Monday Morning Update 8/8/11

From Carlos: “Re: State of Connecticut HIE. Likely to hire Axway, a French company with headquarters in Arizona, to provide the platform. Too bad they didn’t commit to an American company.” Unverified, but it’s like car makers: tough to sort out whether you’re really buying American given that the executives, employees, subcontractors, and taxes paid are scattered around the globe and you don’t really know which country benefits the most. Axway is a publicly traded company (on the NYSE Euronext) spun off from IT services firm Sopra this past June. The CEO is French.

From Leisure Suit Larry: “Re: hospital EHR adoption. Have you seen 2010-2011 numbers? I haven’t seen anything since the 2009 AHA IT survey.” Maybe someone can help out.

From The PACS Designer: “Re: DICOM’s expansion. The stability of the DICOM Standard has been solidified with its expansion into the test and measuring field of practice. The ASTM DICONDE Committee has recognized the value of DICOM as a standard in healthcare, and adapted a version for test equipment called the E2339 Standard titled Practice for Digital Imaging and Communication in Nondestructive Evaluation. There are standards for various test methods which include Digital Radiography (DR), Computed Radiography (CR), and Computed Tomography (CT).”

From Bang Bang Shrimp: “Re: for-profit hospitals. I helped open HCA West Paces Ferry Hospital in Atlanta in 1974. We attached Addressograph charge slips to single Band-Aids at an unconscionable mark-up. We bought disposable ventilator tubing for $1.25 and charged Medicare $22.50. It took the federal government 20 years to realize they were being raped and not even receiving a kiss – thus the Dartmouth Study and prospective reimbursement.”

Thanks to the following HIStalk sponsors that started or renewed their sponsorship in July. Click a logo for more information.

HIMSS got mixed grades on last week’s poll, with 62% saying it deserves a B or C and more respondents giving it a failing grade than an A. New poll to your right: do hospital CIOs have too much influence in choosing clinical system vendor or implementation strategies?

Listening: reader-recommended (from Lake Hartwell) Heartless Bastards, a no-frills, hard-rocking Dayton bar band with a deep-voiced female singer (think Chrissie Hynde of The Pretenders meets Johnette Napolitano of Concrete Blonde) who also writes the songs and plays a mean rhythm guitar. Nothing phony or computer-enhanced here. Excellent.

The British government is expected to officially kill the 10-year, $18 billion NPfIT project next month after reviews conclude that the massive undertaking, the largest non-military IT project in history, is “beyond the capacity of the Department of Health to deliver.” Deadlines have been missed, contractors have pulled out, benefits are unclear, and reviews have concluded that project officials didn’t get enough input from physicians and other clinical users. An editorial reminds that there’s plenty of blame to pass around, including ministers for approving the use of custom systems without requiring small-scale trials, civil servants for approving questionable contracts, and vendors (notably CSC and BT) for continuing to collect taxpayer money despite not meeting their contractual obligations. The project is expected to turn into an HIE-like federated data sharing system, where local health trusts and hospital can buy whatever systems they want rather than those mandated by NHS.

Australia’s struggling, over-budget $425 million HealthSMART system is blamed for faxing hospital discharge summaries to physician practices that included clinical information for different patients. The Health Department says faxing software attached the wrong information to the fax header, acknowledging 13 incidents that had no known patient impact.

The VA awards 15 prime contracts for its technology and telecommunications program called Transformation Twenty-One Total Technology. The value of the contracts could reach $12 billion.

Kaiser Permanente’s nonprofit hospital and health plan business announces Q2 profit of $663 million, up 64% from a year ago. Revenue was $11.9 billion and membership increased to 8.8 million. An e-mail to employees sent Friday from its COO and CFO says KP will begin implementing videoconferencing technologies to link providers and also systems that can send monitoring device data directly to the patient’s EMR. I wondered about the salary of CEO George Halvorson, so I looked it up: for 2009 (the most recent year available), $6.7 million in total compensation.

My Time Capsule editorial this week from the 2006 archives: Vendors Seek to Diversify as the Hospital Systems Market Matures (this was pre-HITECH, when hospitals bought systems because they wanted them, not because the government bribed them to). A snip: “Business will sizzle in ambulatory systems, various forms of telemedicine, data analysis, payer intelligence, genomics, interoperability, consumer health, drug research, home health, and medical device connectivity.”

Brigham and Women’s Hospital announces that a doctor left an external hard drive in a cab in Mexico, potentially exposing the medical records of several hundred patients that had been downloaded to it. The doctor said the information had been deleted, but the hospital announced the loss anyway since it couldn’t verify that the information was unrecoverable.

Adventist Midwest Health names Chet Robson, DO as regional director of medical informatics, ambulatory systems.

Dr. Sam (Bierstock) and the Managed Care Blues Band, self-billed as “The World’s Most Reluctant Band,” release their latest — HITECH Blues. Sample lyrics: “I’m sitting here in prison, I’m living in a life of tears, I could be in my office, but they gave me 20 years. I never should have hacked into, the PHR of Britney Spears. I used to have to deal with, 4 different kinds of EMRs, I had one in my office, the ED, hospital, and the OR. Just ‘cause I saw that information, I’m sittin’ behind bars.”

Here’s the latest HIStory chapter from Vince Ciotti, covering Keane.

Speaking of Vince, he’s looking for stories and information about his next featured company, Charlotte-based SAI (1988 coverage above), if you want to pitch in.

European hospital pharmacy technology vendor Health Robotics is granted a motion to dismiss McKesson’s lawsuit that sought to rescind their joint distribution agreement.

ESD rebrands itself with new graphics and a tagline, “IT Consulting Rooted in Healthcare.”

Twenty-nine Penn State pre-med students are deployed at Mount Nittany Medical Center to coach physicians on its EHR transition. CMIO Stephen Tingley came up with the idea to give students the summer job. A cardiologist expressed his appreciation for the help, saying, “The system is not easy to figure out. It’s so different, like a maze. I’m dreading the day when they’re not here.”

Strange: a rural health center nurse in Pakistan, who claims a dental surgeon sexually harassed her and had her salary withheld for a full year, goes to a press club and pours gasoline on herself. Bystanders step in before she can get it lit. And stranger: a passenger on budget air carrier RyanAir goes into cardiac arrest during a flight and stops breathing, with his wife shouting for someone to bring oxygen. The flight crew, concluding that his blood pressure was the problem instead, brings him a sandwich and soda. After he revived, they came back to collect payment for the snack.

E-mail Mr. H.

Time Capsule: Vendors Seek to Diversify As the Hospital Systems Market Matures

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

I wrote this piece in June 2006.

Vendors Seek to Diversify As the Hospital Systems Market Matures
By Mr. HIStalk

Vendors of traditional hospital information systems are hedging their bets for future success, judging from recent announcements. McKesson said this week it is acquiring RelayHealth to move into consumer health care systems. A group of vendors said they would develop standards to make their home health devices interoperable. And Cerner’s announced growth areas are mostly outside of traditional hospital IT.

The message seems clear – business prospects are better elsewhere. Wall Street likes growth that big conglomerates and publicly-traded vendors can’t get from hospital-only sales, given a finite supply of prospects that are big enough to afford their wares. The recent spike in clinical systems deals may have been transitory, locking up all the laggard customers but leaving fewer for the years to come.

Perhaps we’re in the classic mature market, where the customer base is saturated, vendors are consolidating, product prices go down to reflect decreased demand, and emphasis moves from R&D to solid, user-friendly applications that are differentiated primarily on specific features (think Rubbermaid). Vendors can still make a lot of money, only instead of from product sales, profits come from selling high-margin services and maintenance to existing customers.

Under this scenario, and given high switching costs, hospitals may no longer command the undivided attention of vendors whose gaze is wandering to sexy new markets. Maybe there won’t be any successful hospital-only vendors left, except possibly for Meditech, which is ideally suited for success due to its dominant market penetration, near-universal customer retention, low cost through economies of scale, and private ownership.

Even if the hospital systems market is mature, just about every other health care IT sector isn’t. Business will sizzle in ambulatory systems, various forms of telemedicine, data analysis, payer intelligence, genomics, interoperability, consumer health, drug research, home health, and medical device connectivity. Products in the innovation and growth stages of the product life cycle require high development and sales costs. The aggregate market must be defined and created. Most companies will lose money, but winners will emerge from the turmoil to gain competitive advantage and profitability.

It will be interesting to see how the traditional players fare in these markets, where they’ll need seldom-used capabilities such as technical innovation, nimble execution, and delivery of their message to a much larger number of prospects who behave less cohesively and identifiably than hospitals. Having a good idea isn’t enough. If I were an investor, I’d buy strictly on the quality of company management, choosing vendors with visionary, focused leaders who can rise above a host of new market entrants that are likely to fail due to stumbles in execution.

The original HIT marketplace was first changed dramatically by the emergence of large, full-line hospital systems vendors that moved the industry away from small, innovative best-of-breed vendors and customer self-development. The second change was the absorption of most vendors into unfocused conglomerates or larger competitors. The third wave — obviously underway — is diversification of vendors into non-hospital health care IT.

It remains to be seen whether hospitals will be better or worse off with these changes. We struggled even when we had the undivided attention of our vendors, failing to manage change and gain ROI in an admittedly screwy and ever-changing health care non-system. We may not enjoy giving up the limelight. After many years as a hospital IT person, I’m a little jealous to see the excitement growing in those areas of health care I don’t yet know much about.

HIStalk Interviews Ken Willett, CEO, Ignis Systems

Ken Willett is president, CEO, and chief technical officer of Ignis Systems of Portland, OR.

Tell me about yourself and and the company.

I’ve been in software development ever since I got out of college in 1974. I’ve worked in a number of high-tech startups, mostly in the electronic design industry. I got into healthcare IT as I started a consulting business in about 1994. Ignis Systems was incorporated in 1999. 

One of my first major clients was MedicaLogic, now the Centricity products from GE since they bought MedicaLogic. That then led to EMR-Link, which is the current product that we have. Ignis is no longer a consulting company — it’s a product and services company. A number of people have joined — quite a few of them with GE Centricity background — but we’re now spreading out, bringing in people with expertise in other EMRs. 

The system deals with CPOE from the ambulatory side – orders and results – and in the diagnostic area: lab orders, lab results, radiology orders and results, and so forth.

Describe briefly how the orders flow within an ambulatory EMR.

The EMR is the main cockpit of the provider these days. People who are really using EMRs well want everything to be driven out of the EMR — the decisions that they’re making, documentation they’re providing, and in particular, creating orders for outside services.

In the past, what’s typically happened is labs have provided either Web-based or application-based ordering systems to providers. Providers don’t want to switch to a different application to place a lab order, a medication order, or any other kind of order. They want that out of the EMR.

We provide the ability for them to do the ordering within the EMR. The provider generally provides some minimal information. What they’re interested in is, “What tests do I want run? What’s the justifying diagnosis for this test? When does it need to happen? Is it an urgent or a regular order?” But that’s not really sufficient information for the lab. The lab needs to know a lot more status information about the patient. They need to know about insurance. They need to know what account to bill things to. 

Our application collects the information from the provider, the basics of the order. It then allows a staff person to augment that information to get it to the point where it meets all the order requirements for the lab.  That helps to guarantee that when the results come back through us, they are going to meet the needs of the provider in terms of being a high-quality diagnostic report.

Many people would have assumed this problem was solved many years ago, especially since e-prescribing has settled down to universal standards. Do you think a long-term solution is coming for orders other than what you are offering, or is this as good as it will get in linking an ambulatory practice to the outside world?

I hope it will get better. When I was first involved with MedicaLogic, e-prescribing was just as much of a black hole as lab orders and lab results are now. What happened in the intervening years was there were a few large players on the prescribing side that were the pharmacy benefit managers. Once those large players got their act together and Surescripts was involved and that technology. That made it easy to essentially move that whole industry toward one set of standards and one method for communicating these orders.

The same thing hasn’t happened on the lab side. The lab industry is much more fragmented. There are two or three big players in the US, but they only account for about 20% of the total lab volume. We’re talking about hundreds or thousands of hospital labs, and now, even more in-office labs in large physician practices. It’s very, very difficult to drive a consensus there through just market activity.

What we end up having to do is have lots of different kinds of connections to different labs. They have slightly different flavors of HL7 data for orders and results and have different communications methods. We have to make sure that our hub adapts to those differences.

I think over time, particularly with a push from the federal government for information exchange, there will be some focus on standards. There’s some standards activity going on right now both at the federal level and within the HL7 community that hopefully will get adopted more widely. I think that will reduce the number of variations we have to deal with, but I don’t think it’s going to drive it down to one common standard that everybody’s going to be using.

Who is your target audience?

We sell services to the major labs and also to hospital labs as a way for them to connect the providers and their community, or the providers that they market their lab services to. The same thing with radiology. But the main user of our system is the provider. We have to make sure that what we are doing is a great solution for the doctor as they’re providing care for the patient, even though they typically pay for a small portion of our service. Most of our service is actually paid for by the lab. So it’s not simple from a marketing and sales point of view, because we have one customer who’s making the purchase decision, but we’re going to have a different customer that we have to satisfy from the usability point of view.

Let’s say LabCorp sponsors the implementation for a particular practice. Is the connection only then to LabCorp, or once it’s in place, can it be used for other lab companies?

One of the things that we think is important is to have a single ordering solution that can connect with all labs that a particular provider is going to use. The typical case is probably two to three. Because of insurance contracts, most of the people who send orders to LabCorp also send them to Quest because some insurance carriers require that. Then they may have a hospital lab that they send things to just because it’s in their community.

We have is a single application that allows ordering from any of those. From a business point of view, we have to break that apart so that LabCorp is paying for their piece of that system, Quest is paying for their piece of that system, and then there’s a subscription piece that the provider pays that’s a recurring annual usage fee.

By definition, your practices all have a large entity as a sponsor, correct? Its not really a universal system from the physician side, but rather whatever parts the sponsor wants to subsidize?

That’s true for the larger labs, but we actually have a range of different scales that we operate at. We have a lot of customers that are relatively small practices, maybe a dozen or so providers, but they have in-house lab. They want electronic ordering and electronic results. The smaller-scale LIS systems that they may be using for their in-office lab maybe don’t have that capability. 

We can allow them to do electronic orders and results. Even though the lab system is in the same building that they’re in, they connect through us because it just works better and smooths out the workflow.

Then we have a lot of labs that are in the middle. They may be a single hospital or a multi-hospital organization that may have a single consolidated lab, or they might have a lab at every hospital. We provide the ability for them to connect to practices either within their organization or affiliated practices within their community.

And then of course there are the large reference labs where labs are their only business. We also have a number of hospitals who provide labs and radiology, and we can provide a single ordering and resulting solution that handles both types of orders.

What kind of user or transaction volume are you seeing?

We have about 5,000 providers using our solution at between 250 and 300 different sites. We’re handling between a half million and a million transactions a month through our system. We have unsolicited results in some cases, but they may quite often have an order with a matching result coming through.

What’s the selling point for Meaningful Use?

This goes back to the Meaningful Use criterion around structured lab results. Lab results traditionally, in a lot of cases, have been faxed to providers or they’ve been sent through a remote print engine. They print it on paper, and then maybe they’re rescanned. But the established EMRs that have been around for a number of years can handle HL7 lab results. They can do things like display the patient trend graphs or they can filter the population based on lab values.

We’re seeing a flood of new EMRs hitting the market and a lot of them don’t have that capability. A lot of them believe that lab results just means that you can present a lab report to the provider so that they read it. If a provider or an organization chooses structured lab results as one of the menu items in Meaningful Use, then they need to have a system that can present that structured data to them. In some cases, their EMR may not be able to do that.

One of the things that we provide on the result side is that we can maintain the structured data in our system. We can provide it a readable, high-quality printed report or viewable report to the provider, but we can also provide the trending and the structured data that they need. It’s also sometimes the case that we can provide viewable lab results to a provider who doesn’t have an EMR yet, or isn’t set up to handle structured lab result data yet. We can populate that EMR with the structured lab data once that provider’s ready.

It seems reasonable for EMR vendors to let a specialty company develop the integration piece while they focus on the inherent functionality needed for their own workflows.

We think that’s the right model. In most cases, with a few exceptions, the EMR vendors don’t really do a very good job of interoperability with outside systems. It tends to be an afterthought. It’s a whole different business. EMR vendors usually are as software development and database experts. They’re used to building essentially closed systems that are delivered and installed at the customer’s site.

Interoperability is a much broader game. You have to be an expert in data communications and security, error recovery, and all kinds of things which may be or not that applicable in the EMR that’s installed at a particular customer site. I think it makes sense for people to leave that to us. 

We’re finding that, both with the EMR vendors and also with labs, when they start to add up they’re paying to implement lab interfaces and get them working, maintain them over time, and recertify them every two years, a lot of those companies that just don’t want to be in that business.

You mentioned use of your tools by practices with no EMR. Tell me about Orders Anywhere, which you market as a starter step.

That’s great for people that aren’t on an EMR yet. There are also many EMRs which don’t have electronic ordering at all. They don’t have the ability to generate an outbound electronic order message. A lot of them are designed just to document the orders in the chart. Some of them have an ordering capability but it’s just not very good — they don’t have the ability to configure ordering preferences to what the provider needs and they can’t split orders when they need to be split into multiple requisitions. 

Orders Anywhere is a way for people to have electronic ordering, even when their EMR doesn’t provide it. It’s both for people that don’t have an EMR and people whose EMR doesn’t have good ordering capability.

Are you seeing providers who have decided that HITECH money just isn’t worth the trouble and picking and choosing just those technologies that make benefit them directly, like perhaps your electronic ordering product?

You don’t necessarily find out what the provider is intending as far as the Meaningful Use stuff. I’ve heard stories of doctors who have said, “This isn’t worth it to me right now.”

But I think what we’re seeing is that a lot of the volume growth in EMRs really is being driven by the Meaningful Use rules, so the people who’ve decided that it’s not worth it probably aren’t talking to us anyway. For somebody who has an EMR and they think EMRs are good tools to use, they’re probably going to figure out how to get their use of the EMR up to the point where they can get some Meaningful Use reimbursement.

The other thing that we’re seeing that’s sort of odd and a little scary is vendors who build their systems to the Meaningful Use requirements. They may have some technology pieces and they’re asking, “What’s the minimum we can do so that a doctor can get paid by the government?” Not what’s a good EMR or what makes sense for taking care of patients, but more, “How do we meet the letter of the Meaningful Use regulations so that if they buy our product they can get paid?“

That’s not a very far-sighted view. Those regulations are going to change over time, but that set of things that have been identified by the ONC by the Meaningful Use, they’re really pretty arbitrary. There’s a lot of other things that you really should be doing if you’re going to be a good EMR user.

You’re in a fairly niche-type technical product area. Do you see your expertise translating into other products or services beyond orders integration?

Yes. We have a couple of things in the works that I can’t really talk about them in detail, but there are a number of problems now that are of the form of having multiple back-end organizations with different standards like the labs are in our world, maybe having to have some connection on the front end to every provider, or maybe all providers in a state, or all providers in a certain geographic area.

Understanding how to put together a hub-and-spoke architecture that does the right kind of translations in moving data from one side to the other  — we’ve learned a lot about doing that with labs and radiology. We believe there are similar problems that can benefit from that.

CCHIT chose your tools to test orders integration for certification. Did that raise the company’s profile?

Well, we hope it did. We have lots of experience with lab results and what works in the real world. That was a project of mine to work together with the CCHIT technical team to put together the test suite for Meaningful Use certification for lab results.

Where does the company and the industry need to go?

One of the things that we work very hard at is being really responsive as things change. One characteristic of where we are in the market is we’re hooking up new practices and new labs all the time. We have a hosted solution, a Software as a Service model, and we need to be able to turn things on very quickly, generally within the space of a few days. We can do that pretty readily as a small company. I think it might get more difficult as our organization gets bigger.

But there’s a lot of room for small companies like ours to fill in some of the gaps between these large systems, which often take 12-18 months to incorporate new capabilities. Things are moving too fast – people can’t afford to wait that long.

Any final thoughts?

I think there will be a separation between transport companies and transport technologies and content companies and technologies, sort of like what’s happened in the television industry. Communications companies deliver data from one place to another, then you have other organizations, like Facebook or  HBO, that provide the content.

We’re very much in the content business. We want the information provided by the provider to be useful for the lab, and we want the results from the lab useful to the provider. We don’t necessarily want to be involved in the plumbing that makes all that happen. In the HIE world, some of the work that’s going on with Direct standards, the transport pieces are becoming more of a commodity. Those things will separate themselves out from those of us who focus more on the content.  

News 8/5/11

Top News

A diabetic computer security researcher proves that hackers could theoretically remotely control medical devices such as insulin pumps and glucose monitors, which don’t have enough battery power to encrypt their wireless signals. The same threat had already been demonstrated for defibrillators, but no real-world examples have surfaced.

Reader Comments

From Gary: “Re: drchrono free EMR. I can’t find anything on their site about their revenue source other than VC funding. Is it advertiser supported?” The company says they’ll get back to me on that. Their free product is limited in storage and support and doesn’t include some functions (e-prescribing and electronic billing), so I assume they hope users will move up to a paid version. I don’t know much about the product, but their website is one of the slickest ones around.

HIStalk Announcements and Requests

Listening: a new lost album from The Screaming Trees, a 1990s Seattle band with a fresh roots rock sound (even now) that mixes light grunge with dark twang and psychedelia, like minor chords REM meets Alice in Chains. They never made it big, but should have. I’m kind of loving it as I contribute my air drumming to the mix.

I made a decision last week after careful deliberation: I’m phasing out animated sponsor ads on HIStalk on January 1. Sponsors are responding positively to Inga’s e-mail describing the change, which I appreciate – I think they know intuitively that everybody will benefit from less distraction and faster page loads, which will result (ironically) in more ad views and clicks. That’s the theory, anyway.

Inga will be back to full HIStalk duties shortly. If you want to make her return even more joyful, consider: (a) signing up for e-mail updates on HIStalk and HIStalk Practice; (b) give us the electronic version of the insincere Hollywood air kiss by friending us on Facebook and connecting with us on LinkedIn; (c) send us cool stuff like rumors and secret information; (d) click some sponsor ads to check out their offerings since I turfed off the “no more animated ads” sponsor e-mail to her to send and she probably needs to regain her stature in their eyes for being the messenger; and (e) use subtle peer pressure to send new readers our way since she loves poring over the readership stats.

Acquisitions, Funding, Business, and Stock

ZocDoc, a provider of an online physician locating service, raises $50 million in Series C funding from DST Global. Other ZocDoc investors include Marc Benioff (Salesforce.com) and Jeff Bezos (Amazon).

Sales

St. Vincent’s Medical Center (CT) signs a seven-year agreement with GE Healthcare to upgrade to the SaaS version of several Streamline Health products for HIM.

Centegra Health System (IL) will implement iMDsoft’s MetaVision critical care system for all 113 of its monitored and ICU beds, integrating it with ADT, labs, CPOE, billing, scheduling, PACS, LDAP, and its GE EMR.

People

Paul Ruflin, former CEO of Eclipsys and Noteworthy Medical Systems, joins software tools vendor PreEmptive Solutions as president and COO.

Integrated Healthcare Strategies announces that William F. Jessee, MD will join the consulting firm as a SVP and senior advisor following his October 2011 retirement as MGMA’s president and CEO.

Surgical Information Systems (SIS) appoints Gary S. Long (above) to VP of North American sales and Jonathan C. Lujan to VP for Business Development & Strategic Planning.

David Kissinger, regional VP of maxIT Healthcare, is appointed to the board of directors of Southern Ohio HIMSS, also serving as its public relations committee chair.

ZirMed names former IDX/GE executive Thomas W. Butts president and CEO. He replaces Jerry Merritt, who stepped down “for personal reasons.”

Announcements and Implementations

North Colorado Medical Center goes live with CPOE as part of Banner Health’s $250 million Cerner EMR initiative.

Swedish Health Services (WA) expects the former Stevens Hospital to be live on Epic’s EMR by the fall of 2012. Swedish took over management of Stevens last year and is making $150 million in infrastructure upgrades.

Royal United Hospital Bath NHS Trust goes live on Cerner Millennium three years later than planned, caused by Fujistu’s termination as the local service provider.

RCM software provider Avisena partners with Intuit Health to make the Intuit Health portal available to Avisena practices.

NextGen confirms the earlier rumor I ran – the company is working with MEDSEEK to create a new NextGen Enterprise Patient Portal for hospitals, allowing patients to access staff, review test results, make appointments, and request prescription refills in a single view. It’s business as usual for the existing NextGen Patient Portal – this is an alternative for a different audience.

Ouachita County Medical Center (AR) chooses Healthcare Management Systems for its financial and clinical applications, including EDIS. Meanwhile, CMH Regional Health System/Clinton Memorial Hospital begins its implementation of HMS.

Oroville Hospital (CA), which uses a version of the WorldVistA EHR 2.0 that it customized, helps WorldVistA get it certified for outpatient Meaningful Use by contributing its self-developed e-prescribing module. They say it’s the first version of VistA to be certified for outpatient use. Oroville says it has spent $4 million hospital-wide on implementing the open source product, but did it all with internal IT resources.

Midland Memorial Hospital (TX) connects to the Nationwide Health Information Network and the Social Security Administration MEGAHIT project using the Medibridge.net HIE platform from EHR Doctors. It generates Continuity of Care Documents from VistA/CPRS like the Medsphere version that Midland uses.

Government and Politics

CMS reports that about 77,000 providers have registered for the Medicare and Medicaid EHR incentive program as of July. A total of 2,383 EPs have verified they met MU requirements; 137 attested unsuccessfully (though it’s unclear why.) CMS has issued almost $400 million in incentive payments.

Other

US physician practices spend nearly four times as much per physicians Ontario in dealing with health insurers and payers. Though much of the difference stems from Canada’s single payer system versus the US’s multiple payer model, the authors of the Health Affairs-published study suggest there are ways that US health insurers could reduce costs and increase efficiencies.Other

An article in an Indian business publication says that companies there will get a lot of business from ARRA and ICD-10, quoting Bronx-Lebanon CIO Ivan Durbak. The hospital says it is saving at least 50% of the cost of its EHR project by issuing its $30 million contract to a Chennai-based outsourcer.

In Canada, Ontario Telemedicine Network is expanding by adding an Internet-based videoconferencing solution that participants can access on any PC.

Emergency personnel in western North Carolina paid their respects Tuesday to Asheville Fire Department Captain Jeff Bowen, who died in a medical building fire last week after helping save an oncology clinic’s computers and electronic records.

Max Harry Weil MD, PhD, who in the 1950s developed the “shock ward” concept of today’s ICU, including crash carts, stat labs, and computer-monitored vital signs, died last week at 84.

Odd lawsuit: the family of a man killed by his chemist wife, who poisoned him with the diagnostic agent thallium, sues her drug company employer, the hospital where he died, and six doctors. The suit claims he would still be alive “if only one of the world’s biggest drug makers and an accredited medical center had just done their jobs.”

Sponsor Updates

• Regal Medical Group, a California-based IPA, announces a partnership with MyHealthDIRECT to assist its members in the care transition process.
• MEDSEEK earns a #5 ranking in the State of Alabama’s Best Companies to Work For program in the 50-249 employee category.
• Pamela Bradshaw RN, CCRN, NE-BC, CNO and VP of Nursing and Clinical Services at United Regional Health Care System (TX) credits Clairvia’s CVM Patient Acuity for higher levels of job satisfaction among staff nurses and better patient care.
• CareTech Solutions announces a partnership with Cardinal Path, a Google Analytics Certified Partner, as a value-add service for its CareWorks content management system.
• FormFast will host a free August 18 webinar entitled EMRs Need More to Support Meaningful Use.
• TeleTracking Technology is nominated for Tech Titan of the Year for 2011 by the Pittsburgh Technology Council.
• Perceptive Software expands its global OEM program.
• Nuesoft releases a video on reducing medical practice risk through strong HR policies.
• Merge Healthcare announces sales of $57M in the second quarter. The company also posts a podcast on radiologists and Meaningful Use.
• Lorie Richardson of Hayes Management Consulting discusses eight ways IT can improve training and adoption rates.
• Concerro offers a webcast entitled CXO, WOW & WOM: A Powerful Approach to Patient Experience Management Tied to the Bottom Line.

EPtalk by Dr. Jayne

Nominations are now open for the 2011 HIMSS Award and Recognition Program. Too bad Mr. H is anonymous, because he certainly meets some of the criteria for service to the industry. Nominations are open through October 14.

Weird drug news: the first FDA-approved treatment for scorpion stings has arrived. That’s good news for those of you in Arizona, which plays home to most of the poisonous scorpions in the US. I’ve spent enough time in the southwest to be freaked out by these little buggers. Although most adults don’t need treatment if stung, this is good news for children who might have a too-close encounter of the Centuroides sculpturatus kind.

Like many of you, I’m pretty tired of US politics and healthcare reform being flogged during the debt ceiling discussions. One bright spot in government though is the “Restoring Access to Medication Act” introduced as H.R. 2529 and S. 1368. This would allow patients to use their flexible spending accounts and health savings accounts to purchase over-the-counter (OTC) medications without a physician order, as they could prior to 2011.

I can attest that this issue has caused quite a bit of patient angst and increased healthcare spending as patients come in for office visits to obtain prescriptions for OTC drugs, not to mention healthcare IT spending as many practices created custom order sets and forms to be able to rapidly order a broad spectrum of OTC drugs for patients in a single click. I shuddered the first time I had one of these visits as I wrote scripts for Tums, hydrocortisone cream, and a pregnancy test. (Even worse is the fact that a pregnancy test is not an OTC drug and that a script isn’t required – but my patient had a letter from her benefit administrator demanding a script and stating that they wouldn’t honor the examples given in the FAQ section of the Internal Revenue Service website.) It’s about doing what’s right for the patient, regardless. Let’s hope Congress gets this one right.

I’ve mentioned my thoughts on sunscreen and tanning before, as well as my appreciation for a good glass of wine. A recent study from the Journal of Agricultural and Food Chemistry notes that “A compound found in grapes and grape derivatives may protect skin cells from skin-damaging ultraviolet (UV) radiation.” Maybe Inga and I can sign up for the follow-up study.

There are days when I joke about needing to wear body armor to work, but I’m usually referring to the need for protection from the slings and arrows of my colleagues. The LA Times reports on this, noting that 10% of emergency department nurses had been assaulted in the week prior to being surveyed. Most violence is from patients and family members.

I was recently at a training techniques class with a group of professional Health Informatics trainers. There were a few newbies in the group, and the topic of physicians “getting physical” during EHR training came up. Nearly all trainers reported having something thrown at or near them – from pens and paper to coffee cups, all the way up to laptops. One even reported a physician tipping over a computer-on-wheels in frustration. Seriously, people. It embarrasses me that physicians behave like this. Discipline for these kinds of infractions should be the same as that for surgeons that throw instruments in the operating suite. The fact that EHR or CPOE training is involved is no excuse.

Last, our nominee for quote of the week: This gem is from CMIO magazine and William F. Bria MD, President of the Association of Medical Directors of information Systems (AMDIS). “Another usability problem is the expectation of some physicians that the whole point of these systems is to make them more efficient and happy.” If you’re a project manager out there selling technology as a way to increase physician satisfaction, please think of another marketing bullet point. How about patient safety? That’s something we should all be able to get behind.

Contacts

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

Blackstone To Acquire Emdeon for $3 Billion

The Blackstone Group will buy Emdeon for $3 billion, with the private equity firm taking the publicly traded Emdeon private, it was announced this morning. For the past year, Emdeon earned $19.5 million in profit on $1 billion in revenue.

Nashville-based Emdeon offers revenue cycle solutions for providers, pharmacy benefits transaction processing, and claims solutions for payers.

Rumor of the acquisition was reported here on July 29.

Readers Write 8/3/11

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!

The Pressures of EHR Adoption and a Market Trend of Converged Services and Technology
By Janet Dillione

Recent mergers and acquisitions in the healthcare information technology (HIT) industry bring to light many facets of electronic health record (EHR) implementation that often go overlooked. As many in the medical industry know, implementing an EHR system so it works seamlessly with clinical workflow is more complicated than downloading and installing software with the click of a mouse. There is not an EHR switch that can simply be turned on.

Healthcare organizations that have successfully implemented EHR systems, along with those currently navigating the process, can attest to the need for a scalable system wide approach. To achieve improvements in the quality, safety and efficiency of patient care special attention should be paid to services and technologies that foster EHR adoption across the clinician population.

Recent strategic alliances in the healthcare IT space signify a movement toward a promising future of EHRs, a future with a genesis in advanced clinical documentation. A successful, long-term EHR strategy, one that will position healthcare organizations to overcome the many pressures of the healthcare industry in the years to come – Meaningful Use, ICD-10, Accountable Healthcare – begins with effective data capture. The reality is that an EHR is only as good as the information captured within it, and as the saying goes, it takes a village …

I have no doubt that the industry will continue to see more strategic partnerships. These alliances establish greater resources for the healthcare industry, leading to more streamlined workflows, greater cost savings, satisfied physicians, and improved quality of patient care. However, none of this happens overnight and healthcare organizations should see this as an evolutionary process, not one of instantaneous change. By this I mean, every provider setting has a clinical documentation workflow in place, and pursuing an approach that is diametrically opposed to the status quo can prove counterproductive to the effort.

Despite the enthusiasm for employing state of the art technologies, healthcare organizations should not feel pressured to immediately make all data capture mobile, to put all applications in the cloud tomorrow, or to force doctors to use an EHR without a safety net out of the gate. In time, the increased amount of service and technology convergence across the industry will help healthcare organizations to better address the pressure of EHR adoption, and more importantly, will help them better manage their robust collections of clinical data.

It is becoming increasingly clear that in healthcare, data is knowledge. It drives care decisions, billing and reimbursement, compliance with federal regulations, and is key to overall health system improvement. Today, there is no one solution, no one vendor, and no magic potion that can address all of these issues and capitalize on all opportunities. However, by strategically bringing together the best in technology with the best in services, healthcare organizations will be better positioned to make the transition from traditional workflows to the EHR in a thoughtful, natural way.

An impressive amount of progress has been made over the last several years, particularly in light of EHR adoption pressures. Innovation and automation is transforming the processes and outputs of clinical documentation. What once was scribbled on a notepad, created on a typewriter, or passed from caregiver to caregiver in the hallway, is captured and transferred more efficiently and effectively than ever before. Such effective clinical documentation establishes an important foundation for EHRs.

By leveraging and contributing to technology collaborations, healthcare organizations can access the best in services and technology. This means a transition from handwritten records stored in manila folders to digital information stored within EHRs captured through natural clinical workflows. Moving forward, there will be multiple ways to capture the patient story including keyboard input and speech-to-text technologies.

Once clinical information is captured, we’ll see the application of highly intelligence clinical language understanding (CLU) technologies, often referred to as natural language processing or NLP in other industries. These highly sophisticated technologies will turn our vast amounts of clinical data into knowledge to be leveraged across the healthcare ecosystem.

The convergence going on across the healthcare industry amongst healthcare IT vendors, academic centers, service-oriented businesses, and other organizations is promising, but should be scrutinized by healthcare organizations.  There are many promises amongst the recent M&As and partnership activity, but only few proven results and long-term plans.  As you work to tackle EHRs as a strategic initiative, enlist supportive guidance and build a nimble infrastructure where the EHR can become a launching pad for better use of data.

Janet Dillione is EVP/GM of the healthcare division of Nuance of Burlington, MA.

Meaningful Use and Innovation
By Ryan Parker

All human development, no matter what form it takes, must be outside the rules; otherwise we would never have anything new. – Charles Kettering.

I have recently finished up some consulting work for a startup HIT company (which for non-solicitation reasons I will refer to as Company X.) I was working with them to help develop their EMR. 

When Company X first showed me their product, I was amazed. In just over a year, they had developed an almost fully functioning EMR. Using more advanced coding language than what you would find in most legacy systems (i.e. C#, Silverlight) they came as close to mimicking the clinical workflow as I have seen with an information system.

Everything was looking up. Their product was becoming more and more complete and becoming more and more advanced. But then they ran into an issue. If anyone has worked with or been a part of a start-up, momentum is key to success, and in this company’s case, the Innovation truck slammed head first into the Meaningful Use wall.

To be completely honest, forcing Company X to get their product Meaningful Use certified did have some benefits. There were some system needs they hadn’t thought of previously. In terms of HIE and interoperability, the requirements will have a positive impact as a whole as we move to a more ‘data-sharing’ driven information system structure. However, the innovation, creating a system different from anything else, which, to keep the truck metaphor rolling, was sitting in the driver’s seat of the company, dissipated as executives and engineers dived deeper and deeper into the ONC requirements.

Weeks turned into months of working on the Meaningful Use requirements. Although Company X was making progress, the focus slowly turned from creativity and ingenuity to one of conclusion, as in, “How soon can we meet these requirements and be done with this product?”

Soon, the executives starting turning their attention to other products, focusing on solutions that fall outside of the ONC/Meaningful Use umbrella.

I have no doubts that after they complete their Meaningful Use certification in the near future, and hospitals and health systems get a good view of their product, Company X will receive accolades on their HIT advancements from the healthcare community. Personally, I will be wondering what progress could have been made without standardization. What advancements could Company X have made without the rigors and requirements forced upon EMR vendors?

Ryan Parker is implementation practice director of Preceptor Consulting Corporation of Fort Myers, FL.

HIEs: High Performers Will Be Around for the Long Term
By John Haughton

Improved patient care outcomes, lower administrative costs, fewer medication errors, improved ability to manage chronic conditions, reduced unpaid re-admissions, greater efficiency, fewer ER visits …

There is no question about the benefits that a highly effective health information exchange (HIE) brings. By highly effective, I mean a healthcare ecosystem grounded in evidence-based medicine, clinical guidelines, and performance reporting.

For providers hoping to achieve Meaningful Use (MU) or to become Accountable Care Organizations (ACOs), performance-based HIEs hold the promise of pulling together data from myriad sources — medical staff and community physicians, insurers, labs, imaging centers, behavioral health and home health providers, employers, consumers, retail pharmacies — to finally deliver truly coordinated care.

But there is also no question about the challenges facing fledgling HIEs, the primary one being a sustainable business model. It turns out that, if you build it, they won’t necessarily come. And once the grant money runs out, the organization rapidly runs out of steam.

The only way to build an HIE with enduring power to transform the health of a community is to have providers pay for it. And the only way to do that is to provide high value — quickly. This means demonstrating value from Day One by raising the bar on clinical quality for their customers, namely, patients.

In response to the MU requirement for value-based purchasing and market realities pushing margins into negative territory for about half of all hospitals, HIEs must help hospitals survive and thrive in the new patient-centric business model to garner lasting provider support.

The HIEs that have done this successfully have something in common: they pretty much all have their heads in the cloud, which is to say, they use platform-as-a-service (PaaS) cloud computing technology that offers authorized users easy, but extremely secure access to centrally stored, actionable information for an affordable price.

Here are the seven technology elements needed to play in the high-performance league:

1. Maximum functionality and flexibility. Since around three-quarters of healthcare in this country remains paper-based, technology is needed that supports hospitals and physicians regardless of their technology sophistication. This favors best-of-breed EHR modules that can meet a wide variety of needs, budgets and timetables, rather than a comprehensive, enterprise-wide approach.
2. A full range of value-added tools and services. Think of the app store on an iPhone. That type of flexibility and customization are what is wanted from HIEs, only instead of YouTube, GPS, and Fandango, apps that provide clinical decision support, performance management, quality reporting and analytics, clinician messaging, shared guideline dictionaries, and disease registries are valued.
3. On-the-fly translation. As long as stakeholders continue to speak different electronic languages — all of which are upgraded and updated almost constantly — mapping and translation services are needed for interoperability.
4. Scalability. An HIE is a dynamic entity; it needs a platform that continually accommodates more of everything: providers, users, technologies, regulations… Collaborating across town is great. Collaborating anywhere is the ultimate goal, however.
5. Ease of use. An identity federation service means providers need just one user name and password to interact with each other, health plans, regulators and patients — and just one point of access for all clinical and administrative data held by the HIE.
6. A 360-degree, real-time view. A single, comprehensive view of a patient’s status, including all information submitted by all authorized sources from five decades ago to five minutes ago, will help eliminate redundant tests and procedures.
7. Sharing of best practices. The best HIEs aren’t merely repositories. They must be able to analyze input, generate point-of-care solutions, and disseminate data that draws on documented successes.

So the future is bright for those high-performance HIEs that “bring it” — clinically speaking. HIEs and other data exchange organizations that figure just having the data will have hospitals and physicians beating a path to their door are being naïve and are putting their long-term survival at risk.

Like it or not, healthcare is a business as well as a service, and organizations need to deliver ongoing value to ensure their long-term relevance and sustainability.

John Haughton MD, MS is CMIO of Covisint of Detroit, MI.

News 8/3/11

Top News

Atlanta-based transcription vendor Transcend Services announces that it has acquired electronic clinical documentation and charge capture vendor Salar Inc. in an $11 million cash for stock transaction that closed last week. According to the announcement, Salar had $1.2 million in operating income on $4 million in revenue last year. Transcend says it will migrate its speech recognition technology to Salar-based templates for users who prefer that form of documentation, allowing it to offer customers a hybrid solution that will help them meet Meaningful use requirements. Salar, founded in 1999, will remain in Baltimore as a business unit of Transcend. They are the latest in an amazing string of HIStalk sponsors to be successfully acquired, for which we congratulate Todd Johnson and his fun band of pirates — we call them that since they attended our HIMSS reception in swashbuckling regalia a couple of years ago.

Reader Comments

From E-Reader: “Re: NextGen. Will announce later this week that it will partner with Medseek for a new enterprise patient portal for hospitals.” Unverified, but reported by several readers.

From CIO: “Re: HIS vendor quote. This is my new favorite, just received from GE: ‘While we do our best to eliminate as many crashes as possible with each release, we did not expect crashing to go away with DP7 entirely, only to be reduced.’” Unverified. I actually admire that they came clean technically. While everybody’s #1 preference would be for a vendor to fix all technical problems (and cause none), the #2 preference is for the vendor to at least disclose when a problem exists so it can be mitigated in ways that don’t make the client’s IT department look stupid.

From Amish IT Guy: “Re: EMR. Take a look at this one and see how long it takes you to realize something funny is going on. It’s an EMR for marijuana dispensaries. Do you get a medical necessity button that always says, ‘ Duuude, go for it?’” An LA TV station went undercover last to film some of this vendor’s EMR clients using the system to illegally issue marijuana cards without any physician involvement, causing the company to threaten those users with termination of their accounts so they wouldn’t “blemish the good practices of everyone else.”

From Epic Guy: “Re: overseas expansion. There’s a small office in Abu Dhabi now.”

 From CERNest Goes to Camp: “Re: Cerner’s executive cabinet. The most recent annual report showed 10 executives, with Gorup and Illig as mostly inactive honoraries. That leaves eight execs, of which three have left in the last few weeks (Wing, Herzog, and Valentine) even as the stock was doing very well. If they really do need to go after acquisitions or new business to offset the business that Epic has taken from them, the second order churn at the VP and director level may hurt the traditionally well oiled machine.”

HIStalk Announcements and Requests

Inga has been doing a bit of traveling, so her contributions this time around are mostly straight news, thus the absence of her cute little red icon to indicate opinion, snark, or insight. I expect the ratio to improve next time.

Acquisitions, Funding, Business, and Stock

Mobile healthcare communications vendor Vocera files plans for an $80 million IPO, with shares to be traded on the New York Stock Exchange. Some big securities firms are involved: JP Morgan, Piper Jaffray, Robert W. Baird, and William Blair. The company had $69 million in sales for the year just ended.

NLP provider Coderyte raises $2.5 million from nine investors, including Polaris Ventures and Solstice Capital.

MedAssets reports Q2 net revenue of $147.4 million, up 55% from last year, primarily due to its acquisition of Broadlane in November 2010. Acquisition costs attributed to a quarterly loss of $2.5 million ($0.04 per diluted share) versus $3.3 million in 2010 ($0.06 per diluted share.)

Allscripts reports Q2 numbers: revenue up 11%, EPS $0.08 vs. $0.09, meeting consensus earnings expectations excluding one-time expenses.

The Allscripts conference call transcript is already up. Nuggets:

• CEO Glen Tullman cited a June CapSite survey that found Allscripts leads all EHR vendors in mind share.
• Allscripts beat Cerner at two-hospital, 550-bed Heritage Valley Health System (PA) in a newly announced Sunrise deal.
• A South Australia deal was announced, with SA Health signing a “limited pre-production software license agreement” as the first stage in implementing an EHR across 80 hospitals and clinics. Value of around $50 million was implied.
• The company is expecting 5,000 attendees at the Allscripts Client Experience later this month, where Allscripts will demonstrate full integration of their ambulatory and inpatient EHRs.
• Allscripts may move slowly into more hosted offerings like they offer for Sunrise.
• Glen mentioned a figure of 300-400 big hospital EHR deals being done in the next 18-24 months and he expects to get" “more than our fair share” of those.

Automated Tracking Solutions files a patent infringement lawsuit against a number of healthcare RFID/RTLS vendors, including Awarepoint, TeleTracking, and RadarFind. ATS sells no competing products that I can tell – its only assets are patents (the oldest being from 2005, with one of the technical illustrations above) and its lawyer owner.

CSC completes its acquisition of Australia’s iSOFT Group.

The COO of Humana mentions EMRs in the company’s earnings call:

And then finally, in the Stars and quality area, EMR investment. You may have seen some press releases that we’ve done here recently with companies like Allscript and Athenahealth and others where we’re trying to get a lot more information in electronic medical records going forward, in line with what the government’s doing. We think there’s a real opportunity there. And finally, in the clinical area, the Care Hub, something that we talked about with all of you in the past. Our clinical messaging system and workflow system, more rules, engine and accelerating IT spend there. Mike talked about hiring more Humana Cares nurses throughout the United States, field nurses throughout the United States in areas where we anticipate growing. And then finally, we did some work here recently to in-source all of our DM programs, and we’re going to accelerate that because we’re seeing some nice results there.

Sales

UW Health Partners Watertown Regional Medical Center (WI) selects GetWellNetwork’s interactive patient care solution.

USC University Hospital and USC Norris Cancer Hospital (CA) choose MedAssets as their exclusive provider of technology-enabled business office outsource services.

People

Tele-ICU provider Advanced ICU Care names Bradley Green VP of sales.

Sandlot LLC, a Texas-based subsidiary of North Texas Specialty Physicians, names Kimberly Alise as CEO. She was previously CEO and co-founder of EHR vendor Empower Systems. 

Former Sandlot CEO Telly Shackelford is promoted to CIO of North Texas Specialty Physicians.

Alex Veletsos, formerly of Orlando Health, joins Ascension Health Services as CIO of St. Mary’s of Michigan and St. Joseph Health System.

Announcements and Implementations

In an SEC filing, Cerner discloses it paid $36.3 million for its May acquisition of Resource Systems, a provider of long-term care software.

Integrated Document Solutions partners with SourceMedical to provide document scanning and outsourced paper imaging services to SourceMedical clients transitioning to EHR.

Healthland launches Healthland Centriq, an EHR solution for rural clinicians.

Delaware Valley Hospital (NY) uses professional services from Accent on Integration and the Siemens OPENLink interface engine to integrate and share data with the Southern Tier Health Link RHIO.

Kareo announces the availability of free support to all its customers. The company also notes that internal surveys show that customer satisfaction is up 325% as a result of several recent improvements.

Clinical communications technology vendor Voalté signs its first reseller agreement. Houston-based Halco Life Safety Systems will offer its Voalté One smart phone solution to hospitals there.

Florida Hospital and Cerner will work together on a system that facilitates communication between patient care physicians and their researcher counterparts, connecting Cerner’s clinical systems with its PowerTrials and Discovere applications to automate and integrate diabetes research activities.

Phytel introduces its Hospital Readmission Management solution to automate post-discharge care processes and reduce readmission rates.

An AIDS prevention group in India is finishing its software to track HIV-positive pregnant women and their babies, necessitated by hospitals that don’t bother filing their reports.

Spain-based technology vendor Andago, which offers government and eHealth software (including Continua-compliant mobile health applications for wellness, disease management, and independent living) leases space in a University of Miami research building adjacent to Jackson Memorial Hospital for its first US office.

The Government of Jordan launches a regional health clinic that will use Cisco’s Care-at-a-Distance HealthPresence technology to link specialists from two hospitals for consultations.

Government and Politics

AMIA weighs in on the proposed HIPAA Accounting of Disclosures rule. Their concerns:

• HHS assumes that EHRs maintain user-friendly audit trails that covered entities (not to mention their business associates) can easily extract and hand directly over to the patient.
• The NPRM uses the term “designated record set” inconsistently, and hospitals have a large number of IT systems that may contributed to that set.
• Patients won’t get much benefit since the disclosure list doesn’t address their primary concern – large-scale electronic theft – and will confuse them since they are generally unaware that many people they don’t see directly are involved in their care, such as students and back-office employees.
• The rule proposes to include the full name of those accessing records without asking those caregivers for consent, which AMIA cleverly points out isn’t that much different than looking at patient records without their consent.
• Just a quick look at a patient’s record could generate dozens of entries, but still not capture all accesses, such as seeing a patient’s name on a list or running a query (like from a data warehouse) that touches a patient’s record. They also question whether medical case presentations and guest expert rounding require someone to log the “accesses” manually.
• AMIA worries that provider may simply eliminate access rather than account for it, such as denying research access to students.
• Data transmission, such as batch file extracts, don’t generally populate audit logs.
• If HHS really believes that few patients will request disclosure logs (which is how it justifies the workload involved), then maybe it’s not really worth the provider and vendor cost of making them available.
• Even complete audit logs won’t answer the specific questions that patients probably had in requesting a report, such as “Did my ex-girlfriend who works at your institution look at my record, and if so, why?”
• AMIA is “astounded” that research use must be included in access reports, even those involving an IRB, patient authorization, or a limited data set.
• HHS’s $20 million estimate of cost to providers is absurd since that’s only $30 per covered entity. Even just a wording change to a single provider’s Notice of Privacy Practices would cost thousands of dollars in legal review fees.

Other

We mentioned a couple of weeks ago that Cayman Islands Health Services Authority CIO Dale Sanders told us they would be re-competing their Cerner contract. Here’s more. The bid document says the Cerner system costs $2.7 million per year, but users find it cumbersome and are “largely unhappy with the workflow and user interface.” The hospital is seeking a less-expensive alternative that is free from the “dysfunctional influence of the US financial and economic model” for healthcare.

HHS Secretary Kathleen Sebelius gives EMRs a plug during a tour of the tornado-damaged St. John’s Regional Medicine Center in Joplin, MO. Says Sebelius:

"There’s no question that … the availability of an electronic record may have actually saved lives. They were able to immediately go into the treatment phase and not spend a lot of energy trying to reconstruct (records)."

Georgia’s second annual Health IT Leadership Summit will be held on November 8 at Atlanta’s Fox Theater. Entries for its first innovation awards are due August 24.

Pocatello Family Medicine (ID) sends potential breach letters to its patients after finding that a technician forgot to reactivate the firewall after maintenance work, leaving its EMR wide open on the Internet for several months. The practice says it doesn’t think anybody accessed the patient records, although someone did park some movies on their server.

Weird News Andy reproduces this article from India, which describes the surprise of surgeons in finding that a male patient admitted for a suspected hernia had a complete set of female reproductive organs in his abdomen. He’s recovering well from his hysterectomy.

I love this Epic ad from a 1984 MUMPS journal, as sent over by Limber Lob. Here is his explanation:

Attached is an advertisement from Epic that appeared back in 1984. I had set this ad aside so I could someday ask Judy about the comment at the bottom, which reads, "All Epic software is written in the MIIS dialect of MUMPS."

But a colleague just reminded me that it was all about speed, as Meditech’s MIIS dialect of MUMPS was very fast and ran circles around all other early MUMPS implementations, such as those from Digital Equipment Corporation (DEC) and InterSystems.
As you know, Neil Pappalardo, who founded and still owns Meditech (which still uses MIIS), was the original developer of the MUMPS programming language when he worked for cardiology researcher Octo Barnett at the Massachusetts General Hospital in the mid-1960s. As MUMPS moved slowly towards (ANSI) standardization, Neil wanted to pursue his own ideas at a faster pace, and left MGH to develop MIIS and found Meditech. Back in 1984, when minicomputers were slower than today’s slowest desktop machines, Judy used the MIIS dialect of MUMPS for Epic’s software because it was the fastest game in town But as the other (standard) MUMPS implementations got faster, the benefits of using ANSI Standard MUMPS dominated the language selection decision, and Epic switched to the ANSI/ISO Standard MUMPS that virtually everyone but Meditech uses today. This ad surprised me, as I hadn’t remembered the details, but it’s good to be reminded that system speed has been an Epic priority since the beginning.

Sponsor Updates

• Presbyterian Intercommunity Hospital (CA) selects ProVation MD software from Wolters Kluwer Health for documentation and coding of gastroenterology procedures.
• St. Luke’s Hospital & Health Network (PA) chooses Allscripts EHR and PM for their 1,600 physicians, underwriting a portion of the cost to enable the physicians to qualify for ARRA incentives.
• Heritage Valley Health System (PA) signs up for Allscripts Sunrise, which it will connect to its Allscripts Enterprise ambulatory EHR.
• NP Scharmaine Lawson-Baker (LA) uses Practice Fusion’s free, Web-based EHR and her iPad to care for senior and disabled patients via house calls.
• T-System Inc announces that it will incorporate content from PEPID into its ED information system, T-SystemEV, improving accuracy and patient care.
• Merge Healthcare announces Covenant Healthcare’s selection of iConnect Access to provide images to its physicians. Northeast Georgia Health System (NGHS) also selects iConnect for its HIE strategy, while and Mon General Hospital (WV) chooses Merge Cardio as its enterprise-wide cardiovascular information system.
• Stockell Healthcare Systems announces that ProMedica St. Luke’s Hospital (OH) is ProMedica’s tenth facility to go live with its InsightCS Revenue Cycle Information System.
• Keane, an NTT Data Company, announces that SVP Robb Rasmussen will speak at the CIO 100 Symposium on cloud computing in August.
• Thanks to NPC Creative Services, which counts quite a few HIT vendors among its strategic PR clients and keeps us in the loop with new announcements (and who is an HIStalk sponsor itself).
• Intelligent Medical Objects (IMO) is attending the Aprima and ACE user group meetings in August.
• Gateway EDI is exhibiting at MGMA Alabama, MGMA Georgia, and PriMed Mid-Atlantic in August.
• TeleTracking Technologies attributes its strong second quarter to the 14 new hospital contracts for its TransferCenter referral automation software.

Contacts

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

Curbside Consult with Dr. Jayne 8/1/11

E-mail Dr. Jayne.

Monday Morning Update 8/1/11

From ACC_Champs: “Re: NCHICA’s response to Accounting of Disclosures. By getting input from all sides of the issue, they have drafted a great response.” Some of their concerns:

1. Just because few people ask for Accountings of Disclosures now doesn’t mean they won’t in the future, requiring hospitals to do a lot of unpaid work.
2. The scope needs to be better defined since not everything is stored permanently in the EMR (such EKG strips, as I read from their example).
3. The definition of “access” should be clarified, such as if someone searches for “John Smith” in an EMR and is shown a long list of John Smiths, is that considered “access” of every one of them?
4. It’s not as easy to generate an Access Report as you might think, with hospitals churning out tons of data from many systems (one hospital found that an average six-day inpatient stay generated 1,800 accesses).
5. Access logs aren’t something the typical patient would be able to understand, meaning they may expect someone to spend time explaining them.
6. Patients who don’t understand that hospitals have a lot of unseen people involved in their care are going to file unwarranted complaints to OCR.
7. Employees aren’t protected from ambulance chasers or crazy patients who could easily obtain their full names by requesting an access report.

From Quaid: “Re: Siemens. Hawaii Health Systems Corporation just signed a $28.7 million deal for Soarian.” Verified.

From Anony: “Re: Piedmont Healthcare, Atlanta. Can’t believe I haven’t seen it here yet, but they’re moving from Allscripts to Epic.” As usual, the best way to verify is to check the hospital’s job postings since the Epic implementation method requires hiring a ton of people fast, including posting all jobs instead of just reassigning current staff. Piedmont listed several inpatient Epic positions on July 12, so I’d say that’s confirmation. I should also mention that Johns Hopkins signed its Epic contract this week. Both will apparently be Allscripts Sunrise losses.

From Anonymous: “Re: Allscripts. Continuing to reduce workforce in Raleigh as jobs are offshored, with 15-20 folks gone in the last week or two.” Unverified.

From Nasty Parts: “Re: Compugroup. Heard on the street that they’re buying the Sage Healthcare business. Folks at Compugroup USA HQ openly talking about it.” Unverified.

From KnowurCMIO: “Re: Cerner and Epic. Epic has indeed started expanding overseas — they have a satellite HQ in the Netherlands and have already installed there. I suspect they will begin seeing rapid growth once the implementations stateside slow down. Spaarne Hospital was the first EpicCare client in Europe in 2007.”

From Bob: “Re: shoe hoarder. I read this and thought of Inga.” A Philadelphia mom who happens to be a big-money poker champ owns 1,200 pairs of shoes (one pair worth $4,000) stored in four closets, one of them a converted sitting room. She’s profiled in a film about shoe nuts, which concludes that such compulsion is related to seduction and sex. I’ll let Inga to clarify her own motives.

Here’s the latest HIStory from Vince, this time covering Dynamic Control.

Listening: the new CD from teen rockers Jessica Prouty Band, sent over by her mom, who has a lot of history in HIT. Their sound has matured a lot over the years I’ve followed them, putting them right up there with Evanescence, Within Temptation, and some of the other female-led metal rockers. Big sound for a four-piece, with singer Jessica handling the bass very well. This is a really polished production – you would never suspect that the members are barely old enough to drive to their gigs. Video here.

My Time Capsule editorial from 2006 this week: When CIOs Are Under Pressure, “Man of Action Syndrome” Kicks In, snipped herein: “From my limited experience, I would say that CIOs overrule the concerns of nurse informatics people nearly 100 percent of the time and IT-based physicians at least 50 percent of the time.”

Most respondents believe that HITECH’s legacy will be increased EMR adoption, although the “waste of taxpayer money” camp was right on their heels. New poll to your right, spurred because I got a HIMSS member survey recently: how would you grade your satisfaction level with HIMSS? As always, you are able and encouraged to add your comments by clicking the Comments link on the poll, visible after you’ve either voted or clicked the View Results link.

HIMSS moved its Chicago headquarters this weekend.

Sage announces Intergy v7, which includes user enhancements, certification of all 44 ONC-ATCB clinical quality measures, and 5010 support for the PM/EMR system.  

NHS Scotland contracts with Imprivata for its OneSign single sign-on and password reset solution.

A reader sent over the full text EHR articles that were just published in the July issue Journal of Oncology Practice. Here’s a brief rundown of those I found interesting.

• A US Oncology team, working with iKnowMed to standardize over 500 chemo regimen order sets, found that 10% of them needed to be eliminated, with changes required for all the rest (other than changes in title, the most common changes involved updating the cited references and changing doses and cycles). They mention that EMRs can help address drug safety issues.
• NorthShore (IL) looked at the cultural impact of moving all inpatient and outpatient oncology ordering to Epic in 2005. The main benefit was data sharing among members of the multidisciplinary team (labs, rads, referrals, appointment information) and patient communication (secure communications, online test results). Chemo ordering in Beacon was found to be more complete and safer, with the percentage of complete documentation going from 67% to 93% and pharmacy interventions also increasing. They’re at 100% e-prescribing (other than for narcotics and oral chemo), outpatient med rec is over 90%, and AR days have dropped to 30. They’re using Epic’s data for research and quality monitoring.
• A Vanderbilt group looked at improving compliance with nursing guidelines on chemo administration and documentation using their systems (WizOrder, Horizon Meds Manager, Horizon Expert Documentation, StarPanel). Pros: two-signature compliance improved, standardized MARs were easier for nurses to follow, alerts improved safety. Cons: systems could not track doses by relative day or dose number, could not document infusion stop time, stat and verbal orders required an override, and pharmacy had to adjust schedules frequently to avoid “wrong time” alerts.
• Johns Hopkins pediatric oncologists wrote up their CPOE design process and creation of Eclipsys Sunrise MLMs to check height and weight, to force inclusion of hydration orders, and to provide the capability to adjust chemo doses by percentages. They also developed a fast-track process for creating and approving new order sets.
• Memorial Sloan-Kettering described their Eclipsys CPOE chemo ordering implementation. They created 1,250 adult and 466 pediatric order sets and mandated CPOE-based ordering. They reported nearly universal use of the order sets. I didn’t see anything that documented clinical outcomes, but they did mention problems related to cumulative dose calculations and alerts.

From McKesson’s earnings call:

1. They talked a lot about acquiring Portico Systems (surprising given that McKesson is a massive company acquiring a relatively tiny company for $38 million, which would be just a few weeks’ pay for CEO John Hammergren since he took home $151 million last year) and said little about their drug business.
2. Technology Solutions  revenue was up 6%, but only because of revenue recognition timing – they expect growth to be a little better than last year’s 2%.
3. Hammergren mentioned “significant progress” in the technology business, but basically said focus is on implementation rather than sales even though the company is “continuing to strategically position the business for continued growth.”
4. He said that clinical systems are today’s opportunity, but a lot of McKesson’s customers are running 20-year-old financial systems that might be candidates for Horizon Enterprise Revenue Management.
5. He thinks that big companies (“the anchor tenant”) will be the healthcare IT winners in the payer, hospital, and physician practice markets since smaller companies won’t be able to get to those prospects cost effectively.
6. He mentioned some “consolidation in our overhead and our selling infrastructure last year.”
7. An analyst asked directly about IT customer retention in calling 2010 “a tough year” for McKesson, with Hammergren’s response being that the company had spent a lot over the last two years to make its products better and he hopes the market share changes are a trailing rather than a leading indicator, with the potential of a slight rebound in market share this year with Paragon as the leader.

My sideline analysis of the MCK call (your comments are welcome):

1. Most of the analysts’ questions involved the company’s challenges in the IT business, again surprising given its core business of drug distribution.
2. McKesson seems to be acknowledging that it’s falling behind Epic and other vendors on the clinical systems side and is placing its only hope on a pendulum swing back to financial systems and its struggling HERM.
3. The company hopes that product improvement will stop the market share slide.
4. I inferred no commitment to innovation, acquisitions, or thought leadership, just that McKesson is banking on its huge size and customer touch points to keep selling all of its products.

The local paper covers the $36 million Epic system that will be in place when Orange Regional Medical Center (NY) moves to its new hospital next week. It says that stimulus money will cover half the cost.

In Canada, Nova Scotia will implement a $27 million system for sharing patient medication information, with all pharmacies expected to be linked by 2013.

Hawaii Governor Neil Abercrombie announces that Thomas Tsang, MD will join his healthcare transformation leadership team. He is ONC’s medical director over Meaningful Use, but it’s not clear from the announcement whether he’s resigning that post.

GE Healthcare Performance Solutions acquires Medical Event Reporting System, a Web-based system that helps hospitals collect and analyze patient safety events. It was developed by Columbia university with AHRQ support. The company, also called MERS, had been a GE Healthcare JV partner since 2008. A white paper on its use by Mount Sinai Hospital (NY) is here. GE says it’s working on rollouts to 16 hospitals.

From Cerner’s earnings call:

1. The company talked up its physician practice sales, saying its improvements in the user interface and workflow positioned its products well as clients look for systems that integrate inpatient and outpatient.
2. CERN says it is different from competitors in its willingness to connect to other systems.
3. They are expecting Meaningful Use to keep driving sales for years.
4. They suggest that 50% of US hospitals will reselect their core systems in the next 5-7 years as even those customers who are happy today will find their vendors falling short with regard to interoperability and reporting.
5. The ProFit financial system is doing better.
6. CERN says they expect to take on more outsourcing contracts since they are more able to hire scarce HIT employees than hospitals.
7. Neal didn’t pop in for even his usual one-paragraph drive-by.

Shares in Omnicell touched off a 52-week-high Friday after turning in good numbers after the market close Thursday: revenue up 6.6%, EPS $0.08 vs $0.02. The one-year share price (blue) against the S&P 500 (green) is above. Market cap is $567 million.

Meditech filed its quarterly report Friday, with revenue up 25% and EPS up 33% ($0.86 vs. $0.64). The cost of acquiring the 78% of shares in ambulatory vendor LSS that it didn’t already own was given as $13.7 million in cash, with LSS’s first quarter performance being $0.8 million in net income on $5.4 million in revenue.

Strange: the former head of Alberta Health Services (Canada), who left his job in November after repeatedly telling reporters at an emergency meeting that he was too busy eating a cookie to answer their questions, gets $735K in severance. He seemed overly peeved, but made sense in pointing out that maybe the eager beaver talking heads should attend the scheduled press briefing that was being held in 30 minutes instead of chasing him down the street for their own personal on-camera moment.

E-mail Mr. H.

Time Capsule: When CIOs Are Under Pressure, “Man of Action Syndrome” Kicks In

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

I wrote this piece in June 2006.

When CIOs Are Under Pressure, “Man of Action Syndrome” Kicks In
By Mr. HIStalk

Hospitals and vendors don’t brag when their IT projects harm patients. Therefore, I’m not surprised that press releases haven’t announced several recent, disastrous examples where IT leaders overrode worried clinicians and continued with a flawed clinical system go-live to the detriment of patient care.

Being of a clinical background, I’m compelled to give this scenario a name and an acronym, even though I can’t diagnose or cure it. Man of Action Syndrome, or MAS, is the psychological need of someone in IT authority to veto those more knowledgeable clinicians who express well-founded patient safety concerns about clinical IT projects.

The name is not sexist since I’ve not yet seen a female CIO so afflicted. MAS also seems to spare CIOs with a clinical background.

Its victims are generally male, Type A, ego-driven MBAs with a history of programming or consulting. Anxious to add value by showing business savvy and decisiveness in an ill-suited environment of caring and empathy, they won’t allow budgets or dates to slip. It’s a quantitative thing.

A wise old project management saying is, “Good, fast, cheap — you can only pick two.” Unfortunately, those with MAS obsess on ‘fast’ and ‘cheap,’ knowing that it’s far easier to bury (no pun intended) qualitative project shortcomings that fall into the ‘good’ category. You can always blame users or the vendor.

I’ve been on both sides of the fence. IT people add value in formalizing system selection and planning. Those are repeatable processes where past experience may improve the chance of success. Unfortunately, that kind of management-by-control experience doesn’t work with clinical process change.

Ideally, an assembled group of clinicians would drive clinical system projects. However, it’s hard to engage them. That’s when MAS kicks in: “My neck’s on the line, so here’s what we’re going to do.”

From my limited experience, I would say that CIOs overrule the concerns of nurse informatics people nearly 100 percent of the time and IT-based physicians at least 50 percent of the time. Because those people represent a large number of their disenfranchised non-IT counterparts, the CIO has, in effect, dismissed the concerns of an entire discipline, often with reasoning such as, “They don’t see the big picture” or “They don’t know the pressure I’m under to deliver ROI and on-time implementation.”

Maybe practicing clinicians should be the ones making the go/no-go decision without IT people or other hospital management in the room. I’ve seen clinicians leave meetings shaking their heads, worn down from trying to get their message across to an IT team more comfortable hard-selling their own agenda instead of listening to what’s best for patients.

Perhaps the evolving role of the chief medical information officer will eventually balance the MBA approach. Maybe we’ll see more CIOs who have cared for patients instead of thriving in a Dilbert-esque world. Possibly the new wave of clinicians formally trained in informatics will provide credibility to concerns that the software doesn’t work, the users aren’t ready, or the communication has been poor. Non-IT hospital leadership may eventually understand that that silver bullet they paid for is just lead under the paint. Until then, if you’re a CIO with symptoms of Man of Action Syndrome, please contact your health care professional at once.

News 7/29/11

Top News

Cerner’s Q2 numbers: revenue up 15%, EPS $0.42 vs. $0.33, beating earnings expectations by a penny after excluding one-time items.

Reader Comments

From AzEMRGuy: “Re: Tucson Medical Center. Hiring for multiple Epic positions.” Above is the hospital’s recruitment video, which talks up Epic opportunities. I assume that means Allscripts Sunrise is egressing unless TMC switched systems since the last time I was there. CORRECTION: reader Zaphod Beeblebrox correctly notes that I confused University Medical Center in Tucson (a Sunrise client) with Tucson Medical Center. TMC is already an Epic customer.

From Instamatic: “Re: displaced CIS vendors. This chart from the KLAS newsletter says 2010 sales volume remained about the same as 2009. Would you assume that most of the displacements are Epic’s?” I would assume so, especially given the win/loss numbers that KLAS put out along with the graphic (almost two-thirds of sales to 200+ bed hospitals went to Epic, with Horizon customers being especially ripe for the plucking). I’ve been saying for a year or two that Epic is dominating the market of mid-size hospitals and up (say, 300+ bed community hospitals, but also academic medical centers and IDNs), putting a big-time hurt on Cerner, non-Paragon McKesson, and the former Eclipsys. Not to mention as the healthcare system inevitably consolidates under healthcare reform, more organizations will hit Epic’s sweet spot of size and scope as they look to standardize. Vendors such as GE, QuadraMed, and Siemens weren’t much of a sales factor anyway, so that would seem to leave Epic on the high end and Meditech and Paragon for everyone else as the only vendors booking significant net-new customers. That’s not considering rural and critical access hospitals, which would look at Meditech, Paragon, HMS, Prognosis, and a few others. I think you’ll see the others trying to make their numbers with hosting, upselling, and services – in other words, they’re in a mature market, which can throw off some nice profits while waiting for the inevitable downward slide to accelerate. They all have other business lines, so they’ll be fine. I’m not saying that’s good or bad, just how it looks to me.

From Mathemagician: “Re: Cerner. They can’t compete with Epic any more for hospitals of more than a couple of hundred beds, so they have three ways to drive growth: (a) sell to very small hospitals that don’t already have systems; (b) provide outsourcing services to existing customers, such as IT outsourcing and revenue cycle management; and (c) sell outside of the US where Epic doesn’t tread.” I would agree, adding also Cerner’s apparent interest (possibly Epic-motivated) in providing actual healthcare and healthcare management services rather than just IT products and services. Cerner’s biggest competitive weapon is its market cap, which provides options that the company appears to be tentatively exploring.

From rsm2800: “Re: Journal of Oncology Practice. The July issue contains 12 articles about EHRs in oncology.” Only subscribers can read the full text articles, but the titles relate to CCHIT certification; Memorial Sloan-Kettering’s chemo ordering system (which must be the amazingly cool Allscripts Sunrise work I saw at HIMSS last year); CPOE in peds oncology; standardized CPOE order sets; EMR-based checklists; use of natural language processing to extract clinical information from free text documentation; chemo medication administration systems; patient-physician e-mail; EMR effects on culture; CPOE outcomes; and the interest in sharing information by those with cancer. The topics sound excellent.

HIStalk Announcements and Requests

Have you kept up with HIStalk Practice this week? A few highlights: MGMA joins CHIME and other professional organizations in calling for HHS to withdraw its proposed HIPAA accounting of disclosure rules. DrFirst intros an e-prescribing option for controlled substances. The American Academy of Ophthalmology publishes a list of EHR requirements for ophthalmologists seeking to achieve Meaningful Use incentives. Salaries for physician practice managers remained flat in 2010.  Sign up for the e-mail updates while you are passing through and thanks for reading.

I featured Aventura in the latest Innovator Showcase this week. Just to recap the process: several dozen companies nominated themselves to be included; my expert team of investment bankers and providers chose eight of them after reviewing their application materials; and those companies will complete a video, a customer testimonial, and a telephone interview to be presented with their showcase article. Two of the eight have been featured so far. It’s quite a bit of work for the companies and for me, but readers have asked me repeatedly to give creative vendors a chance to be seen.

Keep an eye on the swinging pocket watch … you are getting sleepy … when you awaken, you will feel happy and rested. You will immediately sign up for e-mail updates to your upper right … your legs and arms are getting heavy … you will make the inevitable electronic connections offered by Facebook and LinkedIn to Inga, Dr. Jayne, and Mr. H … you can barely keep your eyes open …. you love HIStalk’s sponsors and will feel fulfilled by clicking their ads … going into a deeper sleep as you pledge to send me news, rumors, articles, or anything interesting … you’re become a little more alert … when I count three you will awaken rested and refreshed, feeling better than you’ve ever felt … one, two … and almost forgot, you’ll bark like a dog every time you hear the word “interoperability,” you’ll never embarrass yourself again by writing trite Internet phrases such as “wow, just wow” or “Best. Wine. Ever” and you’ll send love notes to Mr. H and Inga … three. Thanks to readers for reading, sponsors for … sponsing, and caregivers for caring.

Acquisitions, Funding, Business, and Stock

McKesson reports Q1 results: revenue up 9%, EPS $1.13 vs. $1.10, meeting Wall Street revenue expectations but falling short on earnings. Technology Solutions revenue was up 6% with adjusted profit of $119 million. The earnings call transcript should be out tomorrow and it usually has some interesting nuggets about the company’s software business.

Private equity firm Blackstone Group is rumored to be in discussions to acquire Emdeon for more than $3 billion. Shares jumped from less than $13 to over $16 on Thursday, closing at $15.49.

Healthcare learning and employee competency platform vendor HealthStream announces Q2 results: revenue up 26%, EPS $0.08 vs. $0.06.

NextGen parent company Quality Systems, Inc. reports Q1 results: revenue up 21%, EPS $0.65 vs. $0.42, beating estimates on both. Shares will split two for one on October 27.

CPSI’s Q2 numbers: revenue up 30%, EPS $0.72 vs. $0.39, blowing through estimates.

Revenue cycle management company Precision Revenue Strategies renames itself MediRevv.

Medicity’s performance is featured in Aetna’s earnings call Wednesday, which said its contract backlog is $200 million. Aetna made $537 million in profit on $8.3 billion in revenue for the quarter. Also stated about Medicity, which it acquired on January 3 for $500 million:

Our strategy is to grow our footprint in this space and to deliver clinical and administrative content through Medicity’s installed base of health information exchanges. For example, Medicity has developed and is beginning to distribute a suite of applications that are certified as being compliant with the federal meaningful use standards. Medicity’s application development expertise and patented distribution technologies are great examples of how the company combines content and connectivity.

At Aetna, we are excited about our role in promoting health information technology because we believe it has tremendous potential to improve the quality of health care and to make health care more affordable. We continue to build a portfolio of businesses that simultaneously generate high growth fee revenues and improve the performance of our health plan businesses.

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Sales

Texas Health Resources contracts with Streamline Health for its Epic Integration Suite.

The Tehachapi Valley Healthcare District Board of Directors (CA) approves the purchase of Healthland’s EHR. The local paper reports that the $400K five-year cost of HMS was one-fourth that of competitor McKesson.

HealthSouth selects Cerner to provide EHR for its 97 inpatient rehab facilities.

Memorial Hermann chooses CodeRyte for computer-assisted coding.

Hoag Memorial Hospital Presbyterian (CA) signs for Unibased ForSite 2020 Resource Management System for enterprise scheduling and a patient portal.

People

Former Wipro Technologies CIO Laxman K. Badiga joins Anthelio as COO.

Pat Cline, president and board member of Quality Systems, announces that he will retire this year.

Accretive Health names Joseph Bellini chief revenue officer.

Shared Health hires former WebMD founding COO Michael Heekin as CEO.

Announcements and Implementations

Misys Open Source Solutions wins the international “Best Use of Open Source Technology” award for its Misys Connect HIE solution.

The Rhode Island REC accepts ABILITY Network as an health information service provider to provide its member secure health information exchange.

Epocrates announces first phase availability of its Epocrates EHR mobile and Web-based EHR, designed for primary care practices with 10 or fewer physicians. The company will also offer a license to a native Apple iPhone app that supports remote patient look-up, schedule access, and e-prescribing capabilities.

Other

CMS’ Office of the Actuary predicts that national healthcare spending will hit $4.6 trillion by 2020, up from this year’s $2.7 trillion. The biggest increase in spending (8.3%) will occur in 2014, when many federal health reforms take effect.

The Salt Lake City paper observes the challenges of connecting physician practices and hospitals via Utah’s Clinical Health Information Exchange, with incompatible EMRs leading the list. An interesting tidbit that may have been inadvertently disclosed by a University of Utah Health Care spokesperson: they’re using Cerner on the inpatient side and Epic for outpatient, but will soon migrate to a single system. You’ll want big odds if you’re betting on Cerner to win that deal.

The Town of Freetown (MA) lays out the requirements Meditech will need to meet to develop a five-story, 186,000 square foot office building there that could bring up to 800 jobs to the area. Meditech’s costs are estimated at $80-100 million.

Tampa General Hospital (FL) files a $9.2 million claim against the estate of a deceased 29-year-old patient who had spent five years as an inpatient. Maybe they should use any proceeds to hire case managers or buy equity in a skilled nursing facility that will accept transfers.

Sponsor Updates

• Cottage Hospital (NH) achieves Medicare Stage 1 Meaningful Use through its use of the Healthcare Management Systems (HMS) EHR.
• Michigan Eye Institute chooses the SRS EHR for its eight-provider, five-location practice.
• Five providers from Aquidneck Medical Associates (RI) receive an $18,000 check for their Meaningful Use of the eClinicalWorks EHR, making them among the first in the state.
• Microsoft recognizes MEDSEEK as its 2011 US Public Sector Partner of the Year.
• Milwaukee Health Care Partnership and Wisconsin Health Information Exchange (WHIE announce a two-year extension of their contract with My Health Direct.
• St. Mary’s Regional Medical Center (OK) selects Merge Healthcare’s cardiology solution, while Sisters of Mercy (MO) adds the company’s iConnect solution.
• Mount Carmel Health Partners (OH) chooses MedVentive Population Manager to support improved patient care and clinical outcomes.
• Lexmark reports record earnings for Q2 and acknowledges the contribution of its Perceptive Software business unit.
• Health Language Inc (HLI) launches an upgrade to its Provider Friendly Terminology solution, now containing over 120,000 terms.
• T-System announces a call for entries for its Client Excellence Awards.
• Sentry Data Systems expands to a new office in Austin, TX while partnering with UT’s health IT program.
• GetWellNetwork adds two options for its interactive patient care system, a multi-function touchscreen and a lower-price, eco-friendly nettop.
• ZirMed announces successful transmission of claims and receipt of electronic remittance advices using HIPAA 5010 format.

EPtalk by Dr. Jayne

Quite a few organizations are using scribes as part of their EHR. A local hospital (which happens to be an Epic client) recently started using scribes in the emergency department, with the goal of having scribe coverage for all emergency physicians by early next year. According to a PR piece, several companies provide scribes and offer scribe training, with an estimated 200-plus hospital emergency departments starting to use scribes over the last two years.

Our group experimented with scribes several years ago when there weren’t as many formal opportunities for scribe training. We mainly wanted to use scribes in physician offices to aid EHR adoption and provide a safety net for older docs who were close to retirement and resistant to EHR implementation, but who still needed to get data into the system for patient safety and care continuity purposes.

A medical assistant or medical secretary would typically receive additional training, but it was rare for the practice to go the distance and hire someone to do the staffer’s usual work while he/she was scribing. As you can imagine, it doesn’t go well when you take a full-time employee and add another full time job to his/her plate. The program was dead before it ever left the gate.

Scribe staffing firms target pre-medical and pre-nursing students who are looking for experience in the healthcare field who are willing to work cheap. Starting salary for a scribe is $8 to $10 an hour. After preclinical training, the firm that’s staffing our local hospital includes a 100-hour “apprenticeship” with a senior scribe before new scribes are allowed to work independently.

The non-profit American College of Clinical Information Managers (ACCIM) recently emerged to hopefully help the rapidly proliferating scribe programs develop standards and monitor themselves. A visit to their website revealed an online training program and an exam leading to certification as a Clinical Information Manager, which can be taken after as little as 100 hours of work with a minimum of 100 patients documented. The exam costs $40 and an annual certification costs $20.

I like the idea that they require certified scribes to complete 20 hours of continuing education a year. Our state medical board only requires 25 hours for physicians and I think that’s pretty sad. Although the website said it would have a list of individual certified scribes, I wasn’t able to find it. Corporate members of the ACCIM include Scribe America and Emergency Medicine Scribe Systems.

As a physician, I’d love to know that all my data is being captured the way I like it while I can focus on the patient in front of me. From experience, though, I know it’s hard to have that level of teamwork and trust when you’re in a shift-work environment. I’ve done my share of emergency department work, and unless the scribes are remarkably consistent, I think it would be hard to have a different one for every shift.

The local paper profiled this change, noting that the scribes “win” by seeing jobs first-hand as they are “attached to the hip of a physician.” Do they really? I wonder what the average shelf life of a scribe is?

Depending on what they see, it might send them running in the opposite direction of actually entering the healthcare field. Most pre-med students are pretty smart cookies who will quickly figure out if they truly have a calling for days where you stand for 12 hours without a meal or a trip to the bathroom in exchange for taking on upwards of $250,000 in student loan debt.

On the other hand, it’s a great way to get experience and actually get paid. Back in the dark ages when I was an undergrad, unless your parent was a doctor and would hire you to work in the office, the only experience you could get was as a volunteer. I’d certainly rather have had the opportunity to do scribe work than to do what I did, which was to edit a medical textbook written by an extremely cranky researcher who had chosen someone without a firm grasp of the English language to do a first pass on her book before firing him. Although frustrating, I must say it prepared me for some of the technical manuals and white papers that grace the ever-growing stacks on this CMIO’s desk.

Do you have scribes at your hospital or health system? Do they make for happier EHR users? E-mail me.

Contacts

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

HIStalk Innovator Showcase – Aventura 7/27/11

Company name: Aventura
Address: 1001 17th St. Suite SL-100, Denver, CO 80004
Web address: www.aventurahq.com
Telephone: 888.484.4643
Year founded: 2008
FTEs: 25

Elevator pitch

Aventura overcomes technical hurdles that exist at the intersection of where your caregivers use your computer systems to deliver the computing experience that doctors and nurses demand.

Business and product summary

Aventura is in the business of making caregivers happy and IT look like heroes. Aventura’s revolutionary new platform fundamentally improves the usability of computing systems for doctors and nurses, leading to increased productivity. Aventura also centralizes and standardizes many aspects of the enterprise environment, saving IT significant time and headaches. Our software is licensed to hospitals through enterprise agreements, and our raving fans are the caregivers that use our solution every day.

The best way to understand Aventura is through a quick example of a user’s experience. A doctor or nurse logs on at a new terminal in a patient room using dual-factor authentication (smart cards, proximity cards or biometric). Based on who this person is, their new location, and any other pre-defined set of rules established by the hospital, Aventura begins updating this person’s existing desktop session (which has been securely locked from their last location) before displaying it.

For example, printing defaults are updated, some applications may be hidden, necessary ones pop up automatically, and some URLs (including already open ones) may be restricted or hidden. This updated desktop and all appropriate applications are then presented to this caregiver.

What is most important about this process is that it all happens in less than five seconds. Log-out is as instant as removing his card. Access is simple and secure. Usability for doctors and nurses is significantly increased because they are no longer wasting time logging in and accessing the right applications and data, and instead can focus on the job they signed up to do: provide incredible patient care.

Who is your target customer?

Today Aventura sells its services to small, medium, and large size hospitals. In the future, Aventura will be delivering its services also to physician practices.

What customer problem do you solve?

Aventura is a small company focused on solving one enormous healthcare IT problem. All the billions of dollars being spent on new IT systems and improving clinician productivity will never realize their full potential because of a “weak link” at the intersection of where doctors and nurses have to access these systems. Adoption of these new systems, including CPOE, suffers not because of the applications themselves, but because of the painful process and useless time wasted by doctors and nurses trying to access these new applications 50 to 70 times a day.

That is simply unacceptable for us, so we’re doing some pretty amazing things to fix it. Aventura has designed something totally new, an architectural framework that delivers what caregivers need in order to do their job from any location, securely, in less than five seconds every single time.

Aventura architecture (click to enlarge)

Who are your competitors?

Today, there are no other companies in the market providing the breadth and depth that Aventura delivers when it comes to delivering a dynamic computing environment. While there are a number of folks piecing together clinical desktop solutions using various virtualization and SSO solutions, these projects don’t overcome the technological barrier and the associated issues of roaming a static desktop session.

Why are you better than your competitors?

The idea for Aventura was born in a hospital. We understand that doctors and nurses want instant access to the right data and computing services from any computer at any time. However, in order to make this happen, we recognized that there are significant architectural limitations in today’s computing environments, and that the only way we were going to be able to address this problem is with an architectural solution.

Other companies have partial fixes; single sign-ons, roaming desktops, expensive one-offs, but they are all still based on a static operating system that was never designed to serve people who work on dozens of different computers in a single day.

Aventura’s new platform called Enterprise Operating Framework allows us to dynamically update clinicians’ computing sessions, and respond to their needs based on who and where they are. Access is intuitive and consistent and completely respects the way clinicians want to work. Further, Aventura is designed to provide this improved caregiver experience using whatever computing infrastructure a hospital currently has in place.

In other words, we can deliver our dynamic computing experience using any virtual desktop technology, or what is even more cool, leveraging only the existing PCs that most hospitals have in place.

Pitch video

Customer interview (infrastructure and customer support manager for a two-hospital, 300-bed system)

What problems have you solved using the Aventura technology and what has been the overall impact on the hospital?

Aventura has allowed us to extend the refresh cycle of the hardware inventory and still take advantage of new software technology that requires greater processing power and memory.  The smart card solution improved the security and authentication process, which helped meet HIPAA requirements.  The ease of use and ability to move the user’s desktop from workstation to workstation has greatly improved the clinician’s workflow.

If you were talking to a peer from another hospital, what would you say about your experience with Aventura? 

We have had a very positive experience with Aventura.  Their staff has been responsive to requests for enhancements and is readily available to provide technical support when needed.

How would you complete this sentence in summarizing for them: “I would recommend that you take a look at Aventura under these circumstances:”

If you would like to reduce the cost of your hardware refresh and provide a secure, standardized desktop solution for your end user.

An interview with Howard Diamond, CEO of Aventura

Hospitals seem pretty happy with single sign-on and technologies like Citrix that allow wireless users to stay connected even though their connection may drop temporarily as they move around. Why do they need your product?

I probably don’t accept your basic premise. Most of the customers that we have and most of the pilots we’ve got going are people that are probably already using an SSO and are already using virtualization like Citrix or VMware or Terminal Services. They still have significant problems in terms of caregivers getting access to the different systems and applications they use.

The average nurse logs in 50 to 70 times a day. Even with an SSO, the amount of administrative burden on them is pretty dramatic.

This would be a fairly key piece of infrastructure if your technology sits between the clinicians and their systems. How do you convince hospitals to trust that aspect to a relatively small company?

That’s a challenge, without question. The approach we take from a sales perspective is we have three phases of implementation.

Our first phase is what we call a lab pilot. If somebody is seriously interested in our technology, for $15,000, we come and show them how it would work in their specific environment to connect it to their specific infrastructure. They get to play with it for three to four weeks in a lab environment.

Once they’ve done that, they opt to go into what we call a production pilot. They try the technology in a real unit of the hospital with real caregivers interacting with real patients.

Based on those two experiences, they then make the decision to buy the software. We set up a pretty sophisticated try-and-buy in their environment.

Sounds like that’s good for the customer, but difficult for the company since hospitals have a long buying cycle anyway. Is it difficult to plan your business around a long-term pilot?

There are two different pieces to it. First of all, we charge $15,000 for the lab pilot. We charge $40,000 for the production pilot. We’re not doing it for free.

We have a hospital doing their production pilot right now. One week into the production pilot, they called us up and said, “All right, we’re convinced. We want to buy the software now.” Even though the theory is that it can lengthen the sales cycle, what is actually does is truncate it, because once they get the technology in front of the caregivers, the caregivers who are not using the technology see the caregivers who are and say, “Wait a minute, you’ve got to be kidding me. We’re not going to wait three months to get access to that. We want access to it now.”

Who is it that makes that decision and what objectives do they have when they come to you or you come to them?

Our point of entry is usually a CMIO if they exist. A lot of time we work directly with IT, but our focus is to get caregivers directly involved pretty quickly because the core of the technology really dramatically addresses things from the caregiver’s perspective. So where there isn’t a CMIO, we work with both CMOs and their like and influential doctors. We definitely get the caregivers involved very early in the process.

Has anybody done studies of the benefits?

Yes, pretty dramatic. Caldwell, which is actually just finishing up their lab pilot and moving to a production pilot, has actually already done a research study where they claim that their analysis showed that doctors would save over 40 minutes per shift and nurses would save over 80 minutes per shift using our technology.

What’s your method of pricing the solution and how do customers justify its cost?

The approach is it like a SaaS charge. Our base price is $15  per user per month.

The ROI actually is pretty easy to do. We show dramatic productivity gains on the caregiver’s side. Because of the fact that we do things like manage printing and provide them with a significant amount of self-help from a printing perspective, we actually show some pretty quick specific gains for IT, particularly in terms of reduction of calls to help desks.

I saw your Web site mentions the roving printer concept. I guess that’s a weakness in a lot of clinical systems. Is that a big draw for customers?

Yes. I’ll be honest with you — when my staff first built it into the product, I thought it was pretty boring. It was not an area that I had particular interest in. It’s turned out to be a dramatically important thing.

It turns out that pretty much every back-end system out there, particularly the EMRs, are horrible when it comes to managing the printing. The fact that we fixed that has actually become an enormous positive for us, even though as CEO, I was too stupid to understand that for a while.

You mentioned a couple of customers on your site, Denver Health and Alegent. Where are they in their implementation and how many clinicians do they have using the devices?

Thousands. Denver Health has been using the technology for a few years and they use it everywhere. The same thing is true of Alegent at their 10 hospitals. If you talk to Mike Westcott, who’s the CMIO at Alegent, he’s actually an embarrassingly great evangelist for us. Greg Veltri, who’s the CIO at Denver Health, is as well. In both cases, they’ve got literally thousands of caregivers using our technology every day.

I was curious why you sell only to healthcare. It seems like that the solution that you have would be of interest to other industries. Is healthcare just the entry point, or is there something unique about healthcare that makes this more attractive than it would be elsewhere?

You’re pretty on top of it. I’m impressed. The reality is that we work with a lot of virtualization partners. The very first thing they ask us whenever they get to know the technology is why we’re not bringing it into other industries.

This technology was born in a hospital, it was developed in a hospital, and the founder started it there. I came and took over the company a little over a year ago. We will go more horizontal in the next year and a half, but I believe that small companies fail a lot because of lack of focus.

Since the heart of the company is in healthcare, we’ll establish our beachhead in healthcare pretty strongly before we move horizontally. But there are a number of other industries that are appropriate for it, and a lot of the virtualization partners we work with want to bring it into places like manufacturing and legal right away.

What do you hope to gain from this exposure?

When we get in front of caregivers, they are blown away by the technology. It literally is something that every time we do a bake-off comparing our technology with anything else out there. Caregivers give it a dramatic grade.

The exposure is just a really important thing. It’s a very small company. We’re just starting out. The technology has just been released in its new form as we talked about some of the stuff we submitted to you. Getting exposure is just great for us.

News 7/27/11

Top News

McKesson completes its $38 million acquisition of provider management tools vendor Portico Systems, announced last month.

Reader Comments

From The PACS Designer: “Re: LogMeIn Central.  LogMeIn has announced a new cloud based service called LogMeIn Central for IT administrators to monitor network uses by iPad and iPhone users.  As the expansion of iPad usage increases in institutions, it appears to be a solution that could ease the management and demand for information access by users.”

From Epic Guy: “Re: Johns Hopkins. Announced today at Epic that they are our latest enterprise customer. Probably not a big surprise to most readers of this blog.”

HIStalk Announcements and Requests

Listening: reader-recommended Joe Bonamassa, an amazing blues/rock guitar virtuoso. Here’s live video of his cover of Yes’s Heart of the Sunrise and Starship Trooper. Pretty old school for a guy who’s only 34.

The folks at CapSite hooked me up with access to their database of actual RFPs, proposals, and hospital contracts after I wrote a little about it a few weeks back. I pulled up a few vendor products and was instantly looking at individual facility price breakout worksheets and actual PDF contract scans (I love terms and conditions, so I was engrossed, although I felt kind of dirty reading some other hospital’s contract even though the facility name was redacted). They’re offering a free 30-day trial of CapSite Lite to providers. I’m not pitching it, just saying that if you would benefit from seeing the kind of deals other hospitals are getting or interested in market reports, you could give it a look for free.

Prognosis Health Information Systems is supporting HIStalk as a Platinum Sponsor, which I appreciate. The Houston-based company offers the Web-native, standards-based, HIE-ready ChartAccess EHR for rural and community hospitals, one of the first to be certified by CCHIT way back in 2007 and again among the first with ONC-ATCB Stage 1. Its affordable, modular solutions include CPOE, clinical decision support, eMAR, pharmacy, clinical documentation, ED, lab, radiology, ADT, document management, patient scheduling, patient accounting, and even an ambulatory EHR, all running on client-free SQL Server with a choice of local or remote hosting. Its value prop involves minimal hardware cost, centralized maintenance and upgrades, automated backups, and shortened time to go-live (Ness County Hospital in Kansas was live four months after choosing ChartAccess.) They’ll even finance its purchase. Thanks to Prognosis for supporting the work we do.

Acquisitions, Funding, Business, and Stock

GE Healthcare has begun the previously announced relocation of the global headquarters of its diagnostic imaging business from Waukesha, WI to Beijing, China.

Sales

Memorial Sloan-Kettering Cancer Center chooses iSirona for medical device integration with Epic outpatient and Allscripts Sunrise inpatient.

People

Martin Tursky, one-time CIO at Aultman Hospital (OH), is named president and CEO of Memorial Hospital of Rhode Island.

Announcements and Implementations

Wentworth-Douglass Hospital (NH) goes live on Soarian’s CPOE this month and on Soarian Financials in October.

Southern Coos Hospital (OR) goes live this week on McKesson’s Paragon EHR.

CodeRyte announces an NLP-based Health System Coding that extracts information from supporting documentation to support accurate HIM coding.

Concerro releases a new video pitching its Internet-based ShiftSelect employee scheduling and shift management system. The male actor is a Bill Shatner-type scenery-chewing bad actor (maybe intentionally so — check out his hammy foot-stomping emphasis at 1:00), but his female counterpart is good.

Italy-based pharmacy technology vendor Health Robotics takes on a Spanish partner to help with US marketing after a legal squabble with former distribution partner McKesson. In a no-holds-barred announcement in March (written by too-perfectly named marketing coordinator Claudia Flaim), Health Robotics accused McKesson of having a “David/Goliath syndrome” in taking a “bullying strategy” after being “unwilling to cope with competition” and then making up “a non-existent excuse for its own failures.” I don’t know who’s right or wrong, but give the scrappy upstart points for coming out swinging, although heavy legal expenses so early in a product’s rollout can’t be good for business, especially when you’re a new Italian company trying to get a US foothold.

Government and Politics

The VA will allow iPhones and iPads on its hospital networks starting in October, with initial access provided to e-mail and VistA. It’s even considering allowing employees to choose one of those devices instead of a laptop. CIO Roger Baker says his IT department will soon roll out approved access to cloud computing applications, which got some VA users in trouble last year who were found to be keeping patient information in Google Docs.

Other

Four hundred Kaiser Permanente IT employees collectively lose 1,500 pounds in its CIO Challenge, including computer specialist Frederick Curiel.

Thumbs up to Apple. Over the weekend, my iPhone slipped out of pocket and hit the pavement, cracking the screen. I scheduled an appointment at my local Apple store with one of the Geniuses, even though I didn’t have much hope they could do anything beyond selling me a new iPhone 4.  After I flashed the designated Genius my best Inga smile and showed him the sad state of my phone, he explained that cracked screens were not covered by warranty. However, he said he would go ahead and switch out my old phone for a new one at no charge. Perfect customer service and the right thing to do, especially given Apple’s  release of the Phone 5 in just a few weeks.

Uh oh. Apparently Google is deleting the Google+ accounts of users not using their real names. Lame. If Inga HIStalk stops following you, go ahead and blame Google.

Nurses at a New Zealand hospital complain that “dumb” staff scheduling software from HealthRoster is to blame for nurse fatigue, saying it creates schedules with long runs of consecutive work days and rotating shifts that allow as little as seven hours between them.

The Chicago Tribune profiles some health-related Web startups that include HealthTap (personalized health information from a panel of experts), Simplee (healthcare expense tracking), ZocDoc (book provider appointments online), and Practice Fusion (free EMR). That’s a lot of Rounded Arial fonts and blue color schemes.

Weird News Andy can’t decide whether it’s the instrument or the “doctor” that’s not the sharpest knife in the drawer. Police find a 63-year-old man lying naked outside his house with a knife handle sticking out of his stomach, which he then removes and replaces with a lit cigarette. He had noticed a protruding hernia and decided to remove it with a butter knife. A surgeon contributed advice that is most likely unneeded by anyone other than this individual: “It is absolutely impossible for someone to fix their own hernia.”

Sponsor Updates

• Ampla Health chooses MED3OOO’s InteGreat EHR for its eleven FQHC and community health centers.
• CAP/SNOMED Terminology Solutions is selecting beta sites to participate in full Lab Interoperability Cooperative pilot.
• Gateway EDI is offering resources for HIPAA 5010 conversion preparation.
• NextGen offers an August 3 webinar on clinical data sharing, with the CMIO of Colorado Associated CHIE and the CMO of Avista Adventist Hospital presenting.
• Wellsoft welcomes new clients AnMed Health (SC), Capital Health (NJ), Southwest Mississippi Regional Medical Center (MS), Pikeville Medical Center (KY), and Thomas Jefferson University Hospitals Methodist Hospital (PA).
• RJ Infusion Services (KS) selects Perceptive Software’s ImageNow to give instant access to patient records from anywhere.
• Baptist Memorial Health Care (TN) selects RelayHealth for a 14-hospital HIE.
• Children’s Memorial Hospital (IL) selects Merge Healthcare’s iConnect to give radiologists and treating providers immediate on-site and remote access to images.
• New York eHealth Collaborative selects e-MDs as a Meaningful Use Partner.
• East Orange General Hospital (NJ) goes live with GE Centricity Enterprise.
• Practice Fusion names the Top Five Worst Electronic Medical Record Myths.
• Tampa General Hospital (FL) selects CareTech Solutions’ Service Desk to augment its existing help desk, focusing on physician support.
• University of North Carolina Hospitals, University of Washington Medical Center, University of Kansas Hospital, and University of Kentucky Hospital go live with Physician Insight Plus from Carefx, which provides dashboards that tracking, analyzing, and comparing performance on clinical and operational outcomes, safety, and utilization.

Contacts

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

Readers Write 7/25/11

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!

Walter Reed Medical Center to be Decommissioned this Week
By Orlando Portale

As part of the Base Realignment and Closure announcement on May 13, 2005, the Department of Defense proposed replacing Walter Reed Medical Center with a new Walter Reed National Military Medical Center (WRNMMC). The new center would be on the grounds of the National Naval Medical Center in Bethesda, Maryland, seven miles from its current location in Washington, DC. The proposal was part of a program to transform medical facilities into joint facilities, with staff including Army, Navy, and Air Force medical personnel.

At the same time, my own organization was in the design phase of our $1B “hospital of the future,” which is scheduled for a 2012 opening (our construction webcam is here.)

In the fall of 2007, I was asked by Congress and the Department of Defense to participate in an independent review of the design plans for the Walter Reed Replacement Project. My role was to identify potential technology and design shortcomings in the Walter Reed replacement facilities.

In May of 2008, our committee submitted a report, noting design and operational deficiencies, but nonetheless advising that the project proceed on schedule.

On Wednesday July 27, the Walter Reed Army Medical Center is closing its doors after more than a century. Hundreds of thousands have received treatment at Walter Reed, spanning World War I, World War II, Vietnam, and the Iraq and Afghanistan conflicts. The move to the new facilities is scheduled for the weekends of August 12 and August 19.

In case you have not been to the old Walter Reed Campus, there are many important pieces of history there. The original red brick hospital was named to honor Major Walter Reed, an Army physician who treated troops and American Indians on the frontier. Dr. Reed had numerous medical achievements, but his most important work involved research that proved yellow fever was spread by the mosquito. He died in 1902 at the age 51 of complications related to appendicitis.

There is a memorial chapel on campus where President Harry S Truman visited after taking office. General Pershing had his own suite on campus for many years. Vice President Richard Nixon was treated for a staph infection over a few days, and received an unexpected visitor one day, then-Senator Lyndon B. Johnson. President Calvin Coolidge’s teenage son died in the hospital from an infected blister he received while playing tennis at the White House. President Dwight Eisenhower and Generals John Pershing and Douglas MacArthur died at Walter Reed.

In 1977, a new addition to Walter Reed was dedicated. The new hospital was as tall as a 10-story building. There were 5,500 rooms covering some 28 acres of floor space. The distance around the top three floors stretched the length of six football fields.

As you can see, the new Walter Reed National Military Medical Center is a beautiful facility. My hope is that it brings comfort and healing to those who have put their lives on the line for this country for us every day.

While our report identified a number of shortcomings with the design plans for the Walter Reed replacement facilities, many of these have been addressed. In fact, recently the new hospital was granted LEED Gold certification, which was an area addressed in our report. Very few hospitals in the US have achieved this status.

More important than the design of the new facility, however, are the extraordinary and dedicated people there who care for our wounded warriors every day. Congratulations to the great team at Walter Reed for all of their hard work and continued dedication.

Orlando Portale is chief innovation officer at Palomar Pomerado Health, San Diego, CA.

Over the past year, we’ve been helping a hospital in New Orleans augment their data center operations to avoid a disaster when the next major hurricane grows out the Gulf of Mexico. Doing this work in the midst of other recent natural disasters across the Midwest and South has helped to reinforce my thoughts about the importance of detailed and actionable plans for disaster recovery and business continuity.

When catastrophic events occur, the concept of business continuity (BC) is really focused on continuity of patient care. This is the ability to continue to attend to those in immediate need and also assist patients who rely on their caregivers on a regular basis.

You would be amazed to know about the number of healthcare organizations with EMRs that have minimal disaster recovery (DR) and care continuity plans. Some hospitals do well in this regard; however, many others have inadequate DR plans that are infrequently revised or tested. Manual care processes for long-term systems outage also suffer from lack of definition or practice. When an organization without good plans faces a major disaster, they quickly learn about their planning deficiencies at the worst possible time.

St. John’s Regional Medical Center in Joplin, Missouri was damaged so badly by an EF-5 tornado on May 22, 2011 that all patients had to be evacuated to other hospitals in the area. When a catastrophic event occurs, the provision of care for patients can be easier and many adverse event risks avoided if some portion of the medical record is available. Recent procedures, conditions, medications, orders, lab results, and radiology reports are extremely helpful in care continuity.

Hospitals can prepare for many types of disasters. We have advance warning for hurricanes, tornadoes, and even floods. Of course, some of the less-frequent disasters such as earthquakes and fire are not preannounced. With knowledge of an impending disaster, the hospitals with an EMR can have a process for the IT department to take steps to assure that current pertinent patient information is available.

Simply printing information at each nurse station in the hospital for the admitted patients is not sufficient. The hard copy reports can be misplaced or damaged. Writing these reports to an encrypted file on a CD, DVD, and even a USB flash drive (a.k.a. memory stick or thumb drive) will assure that important patient data is immediately available after the disaster causing event has passed. When the risk of a disaster is high, write the reports to the disks and flash drive, and along with a laptop PC and spare laptop battery, seal them in a waterproof bag and lock them in a fireproof safe that is anchored to the floor, typically in the data center. If practical and time permitting, prepare a second flash drive with another copy of the data delivered to a key person as identified by the DR/BC plan.

These few simple steps can help you to continue delivering appropriate care for your patients and potentially even save lives in the aftermath of a major disaster.

Jeff White is a principal at Aspen Advisors of Pittsburgh, PA.

Curbside Consult with Dr. Jayne 7/25/11

Last week, Inga mentioned that the results of the annual EHR User Satisfaction Survey have been published by the American Academy of Family Physicians. Unfortunately, AAFP has this content on a restricted members-only site, so I had to bribe my favorite cross-town family doc for a copy.

I don’t want the copyright police to come after my friend, so I won’t share the full article, but I’ll summarize some key thoughts here. It also gives me a chance to hone my “speech” because I’m sure I’ll have colleagues waving it in my face (just like they did the last time the survey was conducted) and wanting to talk about how “our” system did. Some key thoughts:

There were “far more” responses than previous surveys. However, I found the reasons for excluding some respondents pretty funny. They included:

• Not using an EHR
• Not naming the system they used
• Naming a practice management system rather than an HER
• Naming a “home-grown proprietary system or… something that we could not verify as an EHR”

There were 2,719 usable responses covering 205 systems. Only 30 systems had 13 or more respondents. Those that had over 100 respondents included:

• EpicCare Ambulatory – 392
• NextGen Ambulatory – 247
• eClinical Works – 244
• Centricity EMR – 209
• Allscripts Enterprise – 180
• Practice Partner – 123
• e-MDs – 120
• Allscripts Professional – 106

There was a broad distribution of practice sizes.

Detailed information on version and implemented features was not presented. Nearly half of respondents “apparently did not know their product’s version number.” My spidey senses always tingle when small practice users have issues with their EHR. I’ve worked with docs who are using versions that are up to three years outdated and are surprised at how well the “current” version works once it’s applied.

The version paradox isn’t unique to small practices, though. For example, how many different flavors of Epic are there depending on how it was implemented? One of my buddies complained that it was ridiculous that Epic doesn’t have e-prescribing. Turns out her organization hadn’t included it in the initial physician training for some unfathomable reason.

Duration of use of the system ranged from “weeks” to “20 years,” with the majority being up to three years and another chunk being in the three to 10 years category. I think time on the system might be a useful exclusion criteria for future surveys. From experience, even with the best implementation, it still takes some practices a minimum of six to eight weeks for users to settle in and for workflow to stabilize if not longer depending on the commitment of the users and the willingness (or resistance) to change.

Fourteen percent of respondents have switched systems at least once due to dissatisfaction with a previous EHR.

The authors recognize these limits, summarizing:

As we said to begin with, it’s probably best to consider the survey results as input you’d get from a large number of colleagues who volunteered informally to report on their EHR experience. That said, we believe that the results presented in this article and its online appendix can help any family medicine practice considering the purchase of an EHR system.

This is a really key point. The study was not randomized, but rather respondents self-reported. Bias could be toward either providers who have serious concerns about their system or those who are significantly satisfied. Although the numbers were much better this time around, it’s not a true cross-section of users and doesn’t account for variables that can truly make or break an end user’s experience. These include poor implementation, lack of commitment among providers and office staff, and failure to implement recommended best practices.

During the implementation of my first EHR, there was no “kickoff” to bring everyone in the practice to the same page. Nor was their a discussion of workflow changes or process redesign. The trainer showed up and started teaching the template builder without the users having any context to her lessons. Coupled with her training on a version that was different than what we had installed, it was an unqualified disaster.

On the client side, some providers feel entitled to behave badly. I’ve had providers refuse to show up for training, refuse to complete practice scenarios, and refuse to be part of the customization process, yet complain relentlessly that the EHR doesn’t meet their needs. Those of us that have been in this a while know that deploying an EHR on top of a dysfunctional practice will only make it more dysfunctional. Partners who have historically felt disadvantaged in the practice often use implementation as a time to lash out against their peers.

Users often go against what the vendor recommends. Sometimes this is justified, such as when there are defects in the software or specialty-specific or regional issues that the vendor isn’t addressing. But sometimes it’s not. I’m currently watching the equivalent of an EHR car crash as one of my closest colleagues is being forced onto a system that isn’t configured optimally. She’s part of a larger group and is a younger physician with little political power to counter the decisions being made higher up. As a user of the same system, I’m keenly aware that the choices they have made will lead to more work being placed on the physicians, less efficient charting, and potential patient safety and regulatory issues.

I’ve armed her with enough knowledge to try to steer them in the right direction, but so far she hasn’t been successful. Eventually they’ll learn, but at the price of user bitterness and potentially patient safety. I recommend that new users take advantage of all the training and information they can get their hands on, whether formal – training programs, client conferences, user symposia, webinars, and the like – or informally through Internet chat groups, informal user get-togethers, hospital colleagues, or blogs.

Many systems offer the ability to customize on a per-physician basis. Providers who are not fully educated on the risks and benefits of doing so can quickly customize themselves into a corner and out of the ability to achieve a decent workflow (not to mention loss of the ability to reach Meaningful Use). I strongly recommend users make an attempt to use the system as the vendor delivers it for at least a month before customizing (although if the system arrives with defects and bugs, often customization is needed to effectively deploy the system).

I encourage practices to consider using EHR implementation as a chance to look at all office policies and procedures, whether written or anecdotal. Automating bad workflow just allows bad workflow to happen more quickly on a greater scale. I encourage partners to think out of the box and consider whether it’s rational for each doc in the office to have his or her own process for handling phone messages and refills. Often there is one process that is more efficient that can be expanded to the entire office with a little effort, resulting ultimately in greater satisfaction for end users.

A survey such as this one can’t account for all these factors, so my advice to users (and those still shopping for an EHR or looking to replace what they have) is to take it with a grain of salt and do your research. Talk to current users and not just those references served up by the vendor sales team. Talk to your colleagues. Spend as much time hands-on with the application as you can, and carefully consider your choices during the build and implementation process.

And for those users who are dissatisfied with their systems or feel their needs aren’t being met, don’t just fillet your vendor in the next survey. Take a proactive stance. Review your contract and implementation documents and make sure you’ve taken advantage of all the training you were allowed, and if you need more, buy it. It amazes me that physicians who wouldn’t start performing a new surgical procedure if they didn’t feel fully trained are happy to jump into an EHR with only a few minutes of training.

Log defects with your vendor and keep records of any defect and enhancement submissions. Understand your support contract and how your vendor is required to respond to issues. Take advantage of any account management or client management services that your vendor offers. Even if you’ve been on a system for years, don’t be afraid to consider retraining, especially if you have to upgrade your software to qualify for Meaningful Use. It’s a great opportunity for a refresher, and CMIO types like myself can always use the Big Bad Wolf of MU to sneak in additional workflow coaching during “mandatory” training.

AAFP has conducted this survey three times before. The first had 408 responses, the next 422, and the 2009 survey had 2012 responses. It will be interesting to see what the results look like the next time it’s conducted and whether any conclusions can be drawn once Meaningful Use is in full swing.

E-mail Dr. Jayne.

Monday Morning Update 7/25/11

From Give Me a Break: “Re: press releases. Do readers find it as annoying as I do when a vendor issues a press release congratulating its customers for making a list of some kind? The average health system has over 240 apps from 70 vendors.” I do indeed find that particular practice somewhere between pointless and annoying, right up there with those announcements that “applaud” some government decision that benefits the vendor directly. That’s especially true when the award the customer has won comes from a for-profit company looking for publicity (see: Most Wired, any company’s customer awards). I’m generally hostile toward press releases that contain no discernible news, even of the self-serving variety. They’re lucky that lazy magazines and sites are so desperate for free content that they’ll foist crap like that on their readers anyway, hoping that hyperventilating headlines and cutesy writing will keep readers from noticing the waste of their time.

From DeeDee: “Re: University of Missouri Health Care. The video with their being named HIMSS EMRAM Stage 6 has some marketing polish, but interesting. Buy-in of the Tiger public/private venture seems impressive.”

From Tooter: “Re: Webmedx. You didn’t mention that HIStalk ran the Nuance acquisition rumor before the announcement was made.” True enough: I ran MT Hammer’s rumor report on June 24, while Nuance announced the acquisition on July 14.

From Lucy Gucci: “Re: Epic new hire blog posting on WSJ. I remember feeling this way about starting at Epic, too – excited to be a business traveler and still glossy-eyed over the architecture. Also, I’ve heard that Judy is talking about the June new hire class making up a certain percentage of the national job growth for that month.” A 21-year-old new grad (business administration, Asian studies) gushes with enthusiasm about being hired as an Epic project manager, ready to “improve patient care, create better processes, and in general aid hospital systems” as she “moves rapidly toward adulthood.”

Most respondents say the government shouldn’t get involved with EMR usability, although not by a large margin. New poll to your right, from a reader’s comment: what will HITECH’s legacy be?

Listening: reader-recommended Big Head Todd and the Monsters, straight-head soulful rock with thoughtful lyrics and an unchanged member lineup (and relatively unchanged musical style) for 25 years.

Unrelated, but music again: singer Amy Winehouse is found dead at 27, joining other notoriously drug-abusing rock stars to expire at that age (off the top of my head, that list includes Jim Morrison, Janis Joplin, Jimi Hendrix, Kurt Cobain, and Brian Jones).

This week’s Time Capsule editorial from 2006: Your Co-Workers Are Your Biggest IT Security Problem. A snip: “A hospital’s internal documents and policies probably aren’t all that interesting to competitors, but you might reconsider storing Social Security and credit card numbers.”

I hung on every word of Vince Ciotti’s HIStory this week since it covers Compucare, IBAX, and other faded names from yesteryear that still seem recent to HIT long-timers (the notepad cover I use every day is a Compucare one, so I’m just realizing how long I’ve had it). He got help this time around from pioneers Ed Gavin, Sheldon Dorenfest, and David Pomerance. Given the great response Vince is getting, I’m thinking he should reprise his SMS reunion of a couple of years ago, except open it up to anybody who worked in HIT in the old days (before 1980, let’s say) and do it at the HIMSS conference. Then he could really tap into some first-person memories for future installments. Vince is willing to take his show on the road for interested classes or groups (like regional chapters of HIMSS or HFMA) – just e-mail him.

Dell confirms the rumor I ran Thursday from Jamie that healthcare VP Berk Smith, brought over in its Perot acquisition, is leaving to start a healthcare-related company.

Thanks to the folks at Preceptor Consulting of Fort Myers, FL, supporting both HIStalk and HIStalk Practice at the Platinum level. Preceptor offers design, build, testing, and training support for all the top clinical systems (Epic, Cerner, McKesson, etc.). Their name comes from what they do: provide licensed clinicians (physicians and nurses) to get those systems live, which they’ve done in more than 500 healthcare facilities over the past five years. Their motto will be familiar physicians: See IT. Do IT. Teach IT. You’ve spent a lot on that shiny new clinical system, so spend a little more to engage authoritative, experienced clinician experts who will make sure it’s built right, tested as safe, and accepted by well-trained users (think of it as cost-effective CIO/CMIO job security insurance). Find out why the largest health systems get clinical implementation support and healthcare IT expertise from Preceptor Consulting. Thanks to Preceptor for supporting HIStalk and HIStalk Practice.

Here’s a really well done video about Preceptor Consulting I found on YouTube, with some of the “preceptors” talking about working on site at hospitals and some of their clients talking about their experience. “Any time you had a question or an issue, they were right there to help. I don’t think you could make the transition without the preceptors. I don’t think it could be done.”

Athenahealth sues AdvancedMD, claiming the company violated an athenahealth patent. The patent number cited suggests that the suit is related to athenahealth’s centrally maintained insurance billing rules engine.

John Halamka will resign his part-time position as CIO of Harvard Medical School, saying it needs someone full time, but is staying on at BIDMC.

A former EVP and general counsel of Children’s Hospital of Philadelphia pleads guilty to charges related to his embezzlement of $1.7 million from the hospital, accomplished by submitting and approving fake invoices. He bought himself a yacht with its own captain.

CodeRyte will make some announcements this week about a new Natural Language Processing system for computer-assisted coding in hospitals, which a few customers have already signed up for. Fun executive team facts: CEO Andy Kapit taught autistic kindergarten children. Chairman and President Richard Toren invented the EpiPen, which has saved the lives of countless allergic patients. COO Glenn Tobin and Chief Revenue Officer Don Trigg are fairly recent hires from Cerner (COO and UK GM, respectively).

GE announces Q2 numbers: revenue down 4%, EPS $0.35 vs. $0.28. GE Healthcare revenue was up 10%, with profit up 8% to $711 million.

Hospital of St. Raphael (CT) fires three employees after one of them takes cellphone pictures of the fatal gunshot wounds of a 17-year-old ED patient and sends them to other employees.

A hospital in England, which pays the travel expenses of some family members visiting patients in its mental health units, suggests that the family members use Skype instead to save money.

Eighteen former employees of insurance company Molina Healthcare file a lawsuit against their former employer, its former CIO, and outsourcer Cognizant, claiming they were discriminated against as the IT department brought in increasing numbers of Indian workers to the point it was called “little India.” They say the department celebrated Indian holidays while making employees work Thanksgiving and Christmas, promoted only employees from India, and conducted meetings in Indian languages. They charge Molina with firing 40 technical workers the day after Cognizant was approved to bring in 40 H-1B employees. The former employees also claim that Molina regularly violated HIPAA requirements when the H1-B workers would send full, unencrypted patient files to their counterparts in India.

E-mail Mr. H.

HIStalk Interviews Mark Debnam, Founder and CEO, Quality IT Partners

J. Mark Debnam is founder and CEO of Quality IT Partners, Inc. of Mt. Airy, MD.

Give me a brief overview of yourself and the company.

I founded the company in 2000. My first partner, Marty Zola — he’s our chief technology officer – joined about three months later, followed in 2001 and in 2003 by our final two partners, who are with us still today — Carol Wheeler and Donna Eversole.

We are very family-oriented company here. We’re a small company, about 20-25 folks, and we specialize in healthcare IT. We cover just about everything out there. We have seven different application practice areas. We have eight management consulting-focused areas as well. We also do a lot of work in the hospital and medical office building architecture and construction work, in addition to infrastructure.

We just this year celebrated our tenth anniversary. We did it in Hershey Park, Pennsylvania, so it was a lot of fun. We just got back from that. Every year we do that — we fly everybody and their families and to enjoy time together and get to spend that time that we rarely get together.

The company’s been around for 11 years and clearly there have been some new shingles hung out here in the last couple. Do you think the barrier to entry is too low for consulting companies and should a prospect care about the company history when they’re trying to decide who to hire as a consulting firm?

That’s a great question. I think there’s always room for great companies to get into our market space. As time goes by, there’s less and less differentiators, so it becomes highly important to develop a strong differentiation between yourself as a small company.

When I started the company, it was intensely difficult to get in and be a player without good, solid qualifications and stories and references and all that. You have to really a compelling background and a compelling story about what you’re doing and why you’re doing it. You know, that really hasn’t stopped.

There’s a reason we’ve stayed small. As a company, we have always focused on the highest quality of delivery of service. We’ve grown steadily and we’ve had a profit every year since I’ve started the company. The key here is being able to really develop a strong sense of differentiation in the marketplace so that folks can see what they’re going to get in terms of value. People are very discriminating. Our clients are telling us they want more now than they ever have. 

There’s never poor time to get in if you have a compelling story. One of those compelling stories, particularly in the consulting field, is how you interact with and how you provide the best environment for your consultants and the folks that you have on board in terms of support and things like that. It’s a tough, tough business. That’s probably the main reason why we have such a family-type environment here at Quality.

A big company would say their size is a positive differentiator just as you would say your small size is a plus. But one thing that seems to stand out on your Web site is the value-based cost structure. Describe that.

We keep our overhead cost extremely low. By doing so, we are able to keep our rates low. We’re very cost-conscious in our investments, but we don’t shortchange the key investment areas in any way, shape, or form.

We’re very strong on education and benefits and so forth within the company, but we don’t go out and acquire things that are expensive in terms of overhead costs, like extraordinary office space or elaborate anything. We keep things here in a very modest way so that our staff can reap the benefits of their hard efforts. That’s a big, big part.

Our officers of the company don’t get exorbitant salaries or anything like this. We put our people first and our customers right behind that.

I think that as far as keeping the cost down for our customers, it’s been a big, big plus for us. When you are a small company, I think there’s an expectation that we’re not going to hit you with a high cost. On the flip side of that, there has to be a reason why a customer would be compelled to pay you anything to come do work for them.

We have a tremendous performance record and we’re very blessed to have that. We have just a wonderful team of folks that have a reputation for delivering very high-quality service. We have well over 85 to 90% of return customers to the company. We’re very, very proud of that, but you have to earn that every day. I think our customers see the value for sure in what we do.

The consulting company executives that I talk to say their phone’s ringing off the hook with people wanting to buy their business or buy into their business. Are you getting those calls, and why do you think companies want to buy consulting companies?

We get serious calls. There have been a lot of them I’ve received over the years. They know a little bit about what you do and what you’ve done and they’ve heard through the grapevine, etc. I think that they see that as an opportunity to get into the market or expand their current offerings that maybe they don’t have, and be instantly profitable.

If they can retain staff, that’s a huge plus for them to not have to go through a process of having to go and hire people. The time it takes to bring all new staff and build a staff versus the time it takes to acquire a consulting company are vastly different.  You can bring on a team in an acquisition very quickly. I think that would be one of the reasons why folks like getting into that business.

I’ve always wanted to ask this question after I’ve looked at the job ads. What does it take to hire an Epic consultant these days?

You ask a good question there. It takes reputation, it takes a very compelling story; and it takes a special match — let’s be realistic about it — between what the person’s desires are and what the company’s made of.

We’ve been very fortunate. Our largest team here is Epic. We have a very broad spectrum of folks of all ages and genders. I think mostly that they seek to expand their education. We see a lot of that — folks that want to continue and expand in their certifications. For Epic, that’s a big, big thing. They need to be with a company that will support that.

The folks that come from Epic tend to not want to live that lifestyle any more. We’re very, very different in the way we do things here. We don’t kill our people. We’re very, very cautious in watching out for the welfare of our people, and we find that in other consulting firms or Epic, this is maybe not so much the case in a lot of ways. 

When folks come here, it’s not that they want to take a relaxed lifestyle. They just want a strong work-life balance. The company’s committed and convicted to that philosophy. Not burning out the people. People also want to know that they’re going to be working with other folks that are of great caliber, and that they can learn from and grow with them.

Business continuity and disaster recovery are always in the news. What are the top two or three things you see clients doing wrong or not planning for?

It’s the last thing that folks want to pay for and it’s the first thing they want to have when it happens. We, fortunately, have been blessed with working with a lot of customers, like Ohio State University. The common thread is those organizations are committed to really doing it right and doing it thoroughly and have a good plan. Others that will try to do it internally and there’s sometimes a lot of struggles with that.

A business continuity plan is often best facilitated — and I don’t mean this as a consulting plug – by someone with an outside viewpoint. Folks don’t always really understand some of the ramifications of what can happen in a disaster. We’ve done a lot of work in California related to the earthquakes. We had a hospital in Florida hit by a large hurricane right after we had finished up our business impact analysis for them. Fortunately, they had some things to fall back on. These things happen and they’re real. There are some obvious and quick benefits that can come from even a cursory business impact analysis.

A lot of what the consulting companies are asked to do is fairly routine work. Have you seen anything really cool that hospitals are doing?

There’s a number of things that folks are taking on. You publish a number of exciting things that folks are doing with different types of media and hand-held devices.

We have a couple of neat projects that we’re working on. One of which is an imagery project for a large, California-based medical center, cutting edge in real-time capture of image retrieval and large-scale storage of things like sonograms, cardiology, and all these things. There’s really, really cool stuff. We’re leading and implementing a project out there and managing multiple vendors. It involves a lot of challenges. It involves a lot of hand-holding between the vendors, which sometimes you don’t get a lot of cooperation on.

Our customer is taking quite a risk and quite a position of conviction to invest in this technology and hospital doctors are loving it. It’s one of these things where if they get that kind of attention and they get these opportunities to work with those systems, they’re going to be attracted to stay in practice there. We’re working hand-to-hand with these physicians in delivering these technologies. It’s been wonderful, but it has not been trouble-free. It is absolutely bleeding edge technology in a lot of ways and we’ve been fortunate to be amidst that and be leading a project. We’re going live on it as we speak.

Hopefully you’re not getting a call waiting that says, “Uh, it’s not working.”

[Laughs] It’s been a challenge and a labor of love, let me tell you. But it’s great to see this kind of investment.

You offer interim management services. From your experience, is the most common reason that hospitals and CIOs part ways?

I think the most significant reasons are organizational direction and changing of the business ways. Hospitals operate as businesses. There are so many wonderful CIOs out there. A lot of times, though, when you have a change in business philosophy — whether that be through infusion of the business leaders or other means — you have a difference of opinion  that comes to bear. “Well we’ve done this a certain way, it’s been done this way successfully, why should we change it?”

Well, because the business is changing. The hospital is run like a business first. If a CIO is not able to put on their business cap before they put on their technology cap, that’s a concern for that CIO, unfortunately. They could be the brightest, the most brilliant of people and yet not have the ability to make it within that organization.

Projects fail. Sometimes they aren’t the fault of the CIO or any other leadership, and sometimes they are, but when you have a big failure of a project and things just don’t go well, that’s usually not a good marker for a CIO to make it. The higher the visibility, the higher the possibility that the CIO is going to be leaving.

Do you have any final thoughts?

I want to reflect on how great our relationship with HIStalk is and how grateful we are to be part of your family. 

One  the things we’ve taken on here as a very, very important endeavor is our investment and our commitment to charitable causes. If you look at our Facebook page, you’ll see a video that we captured to reflect our works and our investment and our time with the Cleveland Clinic. We have a very successful project going on there in oncology. We’ve written many of the protocols there for the oncology group at Cleveland Clinic, so we’re very highly connected with them.

I had the honor of being at their gala last year and being part of their big show and doing part of their private gala. I had the opportunity to meet all of the celebrities there, spent some time with Brad Paisley. It was wonderful. I was very inspired by that. I’m a musician — I’ve been playing guitar for about 32 years this year. I know you like music. 

I came back and wrote a song. We copyrighted that song and as part of the company, I dedicated it to the Cleveland Clinic. We posted it to our Facebook page and then you  guys published it as well, which was delightful. We’re very interested in helping to find a cure for cancer.  

This is a big thing, among other big things. You’ll see other charitable things. It’s a big, big part of what we want to be. We all go through various challenges in our lives. We really want to bring home the things in life that matter to this company in not just business, but things that affect us all when we’re trying to do business. I just want to leave you with that thought — that the company is very committed to that.

In addition to our appreciation for everything you’ve done for us and helping us get out there and inform the folks, we’re very blessed to have the clients we have, and in having this wonderful staff of folks here on our team and that we’ve had in the history of the company.