News 6/3/11

Top News

Primary care providers treating hepatitis C patients via videoconferencing achieved results identical to those of specialists at a university medical center, according to a NEJM-published study. The program was Project ECHO at the University of New Mexico Health Sciences Center. I interviewed Sanjeev Arora MD, the project’s director, in October 2009. I was impressed.

Reader Comments

From DrLover: “Re: DrFirst. Looks like DrFirst is being inundated with requests for people to enroll in eRx before the submission deadline of the end of June. What normally took them three days is up over a week. Thirty days left for providers to write 10 Medicare scripts to prevent 1% penalty, 25 scripts to get 1% bonus.” 

 From Kramer: “Re: AHIMA. Just about everyone at the top has left. What’s going on?” I haven’t heard much, although one source says there were internal conflicts after CEO Linda Kloss stepped down a year ago. Former CEO Rose Dunn has been brought back in some capacity (note: I erroneously originally assumed it was Linda Kloss who had returned, but not so). All unverified. I have to admit that the first reaction that both Inga and I had when we got your question was that HIMSS was taking over AHIMA, which isn’t the case as far as I know (but isn’t exactly a far-fetched scenario given the historically acquisitive nature of HIMSS).

From N.S. Sherlock: “Re: IBM’s Watson in healthcare. Did you see this? Very interesting.” Above is a video featuring Eliot Siegel MD, professor of diagnostic radiology and nuclear medicine at the University of Maryland School of Medicine. It’s one of two universities working with IBM’s Watson computer to identify potential healthcare applications. They say that Watson can, like a medical student, learn and then apply that knowledge through experience.

From Pogo: “Re: Healthcare Informatics top 100 vendors list. I bet you have more companies supporting HIStalk as sponsors than they do as advertisers.” Maybe. I eyeballed the list and counted at least 35 of the 100 that sponsor HIStalk, HIStalk Practice, or HIStalk Mobile (some haven’t been announced yet, but are coming soon). Thanks to my sponsors and congratulations to those who made the list. If I ever get the time to reflect, I’m sure I’ll be amazed that so many companies support some hospital guy’s part-time blog – it is truly humbling and there’s no precedent that I know of in Internet-land.

From Maia: “Re: ‘spurred’ customer. Perhaps their previous EMR vendor was Dude Ranch EMR.” An EMR vendor’s press release headline leads off with “After Being Spurred by Previous EMR.” Awkward phrasing for sure and there’s plenty more in the remainder of the release (the verb tense wanders aimlessly throughout). The practice mentioned is an OB/GYN clinic, so maybe they should have worked in an accompanying stirrups pun.

From Klara: “Re: six important letters. Something for you to make fun of.” And I shall: an unfortunate Logicalis press release touts the freshly earned CPHIMS credential of one of its managers as “like a PhD in HIT.” Like a mail-order PhD, maybe — you just have to pass a multiple choice test. No coursework, research, teaching, or real-life competence is required. The odd thing is that their employee, according to her LinkedIn profile, holds a master’s degree that’s worth a lot more than a CPHIMS certificate and they don’t even mention that fact.

From Sharky: “Re: Stage 1 MU. IDC Health Insights just put out a list of vendors who have helped customers achieve Stage 1 and Epic isn’t on it. Everyone assumes Epic has customers who have cleared the bar, but why haven’t we seen evidence of this?” I assume because Epic doesn’t do press releases. Note the highlight from the article you mentioned. It’s totally lame, even more so coming from a research company. Attestation started just over a month ago and I doubt many hospitals were ready (compared to small practices, anyway) and especially Epic shops since so many of them signed on in the past year or two. If you run Epic at your place (inpatient or outpatient) and have successfully attested, e-mail me and I’ll set the record straight. UPDATE: Sharky responder points out that the HHS Web site lists several Epic facilities that have already received checks: “Epic customers who have checks in hand include Univ of Wisconsin, Texas Health Resources, Rush in Chicago, Northshore in Chicago, Beaumont in Michigan and many EPs associated with them. Most of them for multiple hospitals. I’ve heard as much as 50% of the money went to Epic sites (that would need to be verified, but worth checking).” Ed Marx of Texas Health Resources confirms that they attested on the first day (April 18) and received their check quickly. I found the the CMS list of providers who have received checks here.

Some unverified responses to HITuser’s question about running Meditech 6.0 in a multi-facility environment: (a) two-hospital Georgetown Hospital (SC) went live a couple of weeks ago; (b) Steward Hospital (MA) is going live late this month on 6.0 and claim their Meditech people are telling them it’s never been done; (c) TheScoop says he knows of just one and it’s in Hawaii. Thanks to those who replied.

HIStalk Announcements and Requests

Listening: Green Carnation, because I’ve always liked them and I needed a shot of Norwegian prog metal.

Thanks to Lawson Healthcare of St. Paul, MN, joining our merry band of sponsors at the Platinum level. If you work in a hospital, you probably know about the company’s financial management, human capital management, customer relationship management, and supply chain management systems. Maybe you haven’t heard about their other offerings: the Cloverleaf line of data integration products, the Initiate patient and provider identity management tools, the MediSuite clinical system for Canadian customers, the recently announced Lawson Analytics for Healthcare, and the Lawson Enterprise Exchange HIE component line (clinical document exchange, clinical portal, and results delivery). Lawson’s healthcare-specific enterprise management products focus on critical hospital resources – people, supplies, and finances. A recent entry on the company’s Simplifying Healthcare blog mentions that its supply chain customer, the hard-hit St. John’s Regional Medical Center of Joplin, fully stocked its temporary hospital within 12 hours. Thanks to Lawson Healthcare for supporting HIStalk.

Your “things to do before or shortly after you die” list: (a) sign up for e-mail updates to your right, ensuring that you’ll get at least something potentially useful among all the spam; (b) cement our symbolic and symbiotic social media relationship by friending Inga, Dr. Jayne, and me on Facebook, liking HIStalk while you’re there, and connecting with us on LinkedIn; (c) send me news and WikiLeaks-like rumors; (d) treat the sponsor ads to your left with click-worthy admiration rather than jaded contempt since these companies not only see you as the powerful, influential thought leader and desirable demographic that you are, they also keep Inga in shoes; and (e) observe my offered high-five for being a loyal HISalk reader and don’t leave me hanging.

Jobs on the Job Board: Certified Epic Ambulatory Builder, Meditech Project Director, QA and Testing Specialist. On Healthcare IT Jobs: Healthcare EA Architect and Developer, Healthcare Software Product Manager, Implementation and Account Manager, ICD-10 Project Manager.

Acquisitions, Funding, Business, and Stock

The co-founder of Citrix Systems starts VirtualWorks, which sells technology that finds all versions of a file on any kind of storage system via a Universal Index. He says small hospitals are particularly affected by “data sprawl” due to virtualization, cloud computing, and use of mobile devices, but no affordable solution was available previously.

Sales

Health Sciences South Carolina signs an exclusive, sole source agreement with HalfPenny Technologies to participate in a demonstration project to share clinical lab data between members of the state’s REC.

Kingman Regional Medical Center (AZ) contracts for Craneware’s InSight Denials to manage its denied insurance claims. The product was developed by ClaimTrust, which Craneware acquired in February.

People

Quality Systems CEO Steve Plochocki is profiled in a Smart Business cover article titled How Steve Plochocki built a new operating model for Quality Systems. It’s pretty fascinating, especially if you’re interested in what was on the minds of EMR vendors as HITECH was being put together.

Patient outreach technology vendor Phytel names Patrick Flynn as CTO.

TELUS Health Solutions promotes Michael Guerriere, MD to chief medical officer, a newly created position.

Announcements and Implementations

Vital Images announces its VitreaView universal image viewer.

TELUS Health Solutions announces its partnership with Carefx to create TELUS CareShare, a set of cloud-based provider services that includes results distribution, electronic referrals, medical reconciliation, and care coordination.

Fujitsu’s annual technology symposium this week had a theme of consumerism in healthcare, featuring speakers from the VA, Stanford, Mayo, West Wireless Health Institute, Kaiser, Continua, and others. The company displayed its PalmSecure biometric solution, document scanners, electronic wait time signage, mobile monitoring, mobile phone wellness management, and Slate PC.

Government and Politics

OptumInsight (formerly Ingenix) CEO Andy Slavitt testifies to members of the Congressional Small Business Committee’s Subcommittee on Healthcare and Information Technology and presents low-cost recommendations to help small practices adopt HIT. He suggests creating standards for EHRs and HIEs, providing federal support for HIEs, providing legal protection for physicians in regard to privacy issues, extending small business loan guarantees for physicians, and continuing support of RECs.

HHS’s Office of Inspector General says it will recover $3.4 billion in the first half of the fiscal year as a result of its audits and investigations.

Four legislators introduce a bill to provide Meaningful Use EHR incentives to individual hospitals within a multi-campus system.

CMS designates June 15th and August 24th as National 5010 Testing Days, encouraging participation by all providers, clearinghouses, and vendors.

Other

 
 

 

A reader sent a report describing the work done by Mercy’s IT department when the tornado hit their St. John’s Regional Medical Center in Joplin, MO. Here’s a summary, beginning on Sunday, May 22.

• Sunday 5:41 PM – the tornado hits.
• 6:00 PM – Mercy Technology Services establishes two conference bridges, one for leadership and one for technical issues. Nobody at the hospital could be reached by telephone.
• 7:00 PM – servers were failing even though the network was up. Power had been shut off to the buildings, generators didn’t kick in, and the UPS finally died. A phone tree was set up to locate employees. Patient charts and a census were printed from Epic at the Washington data center (the hospital had just gone live with Epic three weeks before and none of that information was lost). Kronos time clock data was cross referenced to Lawson to get contact information for employees who had clocked in.
• Monday 8:00 AM – all 183 patients were accounted for and matched to their printed charts. Five patients and one hospital employee had died.
• Tuesday evening – satellite-based voice and data communications were in place at temporary treatment locations at a local auditorium and hotel. Epic was running in the auditorium. Groups from HR, finance, and other areas worked in assigned areas with IT support, including network access, printing, and applications.
• Friday – the tent hospital was in place.
• Saturday – 54 mbps radio-based connectivity was in place in the tent hospital. PCs and multi-function devices were in place on mobile carts. A network was running in the tent hospital, with three drops every four feet.

Thomson Reuters releases its third annual study identifying the top 10 US health systems based on quality of care, efficiency, and patient satisfaction. The list includes three-time winners Advocate Health Care (IL), Kettering Health Network (OH), and OhioHealth (OH).

The average clinician spends 122 hours per year trying to access various forms for EMR, according to a study sponsored by a single sign-on vendor. Without SSO, users require an average of 6.4 passwords to access clinical systems.

The MUSE conference is underway in Nashville. If you are attending and run across anything newsworthy, let me know.

Students at UC Merced are creating a telehealth program to address gestational diabetes, hoping to find sponsors to cover the cost of glucometers and software.

Mobile device management software vendor AirWatch gives Inova Health System $100,000 to fund three projects: a telestroke program, a study of how mobile technology affects inpatient physician productivity, and a pilot that will equip home health nurses with tablets. I mentioned the company in February after getting an impressive HIMSS booth pitch from a co-founder – their tools should give hospitals a lot of comfort in allowing mobile devices (including the always troublesome Apple ones) into the enterprise.

Strange: a company called Medical Justice gets doctors to put a “mutual privacy agreement” in the clipboard full of forms that patients sign, which then gives the practice ownership of any reviews the patient posts about it on sites like Yelp. The company claims it exists to give doctors a way (at $625 per year) to have fraudulent reviews taken down, but another critique suggests that the company also posts its own glowing reviews of its practice customers. The company says it’s not posting fake reviews, it’s just helping patients post their genuine reviews (the article claims all of those they post are five stars and the company won’t provide proof of their authenticity). I can’t imagine any other type of business trying to control reviews posted by its customers, not to mention that phony reviews would probably be posted by non-patients who would not have signed the form anyway.

Sponsor Updates

• Allscripts President Lee Shapiro joins the board of Medidata Solutions, a provider of development tools for clinical trials.
• AirStrip Technologies names former CliniComp president Alan W. Portela its new CEO. He replaces founder Gene Powell, who will remain as chairman of the board and a senior advisor.
• The University of Texas Medical Branch selects ProVation Order Sets as its electronic order set solution.
• ICA’s chief marketing office John Tempesco writes about cutting hospital administrative waste in a recent Business Edge post.
• St. Luke’s Hospital & Health Network (PA) chooses CareTech Solutions to provide remote 24/7/365 IT infrastructure monitoring.
• iMDsoft is reviewed in the recent KLAS anesthesia documentation report, which notes that 100% of surveyed customers said its MV-OR system is part of their long-term plans, with seamless interfacing with clinical and surgical systems being a strong factor.
• Nemours Children’s Hospital (FL) hires Orchestrate Healthcare to install Epic in its new Orlando facility.
• MED3OOO is hosting a free Webinar discussing Why ACOs Should be Physician Led that features Amit Rastogi, CEO and president of PriMed. Sign up here for the June 8th session.
• The Public Health IIM Syndromic Surveillance Interface olf Iatric Systems earns ONC-ATCB certification.
• University Health Systems (NC) wins Concerro’s 2010 Client of the Year ward for optimizing labor management through its use of Concerro technologies.
• Siemens Healthcare certifies BridgeHead Software’s BridgeHead MediStore as a medical imaging and full disaster recovery solution for Siemens SYGO uses.
• NCR Healthcare chooses EPX as its preferred payment provider, planning to integrate its payment processing functionality into NCR’s kiosk and patient portal self-service offerings.
• Awarepoint VP Chris Doran spoke at the VA-sponsored VHA Real Time Location Systems Conference this week in Atlanta, with a talk entitled “RTLS Technology Appropriateness.”

EPtalk by Dr. Jayne

Lots of buzz about cell phones this week. First, multiple media outlets, including the Wall Street Journal, covered the World Health Organization’s conclusion that cell phones potentially increase cancer risk. The agency’s International Agency for Research on Cancer reviewed existing studies looking at the effects of radio frequency fields, classifying phones as “possibly carcinogenic” and increasing the incidence of certain types of brain tumors. Other agents in the “possibly carcinogenic” realm include DDT, car exhaust, lead, and pickled vegetables. Bad news for most office types: coffee is on the same list.

Next, the Los Angeles Times reported that “cell phones used by patients and families are twice as likely to contain potentially dangerous bacteria compared with the mobile phones used by healthcare workers.” Samples collected included drug-resistant staph and other bacteria associated with hospital-acquired infections. A sassy comment on the Web site poses this question: if cell phone radiation can cause cancer, why doesn’t it kill the bacteria? I like the way he/she thinks. In the mean time, folks, wash your hands before using the phone!

More 5010 news as CMS schedules National 5010 Testing Day to be held June 15. For those of you who are close to ready for testing activities, this is your chance to work with clearinghouses, insurance plans, and Medicare contractors to make sure things go smoothly. For those of you who might be a tad behind, I found the Get Ready 5010 Web site to be helpful. Available webinars highlight action plans for both small and large practices and also cover how to work with clearinghouses and payers. The site is sponsored by the AMA, WEDI, HBMA, and AHIMA.

HHS has posted what some are calling a Wall of Shame that lists nearly 300 organizations (including payers, physicians, and hospitals) that have reported breaches of medical privacy affecting more than 5,000 patients each. I take comfort in reading that they weren’t all laptops, hard drives, or other IT-related issues — several organizations were cited for issues involving (gasp!) paper records. Check out the list – lots of prominent organizations appear and it specifies the type of breach whether it was theft, loss, unauthorized access, or hacking.

American Medical News reports that CMS is finally putting their money where their mouth is, unveiling three new Medicare ACO options to aid in the transition to this new care model. This “pioneer” ACO program would provide cash advances for organizations to set up and fund the care coordination needed for viability, assuming that the investment would be repaid through cost savings. It’s unclear what would happen if organizations gamble with the cash and don’t save any money. CMS will hold four training sessions, the first being June 20-22 in Minneapolis. A public comment period is open and you can weigh in at advpayaco@cms.gov and let them know what you think.

For those of you who are always looking for the “next thing,” keep in mind that we’re only a month away from the National Committee for Quality Assurance (NCQA) publishing their version of ACO rules. Due out in July, it will give those of us who have to digest, summarize, define, compare, and forecast some additional beach reading.

I’ll close by mentioning a piece I saw in Medical Economics. The print version was heartwarmingly titled What a rock star taught me about the practice of medicine (the online version unfortunately titles this Brief encounter with rock star influences physician’s career, an editorial.) Internist Gregory A. Hood of Lexington, KY talks about meeting Roger Daltrey of The Who and how being a physician played into his experience. It’s mostly a feel-good piece, but my favorite part is when he talks about being “an extremely fast typist” who can fly through the Ticketmaster screens while purchasing tickets. He attributes his success in scoring front row Daltrey seats to his EHR-honed typing, stating that “EHRs have redeeming features.”

That’s enough to warm my little CMIO heart (as if the heat and humidity across most of the country wasn’t enough). Do you have a story about your EHR’s redeeming features? E-mail me.

Contacts

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

Healthcare IT from the Investor’s Chair 6/2/11

Ask the Chair

 

My broker has found nothing other than the usual suspects and none of them are rated all that good. Would be interesting to have your investment banker dude weigh in on investing in a fund or a reasonable combination of individual stocks, with no promises or guarantees, of course.

I’m guessing that would be me, as both a former analyst-dude and I-banker dude. 

Here’s my view. While I used to make my living recommending stocks, I’ve come to the conclusion that buying individual stocks is nearly an impossible game to win. Why? There’s a theory known as Market Efficiency, which basically postulates that all information known about a company and its prospects is already reflected in its share price.

Now clearly the readers of this blog know more about this sector than the average stock market participant (and are probably better looking and more fun to party with), but we’re talking about the market as a whole, ranging from little old ladies’ investment clubs to the likes of Raj Rajaratnam (the Galleon hedge fund owner recently convicted of insider trading).

As readers of my debut column will recall, buy-side and sell-side analysts spend their time scouring for “market inefficiencies.” In other words, seeking out stocks that don’t fully reflect their value. They do this by attending HIMSS; reading financial statements; talking to users, consultants and company management teams; and other forms of fundamental research.

Now clearly these market inefficiencies do happen for a number of reasons. Sectors go in and out of favor, companies miss (or exceed) their Street forecasts and are over-penalized (rewarded) as a result, or you just might really believe in what a company you use or saw at HIMSS is doing and so want to bet on them. (The key word here is “bet,” so please behave accordingly.)

Now that I’m done flaming about market efficiency (there’s no zealot like a convert), here’s what I do:

• First, my personal investment strategy is based around a core and diversified portfolio of low-cost index funds. That said, sometimes I just can’t help myself. That’s what a “satellite account” is for. If you want to “play” the market (again, notice the word we use), consider allocating 10-15% for that purpose. Mine is in my IRA so I don’t have tax consequences to worry about.
• Next, do your homework. You presumably have an investment thesis beyond just wanting to own HCIT stocks (e.g., love Cerner / athenahealth / Allscripts’ product at my hospital / medical group; Jonathan Bush has a great sense of humor; I use ePocrates every day; etc.)
• Watch the stocks you’re interested in and look at their valuations relative to other sectors, each other, and their history. I’ll note that these stocks have had a great run over the past few years and, in my view, the easy money might have already been made.
• If you can, try to obtain some analyst reports. At the very least, check the company’s SEC filings.
• If you determine that there’s a good buying opportunity, for whatever reason, place your trade and hope for the best! I’ve traded these stocks for my own account a few times, with generally good, but occasionally horrid results – your mileage may vary!

If you’re bullish on the entire sector, one idea might be to divide your HCIT portfolio across a number of stocks to diversify away some of the company-specific risk. As I used to say to portfolio managers who asked me to choose between two different competitors: remember, you’re not selecting the best system for your facility / practice, you’re buying pieces of paper that trade. There’s no reason you have to pick just one.

That diversification reduces risk is something even most economists agree on (though there’s the counter-view: “no guts, no glory”). Just don’t put next month’s mortgage payment or your kid’s college tuition into these stocks — they’re volatile at best! As an aside, the best book on investing I’ve ever read is A Random Walk Down Wall Street, by Burton Malkiel.

Did you attend the Health Evolution Partners’ Leadership Summit? What was it like?

For the second year, I was invited to attend this event in Dana Point, CA. While the conference began years ago as a Versant Ventures event, Health Evolution Partners took it over a few years ago. HEP is a billion-dollar private equity fund focused on healthcare, with CalPERS as its lead investor. As readers of this blog likely recall, the fund’s chairman is David Brailer, MD, PhD, the first “Healthcare IT Czar.”

(In the interest of disclosure, I should mention that I’ve known the good doctor since he was the T.A. in a class I took at Wharton while he as earning his PhD over 20 years ago. He’s been a friend and supporter ever since.)

I view this as one of the best work-related events I attend each year. As Dr. B said in his opening remarks, he asked his staff to find the best one hundred minds in healthcare, and about 400 showed up. The event included a number of panels on topics ranging from the future of for-profit hospitals to innovations in primary care, the emerging super-consumer, personalized medicine, risk-bearing medical groups, and more.

The speakers ranged from such luminaries as Michael Dell and Todd Park (athenahealth co-founder, now CTO of HHS) to CEOs of corporations of varying sizes to policy wonks and, truthfully, ranged a bit in quality (as is ever the case). I’d give them a B+ (as high as I ever grade panel events, btw).

Beyond the panels, however, were several other aspects of the event that made it extremely worthwhile. Friday afternoon had two noteworthy components. First, was “strategy sessions,” where senior executives from companies ranging from Kaiser and Optum (fka Ingenix) to Pfizer and Oracle shared their visions and strategies in a small, boardroom-type setting. This was the first time I’d heard the Optum viewpoint and strategy actually expressed, and I walked out nodding my head in agreement with much of it (though the devil and valuations are clearly in the details).

Finally, the event concluded with a round of “speed dating,” where a number of innovative companies were given short sessions with a range of sponsors, including large vendors, health systems, and funders. In effect, HEP is trying to use this “Innovation Network” to bring the smaller (often more creative) companies together with the execs of the larger (always better capitalized) companies to find some areas of potential common interest and, hopefully, accelerate the pace of progress.

As an observer, it appeared to be an outstanding opportunity for both sides, though I do wish there’d been a way for people in neither group (such as this author) to participate.

Best of all, the quality of the attendees and the networking events were simply outstanding, really the best of its sort I attend. There was a great deal of card swapping, as well as reconnecting going on. A highlight for me was a casual introduction I made between two ST Advisors’ clients and learning that one was on the board of a hospital which was in need of the type of solution the other’s company provided! That kind of serendipity can’t be beat. I’m already looking forward to next year.

Ben Rooks is the founder of ST Advisors, a consultancy which has worked with dozens of HCIT companies and investors typically on issues around strategy, financing, and outcomes/exit planning. He enjoys food and wine, debating market efficiency, discussing healthcare, and most especially, reader comments!

HIStalk Interviews Howard Landa MD, CMIO, Alameda County Medical Center

Howard Landa MD is CMIO at Alameda County Medical Center of Oakland, CA and vice chairman at AMDIS.

 

Give me some background about yourself and about the medical center.

I got involved with informatics almost out of residency. I started putting a patient list on Lotus 1-2-3 back in the 80s. I really got involved formally in the mid 90s when I was at Loma Linda. We had a great CIO. I talked to him about how the systems didn’t work, so he put me on a committee to fix it. We had three physicians. Basically, I said, “Your system sucks” and he said, “No, your system sucks … here you go.” 

We did an evaluation and we chose Cerner. We implemented Cerner in the mid to late 90s. I left there in 2001 and started working for Kaiser in Hawaii. I’m a pediatric urologist, so I did pediatric urology for them part time and got involved with their implementation of a Kaiser’s homegrown solution at that time, which lasted a few years. It really wasn’t a great product. 

When George Halvorson became the CEO of Kaiser, which I think was in 2003, he looked around and said, “We’re a medical company. We’re not a software company. We should take care of patients and let somebody else design software.” We decided to implement Epic. 

I was one of the lead physicians implementing Kaiser’s first ambulatory attempt for Epic in 2004. That went very well and then I became CMIO in 2005. For five years, we finished up the ambulatory implementation and went live with practice management and inpatient.  

As we were finishing up, I started looking around for something else to do. Alameda reached out to me even before Meaningful Use was capitalized. They were looking for a CMIO. They looked around and said, “Well, look what Kaiser’s doing. Look what Sutter’s doing. Look at what everyone around us is doing. We don’t have anything.”

I joined them in the end of 2009 just after we went live with inpatient for Kaiser and cleaned that up. I’ve been working there for about a year and a half. I joined with a CIO who was in the active process of retiring. We got through six months of treading water, and then when Mark Zielazinski joined us as CIO, we really took off looking to what we were going to do, both inpatient and outpatient.

We decided to go with upgrading Siemens Invision — which was a system that we had and had a contract for a number of years left on it — and to implement Soarian inpatient. Siemens’ partner for the ambulatory space is NextGen, so we signed a contract in February to do the whole kit and caboodle. We are really just getting rolling with starting the workload discussions. I’m actually in Philadelphia taking the training classes.

How did you end up choosing Soarian?

We had the Invision system for all the ancillaries and order transmittal as well as financials, scheduling, and registration. About three years ago, Alameda got a grant to implement nurse documentation. The price that Siemens gave them they couldn’t afford, so they went with McKesson, who gave them a very sweet deal to put in nurse documentation with an eye towards replacing Invision or replacing all of Siemens products in the future if it went well.

We have nurse documentation live on Horizon Clinicals, which works reasonably well. We did a competition between the two. We had doctors look at it. We had a lot of the executives involved with it. Both had advantages, but we had a long relationship with Siemens, which had been stormy in the past, but had gotten much better.

From a financial position, it was the better decision. From the ambulatory side, Horizon Ambulatory was a very young product and very questionable, whereas NextGen was a fairly established ambulatory product. Even thought it was not integrated, it still had very good functionality and we went down that road. It was a very close competition, but finally we chose to stick with Siemens. I would say based on the last six months of negotiations and getting things started, I think it was the right decision.

You had an insider’s look at Epic at Kaiser being used on both inpatient and outpatient and now you’re working with Soarian plus NextGen. Do you feel that’s a comparable package?

I think that from a clinician user, physicians and nurses, I think Epic is an easier-to-use product. It’s a more integrated product. It’s a much more complicated product to build, but it’s a much easier product for the end users.

Soarian and NextGen are going to be simpler to build and maintain. They are a little clumsier. They’re a little more primitive than Epic. But I think that they still provide good functionality and I think they’re going to be easier to train and easier to use than the fancy stuff. The basic functionality, I think, is very solid in Siemens and Soarian. NextGen … I’m only just starting to get into, but so far what I’ve seen I’ve been impressed by.

You’re not giving up anything on the inpatient clinical side to go with Soarian from what you’ve seen?

As I said, I think Epic is a more mature product. It’s much more established. It’s been out there really being used in large places and small places. I think that we’re going to have some real work to make Soarian sing, but I think that the potential is there. I think it’s built on a solid foundation.

I think we’re finally seeing a lot of movement in Soarian. You know, for years there were just a couple of players out there who had it in place. Physician order entry was difficult. But the last year or two, we’re seeing a lot of people implementing Soarian. People going live with order entry. This has really been a huge way of that getting going.

Bringing on people like John Glaser and Marc Overhage is a tremendous comfort. People who really get where this needs to go. I spoke to John on several occasions about his vision, and as usual, John is dead on. I think those are great moves by Siemens in the right direction.

How do you feel about Meaningful Use and your readiness for it?

It’s part of our contract. I fully expect to meet Meaningful Use, probably just in time on the inpatient side, where we’re shooting for the beginning of 2013. It’s an aggressive implementation. We’re basically going to do all of inpatient and all of outpatient between a contract signing in February and implementation and go-lives that start early in 2012 and run through 2012 ending right at the end of the year. That’s a very aggressive take on it, but from everything I’ve seen so far, I think we can make it.

Do components like CPOE concern you?

You know, one of the things about Alameda — and probably the reason I joined — was it’s just an absolutely incredible physician staff. As I said, they were looking to put in a system a year or two before Meaningful Use was out there. That was one of the things that most attracted me. They really got it before the government said, “We’re going to incentivize it.” 

It’s an unusual situation to have a large physician group saying, “We want to do electronic documentation. We want to do electronic order entry.” It’s a residency-run hospital and several large residency programs. Residents and many of the attendings come to our office regularly with, “How come we’re so far behind? How come we’re not there already? How come we can’t do this?” 

That to me is the most exciting. I have very few people who’ll come to me and say, “I can’t believe we’re doing anything this stupid,” which you certainly hear in a lot of organizations.

I have to ask you about the hospital’s turnaround that was profiled in Fast Company. I’m really intrigued by how that’s going and how that impacts what you do. Can you describe the situation before you came and what’s been done to turn things around?

I think it really is a leadership and cultural issue. For years, it was a standard, old-fashioned county hospital. Most people’s take on it is that it takes care of the indigent. It takes care of people who don’t have any choice, so they can’t make the demands on the system. We had to just do the minimum and get along. Why push the envelope? 

Wright Lassiter came in and said, “There’s no reason it has to be this way.” The board was very enthusiastic about making Alameda County a real standout in the world of safety net institutions. He brought in Bill Manns shortly afterward as chief operating officer. Spent a couple of years really trying to get the finances arranged, get rid of old debt, really re-establish relationships.

Over about a 24- or 30-month period, he basically replaced the entire executive team. I’ve been there for a year and a half and I’m one of the more senior people. After Bill and Wright, there’s two or three people who have been around four or five years, but most of the executive team has been around for between one and two years. The chief medical officer came in two or three months before me. The CIO came in six months after me. The CFO and chief nursing officer came in the same time as Mark. The entire executive team is really brand new, picked from a large group of people who have been successful in their respective roles.

The idea that it’s a county hospital merely means it’s a county hospital. We’re looking to actively be a place that people want to come to, and at least on a quality basis and a care basis, compete with the Kaisers and Sutters and the health systems in northern California.

The quality metrics have really risen the last couple of years. Patient satisfaction is still low, as is not too surprising at a county hospital, but is increasing dramatically. The attitude of the front line staff and the executives is that this is going to be a different organization than your run-of-the-mill county hospital. They really want to be the flagship.

When you read that article, it almost sounds too good to be true. Is it really that dramatic and as much a function of leadership as it sounded?

It’s hard to say definitely since I wasn’t there, but certainly when I first came in, I saw some of the people who were in the positions before, especially the CIO. I understand how bad it was. The front line staff wanted to do the right thing, but had very little leadership and very little mentoring. The executive staff kept turning over, so nobody was ever really was able to take hold and create a culture of care quality and financial stewardship and pride.

The front end people definitely have a tremendous amount of pride in what they do, but I think the middle and upper staff in the past was really … it was just a job to them. The people providing care … it’s their community. These are their compatriots and there is a tremendous amount of pride and dedication to that community. You talk to the physicians — and I’ve worked at several county hospitals — and the usual attitude in one of, “It’s a job, I’m here, I’m taking care of people.”

This group is absolutely, incredibly dedicated to taking care of this patient population. It is such a pleasure to see and to work with. I think the leadership was the key, but I think you already had a number of good people, especially on the physician side and the front end clinicians and nurses, who really wanted to make it a showplace.

Are you getting interest from other places that want to know what you’re doing there?

Through the Safety Net Institute in California, which is the local extension center for the county hospitals, we’re meeting with the CIOs and CMIOs twice a year. We’re also actively talking about, since a number are going live with Soarian over the next year or two … we’re going to try to go down and help them with their implementations. We’re talking to Pomona Valley, we’re talking to Riverside, and Kaweah Delta. We’re taking about going down and helping them with their go lives, and they can come up and support us. Trading resources in more of a bartering system. Instead of paying outside consultants to come in for huge dollars, bring in people who really use the system who are in similar institutions. That’s the plan.

Do you think that the problems that the Medical Center had and the solutions that they’ve developed is a sequence that other hospitals are going to be going through with healthcare reform?

I think so and I hope so. It does take a leadership that is willing to take some chances and willing to really try to change culture, which as you know is far more difficult than implementing systems.

Healthcare reform … everyone talks about it and everyone says it’s coming. I’m still unclear exactly how it’s going to pan out and how we’re going to make it work. I think the system has to change if we’re going to manage to provide care to everyone in the nation, not just the indigent. The system is — I don’t want to say broken, although I think it is — but it really has to change to start paying for quality, paying for fair delivery instead of increasing the waste.

That’s one thing I learned working for Kaiser. When I was at Loma Linda, we had a large number of capitated contracts for urology. The Kaiser model of an Accountable Care Organization is where it needs to go. Alameda has about 30 or 40 percent of its patients that are county patients for which we are essentially capitated. We provide the care for a fixed amount and we need to provide ambulatory and specialty and hospitalization care for that group.

The better we take care of them, the better quality we provide, the more we do to keep them out of the hospital and keep them healthier, the better we’re going to do financially and the better they’re going to do medically. I’m a firm believer in that model. My years at Kaiser absolutely convinced me of that.

Other than the obvious applied informatics aspect of Kaiser, when you look at the analytics and information needed to compete and provide good quality outcomes, where do you think the industry is in terms of being able to use data to meet standards that someone will be setting?

I think the whole applied informatics piece is a dual approach. One is we need to be able to provide care and collect the information to take care of the patients in a structured format so we can report on it. Then the other side of it, having a structured data that we can take, review the actual data, and derive from that what is our best direction. How do we provide this care in an effective and efficient model? You need to have both pieces. 

I think we’re seeing proxies for quality now. We’re seeing a number days central lines are in place. We’re seeing a number of pressure ulcers that are avoided. We’re seeing those kind of things, which I consider proxies for quality. What we need to do eventually is come back and say, “Are we really improving the overall quality of life of people who we’re taking care of? Are we increasing lifespan? Are we improving quality of life? Are we doing it at a reasonable cost?”

Those are the kinds of things you really need the analytics to drive. We just don’t have the data at the front end. Where we’ve got these measures that are important, but they really aren’t what we’re trying to accomplish. They’re just proxies for it. The more data we have, the more structured data we can aggregate, the better we can actually ascertain what kind of bang for a buck we’re getting for the money we’re spending .

Any concluding thoughts?

I certainly thought several times before taking this position. There are significant resource challenges for a county hospital. It’s a very interesting place to work, but the people that I’m working with and the drive they have to do the right thing, in my perception, have really made it an incredible experience. I’ve been very happy there.

News 6/1/11

Top News

 

HHS issues a proposed rule requiring healthcare providers, health plans, and their business associates to maintain an access report detailing all disclosures of patient information within an EHR or accounting system. Providers must also record every EHR chart access, including details on who opened the patient chart, the date, and the time. The access report must be made available at the request of patients.

Cerner announces a two-for-one stock split, with a June 24 distribution date. Shares closed Tuesday at $120.10, valuing the company at just over $10 billion. Neal Patterson holds $512 million worth. Above is the one-year CERN share price (blue) compared to the S&P 500 (green).

Reader Comments

From All Hat No Cattle: “Re: HHS’s HIT certification. Seems like another needless scam.” ONC announces availability of six Health Information Technology Professionals examinations: (a) clinician / practitioner consultant; (b) implementation manager; (c) implementation support specialist; (d) practice workflow and information management redesign specialist; (e) technical / software support staff; and (f) trainer. ONC is offering vouchers to qualified applicants; otherwise, it’s $299 for the first exam and $199 for each additional. ONC pre-nicknamed the exams HIT PRO, which is trademarked for some reason. I’m not entirely sure what the point is – in the “Why Take the HIT Pro” explanation, they talk about a shortage of qualified HIT workers, implying that passing the test makes someone qualified. There are no educational or occupational prerequisites for taking the 125-question tests, although the target audience is the folks who have finished one of those short, ONC-funded HIT programs that community colleges offer.

From MadCow: “Re: Loma Linda University Medical Center. Pulling an EMR swap, from Cerner to Epic.” Verified. LLUMC’s board approved Epic last week, which will be rolled out through their entire system. Epic will replace Cerner for inpatient and ambulatory clinicals, GE for faculty practice management, and a homegrown registration and billing system. LLUMC will keep their Cerner lab apps because Epic’s Beaker is a few years away from having the capabilities needed for an organization of that size.

From HITuser: “Re: Meditech 6.0. Have they implement any sites running multiple facilities?” A good question, which I will open up to those HIStalk readers who surely know. I’d have to guess yes.

HIStalk Announcements and Requests

A reader asked if I could interview someone from St. John’s in Joplin about their emergency preparedness lessons learned once things settle down there. If anyone is reading from there and would be willing at some point, let me know.

Watching: Life on Mars, a quirky one-season sci fi/cop show in which the lead character is sent back in time to 1973. Harvey Keitel is excellent in it, former Cosby kid Lisa Bonet has a role, and the pop culture (hair, clothes, music, etc.) are cool. Lots of Bowie tunes. It’s the American remake, predictably inferior to the original British version, they say, so I’m hoping the original hits Netflix streaming.

Welcome to new HIStalk Platinum Sponsor Impact Advisors of Naperville, IL. The company’s service offerings include strategic advisory (IT performance assessment, strategy, system selection, contracting, ROI, HITECH readiness, governance, and facilities planning) and strategic implementation (planning, readiness, project leadership, staff augmentation, project oversight, interim management). Impact Advisors has won several awards,including Best in KLAS for Planning and Assessment for three straight years. They’ve also bagged some “Best Places to Work” recognition in case you’re looking for opportunities (I see they need implementation specialists for Epic and Cerner at the moment, as well as HIT strategy folks). Founders Andrew and Peter Smith are HIT long-timers and have boatloads of experience working with hospitals and physician groups and are on the speed dial of quite a few big-name CEOs and CIOs as their trusted advisors. Former FCG President Steve Heck is a VP there, so you can catch up with him when you contact the company. Many thanks to Impact Advisors for supporting HIStalk.

It’s a quiet week by all appearances, which is a relief since I’m trying to catch up after a few days of being semi-off. It seems like about half of the 7,359 HIStalk e-mail subscribers are kicking back an “out of the office” reply this week, so good for everybody who is getting away a bit for the unofficial beginning of summer. It’s a great time to send in your news, rumors, guest articles, or whatever goodies you have that might interest others.

Acquisitions, Funding, Business, and Stock

A London newspaper says that Sage is reviewing its healthcare business and will likely sell it, although it did not provide details or sources.

A Chicago Tribune story on excessive executive pay speculates that McKesson shareholders may push back on the compensation of CEO John Hammergren at this summer’s annual meeting. He’s California’s third-highest-paid CEO at $54.6 million for the year ended last March (the company hasn’t released his FY2011 take).

Announcements and Implementations

IBM announces the expansion of its Dallas-based Health Analytics Solution Center, including the addition of new technology and the doubling of its solution architects and technology specialists. Mobile technologies, remote patient monitoring, and analytics are some of the areas IBM says the Center is addressing.

Health information network provider Availity earns EHNAC recognition for achieving the requirements for the 5010 Readiness Assessment program.

MIM Software introduces the VueMe App for iPad, iPhone, and iTouch. The app allows patients to view diagnostic images that have been sent them from their doctors, or to share those images with a specialist.

Government and Politics

Your tax dollars at work: as of May 19th, the Medicare EHR incentive program had paid providers $75 million; the 15 state Medicaid programs paid an additional $38 million. Including HIT training programs and RECs, HHS says it has doled out a total of $1.7 billion to promote EHR adoption. ONC coordinator Farzad Mostashari also notes that EHR use among primary care physicians increased from 20% in 2009 to 30% in 2010.

ONC publishes a proposed rule that addresses how the agency can remove an approved accreditor of the permanent EHR certification program. The ruling establishes a process to deal with situations where the ONC-AA engages in misconduct or does not perform its responsibilities.

Weird News Andy notes that the Feds are cracking down on healthcare fraud by threatening to file criminal charges against corporate executives whose companies are caught in wrongdoing, even if the executive had no direct knowledge of the illegal activities. Instead of just accepting a fraud settlement from big companies who treat it as a cost of doing business, Uncle is pulling out previous precedents that it says allow it to hold executives personally responsible, noting that several Fortune 500 companies have bought their way out of Medicare fraud several times (can I get an amen?) A quote from HHS’s chief counsel for the inspector general:

To our way of thinking, the men and women in the corporate suite aren’t getting it. If writing a check for $200 million isn’t enough to have a company change its ways, then maybe we have got to have the individuals who are responsible for this held accountable. The behavior of a company starts at the top.

Maybe the government should have cracked down on this guy: a man who used patient information to charge phony narcotics prescriptions to a federal employee insurance plan gets off with a six-year sentence and a fine. He had pleaded guilty to charges of healthcare fraud, HIPAA violations, and identity theft in obtaining the drugs to sell.

In the UK, a member of Parliament says NHS should fire CSC from its $5 billion NPfIT contract since it has implemented only three hospitals in nine years. MP Richard Bacon, always a great source for quotes, says NHS CIO Christine Connelly’s assertion that it would cost more to fire CSC than to let them finish the work is “incredible,” saying if that’s true then everybody involved with Connecting for Health should be fired. Tony Collins reports on a leaked memo that says CSC is proposing to cut the number of trusts it will implement from 220 to 80, but at a rate per trust that’s double what the current contract specifies.

Other

Bizarre: 53% of surveyed teens say they would rather lose their sense of smell than their personal technology, while 47% say they want to be remembered for their social network connections.

 Sponsor Updates

• Carlos A. Labrador, MD (FL) is named as one of 15 eClinicalWorks clients to receive EHR incentive checks from CMS.
• Dell InSite One is managing over four billion diagnostic imaging objects and associated reports with its managed cloud enterprise archive.
• Fujitsu names Perceptive Software its Central Region Premier Partner of the year.
• T-System partners with Isabel Healthcare to integrate its T-SystemEV EDIS with Isabel’s diagnosis decision support content.
• Lawson Healthcare recognizes five provider organizations with its 2011 Customer of the Year Awards.
• maxIT Healthcare will provide consulting services for Meditech Magic users who are implementing the OrderEase software from Iatric Systems .
• Twenty Meditech hospitals have selected Imprivata OneSign in the last six months, bringing Imprivata’s Meditech client base to 150.
• HMS DIRECT, HMS’s remote hosting service division, expands it data center capacity to accommodate the growth of the company’s ASP business.
• Molina Healthcare picks GE Centricity Practice Solution as its primary EMR/PM platform.
• A Gateway EDI/LarsonAllen study finds that physician practices that have adopted RCM tools have higher revenues and collect more patient payments at the time of service.
• NCR is holding a June 16 Webinar called Revenue Cycle: Why Self-Service is Key, featuring Elmhurst Memorial Hospital.

Contacts

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

Curbside Consult with Dr. Jayne 5/31/11

Dr. Jayne Interviews KC Frank, EVP, Document Imaging Systems Corp.

KC Frank is executive vice president of Document Imaging Systems Corp. (DISC) of St. Louis, MO.

Give me some background about yourself and DISC.

DISC has been in business since 1958. Originally founded as a microfilm company, DISC has evolved into a document management solution provider focused on improving our client’s business processes. In 2007, DISC was acquired by The Flesh Company, a 98-year-old print solutions provider. I joined DISC as vice president in 2003 and have helped develop new solution offerings, strategic relationships in healthcare, and growth strategies. I am a long-time member of MGMA, AIIM, AIIM, ARMA, and TAWPI and recently received an AIIM Distinguished Service Award for accomplishments in the Information Management industry.

One of your marketing campaigns, which has been mentioned on HIStalk, is “No hybrid EMRs.” What do you mean by this?

A hybrid EMR is one where providers rely on both an electronic and paper chart post-EMR implementation. I have heard countless stories of physicians walking into encounter rooms with both a paper chart and a tablet PC. Managing patient care in a dual environment is both incredibly inefficient and frustrating. Without a solid strategy to eliminate the paper charts, the hybrid EMR will be a reality for physician groups as they migrate to EMR.

Many practices I talk to think they can scan their documents cheaper or better themselves. What’s your experience?

If organizations truly understood the process of conversion before starting, they would probably all outsource. About 50% of the clients we work with have tried to scan on their own first. Most organizations underestimate the time, difficulties and costs associated with converting their paper charts. It’s been proven many times over that a scanning process managed and executed by inexperienced staff results in double and sometimes triple the cost of outsourcing to an expert service provider.

It’s common sense. Businesses get better each time they execute a process. DISC has converted over a billion documents in our history. Physician groups may have never scanned a single chart when they start planning their implementation. Service providers like DISC are converting documents using technology designed for large batches of scanning, including scanners that cost in the hundreds of thousands of dollars. With better technology and processes built on experience, it’s difficult to imagine a healthcare organization that could scan cheaper and better.

How is working with outpatient medical practices different from working with a hospital, or say an academic medical center?

There are subtle differences such as project design, chart setup, document types, chart access needs, and workflows. Ultimately, with strong project management by the client and service provider, the differences are negligible.

Do you just work with local clients? What’s the farthest client or most exotic locale you’ve visited to convert charts?

We typically provide services on a regional basis. Since we are certified by both Allscripts and NextGen to provide services in the central region of the United States, the majority of our clients reside in an 18-state central region of the US. We’ve provided services as far west as California and as far east as North Carolina. Do they practice medicine in Hawaii? We’re still waiting for that call.

Thinking of some of your more difficult customers, what are some pieces of advice for practices preparing to convert from paper charts to an EHR?

First, decide on a conversion strategy. Will you outsource or attempt an in-house conversion? Will you scan all charts prior to go-live or scan by the schedule after go-live? Will you scan the entire chart or just a portion of the chart? All key strategic questions. Many times organizations lean on providers like DISC to help understand the pros and cons of each of the strategies.

Pick a strong project manager. Many times the HIM or medical records director is the right choice. Make sure the person you choose cares about the success of the project. Do not hire temp staff to manage the project.

If you choose to outsource, choose a partner that has experience with medical record conversion and the EMR you are migrating to. A service provider that doesn’t have experience with your EMR system may not be able to get the documents filed appropriately in that system.

If you plan to scan yourself, do time tests to determine how long it’ll take to scan a chart. This is critical. If an organization plans to scan by the schedule, meets with 200 patients per day, and can scan a chart in 20 minutes, it’s simple math to determine that it’ll take about 66 hours per day (8 FTEs) to keep up on that project. Don’t be caught off guard.

DISC does more than just scan old paper charts. What other solutions do practices need to manage the mountains of paper they’re used to moving? Will you go out of business when all the old charts are scanned?

If we relied solely on scanning historical charts, we would be out of business in five to seven years. Fortunately, we have developed other solutions in both document and content management to evolve with our clients. Although paper is slowly being eliminated from business processes, the volume of electronic documents and content continues to increase.

Today, we are offering solutions such as Daily Go-Forward Scanning, Revenue Cycle Document and Content Management, Accounts Payable Automation, Electronic ROI, and Business Intelligence. We also offer a variety of solutions in other vertical markets, including finance, manufacturing, education, and government. We plan on being around another 50 years.

Does it make a difference whether a scanning vendor partners with an EHR vendor?

Absolutely. Having intimate knowledge of the system the healthcare organization is implementing allows the scanning vendor to automatically load the electronic charts directly into the patient chart within the EMR. Without the auto load, healthcare organizations may be left with electronic charts stored and retrieved in a third-party system or internal network drive. This, of course, is not optimal since providers have to work within two systems to find charts instead of just the EMR.

Both Allscripts and NextGen realized the importance of this integration and put certified programs together to support their clients. DISC is a part of both of those programs.

You’re located in the Midwest, an area hit hard recently by floods and tornadoes. Any great “saves” with your clients during these disasters?

We actually did have a client this year ask us to scan hundreds of boxes of records stored in the first level of their building due to flood concerns. Unfortunately, natural disasters have a history of reducing the historical content of a business to rubble; specifically all the important documentation which resides in a paper format. Fortunately, companies like DISC can digitize that critical information so disaster recovery of those documents is as simple as reloading a backup.

Any final thoughts?

Another common strategic discussion we have with clients is whether or not they should scan the entire chart or just a portion. We have seen successful projects on both ends. Understand that the benefits many organizations expect when going to an EMR, such as eliminating chart filing labor costs and reusing paper chart storage space for revenue-generating opportunities, will not be realized until the entire chart can be removed from the chart room. This decision is typically made with one of two goals in mind – to satisfy clinical needs (partial scan) or to satisfy business needs (full scan).

E-mail Dr. Jayne.

Monday Morning Update 5/30/11

From Pericles: “Re: Allscripts outage at Allegheny General. The article refers to the company’s ‘New Jersey headquarters’ instead of Chicago. Could they have named the wrong vendor?” I assume the problem was with a hosted version of the Sunrise application, which is run from the former Eclipsys hosting center in Mountain Lakes, NJ. That operation and service was turned over to ACS/Xerox just over a month ago in a 10-year, $500 million outsourcing deal.

From Nosmo King: “Re: Nuance. As result of the Nuance partnership with 3MHiS that created CAPD (Computer-Assisted Physician Documentation), there are rumors that Nuance might buy the troubled document creation and management business of 3MHiS, formerly known as SoftMed.” Unverified.

From Mercy IT Gal: “Re: St. John’s Regional Medical Center, Joplin. It’s been a crazy week here at Mercy. A lot of time and effort is going into making sure the patients are taken care of, making sure our co-workers are OK, and securing the assets that were in the hospital. The mobile hospital is pretty wild – looks like a MASH unit (picture attached). The mobile hospital is an attempt by Mercy to show the community of Joplin that we’re not going anywhere. Mercy is committed to the Joplin community and will not abandon them in their time of need, even if it means setting up a temporary structure until we can get something new built. The frustration at work can get pretty high at times, but I can tell you that this week I’ve been pretty proud of working at Mercy. It’s amazing how people have come together looking for a way to help. Probably one of the best stories I’ve heard is from someone who volunteered to answer the hotline assigned to checking to make sure our Joplin co-workers were safe. She said she got a call from someone who had some damage, but was overall OK. She was concerned about her job and stated that she didn’t want to go to Freeman because Freeman is a for-profit hospital.  She said her heart was at Mercy and that’s where she wanted to be. I didn’t mean to turn this into a propaganda e-mail touting the virtues of Mercy, but as you can guess, this has been an emotional week and I guess it’s getting to me. Thanks again for all the hard work you do to keep us healthcare geeks informed and entertained. In case you don’t hear it often enough it really is appreciated. I hope you take some time to relax over the holiday weekend with Mrs. HIStalk.”

Update 5/29: the temporary hospital was scheduled to open Sunday afternoon in time for the President’s visit. Above are additional pictures from St. John’s – the photo album is here. The one with the printer in the lower left is what’s left of the data center.

From Sy Alice: “Re: abstract from the American Urological Association meeting. I imagine the good doctor could have phrased this better: “Good treatments are available for all patients and, depending on what the patient is willing to do, every man can get an erection if he sees a physician specializing in sexual dysfunction.” I’m not touching that with a … well, I’m just not touching that.

From The PACS Designer: “Re: CloudFoundry. CloudFoundry is the world’s first open Platform as a Service (PaaS) offering. The CloudFoundry.org Web site is a community-driven open source project that is led by VMware. With the CloudFoundry Beta, you can try for free the VMware Horizon App Manager, which is an open, user-centric management service for accessing cloud applications.”

From Lab Rat: “Re: Epic Beaker. I wouldn’t even think about implementing it until Epic gets back to work on it, especially in a larger hospital. Label printing is way more complicated to set up than with Cerner or Meditech and instruments were having troubles with the labels.” A Beaker site contact I asked agrees that it needs work.  

Photo: Patriot Guard Riders 

Monday is Memorial Day, a day to honor those men and women who have died in military service to the United States. Try to squeeze in a few minutes among picnics, car races, and the beach this long weekend to remember the fallen who earned that one day of honor the hard way (many of them barely old enough to vote). It’s perfectly fine to be anti-war and anti-military and still be supportive of those in the service – most of the fallen didn’t get to pick the cause they died for, so you can’t hold that against them. I ran one of my favorite poems on Memorial Day 2005 and a time or two since. My flag is flying and I hope yours is too – it’s the (very) least we can do.

Listening: Lez Zeppelin, an all-girl Led Zep cover band (not as weird as it sounds since Robert Plant shrieked like a girl most of the time anyway and cute girl rockers are always better). I’m not a fan of cover bands or even Led Zeppelin in general, but somehow I like their albums (yes, they’ve done two) that are note-for-note covers of the originals. I’m air guitaring to Dazed and Confused right now, wishing I was watching them live. Also: Manchester Orchestra, Atlanta-based emo-ey indie that veers into hard-rocking territory every now and then and sounds just fine.

About two-thirds of provider respondents aren’t so sure their employer has good enough security practices to keep their medical records private. New poll to your right: how loyal are you to working in healthcare?

I was going to run a poll on CHIME’s CIO credential, but I remembered that I did that two years ago. The opinion then was 91% negative (13% said it’s a vanity credential, 33% said it has no connection to competency, and 43% said it’s just another way for CHIME to make money).

Six-employee MobiuSoft of Flint, MI says they’ll hire up to 144 more folks in the next 18 months if their HIE product earns certification (that’s what I’m inferring from the newspaper article, anyway). Former Genesys PHO VP Jerry Van Horn formed the company in 2009.

Quality Systems (NextGen) announces Q4 numbers: revenue up 24%, EPS $0.64 vs. $0.45, beating analyst expectations for both.

Thanks to new HIStalk and HIStalk Practice Platinum Sponsor Gateway EDI of St. Louis, MO. The 30-year-old company’s 85,000 physician users trust its fully integrated tools and proactive service team to monitor their claims, catching and fixing issues before they cause problems for their practices. The fast-growing company’s founder was a physician who created new solutions when existing claims processing tools weren’t doing the job. Users rave about the personal support they get from the customer service department, with one happy physician customer calling them “the Nordstrom of EDI.” Providers get paid faster, big practices enjoy the customization capabilities of the Web-based software, and vendors offering Gateway EDI’s solutions with their PM software give customers an all-in-one solution. Thanks to Gateway EDI for supporting HIStalk and HIStalk Practice.

ED doc Kevin Kitka, DO of Mercy/St. Johns Regional Medical Center of Joplin, MO describes what it was like to be working in the hospital as it was severely damaged by the recent tornadoes. He’s an excellent writer:

A small child of approximately 3-4 years of age was crying; he had a large avulsion of skin to his neck and spine. The gaping wound revealed his cervical spine and upper thoracic spine bones. I could actually count his vertebrae with my fingers. This was a child, his whole life ahead of him, suffering life threatening wounds in front of me, his eyes pleading me to help him. We could not find any pediatric C collars in the darkness, and water from the shattered main pipes was once again showering down upon all of us. Fortunately, we were able to get him immobilized with towels, and start an IV with fluids and pain meds before shipping him out. We felt paralyzed and helpless ourselves.

Speaking of St. Johns, nearby hospitals accepting its evacuated patients had a heavy OB load. The hospitals credit GE Healthcare for rushing a team of employee volunteers to get fetal monitoring set up, one of them driving four hours to get to the hospital and another doing configuration from her laptop while hunkered down in her pantry because her own Dallas neighborhood was under a tornado watch.

Allscripts fires PwC as the auditor of its financial statements. I don’t really understand the reasons or the impact from the SEC filing, but maybe someone can enlighten me.

It looks like Cerner has a new logo and a tag line of “Health care is too important to stay the same.” I like the new one much better – it uses green (my favorite color, and everybody wants to use green these days) and it ditches the robotic-looking, all-caps-shouting CERNER in favor of a cute, non-threatening rounded font that everybody uses when trying to look Web 2.0.

Cerner’s just-published 2010 annual report has a chatty letter from president, chairman, and co-founder Neal Patterson with some fun quotes:

• Thirty-one years ago, had we known exactly how hard, how long and how costly it would be, we might have chosen a different industry. I am thankful today for how youth and ignorance can sometimes prevail over conventional wisdom.
• In my professional experience, vision is the thing you as a leader use to give your organization the courage and motivation to invest in new ideas years before they produce economic returns.
• We view our work over the past 30 years as analogous to building the foundations and laying the electrical grid for a great city that hasn’t been built. Reaching the place where we can actually start to build on top of that foundation is inspiring for us and our clients. Things are starting to get fun.
• In the past several years, we have made changes to our health plan, fired our third party administrator (we prefer to think of it as eliminating our first insurance company), launched an on-site new age clinic and pharmacy, incorporated biometric measurements for our population, realigned the economic incentives for associates in our health plan price tags and rolled out a data-based wellness management program that
  provides personalized health profiles for our associates.
• The Cerner of today is known for care; we expect the Cerner of five or 10 years from now will be recognized for health as much as care. As I mentioned, we can see a plausible scenario where health actually becomes the bigger portion of our growth.
• This is the start of my fourth decade at Cerner. This is the first decade that I will not finish—at least not in the role of CEO. Unfortunately, there is a direct correlation between years of experience and chronological age. Often when I share Cerner’s age (31 years), I make the offsetting remark that Paul, Cliff and I were all in our 20s when we started Cerner. In my case, I was 29. If you add thirty-something to any age, the numbers start getting large. I don’t intend to end this decade as Cerner’s 70-year-old CEO … which is frustrating because this is going to be the most exciting decade yet.
• [This is an entry on his personal to-do list, referring to his sister-in-law Linda, who died of sepsis due to lack of care coordination] Save Linda’s life. Make it systematic that preventable events that harm people are exposed to the appropriate caregivers and eliminated. This will not bring back Linda, but it may prevent the next 50-year-old schoolteacher from rural America from dying unnecessarily from the uninformed, sometimes inadequate, sloppy, delay-ridden thing we call a healthcare system.

Here’s Vince Ciotti’s latest HIStory, which points out the parallel of a 1960s government program that drove financial systems development and sales much like ARRA is doing for EMRs today.

McKesson’s lawsuit against Epic isn’t over. A federal court will rehear McKesson’s case, which claims that Epic’s MyChart infringes on a RelayHealth patent covering patient-doctor communication via the Web. The previous ruling let Epic off the hook, saying that Epic’s customers and not the company itself set up MyChart. The issue at hand is whether Epic encouraged its customers to do so, and if so, whether that constitutes patent infringement.

Rennselaer Polytechnic Institute is awarded a $1.2 million NIH grant to develop patient-specific “phantoms” that can model the organ-specific radiation exposure involved in CT scans.

The new management team at Guam Memorial Hospital finds financial irregularities that include paying $25K per year for software that generates a form that they say could easily be photocopied instead.

Interesting: Regenstrief doctors are developing software that will use EMR data to determine which warnings and side effects are relevant to individual patients, creating dynamic prescription labels.

High-powered venture capital firm Venrock adds Bob Kocher, MD as a partner, expanding to three partners who will focus on healthcare IT companies. He was previously with McKinsey, Brookings, and the Obama administration. Venrock’s previous investments include athenahealth, RelayHealth, Awarepoint, Castlight Health, Coderyte, and Vocera.

Hospital and population health applications vendor Healthways outsources its application development and technology management services to HP in a 10-year, $380 million deal.

GE Healthcare and Thomson Reuters will offer drug companies and other researchers a database that combines de-identified patient EMR data from GE with de-identified claims and prescription data from Thomson Reuters.

A study of 17 physicians in a clinic moving from an old EMR to a new and more powerful one finds that prescribing errors dropped, but mostly because use of unapproved abbreviations was reduced. The total number of other errors increased at the 12-week mark and was identical to baseline at 12 months, suggesting that EMR implementation may cause errors early on and have little effect after a year. Most of those same doctors said the alerts weren’t useful, it was too slow in handling prescriptions and refill requests, and the more sophisticated system wasn’t any safer than the old one.

England’s NHS Direct hotline launches a free mobile app that allows patients to assess symptoms, get self-care advice, and contact NHS’s telephone nurses. It’s Android-only for now, with an iPhone app coming in a few weeks.

Population and risk management software vendor MedVentive raises $1.5 million in convertible promissory notes and warrants. I interviewed Nancy Ham (president and CEO) and Nancy Brown (chief growth officer) last August. I asked some reasonably good questions about technology support for ACOs and whether providers are fixated on EMRs while ignoring potentially more important solutions.

Sponsor Updates

• The use of AirStrip OB by Lovelace Health Systems (part of Ardent Health Services, which uses it in all of its hospitals) is profiled in the New Mexico business paper.
• Billian’s HealthDATA is hosting a June 8 Webinar called Providers’ Perceptions: Mobility in Healthcare. They’re also offering a free white paper titled Social Media Strategy for Healthcare Vendors.

E-mail Mr. H.

A Reader’s Response to HIStory 5/23/11

In Mr. HIStalk’s Monday Morning Update (5/23/11), Vince Ciotti’s HIStory slide show installment focused on the former Lockheed / Technicon … / Alltel / Eclipsys companies and their health information systems. However, this installment is full of factual errors.

Ron Johnson was NOT one of the original Lockheed engineers. Ron was hired at the Technicon company (1980?) as director of marketing, and he was let go after a brief stint.

In addition, the late George Kennedy was NOT one of the original Lockheed engineers. At Technicon, compared to others, George’s role was thin and short-lived. 

Ralph Korpman, MD was involved as a pathologist for the Technicon laboratory information system and famously sold a version of it to the then-HBOC (lawsuits followed; settled out of court).

Jack Whitehead, who owned Technicon Instruments, a laboratory system company (Tarrytown NY), bought the original Lockheed system (along with many of its engineers) and named the company Technicon Medical Information Systems (TMIS), as it was called when I joined the company in 1978. TMIS was set up to take the Lockheed system and commercialize it. 

It was pretty clear who drove that vision in those early days. Unsung heroes, such as Sam Virts, Ralph Boyce, Dick Kortum, Chuck Tapella, Bob McCord, Mel Hodge, Stan Grahams, Bob Williams, Dave Brown, Carole Widener, RN, Shirley Hughes, RN, ……….. (and forgive me for leaving out so many who deserve to be included here).

Around the same time that TMIS started, Spectra 2000 Medical Information Systems was started by another group of former Lockheed engineers and initially financed by Transamerica (LA). This company was later bought by Medicus; Richard Jelineck, PhD, et al. The two competing TMIS and Spectra systems obviously were similar. What set the systems apart functionally was Spectra’s MIS provided the first colored screen text. However, Technicon’s MIS was fully installed and used in a hospital based on documented cost / benefits.

In 1975, two reports were written about the TMIS system: One was written by Battelle Columbus (OH) Laboratories – Final Report on Evaluation of the Implementation of a Medical Information System in General Community Hospital. The other was Demonstration and Evaluation of a Total Hospital Information System – El Camino Hospital, Mountain View CA.

El Camino Hospital has never employed physicians nor have physicians ever owned the hospital. ECH was and still is a community-based, district facility. The community physicians from the Sunnyvale Clinic and the smaller Mountain View Clinic were key supporters of the TMIS. Other, key, physician leaders, such as Ralph Watson, were part of smaller physician practices / groups. The fact that these community physicians were not employed and there was success in gaining wide-scale adoption of CPOE during the 1970s is an accomplishment that other companies and products required 25+ years and paid incentives to achieve.

In 1981, Jack Whitehead sold TMIS and the lab system division, Technicon Instruments, to Revlon. TMIS became Technicon Data Systems (TDS). In 1984-85ish, Revlon sold TDS back to Jack Whitehead’s son, John, who again took the company private and renamed the company TDS Healthcare Systems. Technicon Instruments was sold to a number of companies after Revlon, with its legacy now part of the medical division of Siemens. The name “Technicon” was bought by Bayer and cannot be reused.

In 1996-97, John Whitehead sold TDS Healthcare Systems to Alltel. This lasted 2-3 years before Alltel sold it to Harvey Wilson (formerly of SMS) who started Eclipsys with the idea that he would take the Brigham & Women’s home-grown HIS, put it in a “box”, and take the market by storm.  Harvey lasted awhile at Eclipsys, but his vision never even came close to fruition. 

Yes, a handful of those old Technicon, TDS, … systems still chug away.  On the other hand, Mr. Ciotti writes that he is a frustrated English major, and he can’t even use / spell the word "it’s" correctly! Thankfully he wasn’t a frustrated history major, because he really would have had no excuse for all the “HIStory” errors in this installment (and others?).

This reply was composed by the following, former TMIS / TDS / Alltel /……employees, who remain proud having been able to work with the above, early system, company, and exceptional engineers and clinician developers … and who remain alive and well working in today’s world of healthcare IT:

Jane Baseflug, RN
Connie Berg, RN
Edith Caesar (retired)
Ann Farrell, RN
Deborah (Debby) Kohn, RHIA
Elizabeth West

News 5/27/11

Top News

St. John’s Regional Medical Center (MO) may not be salvageable, according to hospital’s president Gary Pulsipher. He says St. John’s, which is part of Mercy Health System, will open a 60-bed mobile hospital by Sunday and will rebuild. The hospital went live on EHR less than a month ago, but will soon be back online to connect the mobile hospital with other Mercy sites.

Reader Comments

From Easily Amused: “Re: magazine typo. A finance newsletter described a vendor as ‘provider of elf-service and revenue cycle management applications.’ I had visions of Santa’s helpers pitching in to improve collections.” At least they aren’t involved in elf gratification.

From Meaningless User: “Re: attestation. Do you have any info regarding which hospitals have attested to MU and what their success has been? I have not yet heard any announcements or rumors of a hospital achieving MU yet.” I doubt there’s a publicly available list, but some have met the Stage 1 requirements. It would be interesting to know if any have been turned down, but that’s not the kind of news that makes vendor press releases (not to mention that hospitals probably wouldn’t apply unless they were pretty sure they qualify).

HIStalk Announcements and Requests

In case you missed it this week on HIStalk Practice: Kareo lends advice on how to handle medical billing after a zombie apocalypse. Massachusetts eHealth leads the nation in enrolling primary care physicians for its REC. AMA reports a 45% increase in profits for 2010.  Dr. Gregg reflects on egos in the industry. And my personal favorite: the fake doctor who used toothpicks to treat his patient.  None of this news appeared on HIStalk , so if you follow the practice side of technology and aren’t signed up to get HIStalk Practice e-mail blasts, then you are getting left in the dust.

I’m taking a few days off for fun family stuff and trying to spend minimal time on the laptop, so I’m a little bit disengaged at the moment as I struggle to resist the gravitational pull of work and focus on non-work. I’ll be happy to get back to endless HIStalk hours in a few days.

Acquisitions, Funding, Business, and Stock

 

Standard Register enters a definitive agreement to acquire 100% ownership interest in informed consent provider Dialog Medical. Terms of the deal were not disclosed.

Resilient Network Systems raises $5 million in Series A funding, led by Alsop Louie Partners. Resilient’s technology facilitates the electronic transfer of health records.

People

Former Healtheon/WebMD CEO Mike Long is named president and CEO of EGHC, of which he was already board chair. The company’s businesses include a health plan, the Lumeris quality management software line, and ClearPractice EMR.

Announcements and Implementations

HIMSS introduces the ICD-10 PlayBook to educate providers on the transition to ICD-10

Allegheny General Hospital (PA) resorts to paper recordkeeping Wednesday after shutting down its Allscripts EMR. The hospital says it upgraded the system over the weekend and began having slowdown problems Monday and Tuesday. The hospital voluntarily shut down the system for about 12 hours while Allscripts fixed the issues.

CHIME reports that 109 individuals have earned Certified Healthcare CIO designation since the credentialing program was launched in July 2009. I said it was a dumb idea then and I’ll stand by that opinion now. Obviously the credential hasn’t exactly gone viral if only 109 out of thousands of hospital CIOs have signed on over two years, voluntarily jumping onto the hamster wheel of spending hospital money on renewals and going to CHIME meetings to earn CE. To each his own, but I’d be embarrassed to use a non-educational  credential earned by passing a multiple choice test of job-specific knowledge (designed by asking CIOs what they do on the job, then testing them to see if they theoretically know how to do it). My theory has been that CHCIO appeals to CIOs who feel inferior to their better educated C-level peers because they never expended the minimal effort required to earn a graduate degree by any of a zillion inexpensive, flexible, geography-indifferent programs that are out there.

athenahealth releases its sixth annual PayerView Rankings and awards Aetna the top spot among major players. BCBS-RI was the best overall performer, while state Medicaid providers were the worst in terms of days in AR and denial rates. Compared to last year, payers averaged payment one day faster with 5% fewer denied claims.

RCM provider RealMed announces its integration with Epic’s billing software.

Medicomp Systems announces that its Quippe electronic documentation system SDK is available for licensing to EMR developers. The browser-based, iPad-friendly system (which Dr. Gregg, Inga, Dr. Jayne, and I all raved about after working with it at HIMSS) uses the company’s MEDCIN-powered patented prompting technology to create and present EMR information in an amazingly intuitive way that even a non-doctor like me could use immediately after a ten-minute overview.

NCO Healthcare Services earns the “Peer Reviewed by HFMA” designation for several products related to eligibility, bad debt, and and extended office services.

Government and Politics

More grumblings about the proposed ACO regulation, this time from seven US senators. The lawmakers send Secretary Sebelius a letter urging HHS to withdraw its proposed ACO rules, saying, “the proposed ACO regulation will fail to accomplish its purpose” of better quality care and lower costs. The senators claim the proposed rules do not align incentives and accountability and include requirements that are too complex and an ROI that is uncertain.

CMS clarifies financial incentives for ACOs in rural areas, saying participants would be eligible for a savings exemption. CMS says that ACOs with fewer than 10,000 assigned beneficiaries would be exempt from the 2% savings threshold required of larger ACOs.

Add BIDMC to the list of hospitals claiming to be the first to receive HITECH money, $2.57 million in its case.

Other

Emergency physicians claim the biggest challenge to cutting costs in the ED is fear of lawsuits. An American College of Emergency Physicians poll finds that 53% of ER docs say the main reason they conduct the number of tests they do is fear of being sued.

Sponsor Updates

• SCI Solutions is attending and exhibiting this week at the National Association of Healthcare Access Managers conference in San Antonio, providing their traditional “Stress Free Zone” that features massages and cocktails.
• ESD heads to MUSE later this month (booth 910) as well as the Canadian E-Health Conference (booth 203). The ESD folks also shared that their KLAS ratings are up should you be interested in taking a look.
• Oklahoma Surgicare picks Provation MD software for gastroenterology documentation and coding.
• NextGen announces that Springfield Center for Family Medicine (OH) received federal funds for demonstrating Meaningful Use under the Medicare incentive program.
• Tim Reiner, VP of revenue management for Adventist Health System, describes that organization’s use of self-service technology from NCR for patient collections in a YouTube video.
• Yavapai Regional Medical Center (AZ) contracts for several applications from Lawson Software.
• Prime Healthcare Systems, California’s largest for-profit system at 14 hospitals, expands its use of document management technology from FormFast  to improve health information, revenue cycle, and patient registration.
• Self Regional Healthcare (SC) chooses RelayHealth as its HIE partner to improve care and support the Meaningful Use efforts of its eligible providers.
• Tele-Tracking releases Patient Flow Dashboard for monitoring enterprise-wide patient flow and getting more efficient use of existing capacity.

EPtalk by Dr. Jayne

I’ve been fairly critical of the federal Meaningful Use program lately. For the record, I want to mention one piece of the program (even if it did get relegated to the Menu Set) that I’m absolutely in favor of: increasing the number of providers who report syndromic surveillance data to public health agencies.

We’ve seen huge benefits to the field of epidemiology with increasing availability of health-related data. I still like the Google Flu Trend site as an idea even if it’s only search data. And “old school” diseases aren’t going away – the number of measles cases reported across the US just hit a 15-year high. 

The ability to track, trend, and prevent killer diseases is one of the cooler things we can do with healthcare IT (and one that’s proven to work, mind you). Can you imagine the TV show Quincy ME  if Jack Klugman had population-based aggregate data to work with?

In that same vein, a throwdown to my favorite elected officials. Hey Congress, how about putting together a true “Menu Set” of information technology interventions that have been proven to be effective and incentivizing them individually so that providers aren’t faced with the “all or none” problem with Meaningful Use? Any of us who have had to fill out the awful paperwork from the county health department to report a sexually transmitted disease would be happy to interface it directly from our EHR at the click of a button.

The American Medical Association offers a new app to assist with CPT codes. Only available for Apple users at this point, it allows you to search for, track, and e-mail selected codes. The first problem I had with it is that it apparently ignores the iPad’s gyroscope – it can only be viewed in portrait mode, which is a bummer for those of us that like to prop the iPad on our desk landscape-style so we can stream Netflix while we multi-task.

Navigation to the various sets of codes was pretty easy, but there wasn’t enough information on the screen to make a decision about the right code. The user would have to select each code and read the description. It would be more helpful to have a quick blurb visible on the screen rather than having each entry on the list say “office consultation,” which isn’t very helpful. (It was particularly unhelpful in the preventive codes section, but I couldn’t get a screenshot off my iPad to show, so I clipped this from the AMA Web site.)

I didn’t receive any IT-related checklists for a potential Zombie Apocalypse, but Inga did turn up Kareo’s thoughts on handling medical billing after the fact. I hadn’t really thought about Web-based telecommuting as a strategy to prevent employees from being eaten, but it does make a lot of sense.

Rest assured that due to our decentralized, multi-state virtual office architecture, the HIStalk staff is at significantly lower risk for being decimated by zombie attack than most health IT vendors.

Although Kareo’s piece mentions they didn’t know the code for having one’s brain eaten, I can propose (courtesy of IMO’s Problem IT product): E968.7 Assault by human bite and E979.8 Victim of crime or terrorism.

The Journal of the American Medical Association reports on Navigating the Challenges of In-flight Emergencies. There are apparently minimal standards for emergency medical kits, but kits and employee training vary from carrier to carrier. Airlines also have their own reporting systems and protocols, often relying on physician passengers rather than employed medical control officers on the ground.

The article proposes standardized reporting to the National Transportation Safety Board; expert recommendations for first aid kits (and eventually evidence-based kits based on the data gathered through reporting); enhanced training for flight attendants; and enhanced ground-to-air medical support.

Having had to respond to “Is there a doctor on board” more than once, I’m in agreement. Plus, it looks like an excellent opportunity for vendors to go after another potential customer base. Anyone want to hire a sassy CMIO to write your content for airline medicine? I’d be happy to travel all summer and write code for the most common airline emergencies I encounter along the way.

Contacts

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

News 5/25/11

Top News

The market for anesthesia information systems is predicted to increase 50% by 2012 and be valued at $4 billion by 2017. Vendors battling for market share include Picis, GE Healthcare, Draeger, IMDsoft, Merge, and Philips.

Reader Comments

From Baywatch: “Re: UCSF. The CIO is leaving involuntarily. Looks like the board finally figured out that the Centricity debacle was as much of a leadership problem as a software problem. The Epic project is floundering and bleeding money, with poor direction and an incompetent staff.” We asked a UCSF press contact, who replied: “Mark R. Laret, CEO of the UCSF Medical Center, today announced that ‘Last Friday, CIO Larry Lotenero notified me that he will retire at the end of June, completing 10 years of service to UCSF.’”

From TopCrush: “Re: AAOE meeting. I’m at the American Association of Orthopaedic Executives in Orlando this week, along with a few hundred other folks and about sixty exhibitors. ACOs are definitely a concern for these guys. Orthopedic docs are scared of being left out and worried about the financial ramifications. Kind of funny but they have a VIP entrance for participants that have been coming for years or on a chapter board.  AAOE set up a fun Sports Lounge in the middle of the show floor – shuffle board and fuse ball included.” Thanks for the update from the field. I wish I had a special door I could walk through every once in awhile, just to make me feel more important.

HIStalk Announcements and Requests

Mr. H semi-left me on my own tonight, just in case you were wondering why there are fewer smoking doctor images that usual. Mrs. H deserves a date night every once in awhile and I hope he is taking her somewhere special.

People

Community Health Network (IN) appoints Ronald Strachan CIO. Strachan is the former CIO for WellStar Health System and for HealthEast Care System.

Shared Health names Hedge Burt VP of sales. Burt has served as SVP of business development with Entrada, as well as VP of provider sales for Kryptiq.

PACSGEAR names Eli Rapaich CEO. Rapaich succeeds company co-founder Brian J. Cavanaugh, who will assume the role of COO. Most recently Rapaich served as VP of sales at Philips Healthcare.

Announcements and Implementations

The DoD awards SAIC a $53 million contract to provide IT and EHR system support to the TRICARE Management Activity MHS.

Gulf Coast Medical Center (FL) will move to Epic EMR next month.

CMS notifies Jefferson Regional Medical Center (AR) that it has met Stage One Meaningful Use requirements and will receive approximately $3 million. Jefferson uses Allscripts’ Sunrise Clinical Manager EHR.

Catholic Health Initiatives selects Beryl to provide outsourced patient experience solutions, including physician referral services.

Hospital EHR vendor eCareSoft, the US subsidiary of Mexico’s largest HIT vendor, embeds task-oriented tutorials and collaborative e-learning tools into its application. Hospital users can share shortcuts and workarounds and provide feedback to the vendor’s support team right from the application.

Trinity Health (MI), Baycare Health (FL), and Jackson Health System (FL) go live on the LegacySuite solution from Legacy Data Access. LegacySuite provides data storage and Web-based solutions for retired HIT applications.

The Federal Health Architecture (FHA) awards CGI Group a one year contract for $5.7 million to support FHA’s CONNECT NHIE Gateway solution.

Swedish Medical Center (WA) picks PRISM contact management software from Aegis Health Group to automate its physician relations management process.

Jefferson County Hospital (MS) selects Custom Software Systems to provide ChartSmart EMR, document management, and lab modules.

Texas Health Resources, where Ed Marx serves as CIO, receives over $19.5 million in Medicare EHR incentive payments for the meaningful use of its Epic system. THR has invested more than $200 million on its EHR initiative.

Innovation and Research

A new study concludes there’s no consistent association between EHRs and clinical decision support in ambulatory patient visits. Researchers looked at data from 2005-2007 so perhaps newer decision support tools might paint a different picture. However, only one of 20 indicators showed superior quality with EHR visits versus non-EHR visits.

Other

The video above is from St. John’s Regional Medical Center in Joplin, MO, heavily damaged after taking a direct hit from a tornado. Its 183 patients were evacuated, but five patients and a visitor died and several employees were injured. Hospital x-rays were found 70 miles away, with the hospital asking anyone finding hospital records to hold them while they figure out a way to collect them. Missouri’s disaster medical team has set up a makeshift 30-bed hospital in a tent, staffed by 40 doctors, nurses, pharmacists, and support staff.

Health IT ranks among the top 10 most popular career path for college graduates, according to a University of CA-San Diego study. Top jobs include healthcare integration engineers, system analysts, clinical IT consultants, and technology support specialists.

Sponsor Updates

• DIVURGENT will host a CHIME College Live session June 8th entitled Accountable Care Organizations: Overview and the Role of Information Technology.
• Thomson Reuters’ Meaningful Use Quality Manager 1.0 earns ONC-ATCB modular certification from CCHIT.
• Voalte signs up to resell the Epocrates Essentials premium clinical suite with Voalte’s communications solution.
• CynergisTek CEO Mac MacMillian and Ohio Presbyterian Retirement Services CIO Joyce Miller-Evans will present at the Colorado Health Information Management Association’s Long Term Care Spring Meeting this week.
• Geisinger Health System (PA) picks Orion Health Rhapsody Integration Engine as its integration platform.
• Vocera CEO Bob Zollars is named a finalist for the Ernst & Young Entrepreneur Of The Year award for Northern California.
• The Redwood Falls City Council (MN) approves the $50,000 purchase of Provation software for the Redwood Area Hospital. The hospital will interface the software with its Meditech EMR.
• Awarepoint is awarded a patent for its wireless interaction-based tracking system.
• MED3OOO announces the general availability of InteGreat V6.4, which includes the components required to meet Meaningful Use standards.
• University Hospitals Bristol NHS Foundation Trust implements Imprivata OneSign for its 5,100 users.
• Baylor Health Care System (TX) affirms its plans to implement GE Centricity EMR across its entire HealthTexas Provider Network of more than 500 physicians.
• Prime Healthcare Services (CA) expands its rollout of FormFast document management technology to its recently acquired facility, Alvarado Hospital.
• BridgeHead Software celebrates the 10th anniversary of its partnership with MEDITECH.
• Lakeland Healthcare (MI) selects the ChartMaxx Epic integration package to integrate their physicians’ ChartMaxx EMR with the health system’s Epic program.

Contacts

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

HIStalk Interviews Jim Traficant, President, Harris Healthcare Solutions

Jim Traficant is president of Harris Healthcare Solutions, the healthcare business of Harris Corporation of Falls Church, VA.

Give me a brief background about yourself and your new job. Congratulations, by the way, on being promoted to president.

Thanks. It’s a great privilege.

I’ve been at Harris now for 10 years. I worked at a small business prior to joining Harris, so I’ve experienced both large and small companies. I’ve worked in government and commercial business. I’ve got 25 years’ experience as a technologist and as a business executive, but my passion for transforming healthcare comes as a result of being a patient.

I’ve had two liver transplants. The first one, my neighbor saved my life. We were the fifth to have the surgery, the first that weren’t related. I have had two transplants in between an episode of sepsis. 

In my experience traversing the healthcare market, I learned that people are passionate about their work in healthcare, obviously. They have lots of data, but what was missing was information.

After my second transplant, I sent a note to the Harris CEO asking to take the company into healthcare. Harris is a pretty large company. We move information with lives at stake in every market we serve, like defense and intelligence. We have two million passengers that ride on our Harris Network for the FAA. I knew if we could move information in healthcare like we did in those other markets that we could save lives, make a difference, and maybe even create a business. 

Five years ago, I didn’t know if I would ever get to work again. To be honored by working at Harris and leading us in healthcare is a privilege I could not have imagined. It’s just terrific.

Harris has mostly been known, as you said, as a government contractor. It seems like that may not necessarily be the case going forward. Will the company go after the commercial healthcare markets?

The way I like to describe it is that Harris will have a significant role to play in helping to shape the future of healthcare, and healthcare is going to have a significant role in shaping the future of Harris. It’s a really good match.

Tell me about the strategy behind the Carefx acquisition.

We were really fortunate. Early in our healthcare venture — we’d been at this for four years now — we were awarded the Nationwide Health Information Network Connect program. We were working on behalf of the Federal Health Architecture to integrate the largest creators of health information, like military health, the VA, and Indian Health Services, so they could share information securely with each other and then provide that information to the largest consumers of health information at the federal level, like National Cancer Institute, the CDC, Social Security — which spends, you know, a half billion dollars a year just trying to find health information so they can determine benefits.

We had a couple of breakthroughs in that process. One was that Social Security used to take on average 83 days to find health information to determine benefits for our citizens. When they went through the gateway that we created for the Federal Health Architecture, this program called Connect, they went from 83 days to 24 seconds getting that information. That’s the kind of transformation I think the nation’s looking for out of IT being applied in healthcare.

A second thing we learned was that over half of the care provided for our active duty and retired service members comes out of the private sector. If we were going to play a role in transforming healthcare, it wasn’t sufficient that we could just get the federal sector connected to try and create a tipping point in health information exchange. We had to connect it to the private sector. 

What Carefx brought to us was this real strength in the private sector. They were at over 800 hospitals globally, over 650 in the US. What we had done at the federal level to provide this integration and connectivity connecting the infrastructure, they did on the commercial, side but in a different context. They were able to take the information from where it was created and deliver it to the computer screen and organize it the way a clinician thinks and works according to their workflow — labs, images, med reconciliation. 

It seemed like a perfect fit. Culturally, it was a perfect fit. They’re just great talent, great people, very deep in the healthcare domain, and really able to inform this rich technology base that Harris has as we move out and try to play a role in transforming healthcare.

That acquisition was a pretty strong signal of the interest of Harris to get into the commercial space. Do you see the potential for more acquisitions, or do you think Harris will be more of a builder than a buyer?

I would say this about Harris. It’s a great company. It has answered national priorities in almost every dimension over its hundred-plus year history. Healthcare is a national priority that’s going to require bold thinking and a strong presence and Harris is one of those companies. We’ll continue to grow organically, and I would expect over time that we’ll do more acquisitions. We’re committed to playing a key role in healthcare, so all of those options are going to be in play.

Healthcare divisions of big and broad conglomerates seem to lose some of their innovative capabilities. Do you see the Harris culture being different?

We have a very rich culture. In fact, it was one of the surprising things for me when I came out of a small business into this large, now six billion dollar company.

One of the things that many don’t know about Harris is that defense and intelligence invest very dramatically in Harris to take the state of the art in a number of technical disciplines and advance it or apply it in unique ways. In combination of significant investment plus what we contribute, we do about a billion dollars of research and development a year.

What we’ve seen is there are great parallels in healthcare to the challenges that have been faced in these other markets. I’ll just give you an example. What we saw post-9/11 in the intelligence community was we had all of the data. What was missing was a situational awareness at the national level that would be able to piece together all the information that was in these isolated pockets. 

In healthcare, what we see is a very fragmented market. There’s lots of data, but it’s isolated with stovepipes. It needs to be connected. Then we need to make sense out of the information and create situational awareness for healthcare just like we do for intelligence.

The other corollary we see is when you think about what an intelligence analyst does, they sift through a variety of information sources and then apply judgment in a time-critical fashion with national security and lives at stake. We provide that information on a global scale and enable that capability. It’s exactly what physicians do. They have to piece together information on disparate sources and apply judgment in a time-critical fashion with lives at stake. 

We see this transference of technology from our core markets into healthcare as a totally logical and compelling way for us to do this. All this innovation that exists really distinguishes us from a lot of the players in healthcare.

For example, from a security standpoint, we are very unique nationally for ability to secure information and move it anywhere in the world and any device authorized to see it. In healthcare, it’s not going to be, “Can we secure information in healthcare?” It’s going to be, “Can we translate our security in a way that can be meaningful in healthcare, that they can afford it, that it can be used in a very efficient way?”

The innovation exists in Harris. I would say these other companies have innovation as well, but the passion, the national mission, the sense of purpose applies directly. One of the ways I like to communicate healthcare inside Harris and also with our potential customers is that Harris is uniquely trusted at the intersection of life and data and every market that we serve.

It’s a very natural extension for us to move into healthcare. The response we’re getting in healthcare, I think, is evidence of the fact that we really have something to offer.

Harris is used to taking on projects with a large price tag and large scale. Who do you see as your customer in healthcare?

We started at the federal level because it was familiar. We knew how to compete. There are also some real strong forces at play when you look at military health. Harris being a defense contractor — that’s a logical place for us to participate.

The Department of Veterans Affairs — how do we take care of our servicemen and women who served us so well for so long? Those entities are not only providers of care, but they are payers. We knew there would be alignment and rewarding of enterprise solutions that would deliver efficiencies that would help us provide better care at a lower cost. 

We began there and got traction almost immediately, moving our technologies from the intelligence community for imaging, for example. We created an architecture for military health. We acquired a company in the VA that allowed us to do imaging across the enterprise for the VA, and then connectivity between DoD and the VA, not only from the integration or interoperability standpoint, but also for images and photographs and scanned documents, all of those being shared and able to be associated with a health record.

We knew that to transform healthcare, we had to move into commercial sectors. We’re not looking at healthcare in the same way we would look in defense or intelligence. We recognize that the buying and the programs tend to be much smaller in size, but we believe and we’ve demonstrated we could move technologies and do it very efficiently and create compelling solutions that will be affordable and transformative in the healthcare context. 

We’re very excited about what this market has to offer. Just from a business context, it’s hard to deny that it’s four times the size of the Defense Department. I think that’s why others are pursuing it. We’re looking at more as a chance of, if we can make a difference in healthcare, focus on the transformation, then the money will take care of itself. So far that’s been the way it’s played out.

You mentioned the VA and the DoD. I’m interested in the conversations being held about whether they should buy or build or how they can agree on a single system. You have a unusual perspective and viewpoint. What are your observations?

I think we have to be careful in one sense. I think there needs to be seamless system. It can’t be that the information struggles to come back from theatre to stateside and then into the VA. And then we have to think about the continuum. It doesn’t stop there. It has to be able to be connected to the private sector as well. That’s when ONC and some of these federal initiatives become really important as we set the foundation for how healthcare will happen in the US.

The military mission is different from the VA mission. I think we need to make sure that whatever we come up with, I’m not sure one size fits all. But we have to make sure that we can fit the military mission primarily for the military, and then make sure that what we’re providing for the VA is able to provide a continuity of care that bridges both the military as well as the private sector.

I don’t know if you can do that in one off-the-shelf system. You might be able to. I don’t think anybody knows, to be honest.

The other thing that the VA is challenged with, but I give them credit, is they get to work through these very hard solutions on a very large scale in a public way. Everybody’s watching every move they make, so if there’s any flaw, it gets exposed and printed. Most enterprises don’t have that type of scrutiny. 

What the VA and the military have been able to do — quite extraordinarily when you look at enterprise healthcare in managing multi-millions of patients and doing it securely and on that scale — they really helped advance healthcare in the United States. I commend them for what they’re trying to do. I’m not sure what the solution needs to be, but they got the right minds looking at it and I’m confident they’ll come up with the right answer.

Have the taxpayers seen value from their projects?

I’d have to say yes. They have seen value. You have to remember that the VA has led in a lot of instances. Ninety percent of all doctors trained in the United States go through a VA facility in the course of their training, so there’s a benefit broadly to the US for what the VA has done that we can’t lose.

At the same time, there are new technologies and new systems that are coming into healthcare. I think the VA, very strategically, is looking, “Hey, we’ve been doing it our particular way, but that doesn’t mean it has to be the way we do it going forward.” So again, I give them credit that they’ve been self-reflective and wherever they can leverage commercial investment and solutions, I expect that they will do that more, not less, but time will tell.

Harris recently announced the joint venture with Johns Hopkins Medicine to do some work with medical imaging products. I’m curious what the scope of that project is.

Hopkins saved my life on more than one occasion. My first transplant was there. I had sepsis and they again saved my life a second time. I knew a lot of the physicians there. 

I went back to them and after I was given the privilege of starting a healthcare business. I said, “Look, you saved my life, maybe even saved my career.” We started working together. What materialized is when they looked and saw the kinds of things we could do in imaging. I’ll just give you an example. 

In the intelligence space, somebody at the edge of the network — one of our servicemen or women serving in harm’s way — makes a request of imagery of some type. We go through a discovery process and find what’s been requested and enhance it with additional information that would make it more germane to their circumstance. We deliver it anywhere in the world on any device authorized to see it in near real time. It is awesome. Harris is literally a national asset in the imaging context.

What we see is a very unique ability to translate some of those technologies to healthcare in an accelerated way and create solutions that didn’t exist previously. That’s the opportunity we see at Hopkins. They’re the most trusted name in healthcare. Harris, I’d like to argue, is the most trusted name in secure information management. When you put those two things together, it enables Hopkins to leverage the information sciences in very unique ways, in this case particularly imaging, and help fuel the transformation that the nation’s looking for. We’re very excited about what’s possible in that relationship.

When you look at what healthcare IT advances are out there or potentially coming, as a technologist and a taxpayer and a patient, what gets you excited?

A couple of things. I think that when we move from a disintegrated, fragmented, and we can argue primarily paper-based system — although there’s a lot going on to digitize it. But if we had a digital system versus a paper-based system, it would better than what we have, but a far cry from what we need.

What has to happen is it has to be a connected framework for healthcare — where instead of walking into a hospital with your life at stake and your information carried under your arm in a notebook with some CDs in your hands hoping somebody can make sense out of this and figure out how to save your life — that the information shows up when you do and it’s a complete picture of your health. And now we take the knowledge base of these tremendously skilled and dedicated clinicians and enable them to take more information and apply judgment against it in an accelerated way. We will totally transform healthcare.

If we get to a data-driven care delivery model, OMB has said we will take out one-third of the national spend. When you look at the impact nationally of healthcare, the cost of healthcare in the United States and what we get as a return that investment, we’re not getting nearly the return that we need.

The technology will not in itself transform healthcare, but it will enable that transformation. I consider it a privilege and my life’s calling to be part of that transformation, leveraging the rich technologies of Harris to make it happen.

Doctors don’t want to type into a computer all day and patients have no interest in entering their information into personal health records. Do you think there’s a challenge that we may either not have anybody willing to create data or that there won’t be enough people sitting on the back end to monitor and react to it?

I think we’re going to get better at this. We’re in the very early stages of a transformation and it’s a little bit awkward right now. 

I came out of the aerospace world previously. We used to fly satellites, for example. Like in the Apollo 13 movie, they’re staring at streams of paper that are flowing and guys are sitting down and doing math equations trying to solve hard problems. Then we went to the computer, and all we did was emulate what we were doing on paper. We did it on the computer. We would look at strings of bits and bites and try to make sense out of it.

Eventually we advanced the interface so that we could run constellations of satellites with one or two operators. We did that because we were able to distill the information from bits and bites and go from data, to information, to knowledge. 

That’s going to happen in healthcare. It won’t be that we’ll supplant the clinician or the judgment in healthcare, but we’re going to give them a stronger knowledge base from with to apply judgment and be able to deliver it in a simple, easy to assimilate way. It’ll just become part of the workflow.

I really think we’re just in an awkward phase of transition. This is going to get to a point where it will be second nature, just like it is for us on our smart phones and how we engage even socially using computer technology. It’s certainly going to transform healthcare.

What would you say are the most significant opportunities and threats to healthcare IT as an industry?

That we allow it to be digital and fragmented is the biggest threat.

Once we connect the framework for healthcare, there’s going to be innovation in healthcare in an accelerated, unprecedented way that healthcare has never experienced previously. There’s going to be an enablement of a system approach to healthcare that has never been possible previously. We’re going to see competitive models. We’re going to see efficiencies delivered.

We’re going to go through a transformation. I’m not sure how quickly it will happen. It might take us five years. I hope it happens in less than 10, but we’ll get to a place where the information flows in healthcare like it does in other industries.

The biggest risk is that we continue to behave as if digitizing is sufficient, we continue with proprietary technology, we continue in monolithic systems.

My confidence in healthcare is that it’s just part of the transition. It will be the first phase of the transition. It won’t be the endpoint. We will certainly get to a place where we’re operating in a system framework, information flowing securely and ubiquitously. It will patient-centric, data-centric — a whole network built around patients. I think that’s the biggest opportunity. It takes advantage of what America’s great at, and that’s innovation and technology.

I think we’re in a great spot to lead the world and help to transform this. I think it’s going to go from a terrific cost and drag on our national economy to fueling our national economy in ways that we have not imagined.

Do you have any concluding thoughts?

First, thank you for doing this interview. I really appreciate it.

I also would like to thank the caregivers in healthcare. They’re the unsung heroes. They’re the part of the healthcare system that’s yet to to be tapped. I think they know a lot about how we can improve it. I think this future state of technology is going to make it more efficient, better care, lower cost, and transform this economically in the United States.

The last thing I would say, and this is personal, is I’d like to thank the people that work with me at Harris Healthcare for their passion and dedication. I like to say the two best days in a person’s life are the day you’re born and the day you know why. We are fulfilling what for me is a dream. The people that are working with me are just the finest. That goes for the latest part of our family at Carefx — just great people, committed to making a difference. I’m just proud to be associated with them.

Curbside Consult with Dr. Jayne 5/23/11

I was looking for the perfect quote to start this week’s Curbside Consult and thought I had it nailed. Like many avid readers, I tend to remember bits and pieces of great literature, but not everything. Just enough to do passably well at cocktail parties and trivia nights, but not well enough to lead a book club.

So, when I hit the Internet to validate the quote I was going to use, I was blown away by the parts I had conveniently forgotten.

It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way…

This is the opening of A Tale of Two Cities by Charles Dickens. I was going to use the best of times / worst of times metaphor to talk about two recent physician visits, one of which was electronic and one was paper. I’ll let you guess at which one was which because the poignancy of the rest of the quote and how applicable it is to healthcare in general strikes me too much to want to talk about anything else.

First published in 1859, the story is set in the tumultuous time of the French Revolution. The opening line serves largely to portray the contrasts inherent in that time — poverty vs. affluence, ignorance vs. enlightenment, good vs. evil, and so on. When you think about it, sometimes it seems that things haven’t changed as much in the last two hundred as we might have hoped. It feels like we’re on the cusp of a different kind of revolution, and not necessarily for the better.

Undoubtedly, this is the best of times for many people. People are living longer, largely due to improvements in health technology. Mechanical replacements for diseased body parts, amazing new drugs, implantable defibrillators — you name it.

We are, however, in a system with a great deal of inequality about how this technology is employed, resulting in a great cost to society and for many a great personal cost as well. Medical bankruptcies are again on the rise, accounting for more than sixty percent of all personal bankruptcy filings. The worst of times, indeed, when people have to choose between purchasing food and filling their prescriptions.

Meaningful Use should be the poster child for the age of wisdom and the age of foolishness. It seemed so promising: “free” federal money for providers to do what they should have been doing all along, implementing systems to improve patient care and strengthen patient safety. Many providers were already doing these things, and it seemed so easy to reward them.

The way it’s unfolding, though, is just sad. The disparity between the Medicaid and Medicare incentive programs is laughable. At times, the whole business feels like a crapshoot. If this were an investigative study, it would never have made it past the Institutional Review Board.

Many of us on the healthcare IT side of things are living in the spring of hope. We’re well on our way to having the right software installed with the right workflows and the right numerators and denominators kicking out at the end.

For some of us though, this will lead right into the winter of despair. Meaningful Use is the ultimate pass/fail class. Miss the mark by half a percent on one measure and you’re out. This doesn’t seem in keeping with the spirit of trying to improve healthcare and health outcomes.

What if we treated patients like this? “I’m sorry Mr. Jones. I know you’ve done a tremendous amount of hard work to get your diabetes under control, including exercising and losing weight. However, your hemoglobin A1c level only came down from 9.0 to 6.2. The goal was 6.0, so you lose. Here’s a scarlet ‘L’ to wear on your shirt. I’m raising your health insurance premiums by 40%.”

Many of my peers have done the math and know that even with the penalties that are coming, they can “do nothing,” see one or two more patients a day, and come out far ahead of their colleagues who are on the MU hamster wheel. Could the unintended consequence of ARRA and healthcare reform be the downfall of Medicare and decreased health outcomes for our growing senior population? Will it be the final blow to an already ailing primary care workforce? Will it be little more than a windfall for technology interests and consultants?

Only time will tell. But I leave you to ponder on the closing lines of the book.

It is a far, far better thing that I do, than I have ever done; it is a far, far better rest that I go to than I have ever known.

E-mail Dr. Jayne.

Monday Morning Update 5/23/11

From The PACS Designer: “Re: SlideRocket. Microsoft PowerPoint has been the dominate force in the presentation arena for business applications, but there are new ideas surfacing that could challenge their market share.  One is a Web-based application called SlideRocket, acquired by VMware last month. You can try it by importing an existing PowerPoint presentation to see what a Web-based format can do to enhance your creative abilities.”

From Little Birdie: “Re: [SVP name omitted]. Fired from Ingenix last week.” I’m leaving the name off since nobody likes seeing themselves in unflattering headlines, but the source is a good one.

From Lawdy Mama: “Re: Ford’s in-car medical monitoring. The target is much larger. Truckers include a large population of diabetics and, since they live on the road, have problems managing their disease. It can also be dangerous for diabetics to drive while suffering dizziness or other symptoms.” I’m always fascinated by trucker health since I talked to a guy once who runs a company that provides healthcare services from truck stops – it was truly fascinating to hear about their particular risk factors and the challenges of delivering healthcare services to them when every minute off the road costs them money. I guess I can see the value there, although Ford didn’t mention trucks in their announcement. As long as the built-in device doesn’t require drives to interact with it (or drivers exercise reasonable caution by pulling over when doing so), then there may be some medical value.

My Time Capsule editorial this time deals with missing clinical information, even in supposedly advanced IT systems. A snip: “I can think of only two reasons: (a) command and control is so fragmented within our episode-based system of revolving door specialists that everyone assumes that someone else is watching the big picture, or (b) providers are too busy to do anything more than patch and mend, buried in piles of disjointed facts that are difficult to comprehend and act upon.”

I got a nice e-mail that I need to anonymize quite a bit, but here’s the gist. The author said reading HIStalk for years taught him/her two major lessons that he/she will use directly in his/her new vendor leadership role: (a) move your products up the value chain via application and technology integration, and (b) if your product enhances expensive hospital information systems, then price it accordingly based on the value it delivers. The conclusion: “Your blog sure cut down my learning curve for many things healthcare. I thank Dr. Jayne the newcomer, Inga, and yourself for your commitment to the industry.” I really appreciate that.

CMS may not show a lot of confidence in providers, but the feeling is apparently mutual. New poll to your right, for providers: are you confident that your employer’s security practices will keep your medical records private?

I found this installment of Vince Ciotti’s HIStory to be his most interesting so far, in which he also mentions the EMR that’s 40 years old and still running today (and it’s not Meditech).

Welcome to new HIStalk Platinum Sponsor Kony Solutions of Orlando, FL. They help companies (more than 35 Fortune 500 ones, in fact) get their message out to every mobile device that’s out there, providing a highly configurable out-of-the-box solution that allow companies to put mobile-rich apps (smart phone, mobile web SMS, etc.) in the hands of consumers in as little as a few weeks and at a lower cost than any other solution. These are not cookie cutter templates. Healthcare examples of what they can do: generate outbreak alerts, manage appointments, do prescription refills, and create provider-finder apps. Like their ad says, just putting an iPhone app out there is missing a bunch of consumers who use other technologies. I interviewed Aaron Kaufman, VP of the company’s healthcare and life sciences solutions division, just a few weeks back. Thanks to Kony Solutions and Kony Healthcare for supporting HIStalk.

Thanks to the readers who sent over new Annals of Internal Medicine articles on RHIOs and EMRs. Talking points: (a) only 13 of 179 RHIOs reported that they could meet Stage 1 Meaningful Use requirements, and (b) two-thirds of RHIOs won’t survive financially once their grant money runs out. The RHIO article points out that it’s not surprising that RHIOs can’t wean themselves off the taxpayer teat since free-flowing HITECH money encourages them to start up, but nobody wants to pay for information exchange except for directly beneficial transactions such as lab results. It also mentions that RHIOs are being held back by low EHR adoption (the accompanying editorial says RHIOs struggle “in exactly the same way as a cable company would if no one owned television sets.”) Here’s all you need to know about the article, which comes from its summary: “No RHIO in the nation met our expert-derived criteria for the comprehensive HIE needed to substantially improve care quality and efficiency.” The article had some unintentional humor in the footnotes: the authors who concluded that RHIOs are pretty much a failure were, like the RHIOs themselves, supported by ONC grant money. Doh!

Even Epic’s contractors get big new buildings. The company working on Epic’s never-ending construction projects figure they’re never going to be finished at this rate, so they build a 22,000 square foot building to hold their 65 on-site professionals that oversee several hundred construction workers. The construction company says they will have up to 700 people on site next year as they ramp up work on Epicenter 2, a second on-campus Epic auditorium that will seat up to 13,000 people.

A book detailing the 2004 murder of Cerner nurse Julie Keown by her husband (he poisoned her Gatorade with antifreeze), has been published.

A study finds that hospitals are over-promoting their robotic surgery gadgets and, in 73% of their Web sites, are using word-for-word questionable information provided to them from the manufacturer who sold them the equipment. According to the Hopkins surgeon who led the study, “To me, this is exactly what is wrong with American health care.  We are adopting technology without being up front about the outcomes to consumers. And we adopt technology before we properly evaluate it.”

Bizarre lawsuit: a woman sues an Ohio hospital, claiming it mailed her picture of her premature baby who died there. She says she received 154 pictures of her dead baby propped into a variety of poses, including some of his body being held by an unknown hospital employee, even though the mother told the hospital she didn’t want pictures taken.

Sponsor Updates

• DIVURGENT’s latest newsletter addresses activation management. The ACO book by partner Colin Konschak is now available on Amazon.
• Practice Fusion is hiring at its San Francisco headquarters, looking for talent in account management, marketing, engineering, legal, customer engagement, and executive management.

E-mail Mr. H.

Time Capsule: Information Technology Can’t Easily Fix Health Care System Gaps

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 March 2006.

Information Technology Can’t Easily Fix Health Care System Gaps
By Mr. HIStalk

A New England Journal of Medicine study last week found that ethnicity, income, insurance status, and geographic area do not influence the preventative care received by Americans. Great news! Well, not entirely — we’re collectively getting only about half the care we should. The embarrassing gap just isn’t prejudicial, that’s all.

The study used a RAND Corporation list of several hundred medical care standards that are hardly controversial, with common-sense items like, “Providers should reassess the alcohol intake of patients who report regular or binge drinking at the next routine health visit.” So, if the standards make universal sense, why aren’t they being followed? Unless you know of doctors who wake up vowing to harm their patients, it must be something else.

I can think of only two reasons: (a) command and control is so fragmented within our episode-based system of revolving door specialists that everyone assumes that someone else is watching the big picture, or (b) providers are too busy to do anything more than patch and mend, buried in piles of disjointed facts that are difficult to comprehend and act upon.

The authors recommend IT as the solution. Why not? No judgment is required, just analysis of discrete data elements with specific combinations of values. It’s a piece of cake compared to fly-by-wire electronics on a jet.

Sounds good, but I’m seeing red flags all over the place. Can your clinical information system or practice management application detect the following situations?

• Patients <75 years old presenting with an acute myocardial infarction who are within 12 hours of the onset of MI symptoms and who do not have contraindications to thrombolysis or revascularization
• Patients with major depression who have medical record documentation of improvement of symptoms within six weeks of starting antidepressant treatment
• Patients under age 75 with preexisting coronary disease who have an LDL level >130 mg/dl after six months of dietary cholesterol-lowering treatment

You don’t have to go far to find out. If your database person can’t do it in SQL, it probably can’t be done.

AHRQ and other groups have observed for years that we collect a lot of data, but often in unusable forms (paper, free text, or scanned documents), in scattered locations, entered too late to be actionable (diagnoses, surgical records), and with logic and structure better suited for creating bills than delivering care. Reading these standards makes that obvious. We IT folks are on the hook to solve the problem, but current systems (and use of them) are going to be a problem.

RAND was kind enough to make its standards freely downloadable as a public service at . If you’re a CIO, vendor executive, or system user, evaluate your system’s capabilities to capture and repose the necessary data elements. Then, look at how many are actually available.

How many of the standards are you managing by automation today? How many are you working to add? Think competitive advantage since it’s unlikely that this kind of scrutiny will just go away.

I maintain that most hospitals, even those using advanced clinical functions like CPOE and clinical decision support, still are missing much of the electronic data needed to make clinical decisions. While the NEJM article wasn’t written to make that observation, I think it ends up doing exactly that.

An HIT Moment with … Sandy Pitman, President and CEO, SuccessEHS

An HIT Moment with ... is a quick interview with someone we find interesting. W. Sanders Pitman is president and CEO of SuccessEHS of Birmingham, AL.

What were your conclusions about the HIMSS conference and the interests of those who attended it?

HIMSS is the largest tradeshow in our industry, and despite the struggling economy, a record number of people were in attendance this year. This is a very expensive venue for the vendors and each year seems to bring a new level of extravagance.

There is so much information and hype it is very difficult for even the most experienced healthcare executive to discern the true differences among the many vendors at the show. For the novice, I would expect that they came away confused and hardly able to truly differentiate the offerings of the many vendors as it relates to their specific practice and set of circumstances.

I do think, however, that HIMSS is a good opportunity for various vendors to identify complementary offerings and business relationships.

What steps are you taking to get your clients to Meaningful Use?

We have numerous initiatives underway to ensure that our providers can capitalize on the EHR incentive programs. From the start, we sought to help our clients achieve Meaningful Use by seeking certification at the earliest moment possible; we were among the first in the country to achieve certification as a Complete EHR.

Following our certification by CCHIT, an ONC-ATCB, in September of 2010, we launched a series of weekly webinars for our clients, educating physicians on the incentive programs and on changes they could begin making in their workflow to achieve Meaningful Use. Recorded classes were published to our Learning Management System (LMS) so clients who were not able to participate in the webinars could access this information at their convenience. These webinars are still being offered live on a weekly basis.

We also developed a comprehensive Meaningful Use Toolkit which was distributed to clients and is also available for on-demand access via our LMS. This toolkit contains an introduction to the incentive programs, information on enrolling and understanding the program, an overview of all Meaningful Use measures, a Physician Toolkit, a System Administration Toolkit and links to additional resources. The Physician Toolkit is designed to provide physicians with concise information and screenshots demonstrating the system functionality to support Meaningful Use, while the System Administration Toolkit guides practice administrators through the system configuration changes needed to support the Meaningful Use measures. We designed this toolkit to walk our clients step-by-step through the process of achieving Meaningful Use.

Our goal is not just to provide the tools needed to achieve Meaningful Use, but to partner with our clients to make sure that they understand what they are eligible for, how to use the system to obtain it, and that the system/staff proactively work with the physician to ensure compliance.  We will be providing configuration options to “prompt” physicians when compliance opportunities are being missed in an effort to maximize physicians’ opportunities to achieve compliance at the point of care.

Lastly, we have not changed our pricing nor are we charging our current clients an additional fee for the Meaningful Use features, webinars, or toolkit.

What are the specialized requirements of Community Health Centers?

Community Health Centers (CHCs) are, in many cases, run more like a business than a lot of private practices. Typically the physicians are employed, the clinics rely heavily on grant money (which can be a daunting application process for the practice), and they have strict reporting guidelines. These factors make the workflow for the clinics more detailed in regard to data capture and do not allow the flexibility private practices sometimes enjoy in determining the extent to which they want to engage with the EHR.

To some extent, it seems these organizations are a testing ground for what is coming in healthcare reform.  Requirements that have been placed upon CHCs for years are now making their way into private practices.  For example, CHCs participate in Disease Collaboratives that require reporting on protocol compliance for patients with depression, diabetes, and more. Managing clinical protocols and reporting on compliance has now made its way into many of the initiatives for private practices. Many of the initiative programs that are around today in private practices have existed for years in some form with the CHCs.

Specialized requirements for CHCs include the need to:

• Manage sliding fee scales for indigent patients
• Perform monthly, quarterly, and annual reporting such as UDS, cost reports, Ryan White, collaborative reports, and more
• Submit claims with very specific formatting requirements – CHCs have different billing guidelines for Medicare and Medicaid. These are typically paid on an encounter basis, so there are special requirements for billing, posting payments, and transferring balances. 

It has been our experience that Community Health Centers really take to heart the mission of serving the underserved. There is a genuine interest in improving the quality of care for patients. They are often providing a wide scope of services, including comprehensive primary care, dental services, behavioral health, and HIV care while documenting the data necessary to meet federal reporting requirements. Clinical decision support is important to achieving the goal for these clinics of not just meeting the federal reporting or billing requirements, but improving patient care.

There are hundreds of EHR and PM vendors out there. If a practice is interested in choosing one, what criteria and methods should they use to distinguish one from another?

Evaluating EHRs is a daunting task, with so many vendors to choose from and so many features to comprehend. Of course, certification is a huge help in determining which products include core features needed to operate efficiently and profitably.

Unfortunately, the evaluation process only starts with selecting a certified vendor. The disconnect between Certified EHRs and Certified EHRs that can deliver value is significant, and if you choose incorrectly, you may end up with a vendor who is not aligned with your goals and offers no assurance that you will actually receive value. There is a way to accurately measure the potential of Certified EHR vendors — you must consider more than the features and functions a system brings to the table.

When evaluating EHRs, keep in mind that single-database, integrated EHR and practice management systems work the most seamlessly, as there is no need to build and maintain an interface between the two systems. Be sure to consider whether the system is scalable enough to meet the changing needs of your practice. Also evaluate the level of support offered by the vendor, as this varies widely across the spectrum of EHR providers and can make a huge difference in the level of satisfaction with the software.

Quite often the relationship you develop with the vendor is just as important as the feature set you are buying. At some point you are going to run into serious issues (it is almost guaranteed). Having a stable company with experienced leadership that you can count on in a real time of need can be the difference between success and failure.

Do you think usability will be rolled into Stages 2 and 3 of Meaningful Use? Are vendors doing enough to design and test their applications to comply with formal usability standards?

There is talk of trying to roll in usability, but it will be extremely difficult. With most government certification programs you must have a clear set of guidelines that are not subjective. For phase 1 Meaningful Use certification, ONC utilized both CCHIT and Drummond Group. They were very clear that the requirements must be followed to a T with no deviation.

Since usability is largely a subjective issue, I do not know how they can establish ironclad guidelines to quantitatively measure it. With different certifying bodies and many judges employed by each certifying body, it will be virtually impossible to insure continuity.

I think EHR vendors are going through the natural progression that follows any new developments in technology. We first all scrambled to meet the fundamental requirements as dictated by ONC. I am sure that most vendors did their best to consider workflow while developing the base requirements, but given the fact that the core requirements were not finalized until the summer and we early birds were testing in the fall, there is always room left for improvement which, again, follows the natural progression.

ONC has dictated a set of fundamental requirements which is a good thing for the industry, but I think it is up to each vendor to focus on usability in their own way. At the end of the day, it is up to the free market to decide what is “usable” and what is not.

In the automobile industry, there are governmental guidelines that must be adhered to for safety and emissions, but the individual features like color, style, and usability of available options are up to the consumer. In that same vein, I believe that having specific feature requirements as dictated by ONC is a good thing, but in the end, usability and personal taste depend upon the individual consumer.

News 5/20/11

Top News

The UK’s National Audit Office (NAC) says that the billions spent so far on the country’s National Programme for IT has been poorly used and the project needs to be reassessed. The NAC concludes that the investments don’t represent value for the money and officials are not confident that spending more will be any different. The NAC believes the project’s core aim of having an electronic record for each patient will not be achieved.

Reader Comments

From Frank Mac Court: “Re: study on operational RHIOs. Here’s more information on the study.” Earlier this week, I mentioned the report that found only 13 of 75 operational RHIOs met the basic criteria for Meaningful Use. The information was collected in early 2010 and the authors admit that “data exchange could have accelerated in the interim.”  It’s likely that today there are more than 13 HIEs exchanging Meaningful Use-caliber data, though admittedly it’s still a pretty small club.

From Certs Two Mints in One: “Re: [vendor name omitted]. One of our sites is under siege by these folks, whose product holds only Modular EHR certification. They told the customer in writing that they ‘will be ONC-ATCB certified as a complete EHR for Meaningful use by July 1st, 2011.’ Vendors are supposed to be prohibited from pre-announcing their status and clearly they are saying something they can’t know is true. Maybe they failed and have made software changes that they assume will earn them certification.” That’s at least a poor choice of words – swapping ‘will’ with ‘hope to’ would have removed all grounds for complaints from either customers or the certifying body.

From Sarah: “Re: ONC and security awareness. If you heard and met some of the so-called IT consultants that standalone providers hired, you would think they needed some awareness. Many of the providers we deal with have IT people that can’t even set up a domain or workgroup correctly without leaving gaping security and permission holes, let alone manage security at a level we implement internally to protect their PHI. In some areas, the only option (no joke) is Geek Squad. They need step-by-step list for the techs and automated verification tools that providers can run themselves during annual security audits.” I think those are great ideas. Hospitals are reasonably good at basic security, but physician practices often don’t even know they need it, much less how to make it happen.

HIStalk Announcements and Requests

Listening: the just-released Rome from Danger Mouse, spaghetti western-style music mixed with a little R&B and played on vintage instruments (the keyboards are amazing) recorded straight to tape, some by the original musicians from The Good, the Bad, and the Ugly and similar movies. Mellow 60s hip with that shimmery, sharp, echoey movie soundtrack sound that makes you think that a guitar-carrying Claudine Longet could wander in looking wide-eyed and pensive in a mini-dress at any moment. Guest Norah Jones sounds sweet and Jack White is pretty good. If you’re in the right mood (and I’ll leave you to decide what that mood is), it’s transcendent.

This week on HIStalk Practice: the irreverent Joel Diamond, MD resurfaces and ponders what HIStalk would be like if it offered with some quaint, Andy Rooney-style observations. Don Michaels, PhD and VP of Hayes Management Consulting makes his premier on HIStalk Practice and offers tips to determine if one’s organization is ready for an ACO. Julie McGovern with Practice Wise shares insight into the high quality talent to be found in the country’s HIT programs. Massachusetts governor Deval Patrick helps eClinicalWorks celebrate the opening of its new office. Computer trumps doctors in detecting acromegaly. The AMA Board of Trustees argues against EMR standardization, claiming it would stifle product innovation. Participants in an ACO demonstration project contend that CMS’s proposed ACO framework is too risky. While you are paying a visit to HIStalk Practice, check out some the Web sites of some of our sponsors and learn more about their nifty products and services.

On the sponsor-only Jobs Page: Program Manager, Data Implementation Engineer, Healthcare Informatics Analyst, Systems Engineer. On Healthcare IT Jobs: Clinical Nurse Analyst, Regional Business Development Manager, Clinical Project Manager, Director Technical Infrastructure, Allscripts Report Writer.  

I had a routine doctor’s office visit this week. I observed perhaps 10-12 employees of the university-owned practice as I waited my turn, ranging from the front desk people to assistants to nurses. Every single one of them, other than my doctor, were somewhere between significantly to massively overweight, while all the patients in the waiting room were pretty much of normal size. I wondered how effective those employees are at convincing patients to change their dietary and exercise habits? That reminded me of the two respiratory therapists I’ve known who smoked constantly, with their cigarette packs prominently sticking out of their shirt pockets as they counseled patients on good pulmonary health. Healthcare is a funny business.

Acquisitions, Funding, Business, and Stock

Israel press reports that Reed Elsevier is in talks to buy Israel-headquartered dbMotion for $250-$300 million. dbMotion officially told me they could not comment. In February, dbMotion and Elsevier announced a partnership to integrate Elsevier’s analytics solutions into dbMotion’s interoperability platform.

Proof that Irrational Exuberance II is upon us even amidst a recession and smothering national debt, only this time limited to just a handful of darling companies. LinkedIn share prices more than doubled in their first day of trading Thursday, opening on the high end of their range at $45 and closing at $94.25. That values the company, which lost money for years until finally eking out a $15 million profit last year, at almost $9 billion. Hopefully the huge ranks of the unemployed will somehow benefit from the trickle-down effect of millionaire secretaries and trade-in VC wives buying Ferraris and McMansions. I hate everything about LinkedIn except that just about everyone is on it.

People

   

HIMSS runs a bio and interview of its 1990s CEO John Page. Interesting: he says his greatest achievement was splitting HIMSS off from AHA, which he said was essential for its survival. He also mention his greatest challenge – trying not to disenfranchise the management engineers that formed HIMSS as the IT side of the house started invading and eventually pushed them out like greedy European settlers marching red-skinned Americans off their land and into concentration camps called “reservations.” It must be lonely being among the tiny ranks of folks making up the MS part of HIMSS.

Announcements and Implementations

Detroit Medical Center anticipates receiving $40 million in Meaningful Use incentives, including $16-$17 million this year.  Meanwhile, Beaumont Hospitals is planning for $26 million, including $10.3 million this year.

Verizon Wireless and Medco Health Solutions release a mobile app to guide patients and doctors to the lowest cost prescription drug. The app gives information on out-of-pocket costs and lower cost options, based on a patient’s specific insurance plan.

Ford will expand its Sync in-car automation to create “the car that cares,” planning to roll out allergy alerts and connected medical devices to monitor blood sugar with the help of its partners Medtronic, WellDoc, and SDI. I don’t get the point, not to mention that the last thing we need is a bunch more marginally skilled drivers screwing around with yet another electronic device instead of paying attention to the road. Maybe Ford can add monitors for bladder distension and grumbling stomachs and fund the whole project by running GPS-localized restaurant and gas station ads.

Government and Politics

CMS announces that the first Medicare EHR incentive payments will be issued this week. Greenway Medical says their client Childs Medical Clinic (AL) was among the first to receive funds Thursday, as was Cerner client Dr. Juan Salazar (TX).

Innovation and Research

An upcoming study in an economics journal claims that higher usage of EMRs would save a lot of babies. You can guess what they did: combined old (2006) data from several sources that include that of HIMSS Analytics, taking a guess at when those systems went live (since HIMSS Analytics reports products bought but not yet installed), did some kind of county-level breakdown, and found that EMRS are “associated” with lower infant mortality (leading to the dramatic title, “Can Healthcare IT Save Babies?”, that in my mind is a question left unanswered.) I would have been more convinced had they looked at infant mortality at individual hospitals pre- and post-EMR, also ruling out related OB-specific systems that don’t really require EMRs. I don’t doubt that hospitals with the ambition and money to buy EMRs may well have better outcomes with newborns (possibly because they aren’t usually in poor, inner city neighborhoods), but its a stretch to say it was the EMR itself that made them better (or to assume, even with everybody and his brother installing EMRs, that we’ll be seeing a drop in infant mortality anytime soon). It’s a free PDF download if someone wants to critique it in more detail.

Other

Officials with Saint Elizabeth Regional Medical Center (NE) say they will hold off on plans to form an ACO, following the release of proposed ACO rules. The hospital fears potential financial risks may not be sufficient to cover high initial investment costs, including IT-related expenses.

KLAS looks at partial and extensive IT outsourcing and concludes that CareTech, Dell, and Siemens rank high in both categories. CTGHS topped all firms for partial IT outsourcing and CareTech led for extensive IT outsourcing.

In the under-200-bed community hospital market, 80% of organizations report confidence in their vendor’s ability to ultimately satisfy Meaningful Use requirements. The other 20% are looking to replace their vendor. All of the Cerner clients participating in this KLAS survey expressed confidence in Cerner’s ability to meet Meaningful Use; at least three customers from each of the other seven vendors felt achieving Meaningful Use with their current vendor would be a long shot or probably won’t happen.

Weird News Andy likes this quote about NPfIT from UK MP Richard Bacon: “This turkey will never fly and it is time the Department of Health faced reality and channelled the remaining funds into something useful that will actually benefit patients. The largest civilian IT project in the world has failed.”

A NEJM editorial says the provider payment system based on CPT and E&M codes forces EMR vendors to modify their programs to create reams of repetitive and clinically worthless documentation instead of doing something useful, like improving clinical decision support. It points out that payments encourage upcoding and over-documenting, but nobody has come up with a better alternative.

Alan Cremer, founder and acting CEO of drug database search application vendor IntelliDex, e-mailed to ask me to mention that he’s looking for a president and CEO for the company. If you have startup leadership experience, preferably in a medical informatics company, check out the job description and consider throwing your hat into the ring.

Sponsor Updates

• iSirona demonstrated its integration technology at last month’s Vision User conference in Salt Lake City. The company used its software to upload patient vitals from a Stryker Bed InTouch and a Fukuda Denshi bedside monitor, which were then verified and uploaded into the Siemens clinical suite.
• H/P Technologies, which provides staffing and consulting for all Meditech modules, will exhibit at MUSE May 31–June 3 in Nashville.
• The MSO Mississippi Health Partners selects RelayHealth to provide health information exchange for its 800 physicians and 13 hospital members.
• ESD hires Dan Oberle as VP of business development. His previous employers include Santa Rosa Consulting, CTG, and ACS.
• Orion Health and NextGate partner to include NextGate’s  MatchMetrix EMPI and Provider Registry products in the Orion Health HIE solution.
• Dossia partners with Health Language Inc. to embed HLI’s language engine into the Dossia Health Management System.
• API Healthcare announces that it achieved its highest number of deployments ever during the first quarter of 2011.
• Ovum, part of Wolters Kluwer Health, introduces OvidMD, a clinical tool that incorporates medical research with Wolters Kluwer’s UpToDate resource tools.
• Children’s Hospital of Orange County (CA) selects MobileMD to provide HIE services to its 800 physicians and 1,000 referring physicians.
• Healthcare Innovative Solutions co-sponsors a Victoria Era fashion show, which raised over $1,000 for the Seville Food Pantry (OH).
• Hayes Management Consulting unveils a partnership with The Coding Network to provide audit and remediation services to physician practices using MDauditComplete.
• Capario says it is now processing inbound 5010 claims (Errata version) and providing 5010 ERAs with submitters.
• Sage SVP Tony Ryzinski offers up 10 areas for improvement when managing the revenue cycle.

EPtalk by Dr. Jayne

WebMD reports this week that even mild exercise with the Wii Fit game can improve fitness for COPD patients. Big surprise: patients are more likely to stick with exercising at home if it’s fun. I have to admit, the Wii is one of my guilty pleasures and its price point is more realistic for people than some of the other game consoles. If it gets people off the couch for even 10 or 15 minutes a day, I say go for it — although I’m not sure I want to know what my blood pressure looked like when I was trying to find the last three i-points on Island Flyover. But then again, there’s something therapeutic about crashing your biplane into the ocean repeatedly after a long day listening to physicians complain about computers.

I keep getting e-mails from the American Medical Association about their AMAGINE physician portal ,which “offers a low-cost approach to meet the needs of your practice and achieve each level of meaningful use.” If you’re a provider or someone who works closely with a provider, have you checked this out yet? I’d be interested to hear what you think. Featured products on the site when I stopped by included NextGen, Ingenix CareTracker, and Care360 EHR.

I’m still a bit in awe of being a minor Internet celebrity. I wonder if Centers for Disease Control spokesman Dave Daigle was ready for his brush with fame? The normally sleepy Public Health Matters blog featured a new topic this week: Preparedness 101: Zombie Apocalypse. The site has been so popular after being named a Twitter “Top Tweet” that it’s intermittently crashing, so be patient. I’m not sure of the specific impact of zombie apocalypse on IT infrastructure (my medical training was more in dealing with the brain-eating aspects of zombie behavior) but it’s always good to be prepared and make sure you have a disaster plan for each of your critical systems. If anyone has a good zombie preparedness checklist for enterprise EHRs, please share!

I agree with Inga, it was feeling like a bit of a slow news week, at least until I came across this headline: Don’t forget! Your computer job is still killing you. Based on the multitude of upgrades our organization has to complete in order to be ready for Meaningful Use attestation, I was sure the author had been following me around. I’m not sure about their level of medical fact-checking, but I do like their graphics. It’s a good reminder for those of us who have traded walking the clinical halls of academic medicine for a more desk-jockey lifestyle that we need to get up and move.

Finally, having spent some time attending a renowned Southern institution famous for matriculating Mrs. degree candidates, I learned that there are a few things that aren’t fit for discussion in mixed company if one wants to catch a good husband. Since I’ve turned into a grizzled IT veteran (although I do know how to identify a fish fork and exactly how to use it) I’m going to break that rule today. Last November, Mr. H mentioned a UK team that was working on a smart phone app that would instantly diagnose sexually transmitted diseases after urine or saliva was … ahem … applied to a chip that would then be attached to the phone, leading to a quick diagnosis. It seems this product will have an expanded target market after June 1 since Apple has approved a “prostitution-friendly” app aimed at pairing “sugar daddies” with willing companions. I was going to say something pithy about Adam, Eve, and an Apple until I read further to find it’s compatible with Android and BlackBerry devices as well. Instead, to the App Store, I say — “well bless your little heart.”

Contacts

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

CIO Unplugged 5/18/11

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

This is the third in a short series of posts on The CIO’s Best Friends, BFFs who are critical in ensuring CIO effectiveness. This time we cover the vendor account executive–CIO relationship.

Don’t Fudge the CIO–Account Executive Relationship

I was new in my role as a director. For that matter, I was new to managing a vendor relationship. I was getting by, but only because the vendor account executive (AE) took pity and mentored me in how to manage such a relationship.

I had a responsibility to implement new applications to make our hospital easier to use than the competitor down the street. We had significant success, but it had little to do with my abilities. It was the AE.

I nearly ruined this relationship.

I set out to leave the office, looking forward to a family vacation the next morning. I don’t recall the infraction, but I said something unfair and unkind to the AE. I knew I was wrong and felt awful. I fired off an e-mail apology,  but I wanted to do more. My time was scrunched.

On my desk laid two large, wrapped boxes of fudge from the famous Rocky Mountain Chocolate Factory. An AE from another company had shipped these to me as a thank you for hosting a site visit for a prospect. I set aside one box for my team and intended to open the other. In my haste to demonstrate remorse, I repurposed that second box, taped my handwritten note to it, and sent to the offended AE. Damage repaired, I left for vacation.

I posted previously on maximizing vendor relationships, which I prefer to call partnerships. Strong relations in this area are instrumental to the success of provider organizations. The AE is the face of the partner and is as critical to the relationship as any product or service provided.

Partners use unique approaches and generally assign one or two AEs to the provider. I prefer one AE. Some partners have multiple AEs representing specific products and services, which I find suboptimal and challenging to manage. Others call their representative an AE, but those are only a salesperson in disguise. Some are assigned exclusively to healthcare, while others are assigned to diverse industries but have some exclusivity to specific accounts.

I’ve experienced many approaches. What trumps any specific structure is the AE themselves. A strong AE can overcome the weakest structure. Conversely, a weak AE can ruin the reputation and business of the most progressive vendor.

That said, here is what I have found works best:

• Single AE. I can’t handle multiple relationships with multiple partners. But a single AE with a handful of partners is doable. Have you ever bought a car and had to work with the salesperson, and the manager, and the fleet director …
• Formal structure. See link.
• Relationship. We don’t have to like each other, but it doesn’t hurt if we do. Clearly you can’t allow a friendship to trump business judgment. I tend to keep a safe distance for the protection of all parties.
• Transparency. I have yet to meet one AE who did not appreciate brutal honesty. It took some getting used to, but it was a freeing experience. Being transparent allowed for honesty, so I also knew the truth of what a vendor could or could not do. Don’t BS me with jargon — give it to me straight.
• Identity. Who do you work for? I prefer an AE who makes me feel as if they work for me. Obviously they must remain loyal to their company, but bravo to those who master the identity question.
• Accountability. Do what you said you’ll do, and be timely.
• Accessibility. If I need you, be there. I’ll do the same for you.
• Value-added service. Go the extra mile to help me with my business.
• Empathy. Give me an AE who cares about what I need, not about what they have on the dock to sell. Understand our world and our challenges. Skip the clichés — relevancy makes a difference.
• Integrity. I need to work with someone I can trust and solve business problems with.
• Post-sale support. Service and support after the deal is sealed. True relationships continue long past the initial sale. Maintain communication after the big sale and provide service that allows both parties to learn and continually improve.

I asked my partner AEs for their perspective. Their key success factors proved similar:

• Alignment. Beginning with the end in mind. Have a clear understanding of the alignment between strategic business initiatives, IT’s role in supporting those initiatives, and being able understand the relative priority of the active projects for the organization as a whole.
• Questions. If brevity is the soul of wit, the ability to ask good questions is the soul of a successful AE. Questions indicate a desire and willingness to help as well as a tacit admission that he or she doesn’t know all the answers — but they’ll work on your behalf to find others who might.
• Listening. Contrast this with an AE that does all the talking and simply discusses features and benefits or licensing arrangements. They make little effort to learn your business, and they’ll never learn your business while they’re doing all the talking.
• Relationships. Work “with” rather than “around” IT leadership to build relationships with the lines of business. Excellent AEs collaboratively develop relationships, think strategically, and have a network of partners and friends who can help you. They include you in those relationships, and conversely you are able to return the favor. Having a long-term view of the relationship helps navigate through the tactical day-to-day issues that may surface.
• Communications. Talk through expectations at a personal and organizational level. e.g. what do you want from your AE and what do you want from the vendor? Meet regularly to update both organizations on goals and strategy. Ensure accessibility and responsiveness on both sides. Have frank discussions about what’s working and what can be improved. Set agreed-upon and mutually shared goals.
• Trust. Built over time through the experience of working together.

The benefits to all parties are measurable: More innovative ideas to help the company improve its market position. More revenue generating and clinically effective solutions. More cost savings proposals. More vendor stability for the account, reducing personnel turnover. Success for both organizations and, by association, the AE and CIO.

Following my vacation, I returned to the office and found a note from the AE I had offended. “Ed, thank you for your card. Apology accepted. And thank you for the box of fudge. FYI– next time, you might want to make sure there is no note inside of it (from another partner). I am glad your demo went so well! I had a good laugh, and all is forgiven.”

Embarrassed and humbled, I put my tail between my legs. But I did learn many great lessons through that AE. So remember, if you receive fudge from me …

What are your ideas on what makes for a great AE relationship? I would love to hear from both AE and providers.

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

News 5/18/11

Top News

HHS’s Office of Inspector General spanks its fellow agency ONC for pushing interoperability without mandating security controls or encouraging standards. Examples of what it wants to see: requiring portable media to be encrypted, requiring two-factor authentication for remote access to PHI-containing systems, and mandating timely OS patch application and antivirus updates. OIG based this work on a previous project that looked at providers, in which it found unsecured wireless networks, lack of application vendor support for OS-level changes, poor antivirus practices, lack of event logging, allowing shared user accounts, and giving too many users administrative rights over their PCs.

ONC’s response to this report: (a) we turfed security work off to HITSP and incorporated some of its specs as HHS policy and in EHR certification requirements; (b) Stage 1 of Meaningful Use requires providers to fix their own security problems; (c) our job is to convince providers to use EHRs and we will worry about security later in the process; (d) our chief privacy officer is drafting a plan. It sounds to me like the typical external auditor’s report: their job is to find stuff to make sure you keep hiring them, while yours as the IT shop is to balance their sometimes ivory tower observations with your own realities. My only takeaway is that ONC should spend some of its billions to push security awareness, which you would think highly paid hospital and vendor IT people wouldn’t need, but apparently they do.

Reader Comments

From Mia: “Re: CompuGroup. Big layoffs at Noteworthy Medical (last week, I think) and other of their companies. Will be interesting to see how many of the 420 ONC-ATCB certified EHR companies are around five years from now.” Unverified.

From CPOE Zealot: “Re: medication error. Incidents such as these give CPOE a bad rap.” The parents of a five-week-old premature baby who died after being given 60 times the ordered dose of IV sodium chloride sue Advocate Lutheran General Hospital (IL) for wrongful death. Like most fatal medication errors, CPOE was a non-factor here: — most in-hospital medication error deaths are caused by incorrect IV preparation or administration. In addition, the doctor ordered stat labs and then a re-test after getting a high sodium level back, but nobody drew it, leaving the baby on the hyper-concentrated fluid for 20 hours. There is one good reason CPOE gets a bad rap in cases like these, though: vendors sell and hospitals buy the seemingly logical argument that CPOE prevents patient harm, when what it mostly does is prevent lots of errors that were being caught anyway (like poor handwriting, in which somebody just calls the doctor for clarification). The risk of harm doesn’t change much unless you work at the sharp end of the stick where EHRs fear to tread – medication preparation and administration. The best IT systems in existence (including bedside bar-code checking) couldn’t have saved this baby’s life when hospital employees, despite experience and best intentions, are just as prone to distraction and carelessness as the rest of us humans, especially when they are overwhelmed and tired (sometimes because their peers were laid off to help pay for CPOE systems).

From Wireless Observer: “Re: Cerner. Word on the street is that Cerner is getting ready to announce some big organizational changes and these are not good kind of changes for the employees (may be good for Wall Street, however). This is supposed to hit the CareAware division pretty hard.” Unverified. CareAware is Cerner’s solution for connecting medical devices to EMRs (video above).

Acquisitions, Funding, Business, and Stock

FairWarning will hire 70 employees over the next 24 months.

Salt Lake City-based MediConnect Global announces plans to hire 100 employees across multiple departments.

Cerner names SenSage its “Accelerate Partner of the Year” for demonstrating speed to value for Cerner and its customers. SenSage also an expanded alliance with Cerner to offer a SaaS-based version of P2Sentinel, Cerner’s enterprise clinical system auditing program.

CareCloud partners with Xpress Technologies to launch a combined EMR/PM solution for urgent care facilities and hospital ERs.

Sales

Sharkey Issaquena Community Hospital (MS) selects Custom Software Systems ChartSmart EMR.

Onslow Memorial Hospital (FL) contracts with Language Access Network  to provide hospital video language interpretation services.

People

 

Awarepoint names Ralph Keiser (MedeAnalytics) EVP of sales and Jaime Ojeda (PCTS) EVP of marketing and business development.

Government and Politics

CMS announces plans to release applications for “mature ACOs” interested in participating in its new Pioneer ACO Model and taking part in shared savings. CMS is also seeking input on the idea of an Advance Payment ACO Model, which would give certain ACOs access to their shared savings up front so they could build the required infrastructure. For providers wanting to learn more about ACOs, CMS is offering four free Accelerated Development Learning Sessions beginning in June.

Innovation and Research

Of the 75 operational RHIOs in the US, only 13 meet the basic criteria for Meaningful Use (e-prescribing, clinical data exchange, quality reporting) according to Harvard researchers. I don’t have access to the study, but apparently the findings are based on data from 2009 (so old they use the term RHIOs, apparently). Surely there’s been some improvement since 2009. If you’ve seen the full report, please share your insights.

JAMA reports that the use of telemedicine in ICUs reduces mortality rates and length of stay.

The New Zealand government awards a $252K grant to Vensa Health to conduct further research related to its mobile health reminder system. The company recites an impressive list of technology features, but like just about every mobile health vendor, they have no evidence showing that their product is effective in improving health. Like Bill Gates told me at lunch once (well, OK, me and a huge ballroom full of people at the mHealth Summit), reminders and education don’t necessarily work when it comes to wellness – plenty of fat people own bathroom scales.

Other

I got another “urgent news” e-mail blast today from one of the rags that reinforces my argument that most industry publications either (a) can’t distinguish real news from press releases, or (b) don’t care as long as it draws readers and advertisers. Today’s hot news: a bond rating agency issued a press release claiming their study correlated use of advanced IT to hospital profitability and quality. I downloaded the “special report” from Fitch Ratings and it was, as I expected, not worth the excitement, being even less methodical (and therefore even less useful) than the Most Wired survey. Here’s a summary.

• The bond ratings company looked at only the 291 hospitals that use its services. That’s out of maybe 6,000 US hospitals – a tiny, non-randomized, non-representative sample that excludes for-profit and government facilities.
• They checked Leapfrog, Baldrige, and Healthgrades and found that 75 of their clients had won a quality award (all awards are created equal in drawing room studies like this that just match Readily Available Data Set A with Readily Available Data Set B).
• They checked with HIMSS Analytics and found that 24 were at EMRAM Stages 6/7 (ignoring all other forms of IT except inpatient clinical).
• Apparently disappointed to find that only 12 of the 24 EMRAM 6/7 hospitals had won quality awards, they invented an excuse related to “the evolution and maturation of how quality is measured.” (maybe that should have been the headline – that half the hospitals who reached IT Nirvana haven’t won even one major quality award as a result).
• They found that richer hospitals won more quality awards and had more IT (neither of which necessarily has anything to do with patient outcomes).
• They looked at utilization trends and concluded that higher IT hospitals (meaning richer ones) are improving, although they did not look at their absolute performance (meaning a hospital could still be terrible as long as it’s less terrible than before).
• The bottom line: even if the bond ratings firm had conclusively proved any kind of relevant correlation (which they most definitely did not), that still wouldn’t have proved causation. The implicit message in running this yawner of a study as real news is that everybody now has the justification to buy more IT, which is an absurd conclusion for an industry that somewhere down deep is supposedly based on science.

Speaking of questionable studies, here’s another one: do seven percent of doctors really use video chat in patient care? I’m not interested enough to buy the company’s report to evaluate its methodology, but I would have to bet that they surveyed a disproportionate number of telemedicine physicians or tele-ICU intensivists. Most docs won’t even e-mail patients, much less fire up a Skype session for a leisurely and probably unreimbursed Webcam chat.

Quality IT Partners, Inc. announces its Facebook launch featuring a dedication to the Scott Hamilton Cares Initiative, including a song and video written and produced by the company.

Sponsor Updates

• Sonoma Valley Hospital (CA) picks ProVation Order Sets.
• BridgeHead Software will exhibit at the 2011 International MUSE Conference May 31-June 3 in Nashville.
• Emdeon introduces Emdeon Audit Advantage, which will provide real-time prescriber eligibility and patient coverage alerts to pharmacies. The company also wins a five-year GSA contract that allows it to offer products to  over 90 government entities.
• Healthwise Patient Education EMR module earns ONC-ATCB certification.
• Imprivata announces GA of OneSign Anywhere for authentication and single sign-on for remote and mobile users.
• Delta Health Alliance, one of the country’s 17 Beacon Health communities, collaborates with Medicity to connect participating physicians and hospitals.
• Daughters of Charity Health System (CA) expands its partnership with Passport Health Communications and adds three additional RCM solutions from Passport’s eCare Patient Access Suite.
• McKesson medical director David K. Nace, MD is named first vice chairman of the board of directors of the Patient-Centered Primary Care Collaborative.
• Practice Fusion says it has grown from a team of four in 2007 to 75 today. The company is expects to reach 150 employees by the end of the year and is seeking new office space.
• MyHealthDirect assumes a silver-level sponsorship for the 19th Annual Medicaid Managed Care Congress this week in Baltimore. CEO Jay Mason will also participate in a panel discussion on ACOs and patient-centered medical homes.
• API Healthcare publishes a whitepaper entitled Achieving Quality of Care and Controlling Costs, which includes best practices for workforce automation.
• Concerro creates a Mac versus PC parody that compares healthcare scheduling solutions with paper-based systems.
• The City of Philadelphia selects eClinicalWorks to provide an EHR/PM solution for the Department of Public Health, which includes 230 providers and 20 primary care and correctional clinics.
• JEMS Technology announces a rental program that allows hospitals to provide smart phone video consultation capabilities (JEMS Consults) to their physicians starting at under $1,000 per month.
  

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Contacts

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

Curbside Consult with Dr. Jayne 5/16/11

When I started as a solo practice physician, if someone had told me that someday I would be able to have actual conversations about the business side of the house, I would have told them they were crazy. As a naïve postgraduate, I actually believed that most of practice would be about caring for patients. Tincture of time and a few rides on the revenue cycle roller coaster quickly proved otherwise. (No one likes going bankrupt, which is a real danger for small practices these days).

Knowing other providers have also had this experience, it shouldn’t have been surprising to me that business-related articles on HIStalk have generated quite a bit of feedback. In a recent EPtalk, I talked a bit about the need for office-based physicians to work on maximizing their use of practice management systems as a prelude to maximizing their use of electronic health records.

One reader asks:

When determining the first pass clean claims rate, do you count as ‘unclean’ a claim that (1) doesn’t make it through the EDI/clearinghouse scrubber (rejected), or (2) makes it through the clearinghouse/scrubber but is then denied by insurance (e.g., wrong coding, more medical information needed, etc)? I have seen a clean claims rate calculation as being just those rejected by the scrubbers, but I have also seen it where it includes every claim that wasn’t paid with only one touch.

I have to rely on my anonymous celebrity claims expert Bianca Billinghouse, who responds:

First pass is defined as a clean claim when it makes it through the practice management system’s claims scrubber as well as the clearinghouse. If it doesn’t make it through the clearinghouse, this is what we term a rejection. The office staff typically didn’t run their claim edits and it was caught by the clearinghouse. These count against the practice. If it makes it all the way through to insurance and results in a denial, depending on the reason, then it falls into controllable or not controllable denial. We see this often with eligibility, even though we are attempting to do this upon check-in.

I also got a fair amount of feedback on last week’s Curbside Consult about evaluation of practice management systems and their readiness for 5010. Several readers suggested other organizations as sources for evaluating practice management systems, such as KLAS or AC Group.

Another wrote with an interesting perspective on 5010 compliance, which I thought I’d share:

The new 5010 standard, in the short run, is the same old data repackaged a slightly different way from the 4010 standard. The truth is that if you send your claims via a clearinghouse in the short run, you don’t need to do anything. The clearinghouse and the insurance companies need to be able to exchange data in the 5010 format by January of 2012, and many companies are doing testing now through the end of the year. The reason that a provider doesn’t need to stress about this is the actual new data from the provider — i.e. ICD-10 codes — don’t go into effect until 2013.

Software companies, as you can imagine, use any change as a way to sell an upgrade or new release, and most of my clients are told you must do this or that. Whenever you are told you must do something by a software company, nine times out of ten you probably don’t. If you’re an office that sends all your own claims yourself direct to all the insurance companies, you may need an upgrade by January 2012. If you use a clearinghouse or a billing service, you probably have another year until your software needs to accommodate ICD10 codes. If you’re looking at a $2,000 upgrade vs. paying a clearinghouse $50 per month to take care of things for you, that is your choice.

Considering that my primary ambulatory system is with a vendor that doesn’t charge for upgrades (they’re included in maintenance), I have no skin in the game on upgrading vs. not upgrading as a cost-saving maneuver. Interestingly though, the same day I received that e-mail, I also received my snail mail copy of American Medical News with the headline, “Not electronic-claim compliant? Then expect no payments in 2012.”

The article mentions that 5010 requires submission of nine-digit ZIP codes on claims, which I suppose a clearinghouse with the postal database can “plug” as the claims pass through. It also includes the ability to “distinguish between principal diagnosis, admitting diagnosis, external cause of injury, and patient reason for visit codes” which I can’t imagine a clearinghouse being able to manipulate unless I’m not understanding what that means. (Damn it Jim, I’m a doctor, not a biller!)

However, 5010 is also a precursor to ICD-10. I worry that physicians who think they can delay the upgrades for 5010 adoption will unwittingly delay progress towards adoption of the new coding standard, which is already anticipated to be an extremely difficult transition for physicians.

Of course, another conversation with Bianca was in order:

He’s obviously using the clearinghouse spin, touting that they will take care of everything. Ultimately, it’s still the provider’s responsibility to comply with the mandates. I wouldn’t feel comfortable relying solely on my clearinghouse to map/plug the required loops/segments. He’s right that clearinghouses help in the process, but what will the clearing house do when its clients don’t get their claims paid because the primary payer wants 5010 and the secondary wants 4010 or even paper?

The American Medical News article goes as far as recommending that practices increase cash reserves and consider lines of credit to buffer potential rejections after the switch, which certainly doesn’t do anything to reduce physician anxiety. Personally, I’m extremely thankful that Bianca is looking out for my colleagues and me (no one ever gives the billing / claims / collections folks the credit they deserve). But I still I think I might have to temper my anxiety over ICD-10 with a nice Riesling.

E-mail Dr. Jayne.