payment for performance is actually happening within the practice.

An example of an e-Prescribing application is "The National ePrescribing Patient Safety Initiative (NEPSI)", which is a joint project of dedicated organizations that each play a unique role in resolving the current crisis in preventable medication errors. Their website, Nationalerx.com, offers physicians a free solution that will help them create an electronic prescription that can be forwarded to a pharmacy. Also, by using such an application, CMS will pay each physician $3K to $5K for proving that meaningful use is taking place within an EMR system.

Some other questions that need answering are:

• Does the EMR solution permit import of lab results through a data port? If not, it should not be viewed as enhancing further meaningful usage.
• Does the EMR solution have export capabilities to send data to a remote storage location for redundancy and secure archiving purposes? If not, what other method will you use to protect valuable patient data parameters that could populate a PHR for the patient, or a Continuity of Care Record (CCR) for another provider?

In summation, the most practical solution should interface with a master database to permit easy creation of electronic prescription capabilities, a data import/export feature, and adequate security protection to insure safe meaningful use concepts.

Finally, while it doesn’t affect the primary care marketplace to any great degree, it is important to note that the trend for the future will be migrating data from numerous silos into a federated architecture to enhance the chances for data sharing, and also help in the review of trends to improve the overall quality of health treatment processes.

Todd Park, athenahealth Co-Founder, Named CTO of HHS

Todd Park, co-founder and board member of athenahealth, has been named CTO of the US Department of Health and Human Services. He will resign from athenahealth’s board on August 10 and will divest his ATHN stock position to meet government service requirements.

Park will report to Deputy HHS Secretary William Corr and will start on the job later this month.

An athenahealth press release quoted him as saying, “My entire professional career has focused on developing technologies and services that can help our health care system work the way it should. I am extremely excited about the opportunity to help the Administration explore and catalyze new ways to improve the health status of the United States through the power of data, technology, and innovation.”

I interviewed him nearly a year ago.

CIO Unplugged – 8/1/09

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

The Lost Art of Mentoring
By Ed Marx

Who taught you life skills? Did anyone coach you in the ways of culture and values? An uncle? Your grandma? The television?

I just watched the movie Gran Torino with Clint Eastwood. In a nutshell, Eastwood attempts to teach the immigrant neighbor boy how to be a man. He starts by teaching Thao the skill of carpentry: how to hold a hammer, and which tools to always have on hand. Then he comically endeavors to educate the kid on manly talk and on how to act like a man. Eastwood verbalizes it, then demonstrates it, and finally observes Thao doing what he’d learned. The mission took time, money, energy, and the forging of a relationship, but it was worth it.

Some of us wish we had that mentoring experience. Speaking from experience, we all need mentors. When I became CIO of a large prestigious organization in my mid-30’s, I was both elated and scared. What accelerated my comfort and success were my mentors. Even with my experience today, I simply can’t grow without a mentor.

Dictionary.com defines mentoring as…an ongoing, planned partnership that focuses on helping a person reach specific goals over a period of time. Unfortunately, the art of mentoring has rarely caught on in the business world, healthcare included. We see this reflected specifically in the graying of existing leadership and the lack of succession planning.

This type of one-on-one interaction between individuals—lost somewhere after the apprenticeships of the pre-industrial age—has been replaced with short-term, focused leadership programs. These programs attempt to turbo-charge management education by cramming years of collective wisdom into a one-week synopsis. For example, the College of Healthcare Information Management Executives (CHIME) has an excellent leadership development program entitled “The CIO Boot Camp” that cannot keep up with the demand for enrollment. One reason for its popularity: it fills the mentoring void in today’s organizations.

Is mentoring beneficial in healthcare? Done right, both formal and informal mentoring programs can promote patient safety and implement clinical process change. Mentoring is key to building alliances within an organization and to ensuring a new generation of trained leaders. Committing to mentor another person is an investment in the long-term success of an organization, a selfless act of service for the sake of the profession and the future of healthcare.

This type of partnering also offers something a person might not get directly from their supervisor: broader experience, organizational perspective, and new skills.

For instance, an information technology professional will benefit greatly from having a CFO or CNO as mentor. Consider the differences between learning the technical aspects of one’s position and career versus learning leadership from someone else in authority, regardless of his background. In other words, an IT person should not enter a mentoring relationship with another IT person, lest their focus becomes overly familiar to their specialization.

Determining the appropriate mentor. Examine your strengths and weaknesses. A professional who lacks a strong clinical background should seek out their CMO/CNO or another well-respected clinician. Conversely, someone who already has a strong clinical background may want to seek out a CFO in order to gain key insights into the healthcare financial world. Seeking such mentors within your own organization offers the advantage of proximity and familiarity. Furthermore, the development of such relationships assists in the overall development of teamwork and connectedness. (Mentors from outside of the organization or healthcare might offer a level of anonymity and broad perspective, but they would lack the context for key elements of discussions.)

Mentoring Programs and Recruiting. Job candidates respond favorably when they understand that the organization cares for their professional development and will enable them to achieve career success. Over time, as the mentoring program becomes a major differentiator in recruitment efforts, your organization will become an employer of choice. Gallop has statistically demonstrated that an organization with a high level of engaged employees significantly outperforms non-engaged workforces in areas including customer satisfaction and financial results—both employee and employer win. Clearly, such programs lead to improved health in the corporate setting.

Mentoring Enables Clinical, Business, and IT Success. Most IT leaders have a clear understanding of their task: to leverage technology to enable clinical and financial success.

Much of this understanding however resides in head knowledge, not in transformative experience. Clinical mentoring, for example, would facilitate the adoption and understanding of what really takes place in the clinical setting. The IT leader gets first-hand experience and sees with their eyes what they had merely heard and read about.

Partnering an IT leader with a CMO or CNO will expose them to new insights and understanding. One academic medical center I know sends its IT leaders on annual short-term mentoring assignments to all of its clinical departments including ED, Radiology, Lab, etc. The CIO began routine rounds with physicians and residents. In each case, the mentor allowed the IT leader to experience the specific clinical care setting, answered questions, and discussed the critical intersection of IT and quality patient care. Each IT leader came back with a new sense of purpose and motivation. They in turn made immediate changes to IT systems and support to help ensure a higher quality of care.

Mentoring serves to develop future IT leaders. Given the limited pool of emerging leaders, mentoring becomes more critical than ever. Identifying and growing talent within our organizations is imperative. Our leadership effectiveness is not so much based on formal education and rigorous reading, but in real life, on-the-job experiences. Partnering up-and-coming IT leaders with members of executive leadership allows for this real life experience, accelerates growth, and ensures critical succession planning.

Restoring the Lost Art. We are the sum of our collective inputs. I credit my success to my mentors. I have been deliberate in this process. On even years, I mentor someone; on odd years, I am mentored. I require each of my direct reports to do the same. I’ve been formally mentored by health system CEO’s, COO’s, CFO’s, CMO’s and hospital Presidents. I have mentored many who have since moved into positions of authority. Check out the many resources available on establishing quality mentoring programs.

Resources. Anyone who posts a comment below or via FaceBook, Twitter, or LinkedIn, I will send to you a simple one page mentoring contract you can use to facilitate your own relationships. I will also send to you a list of “golden nuggets,” the bits of wisdom I have learned from being both a mentee and mentor.

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

Monday Morning Update 8/3/09

Meditech’s Revenue Flat, Earnings Up
Xbox Game Used for Hospital’s Veterans Therapy
Hospital Employees Charged with Selling Patient Information

From Colorado Epic Doc: “Re: Microsoft. Microsoft is taking credit for the improved outcomes at Kaiser in Colorado and claiming that patients are using HealthVault’s platform to communicate with their doctors, when in fact it is Epic that provides the portal. ‘The whole system is build around empowerment of patient, increased collaboration between healthcare professionals and with the patients, pay per quality ad performance. The patients are encouraged to manage their own health, are educated and informed. They have their own health space (called My Health Manager) based on HealthVault platform and can communicate easily with the healthcare team.’” It mentions an EHR without naming Epic, but mostly touts HealthVault and Amalga, which would do next to nothing without a robust EHR as the centerpiece. Microsoft’s folks are good at self-evangelizing.

From Support Tech: “Re: Sage Software. They’re closing the New Smyrna Beach office and laying off the staff. The office had the most senior and experienced MedWare product support teams. Support staff were initially told we would be able to work from home. Only two techs were willing and able to relocate.” Unverified, although someone posted a similar comment on JobVent. But from what you wrote, they didn’t lay you off, you opted not to take a company transfer to a location 2 1/2 hours west. I give Sage credit for offering, as inconvenient as it might be for employees to take them up on it in a terrible Florida housing market. Jobs are hard to find and the Tampa area is nice, so I hope everybody made the decision that was right for them.

In the last poll, I asked HIMSS members about its level of involvement in government relations projects. Participation wasn’t all that high, but 62% said HIMSS should do less of that, 16% said more, and 22% said about the same. New poll to your right: what do you think about the NPfIT project in the UK?

Welcome aboard to brand spankin’ new HIStalk Platinum Sponsor MedAptus. The Boston company, founded by doctors, offers charge capture automation for physician groups; an Inpatient Edition for managing patients and charges by hospital specialists like hospitalists and anesthesiologists; the EMR Edition for physician groups wanting to add robust charge capture to their clinical workflow; and other solutions for hospital-based outpatient clinics, infusion services, and large academic medical centers and IDNs. Lahey Clinic is saving $1 million a year with its coding and compliance tools. Looks like a strong management team and solid financial backers. Thanks, Medaptus, for supporting HIStalk and its readers.

Listening: Sloan, Canadian power pop.

Clinical Architecture has put together a 15-minute narrated screencast on how to work with the NLM’s RXNorm drug nomenclature database.

Several Boston-area companies wanted to distance themselves from the unnamed and supposedly struggling HIE vendor we mentioned earlier without naming them. One was PatientKeeper, who e-mailed to say (a) it’s not them, and (b) they are, in fact, hiring like mad, especially developers.

Wolters Kluwer Health announces a redesign of the user interface and searching tools in the Facts & Comparisons Online for Health Systems drug reference tool.

Meditech just filed its latest 10-Q. Revenue was flat, EPS $0.57 vs. $0.46. Its customers who have reached Stage 6 of the HIMSS Analytics EMRAM are listed here.

The former Fletcher Allen Health Care CFO who tipped off authorities about its fraudulent bookkeeping for a construction project lands a new job with Marin Healthcare District (CA), where he will coordinate a computer implementation run by Affiliated Computer Services. The Fletcher Allen CEO who fired him for refusing to take part got two years in jail for conspiring to defraud a state regulatory agency, joined there by several other Fletcher Allen brass. The CFO was charged with making false statements, a misdemeanor.

More big salaries for supposedly non-profit hospitals: the former CFO of Danbury Hospital was paid $4.7 million in one year, while an HR VP (!!) got $2.1 million. Paging Senator Grassley.

Investors in Maaguzi, a 2005 clinical trials software startup, made less than 20 cents on the dollar when the company was sold last week. Blamed: a poor economy, delays in getting product to market, huge contractor expenses to get the software ready to sell, and lack of access to further financing. There’s a good lesson to be learned: everything looks wonderful on its site, so don’t believe everything you read.

Pondering: Cash for Clunkers was so successful to the point of blowing its entire budget in a week. Maybe that’s the model that should have been used for EMRs. Trade in your old, character-based, non-interoperable system for a new one and get cash back. (Actually, Cash for Clunkers seem to indicate that today’s cars are overpriced by $4,500).

A New York hospital offers a new treatment to veterans of the wars in Iraq and Afghanistan who suffer from post-traumatic stress disorder: Virtual Iraq, a $50,000 simulator created by customizing the $20 Xbox video game Full Spectrum Warrior (now available as a free download, courtesy of the US Army, which paid $5 million toward its development, only to get screwed when developers ignored all the Army’s specs). According to a therapist, “It’s like watching a scary movie over and over again; by the 100th time you see it, you’re not as fearful.”

Microsoft CEO Steve Ballmer says Apple is too expensive, Linux is too cheap, and Windows is just right.

A New York clinic owner is arrested and charged with bribing hospital workers to send a lawyer friend the names of patients involved in auto accidents, who then steered them to the man’s chiropractic and acupuncture clinics. The clinic helped patients exaggerate their injuries so they could file lawsuits, the charges say, while the clinic billed their no-fault insurance carriers for millions in bogus services. The clinic owner has no clinical credentials. Two hospital employees have been charged so far.

E-mail me.

News 7/31/09

Cerner boosts earnings on cost cutting, but misses estimates and issues warnings
FTC pushes Red Flags rule back again
Ad industry worries about increased government oversight of healthcare advertising

From Michael: “Re: trouble. A number of reliable sources are saying that the high visibility HIE vendor in the Boston area is in trouble. The senior engineers have left. Less than a handful of employees can be seen entering the building. Phones are not answered. Customers are bailing.” We guessed at the vendor in question and Inga placed some calls to their offices, all of which went to voice mail. It’s hard to believe that a company in that business would scale back right on the cusp of massive government HIT spending, but I can’t explain why they’re so hard to reach. Lots of their developers are offshore, I’ve heard, so maybe nobody’s left near the phone.

From Perez: “Re: site name. ‘So,’ my wife said walking by, ‘what’s new on your his story website?’ An avid reader of Perez Hilton, she’s always looking for similar vices she can nail me on. ‘It’s HIStalk’, I said. ‘Hiss – like the noise a snake makes. It’s an acronym, not a guy thing.” This got me thinking … what IS the gender ratio of HIStalk readers?  And is it even possible to have a cool name for a site like this that someone like my wife would understand as something more than just another celebrity gossip website?” According to one of the site analyzer tools, the HIStalk audience is 63% male, 37% female. As to names, maybe we need a synonym since I made up HIStalk back in 2003 with the firm belief that I would be the only one reading it, so the name wasn’t too important. I bet some of those marketing people I’m always making fun of could come up with something.

From C.C. Ryder: “Re: Utah’s law requiring patient ID. You’ll note that this is useless — there are no penalties for the provider not asking or the patient not providing.” Right you are, according to the bill’s text.

From Raleigh in Raleigh: “Re: Allscripts. Heard that Allscripts has offloaded their field engineering staff to Decision One. The move will be announced by the end of this week. All the field engineers were told about it on Monday.” Unverified.

From The PACS Designer: “Re: HP printers in sync. TPD got a kick out of some guys who synced a group of printers to produce a clever video of printing coordination.” It’s brilliant.

Summa Health (OH) goes live with Sentillion’s single sign-on and context management, with an eventual rollout to 4,000 caregivers.

A software entrepreneur whose wife was dying of cancer promised her he would develop tools to help home medical companies. He started Ankota.

Nurses at St. Joseph Hospital (CA) accused by administrators of intentionally oversedating ICU patients blame what sounds like Pyxis Consultant narcotics tracking software, claiming it didn’t give a true picture of their activities. One of them admitted that the night crew regularly brought in food, played their guitars, read books, played games, checked eBay, and watched Internet video, but said they gave good care nonetheless.

Cerner reports Q2 results: flat revenue, with obvious cost cutting to earn $0.52 vs. $0.42, missing estimates slightly and warning of lower Q3 earnings and FY09 revenue. Global revenue declined by 21%, but domestic revenue was up 6%. Pat yourself on the back for helping the cause if you’re paying maintenance fees because that revenue was up 13%. From the earnings call: as everybody is finding out, providers are not making capital expenditures and are also waiting until meaningful use is defined (thanks for the slowdown, Uncle Sam). They announced plans to take over more of the IT operations of customers and to sell Lighthouse clinical optimization services. They’re also looking to sell into small hospitals (better be ready to cut the price). This sounds interesting, even though I don’t have a clue what it means: “For the most part, the core of our business runs on several hundred large relationships, across a few thousand individuals. The real consumers that establish the success of our brand are those that rely on our solutions and services as part of their day-to-day role in healthcare … This is only one click away from an even bigger audience, patients. The number jumps to 60 million to 70 million plus interactions across our client base annually … We envision a day when Cerner has more than 120 million relationships, self organizing all with a contextual identity, consuming Blue Sky services to navigate and address their healthcare needs.” Sounds like they’re trying to add some dot-com sexiness or maybe planning to get into some kind of consumer advertising, maybe to avoid talking about Epic. Blue Sky is Cerner’s cloud computing strategy. Neal wasn’t on the call.

The government wants to ban peer-to-peer software from government and contractor computers following reported information leaks and a consultant’s demonstration of how installing LimeWire opens up the My Documents folder for full sharing. LimeWire’s chairman showed up to dispute that claim, stating that no files are shared by default and Office and PDF files aren’t shared at all. Arguments aside, there’s no reason anyone needs LimeWire to do their jobs, so banning it makes perfect sense to me.

The advertising industry is upset that the government is raining on its parade — frowning on consumer drug advertising, considering laws against Internet user tracking, threatening increased FDA oversight of nutritional claims, and flexing control over ad budgets at Chrysler and GM. They’re also worried about potential FDA regulation of health-related searches. But, this advertising CEO had a brilliant comeback: “Advertising is the makeup on the public face of capitalism, for better or for worse, so any tension that people feel about capitalism comes right down to their feelings about advertising. If what happens in business offends them, the advertising gets blamed.”

Computer Weekly points out that the UK’s NPfIT is being used as an example, but not as the government planned. It quotes an Economist article: “They’d wanted the NPfIT to be used by various governments as an exemplar. It is – as a type of scheme to be avoided.” And, quoting another newspaper editorial: “We only have to read current headlines from England to see the unintended consequences of trying to implement a nationalized HIT system … the programme was started in 2002 and implementation began in 2005. It was originally supposed to cost $3.7bn over a three year period of time for full implementation … it  should have been up and running successfully since 2008. As of this month, only very small parts of the NHS NPfIT are working correctly and two of their four main contractors have either been fired or quit. There is now a revised completion date of 2015 and a revised projected cost of $32.9bn – if it is even finished…”

Former MedAssets software VP Wade Wright joins RemitDATA as CTO. The Memphis company sells Web-based tools for practice reimbursement and document management.

The National Library of Medicine’s PubMed search engine will get a Web page makeover later this year, with the goal of improving the way related information is presented when users search.

Buffalo-based Computer Task Group’s profits fell 32% in Q2, but the CEO says the company is getting lots of EMR activity that should help business.

The big Medicare fraud raids this week were made possible by cooperation among the FBI, HHS, DEA, and the Texas Attorney General, but also software that can detect fraud “as it’s happening, using real-time data analysis of Medicare billing records.”

Odd lawsuit: an anesthesiologist claims someone at his previous hospital employer caused him to lose his new job by stealing his credit card and ordering a sex toy under his name, shipping to a female colleague.

HERtalk by Inga

From Richie Simmons: “Re: obesity rates. I think we should start with Congress reducing their obesity rates! While at Healthcare Unbound Conference, I was appalled by the number of obese participants. Surely they see the numbers every day as to why there is now such a market for remote patient monitoring. Check out this related article.” The article, entitled “Overweight and Obese Health Providers Aren’t Taken Seriously”, looks at the problem of overweight providers who struggle when they need to advise a patient to lose weight.  Maybe we need to start some virtual HIStalk weight-loss contest. Perhaps the winner could have his/her picture posted in HIStalk in a speedo/bikini (a la Valerie Bertinelli in People magazine).

From Friend of Minne’s: “Re: new Allscripts partner. Allscripts does have a new partnership with mPayGateway. I’m at the ACE meeting in Orlando and they are showing off the new product, called Patient Payment Assurance. It’s already in GA for the Tiger product and will soon be available for the other product lines.”

Speaking of the Allscripts Client Experience (ACE), the company announces a record 2,700 registrants for the event, which includes both Allscripts customers and the former Misys clients.

Last week we noted that Cardinal Health hired the former Motorola exec Patricia Morrison as CIO. Interestingly, Morrison sits on the board of SPSS, the company IBM just announced it was buying.

Genesis Physicians Group, a 1,400 member physician organization in Dallas, has secured Covisint to provide its cloud-based healthcare platform. The solution will provide physicians a centralized view and SSO access to such applications as e-prescribing, EMRs, and referral management.

The FTC again pushes back the deadline to enforce the “red flags” rule, moving it from August 1 to November 1 to provide additional resources and guidance to businesses.

St. Elizabeth Healthcare (KY) announces plans to roll out Epic throughout its entire system, which includes 31 primary care offices. Beginning in September, St. Elizabeth’s will  introduce EpicCare Ambulatory to its nearly 1,000 physicians. St. Elizabeth’s is also adding Resolute Hospital Billing, EpicCare Inpatient, Prelude Registration and Cadence Scheduling.

Legacy Hospital Partners (TX) announces four new management team members, including former PHNS COO Lawrence V. Schunder as CIO and SVP of business processes.

Crittenden Regional Hospital selects Healthcare Management Systems to supply financial and ancillary clinical HIT solutions, planning to go live in October.

The University of Miami UM-JMH Center for Pain Safety deploys a hand hygiene compliance pilot project that uses IR-RF sensors in soap dispensing units. The IR-RF devices read staff ID badges and monitor the location and timing of hand-washing events. Dynamic Computer Corporation and Versus Technology provided the technology for the project, which I am going to propose to a couple of my favorite dive restaurants.

Affiliated Computer Services promotes Connie Harvey to group president of business process solutions.

Did we really need a scientific study to figure this out?  A PhD surveyed 1,400 adults and concludes that taking time for leisure activities helps people function better physically and mentally. And, the more time you spend doing different enjoyable activities, the better one’s health tends to be. I’m thinking about heading to a beach to confirm if this is true.

Here is a brilliant new business model for healthcare. An Iowa dentist gives up his traditional practice and sets up shop at Iowa 80 Truck Stop (the world’s largest truck stop). About 35,000 people a week stop at Iowa 80 and Dr. Thomas P. Roemer correctly guessed he could stay busy helping truckers who needed immediate dental care (apparently he does a lot of extractions.) Some days he doesn’t see any patients; others he sees as many as 15.  I bet it’s only a matter of time until some enterprising doctor follows suit.

E-mail me.

News 7/29/09

McKesson beats earnings estimates on flat revenue
Confirmed: VA puts Cerner LIS project on hold 
Varian acquisition does not include Varian Medical Systems (correction below)

 

From The Alchemist: “Re: shocked, amazed, and totally blindsided.” IBM announces that it will acquire statistical and data mining software vendor SPSS for $1.2 billion in cash. Everyone who has taken Stats 101 in the last few years has almost certainly bought a copy of one of their products. IBM is paying 4x annual revenue and 33x annual net income, which seems way too much to a cheap seater like me.

From A Reader: “Re: Cedars-Sinai. Went live on schedule across the house with EpicRx (Epic pharmacy module) this weekend, after the activation of all Epic revenue cycle modules (Cadence, Prelude, Resolute, and Coding/Abstracting) in March. Next Epic clinical roll-out will be in the emergency dept (all disciplines) plus inpatient nursing and clerk order entry in the fall.”

From Captain Hook: “Re: Epic. I represent a hospital who recently selected Epic to replace Meditech after more than 20 years. Meditech let their product languish and chose to take money out of the business instead of investing in their product. The choices were clear — stay with Meditech and share in that stagnation or seek a solution that created a connected, integrated care environment, which Epic does. Does it cost more than Meditech? You bet. We are well on our way to creating that integrated care community (including patients) and would have been nowhere near it with Meditech.”

From Tony Romano: “Re: Google. A hospital where I used to work was looking for a CMS to run our intranet and to search documents. Proposals ran into the tens of thousands of dollars and required an IT learning curve. Enter Google Appliance for $3K – searchable documents from the storage servers already set up.” I love Google Search Appliance and it truly mystifies me why most hospitals don’t have it. Why work to set up a complicated folder structure, permissions, and document naming convention when you can just let Google crawl the darned things and offer a full-text search? Everybody has tons of policies, paper order sets, forms, meeting minutes, lists, etc., but nobody can ever find them easily. Google Mini handles 50,000 documents for $2,990 for two years.

I got both “like it/don’t like it” comments about putting the biggest news stories first, mostly because of appearance. One person said they didn’t want me picking the top stories and instead suggested tagging every item in some way, but that’s beyond the scope of this little makeover. So, here’s the compromise, as you’ve already seen. I’ll put the headlines of what I think are the main news items first, then go right into the usual format.

McKesson announces Q1 numbers: flat revenues, EPS $1.06 vs. $0.83, handily beating earnings estimates. The company raised its full-year outlook.

Meddius announces the launch of SecureTransport, an SSL-based connectivity platform that allows healthcare networks to exchange information over a public network without using site-to-site VPNs.

Stamford Hospital (CT) buys 100 licenses for eClinicalWorks. The hospital will use EHR, PM, the patient portal, the electronic health exchange, the Enterprise Business Optimizer, and eClinicalMobile.

I don’t even know where to begin with the spelling and grammar errors in this CIO job posting. Other than bizarre upper case and underlining, maybe the zero-for-two spelling of the two vendors mentioned: “Siemans” and “GE Contricity.” Or, maybe they’ve had a bad experience with GE and made up their own derogatory name.

Confirmed in a Modern Healthcare story by Joe Conn: one of the halted VA projects is the one that would have replaced VistA’s LIS with Cerner. That could be a bump in the road or it could be a second chance to reevaluate what a lot of people (me being one) thought was an ill-advised push toward commercial software.

Healthcare Growth Partners releases its Q2 HIT industry transaction report (warning: PDF).

St. Barnabas Hospital (NY) chooses Eclipsys Sunrise Acute Care, hoping for a quick implementation that will meet meaningful use requirements.

I Google “histalk” a couple of times a year just to see who’s saying what, so I was happy to find a PowerPoint PDF from John Lillie, interface supervisor at SISU Medical Systems (it’s a non-profit IT resource sharing organization in Duluth, MN). In his slide urging attendees to keep up with their HIT education, he mentioned, in order, the State of Minnesota, HIStalk, HIMSS, AMDIS, and HITSP. Thanks, John. I need to buy him a beer or something.

Inga did a great HIStalk Practice interview with Christoph Diasio, a pediatrician who likes technology, but not necessarily EHRs that take more of his time. “That’s just not enough money for it to be worth it for me to do this. This is just a major gift to the EMR industry and it’s the guy who’s head of the VA said, ‘We’ve basically had major market failure,’ and that’s why you’re having to pay people to adopt EMRs that slow them down. A one-time payment or a couple years’ payment is just not going to be enough to convince me that I should do something that doesn’t make sense to me.”

A New Zealand newspaper article says the growth of integration technology vendor Orion Health has slowed from the predicted 20-30%, much of that because of hospital conditions in the US. Says the CEO, “Even though there is going to be a huge investment over the next three years, in the last six months there have been hospitals that have been struggling.”

Speaking of Orion Health, estimates for an EHR for New Zealand are $32-$96 million US if you believe the government or $300 million if you believe Orion’s CEO. He mostly seems unhappy at the prospect of competing with US vendors for the business, saying the health boards seem “pretty keen on getting a big American product in here … If they are New Zealand-supplied solutions, we can take that intellectual property and can sell it to the rest of the world.”

Agfa’s Q2 numbers: revenue down 12.9%, earnings up 2.7%. Healthcare sales dropped because customers delayed their IT investments.

Inga and I have been working hard to bring you some interesting interviews, several of which are yet to come. Know someone we should talk to, preferably on the non-vendor side of the house so that nobody claims bias?

A proposed e-health plan for Australia recommends that the government steer clear of a “big procurement” free market approach and instead create standards and technology goals that developers can follow, with e-prescribing being the highest priority.

Agilent Technologies will acquire rival medical instrument maker Varian for $1.5 billion. It looks like most of the rags missed the HIT connection that we hospital types got immediately: that acquisition includes Varian’s widely used oncology EMR, ARIA (formerly OpTx, acquired by Varian in 2004). Agilent, you may recall, was a 1999 spinoff of Hewlett-Packard’s medical products business by then-CEO Carly Fiorina in her first year with the company. CORRECTION: some of the initial media reports were incorrect and have been updated — thanks to the reader who pointed out that Varian Medical Systems, spun off in 1999, is not part of the acquisition. Agilent is buying only Varian, Inc., which shares its headquarters with Varian Medical Systems. Oddly enough, Varian Medical uses the domain varian.com, which didn’t help my confusion. Also not involved in the deal is a third spinoff, Varian Semiconductor Equipment Associates. So, no change for ARIA customers.

IBM and Nuance announce an expansion of their joint agreement to accelerate the use of advanced speech recognition in several industries, one of them being healthcare and life sciences. IBM still has ViaVoice as far as I can tell (one of the last consumer-grade competitors to Dragon Naturally Speaking), but Nuance even sells that under some kind of exclusive distribution agreement.

E-mail me.

HERtalk by Inga

From St. Pauli’s Girl: “Re: new Allscripts partner. I hear that Allscripts has signed on with another strategic partner, this time mPay Gateway.” Unconfirmed, but sounds like it would be a good fit. mPay Gateway offers a Web-based credit card payment system that helps practices calculate and collect patient monies at the time of service.

QuadraMed launches Quantim Coding Simulator, its ICD-10 compliant encoder training tool. The new tool is designed to enable coders to gain proficiency in using ICD-10-CD/ICD-10-PCS code sets. QuadraMed is showing it off at this week’s AHIMA Assembly on Education Symposium in Las Vegas.

Adena Health System (OH) selects Rhapsody Integration Engine to improve access to and facilitate messaging with the hospital’s Meditech system.

Orlando Health expands its use of MedeAnalytics software with the addition of Patient Access Services. The new tool will facilitate front-end patient workflow, including helping staff to estimate patient payment obligations.

RelayHealth signs a deal with VHA to supply its RevRunner financial clearance services. The agreement also establishes revenue management educational opportunities and preferential pricing for VHA’s members.

I mentioned in HIStalkPractice yesterday that obesity rates are rising rapidly and one in four Americans is considered obese. The medical costs for an obese person is $1,492 per year more than normal weight people and 9% of all medical spending is attributed to obesity care. Care for obesity-related conditions is costing us $147 billion a year. Since Congress seems interested in becoming involved in every other part of our life, how about they come up with a plan to give some money for everyone who is not obese and tax those that are? OK, I see all sorts of flaws in the plan, but really, when you consider how much we spend for healthcare compared to other countries and our 30th ranking for life expectancy, shouldn’t we be doing more to “fix” obesity?

Meanwhile, if you are considering bariatric surgery, refer to HealthGrades’ new report identifying the 88 best performing hospitals for the procedure. Patients treated at one of the top hospitals have, on average, a 67% lower chance of serious complications than those treated at poorly rated hospitals.

Speaking of HealthGrades, the company reported Q2 profits of $1.73 million, up from $1.21 million for the same quarter last year. HealthGrades is expecting full year revenues of $50 million, which is a 25% increase over 2008.

Arizona’s University Medical Center contracts with MEDSEEK to redesign its consumer-facing Web portal.

Advocate Health Care (IL) signs a three-year extension for its license to IntraNexus’ SAPPHIRE Patient Financial Management software suite. The extension covers all nine Advocate hospitals and continues a 16-year business relationship.

I love pop culture, but I am officially sick of hearing about Michael Jackson, his probable drug problems, and his likely negligent doctor(s). There. I feel better. OK, now back to pondering what it will take to get an invite to drink a beer at the White House.

In a report to the Board of Trustees for Phelps County Regional Medical Center (MO), CIO David Dowdy reports the hospital’s EMR has helped reduce mortality rates by 15%. Phelps has achieved Stage 6 EMR adoption with its Meditech product.

KLAS releases a new report that concludes hospitals are considering vendor-neutral solutions for archiving and accessing medical images in order to avoid being locked in to closed, proprietary software.

Another KLAS reports suggests that the release of Medtech 6.0 will provide an improved user interface and easier navigation, but many users may struggle to achieve full CPOE adoption. The biggest hurdle for most hospitals will be covering the costs associated with implementation and hardware and infrastructure upgrades.

And, Hilo Medical Center (HI) engages Healthcare Informatics Associates in a multi-year contract to implement MEDITECH 6.0 across its East Hawaii Region facilities.

E-mail Inga.

HIStalk Interviews Loren Leidheiser DO, Chairman & Director, Department of Emergency Medicine, Mount Carmel St. Ann’s Hospital, Westerville, OH

What made you decide to use speech recognition instead of the usual mouse and keyboard? 

I think speech recognition offers a lot of efficiency both financially and also in time savings. The accuracy is outstanding. It allows you to perform chart documentation and navigation through an electronic medical record much more effectively than without it. That is so much better than point and click with a mouse and a traditional keyboard.

What did you use before? 

I’m an emergency physician. We would document 100% of our charts with traditional dictation. That was a very, very costly process. It cost us probably close to half a million dollars a year for an emergency department that saw about 70,000 patient visits. 

The accuracy wasn’t all that good. Our traditional dictation would be farmed out to transcriptionists over in India. When it came back, it really needed to be cleaned up.

We went with the Allscripts emergency medicine product, which was a dynamite electronic medical record. The problem we had was that even the best-in-breed still left a lot to be desired with being able to capture the unique elements of the history in physical examination. And really, the point-and-click, drop-down menus were clunky at best in terms of telling the story. Even the navigation through the software was somewhat cumbersome.

Speech recognition was a natural solution to a lot of the shortcomings of electronic medical records and also with traditional dictation. Your startup costs are reasonable. The training time is very short. Even physicians, allied health professionals, nursing staff — the training time and complexity is so minimal that it’s certainly not a barrier. The cost savings once the initial costs are incurred — really, your investment just pays off over and over and over.

How hard was it to get Dragon to work with the Allscripts product and to get the accuracy up to par?

The Dragon product runs in the background and then it populates data elements right into the electronic medical record. I can tell you, from day one, we’ve had great success using Dragon with Allscripts.

We started back with Dragon 6.0, which was really a product that needed a lot of improvement. That improvement has been seen. In other words, right now, the 10.0 version is absolutely dynamite, for lack of a better way to put it.

Allscripts recognized how good Dragon was and actually started incorporating it with their software, making some special considerations with regard to being able to use speech recognition to navigate through their software, and actually started marketing the Allscripts product with Dragon as a bundled offering to hospitals’ emergency departments.

The onset of the roaming feature, which allows a group of people to save their voice files on a central server and then pull them into any application that you’re using in a given geographical area, has been huge. What a wonderful addition. That has worked well with the Allscripts product as well.

What would you say the main benefits have been and what were some of the drawbacks?

I think one of the main benefits is that you can tell the main story uniquely in terms of documenting a history and physical examination, review of systems, medical decision-making. All those functions that are key, absolutely essential to a physician and an allied health professional, and by that I mean a nurse practitioner or a physician’s assistant.

Dragon offers a way to do that that is so much more efficient and accurate than drop-down menus and with traditional typing. You just can’t achieve the level of accuracy by other means. So I think the cost savings is huge.

The drawback I see is that there have been criticisms about the accuracy, but as I said, what I’ve seen is that the accuracy just keeps getting better and the ability to meet the end user’s expectations has been a commitment that has been a work in process that has been achieved. I’ve used the product for many years, and I put on the headset — I’m a traditional headset user — and for me, it’s just part of the process of being a physician, just like putting a stethoscope on, a normal part of my evaluation of a patient.

I think some people have found that there have been occasional problems with recognition, but there have been problems with traditional dictation being transcribed when it came back with errors. You have to look at it and skim it to make sure it’s OK.

The speed is not a downside. The speed and accuracy actually improve as you talk faster. The recognition is actually improved when you do that. If you slow down, then there are problems.

So I wonder if some of the criticisms is that people don’t know how to use the product. In our institution, we’ve got about 25 physicians that use the product and probably about 15 or 18 mid-level providers. Part of what I do is say, "OK, let’s sit down together and let me show you how I use it." The macro feature where you can store a letter or a pre-set amount of text, then simply use a voice command to spit out, let’s say, a normal physical examination, is huge. That has been a wonderful feature as well. It’s all those little shortcuts that you can really use to improve things. 

These things are easy to use. To navigate through software is very easy. It’s very intuitive. Nuance just continues to make it better and more logical. 

What do you think benefits are, if any, to patients?

I think the benefit to the patients is that it more accurately reflects the medical encounter with the patient. I can be more efficient in my order entry in the medical record. I can do that much more quickly with Dragon. I can document more accurately the historical elements of what’s going on. In other words, tell the story better.

I can reflect what has actually happened in the emergency department by very efficiently using voice recognition to capture a decision or discussion of the risks, benefits, and alternatives with the patient. I can do it at a lower cost as a result of voice recognition compared to traditional dictation, or as a consequence of the increased cost that I incur spending 14 to 18 cents a line for traditional dictation.

Do you feel that, in all the meaningful use discussion, that the use of speech recognition is going to be a help or a hindrance?

I’m very biased on that and I’ve said this for years. When I first started using Dragon back long ago, I thought traditional dictation is going to go away. As much as I hate to see automation taking human jobs, I just don’t think we can surpass the accuracy and efficiency of voice recognition.

I think it’s only going to become more pervasive, in at least the healthcare industry, as we need to have short turnaround times on the documentation in a hospital setting. Now maybe an office setting is different, but the healthcare industry changes and evolving. Already, if you look at what’s going on in the government, we’re trying to cut costs and trying to take money out of the budget for healthcare, in Medicaid and Medicare. This is going to be yet another way we can be more efficient in how we operate.

It’s not going to be just healthcare, either. I think you’re already seeing that with the phone lines, where continued use and development of voice recognition just makes sense. I don’t think it’s going to go away, I can tell you that.

So why do you think so few hospital-based doctors use speech recognition?

You know, I wonder the same thing, because I’ve been using it for probably eight years. I think I’ve been patient with it, I believe in it, and I’ve seen it work. I see it in my own practice.

I don’t know if it’s an issue where doctors just don’t have the energy, or maybe they define themselves as needing to focus on having to diagnose appendicitis, but think they don’t have to focus on the things that are more business-related. I don’t know. I’m in Columbus Ohio, and I’ve talked actually to several other practices who had an initial bad experience with voice recognition, then abandoned the idea and never came back to it.

But I think it’s like most things that we see. With time, the technology improves, the accuracy improves, and all of a sudden you find that the product is now one that really works. And maybe it’s just that I’ve been patient and also persistent. But I also thought that it was going to allow us as a group to reduce our cost of doing business and be more efficient and that has been the case.

Frankly, I think in large part that voice recognition has allowed us to pay for electronic medical record in two and a half years, based on the cost savings that we’ve achieved by eliminating traditional dictation, because half a million dollars a year was eliminated as a result of two things: voice recognition and the electronic medical record. That just continues to accrue year after year after year.

But in terms of why other people haven’t seen the success? I don’t know. Maybe we have, where I practice, a very wonderful support system in the IT department, and a very open-minded, progressive hospital administration that says, "Hey, we have the same vision that you have, and we see that this is going to work and we appreciate the fact that you’re going down this road to develop this."

So we’ve had a lot of support. And when it came to me saying, "Hey, I’d like to upgrade Dragon to the next level," they said, "OK, here’s the money, we’ll make that happen."

Our sister group wanted to have $300 handheld microphones, with a built-in mouse and everything, whereas I was happy with a plug-in headset that cost $15. And I think I get better speech recognition than they get for the $300 handheld mic. But the fact is, we’ve had support from administration who says, "Yeah, go ahead, we’ll support both. You can use the $300 handheld mic and we’ll also pay for the $15 headset." 

Maybe it is that doctors don’t want to wear headsets. You look like air traffic control person. But you know what, if it gives me the desired results better, then I’m going to wear the headset, because it frees up my hands to use the keyboard and the mouse. You know it’s not easy.

I think we want instant gratification. We want a product that, boom, just works out the box. But the fact is that the effort and the time is not that great, and really, if they give it a little bit of time they find that this really is everything that it’s said to be.

QuadraMed Names Duncan James CEO

QuadraMed announced this morning that Duncan W. James will become CEO of the company when it files its 10-Q report next week. He succeeds interim president and CEO James Peebles.

James was previously with McKesson Provider Technologies, where he was group president for Health Systems Solutions from 2000-2009. Previously, he was senior VP for consulting firm Scient and VP of marketing and product management with McKesson.

Monday Morning Update 7/27/09

Top Stories

1. Enforcement of the Red Flags Rule starts this week. Providers who extend or facilitate customer credit (even doing nothing more than mailing bills after services are rendered, some attorneys have interpreted) are required to check patient ID to prevent identify theft, have a policy on handling questionable patient documents and patient complaints, and check to see that patients who claim insurance have proof.
2. Bankrupt OB systems vendor LMS Medical Systems sells its its assets to the Canadian subsidiary of PeriGen for $3.5 million. McKesson bought the IP rights to CALM OB in April, relabeling the product Horizon Perinatal Care, but LMS supposedly kept the rights to support McKesson’s customers and to sell the product outside McKesson’s customer base. Perigen, renamed from E&C Medical Intelligence in April of this year, also sells OB risk reduction software.
3. David Blumenthal of ONCHIT says he doesn’t have an opinion on whether health systems should comply with FISMA, the security guidelines for federal computer systems, to share information with federal agencies.

The Top Stories thing above is an experiment that a couple of readers asked for, putting the stories that I think are most important at the top. I like the concept, but I worry that people will infer that everything else is trivial, which it isn’t (I wouldn’t put it on HIStalk if I didn’t think it was important). What do you think, good idea or too enabling of skimmers who will miss important information? I will say that I get e-mails all the time from people who say, “Wow, I just read this and you should put it on HIStalk” even though I have already covered it in detail, so I already worry that some readers are missing good information.

From Dan: “Re: EMR powered by MS Office.” It’s CCHIT-certified gloStream, which we’ve mentioned in HIStalk Practice (in fact, I see that item is listed on the company’s News page, so that’s pretty cool). The user interface is Office-based (which I wouldn’t necessarily find advantageous if it uses Office 2007’s ribbon bar, which I spend way too much time whining about instead of just learning to love it or downloading this free utility to bring back the old menus).

From Otis Miman: “Re: Epic. Meditech hospitals in some areas are getting pressure to upgrade to Epic since physicians are using Epic in their practices. This seems like a tremendous cost burden to healthcare – to throw out a a cost-effective, integrated solution instead of a more expensive, non-complete HCIS and non-integrated solution. Having little or no competition in the marketplace is not a good thing.” Both Meditech and Epic, having sprung from related loins, have the same tendency to not want to play well with others, probably more so than any other HIT vendors. Epic is simply capitalizing on a stagnant HIT market that isn’t putting up much of a fight, although I think hospitals would be hard pressed to get ROI on the cost difference between Meditech and Epic (not many Prius owners are candidates to move to a Cadillac Escalade, not to detract from either system). Every vendor has a showcase site or two that has done great things with their system. They also have some real whiner customers who blame the vendor and vow to buy again from someone else, only to find that their failure cloud follows them. Which category a given site falls into is much more a function of their own abilities than those of their vendors. Anyone who is seriously considering buying Epic who hasn’t been on their current system for at least 6-8 years is demonstrating that they have no idea what they are doing (why didn’t they buy Epic in the first place if that’s what they wanted?) Big-name hospitals choose Epic mostly because all other big hospitals choose Epic, just like they used to buy Cerner and, before that, SMS. Theoretically, the march of the lemmings will eventually end since the market is ripe for new entrants, but so far vendors are just handing their customers over to Epic with heads hung. I don’t blame vendors for selling what customers demand – I blame customers for not demanding better, cheaper, and more open systems (and for being too easily influenced by what everybody else is doing).

From Looking for Answers: “Re: Cerner. I hear the Cerner PETA person wasn’t disgruntled, just looking to score points with his babe — though he does enjoy a good steak! ;-)” Reason enough, I say. 

From Eclipsys Watcher: “Re: Eclipsys. I’m hearing rumors of major organizational changes in the next several weeks with more layoffs, etc.” That’s usually a safe bet with most vendors these days, but especially unsurprising since a new Eclipsys CEO was brought in, presumably to make changes. And, while the excuses have changed, company performance hasn’t – shares are worth less now than 10 years ago and its limited clinical product line which, despite having CPOE and documentation that are among the best, still lags way way behind in new sales to Epic, Cerner, and maybe even McKesson. A strong CPOE and documentation system, integrated pharmacy, industry-leading EPSi, and what used to be a strong consulting practice – if none of that translates into sales and then financial results, you have to blame the corner office people. I haven’t been a big fan of most of the company’s management team once Harvey Wilson stopped being actively involved, but most of the folks I knew have been replaced, so maybe the new blood can shake the company out of its doldrums. I can’t decide whether getting into the practice EMR business is a logical extension or a distraction for them.

From The PACS Designer: “Re: Google Wave. As a software developer, TPD gets to see new and interesting applications in their early concept development stage. Google has an upcoming release of an advanced collaboration tool that combines e-mail with instant messaging and many other features in an application called Google Wave. It could be use in healthcare to improve communication amongst numerous caregivers and departments.” According to the demo, it was developed by the Google Maps people. Google has so darned many Web tools out there that I bet someone could write some cool hospital apps purely by mash-up. If I were Medsphere trying to get a foothold against legacy vendors, I’d look at that as an inexpensive way to interject some cool factor. An internal messaging app based on Gmail Chat? An Intranet based on Sites? Documentation via Forms? Social networking with Orkut or Wave? Dumping resource-intensive internal e-mail in favor of Gmail? All possible, all useful to customers, and all with a free backbone for vendors to use for their product extensions.

Listening: In This Moment, a female-led metal band now on the Warped Tour.

Jonathan Bush on Fortune, referring to Epic: “The Cleveland Clinic has software that they had to pay $200 million to get. It was written in MUMPS in 1974. There is nobody left alive who can write MUMPS any more. That’s the model … the curve of innovation, the disruptive technology engine in healthcare is broken.”

I’m a Tiger Direct junkie, but this deal is stunning even to me: Dragon Naturally Speaking 10 Preferred with a headset for $49.99 (it’s $118 on Amazon). The rebate ends 7/31. Amazon has a lot of reviews, the gist of which seem to suggest that some users will struggle to get it up and running, but those who do find it pretty amazing. It’s heartening to read the reviews of people who can’t type because of nerve disease, wrist problems, etc. for whom DNS is their lifeline. (Note: this version isn’t for use with EMRs – you would want to look at DNS Medical for that.) I keep thinking that maybe I’d enjoy dictating HIStalk, so I may get it. I know some writers who record interviews, then play them back into headphones while repeating what their subject says into Dragon so it can “transcribe”.

AT&T says the $300 subsidy it pays for each new iPhone it sells hurt its most recent quarterly numbers, but will eventually pay off in lower churn for its exclusive service. The carrier activated 2.4 million iPhones in Q2, many of them because of the new 3G S model.

Cardinal Health names Patricia Morrison as CIO after its spinoff of CareFusion and the Friday announcement that CIO Jody Davids was quitting. The new CIO has no healthcare experience, having been CIO at Motorola and Office Depot. That brings up an interesting argument: should hospitals do what Cardinal did and bring in IT leadership from another industry that’s more technologically advanced than healthcare, or is it better to get healthcare experience even though it’s a technologically backward sector? Who would you pick for CIO: a geek doctor who thinks 10-year-old, off-the-rack apps are cool or someone who knows nothing about patients, but who has vast experience with e-commerce, state-of-the-art infrastructure, and self-developed technology as a strategic differentiator? I waffle on that, I admit.

The results of my poll on CHIME’s new CHCIO credential: 9% think it’s a good way for CIOs to demonstrate competency, 13% say it’s a vanity credential, 33% say it has no relationship with competency, and 45% say it’s just another income source for CHIME (so, that’s 91% against). New poll to your right, for HIMSS members: should it devote fewer resources to Government Relations, more, or about the same?

I continue to be impressed with EHRtv. Check out its EMR Matters newcast. I don’t know how they get such dazzling video and audio quality with fast streaming, but I’ve never seen anything like it. There’s also an interview with Allscripts CEO Glen Tullman a few weeks ago that I hadn’t seen. I think it’s brilliant, much more interesting than sticking a $100 camcorder in someone’s face and asking a few trite questions.

Bill Stead of Vanderbilt and Informatics Corporation of America CEO Zegiestowsky talk about interoperability in this article. Here’s what Bill had to say about Vandy’s StarChart, now commercialized by ICA: “The simple idea was to assemble information from any source and to use computational algorithms to turn it into something that can be used. It has no boundaries and it’s analogous to what Google has done. Google answers questions by crawling over any number of sources of information — each of which are used for a single purpose but none having the original purpose of answering your question.” Bill’s the man, I say.

Housekeeping stuff: put your e-mail in the Subscribe to Updates box to your right (like 4,474 of your peers and despised competitors have done) so that you’re among the first to know when I write something new (remember Todd Cozzens of Picis at the HIStalk reception at HIMSS, asking for a show of hands of how many people run to the PC to read it as soon as the e-mail comes? Several CEOs raised theirs). It’s spam-free since I don’t use it for anything else and don’t make it available to vendors even though I get asked all the time. The Search HIStalk box lets you dig through the six-plus years of HIStalk to find whatever tickles your fancy: your name, your employer, or a vendor. Click the disturbingly green box to report a rumor to me, which I always enjoy. The links at the top of the page let you go do HIStalk Discussion, Industry Events (the HIStalk calendar), and also the Archives links to previous articles. You can e-mail me for anything else (interview ideas, guest articles, volunteering to write for HIStalk, etc.) Thanks to you for reading and to HIStalk’s sponsors for bringing it to you.

The HIMSS conference will go back to New Orleans in 2013. I’m surprised since I thought HIMSS was sticking with Orlando, Atlanta, and Las Vegas (which never seemed to pan out, actually). I figured the 2007 conference in New Orleans was strictly a one-time charitable, post-Katrina offering. I didn’t think it was all that great, so I can’t say I’m elated at the news (I miss San Diego and maybe even Dallas, which was at least cheap and had barbeque). Now that we’ve had a snowy conference in Chicago to keep attendees hanging around the exhibit hall, maybe HIMSS should have cut a deal with Detroit, Cleveland, or Pittsburgh, all of which could surely use the economic boost.

Bill Gates, speaking from India, says the American healthcare model is flawed because the government won’t adopt a national identity card, doctors aren’t allowed to share electronic medical records (?), and virtual visits are banned (?) He also predicts that cell phones will be used to test for diseases and that voice recognition will be big (maybe he got the Tiger Direct e-mail too).

The LA coroner’s office is investigating security breaches in which Michael Jackson’s death certificate was viewed “hundreds of times” by employees, some of whom were said to have printed it. They had blocked access to all but the highest-ranking employees, but later found a flaw that could have let others in. The chief coroner investigator says he thinks such violations are only internal policy violations and didn’t break laws, but my understanding that HIPAA is still in effect even when the patient is dead (although maybe coroner’s records don’t count since they become public documents when completed anyway).

HITSP’s Privacy and Security Workgroup wants EMR standards that include encryption, access controls, and audits. Deb Peel isn’t happy with their prioritization of patient consent management, which isn’t scheduled until 2015 and which she calls “foxes designing the hen coops.”

Bad news for hospitals: if CIT Group goes into bankruptcy, that could be one fewer line-of-credit vendor willing to loan money based on receivables.

Australia-based medical device vendor Applied Physiology gets $5 million in financing to launch its Navigator circulation guidance system, which turns information from cardiac monitors into graphical treatment guidance for doctors.

CPSI announces Q2 numbers: revenue up 11.2%, EPS $0.32 vs. $0.28, missing expectations for both.

The City of Los Angeles submits a plan to City Council to replace outdated e-mail technology (“the slowest, most inefficient, crash-prone e-mail system in the history of mankind”) with Google Docs. 

Odd lawsuit: an AIDS advocacy group sues the LA County Health Department, alleging that it isn’t doing enough to stop the spread of disease among porn stars.

E-mail me.

News 7/24/09

From Org Insider: “Re: HIMSS. I was told HIMSS may have exceeded the 20% lobbying limit allowed by Congress and the IRS and is trying to rearrange its financials to satisfy the requirements so its 501(c)3 status won’t be jeopardized.” Unverified, but per the Webex I mentioned below, it doesn’t sound like that’s the case. If anyone has firm information, send it over, but I would be very surprised if this is true.

Inga verified with a spokesperson that Elekta, Sweden-based parent company of IMPAC Software, laid off 100 employees as BadNoodle said earlier this week. She said it happened at the beginning of the fiscal year, which would go back to May or June, I think. They have 3,000 employees and they didn’t say where the cuts fell.

Six-hospital, 1,260-bed Kettering Health Network (OH) will spend over $50 million on its just-announced EMR project, buying from — who else? — Epic.

Electronic drug detailing vendor Physicians Interactive acquires Skyscape, which sells online medical references for portable devices.

Christopher Pike is named VP/CIO of Health Alliance Plan (MI).

The HIMSS Webex for staff about its governmental relations activities didn’t say too much. HIMSS does not employ a registered lobbyist, but estimates that it spends 4-8% of member dues on lobbying. It says it started up its government relations group in 1998 because of member concerns about HIPAA. It began offering government relations services to “sister organizations” in 2008, which seems odd (CHIME? AHIMA? They didn’t say). Mentioned: Institute for e-Health Policy, run from the HIMSS Foundation instead of the main organization.

Two of the seven out-of-cluster NHS trusts stay on with iSoft rather than switching to a local implementation of Cerner Millennium, saying it was too risky and expensive. “The implementations of CM [Cerner Millennium] in London have had a damaging effect on trusts, which has led to the creation of a new deployment model, which has yet to be tested on a deployment.”

And in Australia, Lismore Base Hospital officials claim that Cerner SurgiNet has compromised patient safety such that “negative outcomes, including death, will inevitably result from the continuing use of this system.”

If  Epic, the NHS, and bad Australian publicity weren’t problems enough, Cerner has now incurred the wrath of PETA, which is all over it for using glue traps to inhumanely kill mice on its campus. Cerner’s director of properties, PETA says, told its people that “their use of glue traps was no one else’s business but theirs.” You have to figure a disgruntled CERN employee must have turned them in.

eHealth Initiative releases the results of its HIE survey. Conclusions: more HIE initiatives are underway, those actually operational jumped way up, and doctors reported a positive impact on their practices.

From Weird News Andy: a woman gets a call from a hospital’s ED doctor saying her husband had died there from electrocution. She and her sons rush to the hospital, only to get a call from her husband, to whom she replied, “‘Doug, you’re dead. We’re going to the hospital to view your body.” The hospital had called the wrong Doug Wilcox’s family. The hospital refused to talk on camera and hasn’t contacted the woman to apologize, but e-mailed a statement blaming “a breakdown in our communications.” Understandable, but the bunker mentality won’t win it any friends.

Misys announces year-end numbers: revenue up 41%, profits up 43%, helped mightily by the performance of Allscripts.

Microsoft turns in terrible Q4 results Thursday evening: revenue down 17%, EPS $0.34 vs. $0.43. For the year, the company’s revenue fell for the first time since it went public in 1986, falling short of expectations by a mile. Windows revenue tanked a staggering 29%. Shares are down 7% in after hours trading, back to 1996 levels.

The OMB director isn’t impressed with Aetna’s claim that its software reduced the use of medical services by 6.1% back in 2001. “One cannot reject the hypothesis that the true effect … on outpatient and RX charges is zero.” Aetna’s CMO co-founded the ActiveHealth Management, which developed the software and then sold out to Aetna in 2005. OMB says it didn’t do much except for hospital inpatients. That’s its PHR above, from a pretty cool video on its site.

Credentialing software vendor Medversant files a patient infringement against Morrissey Associates, saying it is “marketing for sale a process that is consistent with our AutoVerifi process.”

A judge in a medical malpractice lawsuit in Canada gives Meditech a nice pitch from her bench, explaining a $5 million ruling against a hospital that had misfiled a patient’s paper-based meningitis diagnostic results for a full year, resulting in his incapacitation. “Despite the UBC Hospital’s acknowledgement of its heavy responsibilities and its knowledge of past failings, it relied exclusively on a manual system with no back-up system in place to manage virtually inevitable employee error. The absence of such a system is particularly unfortunate given that in September 1999, the hospital possessed that capability through the Meditech computer system, which it was using to track films for billing purposes.”

Ann Coulter is a bit of a wack job even to a conservative like me, but this is a fun quote: “The reason seeing a doctor is already more like going to the DMV, and less like going to the Apple ‘Genius Bar,’ is that the government decided health care was too important to be left to the free market .. We already have near-universal health coverage in the form of Medicare, Medicaid, veterans’ hospitals, emergency rooms and tax-deductible employer-provided health care – all government creations …  The whole idea of insurance is to insure against catastrophes: You buy insurance in case your house burns down – not so you can force other people in your plan to pay for your maid. You buy car insurance in case you’re in a major accident, not so everyone in the plan shares the cost of gas.”

HR 2630, submitted by Rep. Ron Paul, would give individuals to opt out of any federal EHR system, repeals the act requiring HHS to create a unique patient identifier, requires informed consent for any use of electronic patient information, and prohibits the federal government from requiring providers to participate in an electronic healthcare system. It’s from a few weeks back, but I just ran across it.

Christ Hospital (OH) extends its outsourcing agreement with CareTech Solutions.

I mentioned earlier that for Red Hat VP had started up Axial Exchange, which offers open source healthcare interoperability solutions. She and her startup venture get profiled in the Raleigh paper.

WebMD announces the free Medscape Mobile for the iPhone.

Zynx and eClinicalWorks sign a deal to make the former’s AmbulatoryCare order sets available to eCW customers.

Medicity spinoff Allviant, which will market consumer access tools, announces its advisory board members.

The DoD will expand its PHR pilot that ties its data into HealthVault and Google Health, but it’s also evaluating RelayHealth. DoD required Google and Microsoft to use only US-based servers and to delete all information immediately for an employee who opts out.

Odd lawsuit: a woman who gained 20 pounds during her hospitalization for Crohn’s disease is suing the hospital, saying it overhydrated her with IV fluids. She wants compensatory damages.

E-mail me.

HERtalk by Inga

The local paper reports on the status of an Epic installation at Atrium Medical Center, which  is one of three Premier Health hospitals now live on on Epic’s EHR. Ambulatory clinics are also getting on board. Officials estimate the implementation will be completed by the end of 2010.

The VA selects Anakram.TFA Two-Factor Authentication as its enterprise authentication tool for remote access to VA systems.

John Muir Health (CA) claims it saved $8.5 million using VHA’s Non-Salary Cost Reduction solution over a two-year period.

St. Joseph Medical Center (PA) selects McKesson’s Revenue Management Solutions to manage its medical billing processes. St. Joseph physicians will deploy McKesson Practice Complete for RMS services, along with Horizon Practice Management software and RelayHealth payor connectivity services.

Tufts Medical Center (MA) places an order for a Carestream Health RIS/PACS system and contracts for Carestream’s eHealth Management Services for remote disaster recovery.

Someone at the University of Michigan Health System clearly listened to his/her mother. UMHS lawyers and doctors are quick to say they’re sorry and admit mistakes up front, finding the policy creates savings in time, money, and feelings. Between 2001 and 2006, malpractice claims fell from 121 to 61 and the average time to process a claim fell from 20 months to eight months. In addition, costs per claim fell 50% and insurance reserves dropped by two-thirds. I like the words of Richard Boothman, the system’s chief risk officer: “What we are doing is common decency.”

The National Institute of Health Clinical Center picks the QuadraMed AcuityPlus platform to ensure interoperability with existing ADT and staff scheduling systems. The NIH facility will use AcuityPlus to make its nurse resource allocation process more efficient.

HIT consulting company Virtelligence is recognized by the Midwest Minority Supplier Development Council as Class II Supplier of the Year. The award is based on such factors as company growth and development and quality of products and services.

Carefx says its Fusionfx clinical workflow solution is now successfully deployed at Fletcher Allen Health Care (VT). My interview with Fletcher Allen CIO Chuck Podesta posted earlier this week. One reader wrote in saying that, based on the interview, they’d work for Mr. Podesta.  I concur.

The VC folks seem to think health care companies are worth investing in these days. In the second quarter, health care firms raised $2.2 billion in VC funds, surpassing last year’s $1.89 billion figure. HIT providers are of particular interest as result of growing demand for health care solutions.

Speaking of VC money, MedVentive, a provider of P4P software for evidence-based money, raises $7.25 million in series C funding. Excel Venture Management led the round.

Those choosing an alternative to Mr. H’s DIPSHIT certification program may want to check out Johns Hopkins new master’s degree in health informatics. The one-year program focuses on how to develop IT systems to be used in hospitals, clinics, and public health settings.

E-mail Inga.

HIStalk Interviews Chuck Podesta, SVP/CIO, Fletcher Allen Health Care

You’ve been on the job for a year now. What were some of the high and low points?

The high points actually started with the interview process. I was very impressed with the organization. I was very excited about the EHR the project with Epic. A lot of the heavy lifting had already been done around project organization, budget, and resources. I was excited from that standpoint. I was starting at a time when the project was kicking off, which is an exciting time as opposed to all that pre-planning stuff that you have to do.

Any low points?

No, I really can’t see any. Burlington, Vermont is a beautiful city. It was the first career move I’ve ever made that had a boost, not only from a job perspective, but from a quality of life as well. 

You’ve just gone live with some early parts of PRISM and Epic. What’s next?

We’re into Phase II right now. We’ve gone live with the ED, the electronic health record, which included CPOE, bedside medication, and of course all the nursing functions and charting. We’ve also got the monitors linked in to the flowsheets as well. We completed that on June 6. It’s going very well.

We have CPOE, with 92% of all orders being entered by physicians after just a few weeks of going live. That’s extremely successful for us.

Phase II is our first ambulatory site. We have a large faculty practice, so we’re rolling it out in the outpatient area. That goes live in November. In the rest of 2010, we’ll be implementing our ambulatory sites. Along with that, we are also implementing Beacon Oncology for Phase II — that’s December of 2009 — along with MyChart, the patient portal. 

December 2010 will be our last ambulatory practice and the Cadence scheduling system. That finishes up the three phases of the project.

In conjunction to that, too, we have the opportunity to offer the Epic licensing to other community hospitals in the state and in the ambulatory sites as well. Our project is called PRISM — Patient Record Information System Management — and the extension of our PRISM project is called PRISM Regional. That’s a hosted group purchase solution. We’re working closely with Epic on that.

How will you be using MyChart?

Actually we just fired that up. We’ve got a team in place and we’re working closely with marketing to put together a plan to market that to the community. Two options that we’re looking at right now since we have the inpatient up — we can roll it out from that, but we’re thinking that the biggest bang for the buck is on the ambulatory site. So there’s the decision that we have to make: do we roll it out in December for the inpatients in our first practice and then just continue on with the practices, or, do we wait until we have all the ambulatory sites up and roll it out after that?

My guess is we’ll probably implement the inpatient side of it and then we’ll add on each ambulatory practice as it comes up. So the practice will have to work with their patient population to get them signed up to use it. But we’re still in the early stages of that right now.

Have you changed the project scope or timeline due to economic conditions?

No, we really did not. We were not part of a bond or anything like that. The money was basically money in the bank, so it wasn’t an issue that we were running into bond covenants or anything like that, or we would have to stop and conserve cash or anything along those lines. We were lucky that we got all that done before the market started to tank. So the investments were there. We met all of our deadlines.

What is the expectation for return on investment?

We’ve got a benefit utilization group. We came up with some of the different benefits. We’re also convening the group now that we’re live, actually going in and start to measure those. But a lot of the standard ones that you would see: measuring medication errors, some types of quality patient safety.

But what we see as the biggest bang for the buck is utilizing the system to help us drive towards a best practice. For example, if we have an initiative to reduce nosocomial infection rates, how can we use the system to prompt the clinicians to protocols that drive that number down? That’s what we’re really focused on right now. With Epic, with the Clarity database, which we have as well, which is the clinical decision support database of the Epic system — we’re going to utilize that heavily to start looking at where we can impact the care process.

Any specific timeline for being able to show those metrics?

I think once we deal with the initiatives we have right now, like medication errors, by the end of summer we’ll have some good data on those. We did calculate the "before" picture prior to going live. We were collecting data probably for a year before we went live on certain measures. Once we get over the learning curve, we’re going to go back and see how we’ve impacted those. By the end of the summer, beginning in the fall, we should be able to do that.

How are you engaging physicians?

To me that’s been a real success here. We’ve got an orthopedic surgeon who’s about half-time on the project. He has been instrumental. He knows the system inside out and has been instrumental in working with physicians.

We also have a physician advisory committee that’s very strong, providing physician leadership. The chairs have gone along on with them, so that’s working well. Our CEO is a physician, so that definitely helps with pushing the adoption. The physician leadership actually voted in the bylaw that, to be credentialed to practice at Fletcher Allen Healthcare, you have to use the system, including CPOE. That’s part of our success in driving that percentage up as well.

That was key and also our education process. It’s one thing to have a policy, but another thing is to implement a procedure that works. We did a lot of work with pilot groups. We took a pilot group of 10 physicians and ran them through the standard eight hours of training. With their feedback, we were able to design a training program that worked for physicians which was a combination of the e-learning modules and didactic classroom training. 

We let the physicians decide which learning environment they wanted to do, e-learning or didactic training. But in all cases, when it came to the certification process, that was in the classroom. So we let them learn the way they wanted to learn, but we made sure we certified them and there was a standard way to do that. That worked out very well and was very well received because you could do the e-learning modules offsite on the weekends and such.

The other thing that was unique with Fletcher Allen is that this whole project — the PRISM project — reported up through operations, not to IS. The two executive sponsors were the senior vice president for patient care services and the president of faculty practice. As the CIO, I had operational responsibility but not executive responsibility, which showed the organization that this is not a technology project but a process redesign. It was a change to the way that we deliver healthcare. I think that was a good way to go.

I understand you’re on the board of the VITL?

Yes, Vermont Information Technology Leaders. That’s the HIE.

How will you participate in the HIE and what’s going to be your involvement technically as you move forward?

We will actually link up with the exchange based in Vermont. We have an opt-in process, so the consumer — the patient — has to opt in for the records to be shared. By the end of the summer, we should have those links in place.

We’re starting with lab results and orders, but then we’ll move rapidly to bi-directional continuity of care documents with VITL. The power of that is going to be that if we have other hospitals run Epic in our a single database, they’ll be automatically connected to the VITL exchange. That will be very powerful.

Is it tough being an Epic shop in the epicenter of GE-IDX?

Yes. I came from Massachusetts, so I don’t have the Vermont history here, but I do understand it was probably more of a tense situation back in 2003, 2004, and 2005 when the selection process was going on. I got here after that was all complete.

We do still have the revenue cycle for IDX. We also have ImageCast, the radiology system. So, we still have a relationship with GE-IDX. If we had gone with everything Epic and not had any GE here at all, it probably would have been a different issue. 

We meet with them on a regular basis. We’re actually in the process of potentially doing an upgrade of the IDX system as well, so the relationship seems to be good. GE is also the vendor that’s doing the exchange for VITL, so there’s plenty to do for everybody.

I understand Fletcher Allen gave the ACLU an advisory committee seat. Is the way you’re addressing privacy a lot different than where you worked previously?

Yes. If you look it at the HIPAA rules, opt-in is not a federal law. It does not come into any of the HIPAA guidelines. I think Minnesota is the only state that has actual legislation and made opt-in a law. But in my mind, it is the gold standard, and probably with the new ARRA privacy regs will probably be standardized in most places. So we decided at VITL to adopt that ahead of time knowing that it was coming, and then as part of PRISM and PRISM Regional we’re following those guidelines as well. We had a subgroup which I was on that is part of VITL; we did a lot of work in that area, and not only the policies themselves, but the procedures to implement.

What lessons learned can you share with other CIOs about your PRISM project?

I’ve been through a few of these with different vendors. I’ve done MEDITECH and SMS before Siemens. I’ve been doing this for about 30 years now and each one’s a little bit different; I always learned something new on each one. 

For go-live support, we had about 185 people with yellow shirts on, including the vendor, consultants, the IS team, the PRISM team, super users — it was just a sea of yellow out on the units and in ED. It really gave people comfort, even if they didn’t have a question, to look up and see four or five people in yellow shirts on. We had a lot of positive feedback on that, knowing that if they did have a question there was somebody there to answer.

We put in a best practice service center and spent a lot of time doing 24/7 with our service center. We ended up answering 9,000 calls in about an eight-day period. It was only about a four percent abandon rate. We trained those in the service center. We actually put them through the same training that the nurses went through. On the front end they had a lot of knowledge on the Epic system.

Senior leadership visibility. As senior leaders, we all had the yellow shirts on as well. We were here 24/7 doing different shifts, just being visible more as cheerleaders and support. Our management team delivered food. These seem like little things that are huge. When you’ve got a nursing unit in there struggling from the standpoint of learning a new system in patient care and all of a sudden the manager wheels a cart up in there with all kinds of food on it, it just means a whole lot to them that we were all in this together.

So those were the keys, and I think what I mentioned earlier: if you want to drive your CPOE adoption rate up, you really have to focus on that with good physician leadership. Also, potentially changing the bylaws, and the training, and support.

Also, one tip that I’ll give. If you are an academic medical center, if you have access to medical students within an urban area, use them to support the physicians. It worked out great. We paid them a small stipend. Typically they’re broke, they’re happy to get a little bit of money, and they’re young, they’re doing the Twitter stuff already so they just take to this stuff. They were tremendous. I think we ended up with about 20 medical students that supported the physicians. They were a great help as well.

But to me, what I learned on this one was really that the go-live support, the command center, the service center, and the people we had there — to me, that was the key. A lot of organizations may short-change that a little based on cost, but I think it’s key to getting past the go-live hump and then moving into a support model.

Last question: in your opinion, what are the biggest threats and opportunities across healthcare IT today?

The biggest opportunity is with the ARRA money. I think the threat is also with the ARRA money, depending on how meaningful use and certified EHRs develop and are identified. The HHS is leaving some of that open for public comment.

I think the biggest threat is that some of these vendors might not be ready. For the ones that do have the product, the line to get that product could be out the door. So from a timing perspective, it’s going to be difficult.

I think there needs to be some new models that are created for implementation across the country, because if you look at HIMSS’ eight phases of adoption, you’ll see how many are not even near meaningful use. The vendors don’t have the capacity and there are not a lot of educated resources on implementing EHRs. Those individuals that are educated are going to be snapped up by the consulting companies, then, charged back at three hundred bucks an hour.

So I think workforce development and the implementation itself is a threat, based on ARRA. That’s why I’m seeing some of these community hospitals going to their local large-hospital academic medical center and saying, "Can you help us?"

I think the model that we’re creating here with PRISM Regional — I’m starting to see with other Epic sites across the country — Geisinger, Cleveland Clinic – -some of the others where they’re actually looking at putting the system in and helping these community hospitals get to that meaningful use. So that’s where I see the opportunities are, but the threats as well.