News 4/22/11

Top News

CPSI reports Q1 net income of $5.37 million ($0.49/share) compared to $2.92 million in the prior-year period. Analysts were expecting $0.46. Sales revenue grew from $31.54 million to $40.38 million.

GE’s Q1 numbers: revenue up 6%, EPS $0.31 vs. $0.17, with $1.8 billion in profit from GE Capital. GE Healthcare put up good numbers.

Reader Comments

From Ishmael: “Re: Meditech. I am just loving being a Meditech beta tester for CHW’s rollout. It’s great when my livelihood and patients’ lives are on the line, especially when I’m not getting paid for it! I actually don’t mind the software as much as my median doc or nurse colleague, which are about an 80-20 split on hate/don’t mind. No one loves it.” I guess to be fair users almost never love enterprise software like they might Facebook or something. My armchair psychologist theory is that having software imposed on you with mandatory use is a reminder that you are subservient to management, and no matter how benevolent, nobody likes to give up control (and that’s what work software is – a package of rules, controls, and monitoring tools). Another problem I can cite from experience is that Meditech is the hardest system I’ve ever had to replace, and we’re talking the old Magic product – users hated anything that wasn’t Meditech. We took an IT black eye for replacing it in the hospital we acquired.

From St. Pauli: “Re: kudos. When I moved from medical practice to an informatics role, I researched any and all sources of information. HIStalk was one of the first I found and continue to read regularly. I admire anyone’s ability to write well and regularly and the expansion of HIStalk to include Inga, the reader polls, Dr. Jayne, Readers Write, and Ed Marx have increased HIStalk’s value logarithmically. I was recently promoted and would like to thank those responsible – my family, bosses, and employees. HIStalk is included in that list. This is not a lame attempt to get mentioned – I just want you and others that contribute to HIStalk to know the benefits you have given one of your readers.” Thanks – that made my day.

From Rango: “Re: HCRAP. Inga mentioned it, now I have to know what it means.” A couple of huge companies e-mailed to say, “We want to spend a ton of money and sponsor your site at a higher level than anyone else” (I’m paraphrasing slightly). I don’t do that – sponsorships are relatively inexpensive and everybody gets the same treatment – but I wanted to yank Inga’s chain. I first told her I was studying the Periodic Table of the Elements to find metals higher than Gold and Platinum and was feeling good about the Roentgenium Level and would calculate the price of that sponsorship based on its atomic number relative to those of the other metals. I then told her about the brainstorm I’d just had about two new sponsorship programs. The HS program (Hollywood Squares) allows a sponsor to not only run their own ad, but to buy the spots of their competitors (at a 50% premium) to block them from doing the same. The second option carries a 100% surcharge, for which we will send every news and rumor item about a company for their approval before we run it, which I dubbed the HIStalk Company Reputation Assurance Program (HCRAP). She was suitably amused, or at least pretended to be.

From iFad:”Re: iPad. It’s cool, but does anybody really think it’s revolutionary? We’ve had PCs for going on three decades and are still trying to figure out how to use them in healthcare. Call me a cynic, but there aren’t many paperless healthcare organizations and pie-in-the-sky simplicity and streamlined workflows remain just that. Reality check poll: if you own an iPad, do you really expect improved outcomes or productivity that you couldn’t get from a PC?”

HIStalk Announcements and Requests

  Several dozen companies have asked to be featured in the innovation showcase I’m starting up. As usual, my reach exceeded my grasp given that my time is almost non-existent between my hospital job and HIStalk job. Despite my being the rate-limiting step, it’s underway, albeit in a more controlled manner than I’d like. Stay tuned. I hadn’t heard of several of the companies that are interested, which I think is great since I’ll learn about them along with everyone else.

Welcome to new HIStalk Platinum Sponsor HMS of Nashville, TN. HMS provides Meaningful Use-ready enterprise solutions for 680 hospitals, focusing on the often-forgotten community and specialty hospitals that deliver much of the care out there in the real world. They’ve been around since 1984 and offer a broad line of products: EDIS, LIS, PACS, pharmacy, radiology, surgery, AP/GL/MM, payroll/T&A, HIM, quality management, transcription, CPOE, eMAR, device integration, clin doc, patient accounting, claims, document management, and a bunch more I left off since the list is obviously comprehensive. The company’s inpatient EHR, EDIS, and ambulatory EHR all earned ONC-ATCB certification in 2011 and HMS clients are already receiving inventive payments for using them, which can be run locally or hosted by the company. Thanks to HMS for its support of HIStalk.

Jobs on the job board, where sponsors post free: RVP Sales. On Healthcare IT Jobs: IS Clinical Systems Analyst II Nursing, SAN Administrator / Engineer, Epic Ambulatory Specialist.

Acquisitions, Funding, Business, and Stock

The State of Wisconsin awards Merge Healthcare $500,000 in JOBS Tax Credits and a $500,000 loan from the department of commerce to consolidate operations at its Hartland, WI facility. The project is expected to create 100 jobs and represents a $2 million investment.

Quest Diagnostics reports a 13.3% drop in net income compared to last year, falling from $162.4 million to $140.8 million ($0.86/share). Analysts expected $0.99 to $1.05. Revenue was up 1%.

Here’s the Cerner video presented by the ADP and the Small Business Administration, featuring co-founder Cliff Illig. It’s good.

Israel-based EarlySense, which sells a continuous patient monitoring system whose sensor resides under a bed mattress with no direct patient contact, announces that it will locate its US headquarters in Massachusetts. MetroWest Medical Center was also announced as the company’s first Massachusetts hospital customer.

Canadian vendor PatientOrderSets.com, which I mentioned last time, gets $750K in funding from a government-funded accelerator.

Sales

Emerus Hospital Partners (TX) selects InsightCS patient access, patient accounting, and revenue cycle information solutions from Stockell Healthcare Systems.

Allina Health System chooses Micromedex from Thomson Reuters as its drug information vendor after a month-long bake-off.

In Canada, Ottawa Hospital orders 1,800 iPad 2s for its physicians, saying they will pay for themselves through increased productivity and reduced errors.

NextGen gets a $6.7 million contract extension to provide an EMR to Maryland’s prison system.

People

Sad news: Craig Maszer died on April 11, 2011 at Brigham and Women’s Hospital after a long battle with multiple myeloma. He was a resident of Andover, MA and a principal at Champions in Healthcare, where he worked alongside his mother, industry long-timer Stephanie Massengill. Others may remember him from his time with Sentillion and Eclipsys. Craig Maszer was 46 years old. Condolences.

Omnicare names Randy Carpenter to SVP/CIO. He was previously CIO of HealthSouth and had hospital CIO experience before that.

University of Arkansas for Medical Sciences (UAMS) names David Miller as vice chancellor and CIO. He was formerly with University of Chicago Medical Center. I think I probably mentioned that awhile back — he and I swap e-mails occasionally and he let me know as soon as it was official.

OB-GYN PM/EHR vendor digiChart names Phil Suiter as president and CEO. The former president and CEO, founder and Vanderbilt professor G. William Bates MD, will remain with the company as board chair.

Former HealthPoint Medical Group CIO Steve Fisher joins MD Solutions as SVP of advisory services.

Announcements and Implementations

 

McKesson Horizon Enterprise Visibility earns top marks in KLAS’s new report on patient flow solution. TeleTracking and Allscripts Sunrise Patient Flow earned the next highest ratings. Only 20% of hospitals are using a patient flow system, but 85% of those say they provide benefits, especially in terms of resource collaboration and communication.

Denver Health (CO) implements Microsoft’s Chronic Condition Management platform to facilitate communication between providers and diabetic patients and promote better self-management of chronic conditions.

Wayne Memorial Hospital (NC) goes live on EXTENSION’s HealthAlert for Nurses for nurse call messaging.

The Methodist Hospital System (TX) will use the Rothman Index for scoring patient condition from EMR information into a dashboard.

Two Siemens Soarian customers successfully attest for Meaningful Use Stage 1: MedCentral (OH) and Riverside (VA).

Government and Politics

Indian Health Service becomes the first federal agency to have its EHR (the IHS Resource and Patient Management System, or RPMS, based on the VA’s VistA) certified as a complete EHR.

Other

A Sage Health survey finds that patients believe EHR use increases care quality and results in a more accurate health record. Eighty percent of patients have a positive perception of EHRs, compared to only 62% of physicians; privacy and security is a concern for 81% of patients but only 62% of  doctors. Both groups agree that the biggest benefits of EHRS are real-time access to records and  the ability to share information among providers.

A Texas hospital tries to convince county voters to create a hospital tax district after it experiences financial losses, layoffs, and wage freezes. The new tax dollars will pay for a  new EMR, which will cost $1.2 million plus $18,000 per month maintenance.

Strange: the family of a patient who died after heart surgery is suing the surgeon and hospital after an anonymous caller told them that the surgeon’s 7-year-old daughter was showing a video of the surgery to her friends. The family claims the surgeon was so interested in making the movie for his daughter that he left the OR before the revascularization procedure was complete, allowing a non-physician to close and monitor the patient. The family also claims they found out only after the surgery that the surgeon has the worst outcomes of any surgeon in the state for the procedures he performed.

Sponsor Updates

• Healthcare Growth Partners releases its Q1 2011 market and M&A report, which summarizes the capital market, M&A, and capital raising activity for the HIT and services sector.
• Salar’s TeamNotes and Charge Capture software products earn ONC-ACTB EHR modular certification from Drummond Group. 
• Central Illinois HIE picks ICA as its vendor of choice to provide the HIE’s technology and infrastructure.
• ZirMed and e-MDs partner to offer eMD clients ZirMed’s RCM services.
• MEDSEEK obtains CCHIT ONC-ACTB EHR module certification for its eHealth ecoSystem, Version 3.4.
• The Huntzinger Management Group posts a video of its HIMSS presentation Discussing the Future Viability of Hospitals.
• Hartford Hospital (CT) reports it has increased its early discharge rate nearly threefold by offering its clinicians access to Carefx’s business intelligence dashboard.
• Harrison Medical Center (WA) is live on GE Healthcare’s eHealth Information Exchange.
• EMRConsultant.com adds more than 100 EMR products to its database, a free service used by over 12,000 practices.
• Mission Hospital (CA) has implemented Meditech C/S 5.64 CPOE at both its Mission Viejo and Laguna Beach campuses, assisted by H/P Technologies, which has been involved with Meditech and Epic go-lives at Cedars-Sinai, Mission Hospital, and University of Chicago.

EPtalk by Dr. Jayne

Earlier this week, the College of Healthcare Information Management Executives (CHIME) addressed a letter to new National Coordinator for Health Information Technology, Dr. Farzad Mostashari. It summarizes CHIME’s comments on ONC’s Federal Health IT Strategic Plan.

After the introductory pleasantries, CHIME delves into key areas close to many of us:

• Consent issues for health information exchange, not only clarifying how consent will be stored / transmitted, but how it will integrate with personal health records; unifying the patchwork of laws across various states; and national standards to pull it all together and fix the problem created when HIPAA allowed states to preempt federal regulations.
• Making movement to Stage 2 Meaningful Use requirements contingent on having a certain percentage of providers and hospitals compliant with Stage 1.
• Clarifying disagreement between HIPAA and HHS (Department of Health and Human Services) regulations on timely release of information and making sure that granting patients instant access to health information will not be harmful.
• Greater focus on the usability of technology.

As a practicing physician, the last one has the greatest impact in my day-to-day practice. There have been some unfortunate downsides to the speed of the Meaningful Use timelines. The relatively short time between the publication of the final rule and implementation has stressed vendors intent on incorporating items that may or may not be clinically helpful, yet cannot be ignored if they are seeking certification.

Let’s just look at a simple measure, documentation of tobacco use. Prior to the Meaningful Use hubbub, many EHRs did a perfectly fine job of collecting the information physicians needed to do appropriate health interventions. Physicians saw patients, counseled them, documented their findings, etc. However, MU required the documentation to meet certain standards of compliance. Was there any randomized, controlled study that showed that documenting tobacco use in a certain way changes patient outcomes? Or was it just nebulously decided that it should be “this way” going forward?

I’m certainly not privy to how it was all worked out, but vendors did a fair amount of retooling to make sure all the MU items were documented in the prescribed fashion. Don’t get me wrong, I support uniformity, the ability to report data across disparate systems, etc. But I also can’t help but think that the amount of development, testing, and implementation resources that were focused on making software changes that don’t materially benefit physicians (or patients) could have been better spent on making systems more usable.

This doesn’t even take into account the amount of time and resources spent by EHR customers to upgrade perfectly functional/serviceable systems to “certified” versions, regardless of pre-existing organizational priorities. A CMIO friend of mine laments the sheer number of projects (many of which would really have provided benefit to his physicians and their patients) that have been placed on hold so that all resources can focus on achieving Meaningful Use. The pursuit of MU has put his organization back a year or more on its five-year strategic plan.

I hope that ONC gives some thought to these comments as well as the thoughts of many others in the trenches who have submitted their thoughts. Do you have an interesting comment submitted to ONC? E-mail me.

Contacts

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

CIO Unplugged 4/20/11

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

This is the second in a short series of posts on “The CIOs Best Friends,” BFFs who are critical in ensuring CIO effectiveness. This time we cover the CFO – CIO relationship.

The CFO – CIO Relationship

When asked to take on additional responsibilities, I inherited our financial applications team. This scared me. Not because of the expanded scope, but because I’d have to deal with our CFO, a person feared in the halls of IT.

During the first week in my new role as corporate director, the CFO demanded an update on the troubled decision support project for which my team was responsible. I gathered players and facts and cautiously took my seat in the arena … I mean, in his conference room. He was not happy about the multiple delays and lack of concrete plans for resolution.

My project manager struggled in her responses. The CFO’s gaze then landed on me.

I don’t recall if my summation came across as eloquent or suspect, but my speech carried a mix of service compassion and urgency. I ended with, balls to the wall. The CFO smiled. I made a connection — one free pass for the new guy to facilitate resolution.

No C-suite relationship has changed more this past decade than that of the CIO – CFO. As technology influence becomes increasingly strategic to success, wise organizations are evolving. CIOs are crawling out from under the CFO’s shadow and taking their rightful seats at the executive table.

Regardless of whom the CIO reports to, the relationship with the CFO remains essential. I have worked with several over the years, a mix of old school and new school. Here is what I discovered as keys to both personal and organizational success.

Connection. You have to establish a relationship that transcends organization boundaries. Something unique happens when you break bread together. Get out of the office with your CFO at least monthly for breakfast or lunch. Or, if you both enjoy working out, then a few-mile run or a one-on-one basketball game may be the answer. The point is to get out of the office and get acquainted on a personal level. A healthy foundation sets the tone for a thriving work relationship.

Collaboration. One way to supercharge the relationship is to join forces on an initiative or project, ideally one that benefits the organization and is important to the CFO. Welcome proactive ideas on taking costs out or leveraging technology to increase revenue. i.e. redesign processes to enable a faster month-end close or any technology to accelerate cash collection. Suggest working together to ensure Meaningful Use achievement. Don’t wait to be asked. Be the first to anticipate and reach out.

Knowledge. Learn everything you can about finance. Take courses and read what the CFO reads. I attend HFMA conferences and read their periodicals. Participate in finance webinars. Speak their language and understand what is important to them. How do they measure their success? What are the key benchmarks, and are they up or down?

Execute. Do it well. Never undertake anything halfway. With finance, precision is the standard, and you cannot afford to miss a commitment. If you cite a number or percentage, hit the mark exactly.

Trust. Be good stewards of your finite resources. Be transparent and accountable. Have a finance person on your team to assist with budget oversight. Ensure that your governance process has a closed loop process where you measure baseline and ROI achievement, and then report on it. If you say a new application will reduce costs or increase revenue, then ensure the specific budget is updated to reflect this. Conduct a zero-based budgeting exercise and review every budget line item with your managers and finance. Trust takes time and relationship.

Shared Vision. Once you establish the relationship and build trust through collaboration and execution, you can then arrive at a shared vision for the role of technology in your enterprise. You need the CFO’s support to be successful, and he or she needs yours. Give the CFO every reason to be enthusiastic about endorsing the direction of IT to ensure a commitment of resources available over multiple years.

The benefits of a strong CIO – CFO relationship are many and lead to a stellar organizational ROI. I have multiple examples of how the support of the CFO helped me fulfill the shared vision and positively impact the organization’s quality of care, patient safety, and business growth. Everything from financing critical infrastructure, implementing EHRs, obtaining Meaningful Use, or starting new businesses.

Some of you may be saying, “But you don’t know my CFO. He starves me deliberately.” Actually, I’ve worked with both types, the backward-thinking and the progressive. I feel your pain. But don’t let the die-hard keep you from making your best effort. If nothing else, your character and strength will improve. Be proactive for the sake of organizational success. Be relentless and keep developing the relationship.

That intimidating CFO? He turned out to be quite personable and of excellent character. I was so impressed that I asked him to be my formal mentor. He accelerated my growth. He pushed me to new heights personally and professionally. I moved from corporate director to CIO because of his influence.

Leverage these ideas and ensure your relationship is not sub-optimized. Accelerate quickly at full throttle. Balls to the wall!

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 4/20/11

Top News

CMS’s EHR Incentive Program attestation process is live.

Sad news: industry longtimer Marc Holland died suddenly on Saturday, April 16, 2011. He joined HIMSS as VP of market research four months ago following positions with System Research Services, several market research firms, and Montefiore Medical Center. He wrote a nostalgic reflection of his 30+ years as a HIMSS member in January, including his optimism that healthcare IT’s future is bright. Marc Holland was 62.

Reader Comments

From Petra: “Re: first-day Meaningful Use attesters. Why aren’t more vendors promoting customers who have successfully registered? They’ve hyped this for a year, so I would expect a flood of news. Where’s the beef?” I haven’t seen anything mentioned. It may not be all that newsworthy, but you know at least some of the rags would run the story anyway and vendors don’t usually turn down free PR.

From HIS Fan: “Re: UW Health (University of Wisconsin health). Announced yesterday that CMS has accepted its Meaningful Use data for Stage 1 as submitted. They are an Epic shop and achieved Stage 7 last year.”

 From Dr. Victor EHRlich: “Re: Epic’s mammography module. Two customers are planning to de-install in favor of niche vendors.” Unverified.

From WildcatWell: “Re: Dell’s aggressive EMR marketing efforts. I called and the phone kept ringing and ringing, redirecting a caller to sales and then ringing … well, I stopped after five minutes. How do you think support calls will be handled?” I tried the number and it was not necessarily a pleasant PBX experience, but someone did pick up after six rings or so. I’m not listing the number since someone will surely shriek that I’m pandering to a sponsor (via Dell’s acquisition of InSite One), but it’s easy to find. I would try again since maybe you just caught them at a bad time.

From Kerplunk: “Re: Zite for the iPad. It’s a content discovery app that I’m in love with and it’s free.” It’s a personalized magazine that gets smarter as you use it, the developer says (and the 4+ rating seems to indicate that users agree). One of my first and favorite iPad apps was Flip, so I’ll try Zite to see if it’s similar.

From Susan: “Re: Concerro. They released a video at AONE that is racist, a takeoff of the Apple vs. IBM commercial in which a disheveled black woman represents paper scheduling and a well put together represents electronic scheduling. As a black nurse, I find this reprehensible.” I watched the video and didn’t have that reaction since companies can never seem to please everyone with their well-intended attempts at representing diversity or by just treating everyone (like actors) equally. However, since I’m seeing it through white male eyes, I invited Concerro to respond.

Thank you for taking the time to express your concern about our new video. The Concerro marketing team went to great lengths to find the best actors for each of the roles in all of our videos. Our “paper” actor was selected because she played an excellent frazzled nurse and a younger person was needed to play the role of a “less experienced” nurse. It’s unfortunate that this has been taken out of context and we sincerely apologize for offending anyone. Concerro stands by these videos and we are proud of our actors.

 From NonCredentialedTechie: “Re: from Slashdot. The head of a clinical division at an academic hospital sets up his own server at work, asks IT to allow people to access it through the hospital network, and is ‘taken aback’ when they say they’ll need an account on his server. The best part are the comments.” I love this, even though it may be a troll and not a real clinician writing it. The author claims he’s miffed that IT isn’t thrilled about his server and says he’s considering “taking this up the chain” and asks readers if they think he should give IT an account. Here’s the best response from the many hundreds posted:

What you’ve done would cause any professional IT group to get out the hot tar, feathers, and rail. Or at least come into your office and ask you politely to remove the damn server from their facility. And never do this again. You must have missed all the security briefings, the issues with HIPAA, and whatnot when you were looking at systems. What you’ve done is to create a ‘rogue system’. Imagine one of your kids sets up a server in your house. You don’t understand it, you don’t know if it’s happily sniffing network traffic to steal passwords so pizza can be ordered using your credit cards, serving up pr0n, or just running minecraft. Would you willy nilly allow the kids to open a port on your firewall without the ability to audit what they’re doing ? Of course not. Personally I’m amazed that they only asked for an account on your little server. I would have gone over and watched while you removed it from the facility and put in in your car.

HIStalk Announcements and Requests

  Listening: new Foo Fighters. I never paid them much attention, but I should have … Wasting Light sounds great first time through. It was recorded directly to analog tape in Dave Grohl’s garage, yielding a sound that I nostalgically remember as “music” before lesser talents hijacked the term sometime in the late 90s to define computer-created dance tracks. This is amazingly good and gets a rare highest recommendation from me.

Acquisitions, Funding, Business, and Stock

Cerner is one of six companies profiled in a new video series by the Small Business Administration. Cerner vice chairman and co-founder Cliff Illig shares details of how he and fellow entrepreneurs Neal Patterson and Paul Gorup created the company in 1979 and how Cerner has evolved over the last 32 years.

Healthcare disclosure management provider MRO Corp. acquires the assets of Keystone Management Solutions, a provider of release of information services.

Community Health Systems files a motion to dismiss the lawsuit filed against it by Tenet Healthcare, which claims CHS admits ED patients for purely financial reasons. CHS, whose December bid to buy Tenet for $5 per share in cash and $1 in stock was rejected as insufficient, changed its offer to a $3.3 billion all-cash offer, saying that move eliminates the basic for Tenet’s lawsuit against CHS, which alleged securities fraud. This pair is like hot-blooded lovers who can’t decide whether to kill each other or to make passionate love (or maybe both simultaneously). I think I’d be cautious about waving $3.3 billion in cash around right as the public tries to figure out where to cut healthcare costs.

Sales

HealthInsight selects Axolotl’s Elysium Exchange infrastructure for the Nevada HIE.

Physician management services organization TeamPraxis (HI) chooses Microsoft Amalga to facilitate the sharing of patient information.

Presbyterian Intercommunity Hospital and Bright Health Physicians (CA) will implement the Shareable Ink documentation system as part of its rollout of Allscripts Enterprise PM/EHR.

Five hospitals in Canada will implement order set management tools from PatientOrderSets.com, increasing the Canadian vendor’s client list to 140 hospitals. The company changed its name from Open Source Order Sets in January, explaining that its collaborative network is cloud-based, but not open source in the software development context.

Lutheran Medical Center (NY) contracts for Service Desk healthcare-specific IT help desk services from CareTech Solutions. The company started up 24×7 services within three weeks to support Lutheran’s EMR rollout.

People 

University HealthSystem Consortium (IL) hires Mike Hebrank as VP and CIO. His previous employers include Helix Health and Greater Baltimore Medical Center.

Announcements and Implementations

  Seventy Hawaii physicians on the island of Oahu form Health Information Helping Others (HIHO) as a pilot project for the Hawaii HIE. HIHO will use Wellogic’s Direct Project technology for data exchange and secure messaging. Got to love the happy acronym, which is far less cynical than some of the ones that recently concocted by Mr. H (HCRAP comes to mind).

Roche introduces a new EMR interface for the VA that transmits patient diabetes data into the VistA computerized patient record system. JResultNet allows providers to automatically transfer patient blood glucose test results from the ACCU-CHEK 360 Diabetes Management system to VistA.

Thomson Reuters announces Micromedex Drug Interactions for the iPhone. It’s free to Micromedex customers, $50 per year otherwise.

PenRad announces plans to develop the next generation of its PenVasc Vascular Data Management System for vascular labs.

General Dynamics becomes the first healthcare application service provider host to earn HITRUST certification, which documents that its hosting service meets HIPAA and HITECH security requirements.

Government and Politics

Lawmakers in Maine are considering legislation that would give patients the ability to control what portions of their medical record could be included in the state’s HIE.

Without any clear explanation, ONC extends the comment period for the Federal Health IT Strategic Plan: 2011 – 2015 from April 22 to May 6. Comments can be made or reviewed here.

The Kansas Board of Pharmacy will require pharmacies to use the NPLEx system, which alerts store personnel when customers try to buy products like Sudafed from multiple locations to skirt sales limits imposed to thwart methamphetamine production. The system is provided nationally by the National Association of Drug Diversion Investigators and paid for by the drug companies whose products are involved.

Innovation and Research

A BBC article says that governments like Britain’s spend billions on ambitious electronic medical records projects, but small upstarts are tackling much smaller problems with greater success. The CEO of a company that offers a smart phone-based communication system says that hospitals have spent a fortune on IT, but caregivers still can’t monitor patients with it. “Cans of tomatoes are being treated better than patients,” he says, referring to the more advanced technologies used by the average grocery store. Another company is piloting a cloud-based hospital management system in a 2,000 bed hospital in India, saying that it’s a poor part of a world, but patients there get “more efficient, more high-tech service than patients in the UK” because they didn’t have to work around legacy systems or government policies.

Do you run a small and innovative healthcare IT company? Does it offer a product (not a service) and have at least five employees and one referenceable site? If so, a team of volunteer HIStalk readers and I will consider giving you a national audience right here on HIStalk. This isn’t like a venture fair, where you have to fly somewhere, pitch to an indifferent audience of allegedly interested investors, and then go home with nothing to show for it. We’re offering you the chance to reach HIStalk’s readers directly and at no cost, just because I like to shake things up a little by giving the little guy a chance to earn customers and investors (and because readers keep asking me to showcase those little guys). If your company would like to be the guinea pig, e-mail me and we’ll work through some simple details. I’ll post your story, an interview with you and your referenceable site, and your video pitch.

Old news that I just ran across: MediAngels says it has launched the first 24×7 Global eHospital to serve patients anywhere in India and elsewhere over the Internet. It has 300 physicians, including those from 85 super-specialties, who will render consultations and second opinions. The maximum fee, which is charged only if an international panel of physicians is involved, is $100 US. It claims to meet HIPAA standards (which is says were “enacted by the USA FDA”) and can also arrange medical tourism.

Here’s a fun and interesting video featuring Halle Tecco, a new Harvard Business School grad who founded non-profit HIT accelerator RockHealth (mentioned here last week) with medical partners Mayo Clinic and Cincinnati Children’s Hospital. “I didn’t even go to Recruitment Week or apply for any of the big jobs because I knew it could be really tempting because they pay probably like five times as much as I’m going to make, but at the end of the day, I’m more concerned about doing something interesting and meaningful with my time on this earth, whether that’s right out of business school or ten years down the road.”

Other

Ten percent of ambulatory providers are switching PACS or RIS vendors due to market consolidation or poor vendor performance, according to a new KLAS report. KLAS also noted that providers will generally forego some functionality for solid PACS/RIS integration, though single-side vendors do well in their respective markets. Intelerad IntelePACS was the highest rated PACS and MedInformatix the top RIS.

The Rhode Island Board of Medical Licensure and Discipline reprimands a physician who posted details of her ER experiences on Facebook. The postings did not include any patient names, but the nature of the injuries described allowed at least one person to identify a patient. Alexandra Thran was found guilty of unprofessional conduct and ordered to pay a $500 administrative fee.

American Medical News runs an interesting question on its Ethics Forum: is it ethical for doctors to use their IT systems to “cherry pick” or “lemon drop,” meaning choosing only the healthiest patients to maximize pay-for-performance money while increasing costs overall? It gives interesting examples of Medicare HMOs, which have been caught recruiting only patients from affluent areas and discouraging sick patients from re-enrolling by charging high co-pays for dialysis and cancer treatments. It theorizes that the EMR could be a powerful profit-making machine since doctors could theoretically just drop patients whose performance targets would be difficult to meet. It’s an interesting article — if a system can be gamed, you can bet it will be, both legally and illegally (see: tax laws).

 Sponsor Updates by DigitalBeanCounter

• Vitalize Consulting Solutions held its all-company meeting at Hyatt Lost Pines Resort in Austin, TX earlier this month, including a build-a-bike team exercise that surprised 34 children of the local Boys and Girls Club with brand new bicycles, hlemets, and locks.
• Nathan Littauer Hospital (NY) selects ProVation Order Sets as its electronic order set solution.
• Cumberland Consulting Group promotes Amy Meiners to principal.
• Presbyterian Intercommunity Hospital and Bright Health Physicians (CA) sign an agreement to deploy Allscripts Enterprise EHR and PM solutions. The ambulatory systems will integrate with the hospital’s existing Sunrise inpatient EHR/RCM system.
• St. Joseph Health System (CA)  will implement MedPlus’s ChartMaxx electronic document management product.
• Cognify, Inc. selects Greenway’s PrimeSUITE to further integrate and advance its Web-based participant tracking system that monitors care plan continuums.
• The Rules-Based Charging solution of Surgical Information Systems earns the “Peer Reviewed by HFMA” standard for the fourth consecutive year.

Contacts

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

Awarepoint Acquires PCTS

Real-time location system vendor Awarepoint announced this morning that it has acquired Patient Care Technology Systems (PCTS), a vendor of software that helps hospitals track people and physical assets. Terms were not disclosed.

Charlotte, NC-based PCTS has 60 hospital customers that include New York-Presbyterian, Advocate Health Care, Providence Health & Services, and Aurora Health Care. It will continue operating from its current office, with the PCTS executive team reporting to Awarepoint CEO Jay Deady at the company’s corporate headquarters in San Diego.

Deady was quoted as saying that the combined solutions will allow the company “to capitalize on an enormous untapped RTLS market” in which US market penetration is estimated at 10-12% and around 5% internationally. The company’s value proposition includes reducing medical equipment rental costs, reducing procedure time and nurse labor involved with in locating needed equipment, and ensuring that equipment is correctly reprocessed between patients.

We spoke to Jay Deady on Monday after running a rumor from RTLS Battle predicting that the acquisition would be announced this week. He said Awarepoint’s 93 hospital customers, having realized significant return on investment from the company’s asset management and tracking capabilities, were pressing the company to move quickly into patient workflow solutions that can support discharge planning and real-time monitoring.

“Integrating a workflow engine into our software and building out the workflow library was going to take 18-24 months,” he told us. “At our recent user meeting, our customers told me they are ready to go right now. Awarepoint and PCTS have three shared accounts — Christiana Care, Aurora, and Advocate Good Sam. I visited those clients and got rave reviews about PCTS’s workflow engine and content library. It just seemed logical to meet the needs of clients in accelerating to market and not taking two years to develop.”

Deady says that completing the transaction required “a very fast close” due to competing bids from private and publicly traded companies and a private equity firm.

PCTS’s relationships with other RTLS vendors will continue, Deady told us. “This is not a one-size-fits-all environment. We will continue to work with other technology partnerships. A lot of our clients were asking us about other RFID technologies, such as passive RFID for inventory tracking. PCTS has an RTLS integration engine and can integrate that in being able to play well in the sandbox with other active and passive players. That was a big decision point for us to merge with PCTS.”

Deady summarized the benefit to customers as being similar to the consolidation of hospital clinical systems starting in the late 1990s. “Customers don’t want to go to different companies for technology, inventory management, asset management, hand hygiene, and temperature monitoring. Up until a year ago, a hospital that wanted to deploy all these technologies would be doing business with seven or eight different companies. Our goal in merging with PCTS is to give them one place to go.”

Curbside Consult with Dr. Jayne 4/18/11

I try not to waste too much time on the Internet, but keeping an eye out for interesting stories on health and technology is an occupational hazard. How could I not read a piece with the headline Playboy Mansion Illness Traced to Hot Tub Bacteria when it crossed my screen? Apparently our old friend Legionella (the bacteria that causes Legionnaires’ disease) was found in a hot tub at the Playboy Mansion after scores of visitors were sickened.

As if a story about hot tubbing with Hef isn’t tawdry enough, epidemiologists were no doubt engrossed when the case was presented last week at the Centers for Disease Control’s annual conference in Atlanta. So what does this have to do with health and technology? Well, it seems that epidemiologists used social media to contact the 400+ people who were at a fundraising event where they came into contact with the bacteria.

In other news, the Associated Press reports that Odd Work Schedules Pose Risk to Health. From my experiences as an intern and resident, I could have written that one — it’s not good for the caregivers or their patients. According to Dr. Charles Czeisler, chief of sleep medicine at Brigham and Women’s Hospital in Boston, 30-50% of night shift workers admit to falling asleep at least once a week while working.

Although the article highlights findings related to recent issues with air traffic controllers snoozing on the job, the facts play to all of us in healthcare and IT, also. Czeisler states that taking work home on BlackBerrys and computers as well as the 24×7 availability of work and entertainment options contributes to sleep issues.

Somehow I missed this in my recent studies for my medical board recertification exam, but night shift workers are more likely to have chronic intestinal and heart diseases. Apparently, the World Health Organization has also identified shift work as a probable carcinogen. Not good news for those of us in the business of 24×7 technology and patient care activities, or the patients either. Having been sleep deprived for nearly five years during my training, I understand the near misses (and sometimes real misses) that can happen in the middle of the night when the thought process starts to get fuzzy.

These types of situations are great for employing technology as an additional safety net for our patients. Long hours aren’t going away (nor are distractions, overloaded schedules, nursing staff burdened with regulatory nonsense that detracts from patient care, or any of the other dozens of things that impact clinical decision-making). But well-placed clinical tools (like the Thomson Reuters tools mentioned by Dr. Gregg on HIStalk Practice)  can really make a difference.

Personally, I’d much rather have my anesthesiologist calculating drugs and dosages in a well-crafted electronic record than doing equations on the leg of his scrub pants (which, thank goodness, I haven’t seen in a long time). However, the systems have to be well designed, easy to use, and accurate if they’re going to make a difference. Users have to commit to attending training, using the system properly, and not short-cutting steps. IT teams have to keep the systems available (not to mention happy and healthy) continuously. Otherwise, make sure you have your scrubs on — and your favorite ballpoint pen.

E-mail Dr. Jayne.

HIStalk Interviews Carlos Nunez MD, Chief Medical Officer, CareFusion

Carlos Nunez MD is chief medical officer of CareFusion of San Diego, CA.

What led you take the CMO position at CareFusion?

I was with Picis for almost 11 years. My title there was chief physician executive, which was essentially the CMO of Picis.

My background in medical technology and information technology goes back a little over 20 years, all the way to the time when I was still practicing medicine and even into my training as an anesthesiologist and as an intensivist. I guess being at Picis automatically type-cast me as being an informatics person, but my interest and my background really is more than just healthcare IT, but healthcare technology, of which I think IT is a very important part.

When you look at what’s happening in healthcare right now — I probably don’t have to tell you — healthcare is notorious for embracing fads. More than ten years ago, when the IOM came out with the report, To Err is Human, everybody was all about safety. When Leapfrog said CPOE was necessary, everyone was all about CPOE. A year or two ago, it was RHIOs. Six months ago it, was HIEs and Meaningful Use. Now healthcare reform has got everybody all in an uproar about ACOs.

When you see what’s happening in healthcare beyond the fads, and you look at the themes that have persisted for the last 12 years or so, it’s this focus on quality, safety, cost, and efficiency. Regardless of whether you’re talking about an ACO or an HIE or Meaningful Use, those are the themes that continue to rear their heads in everything that either is a fad or a discussion or the theme of the moment.

I think technology is perfectly positioned to help, specifically with American healthcare, but global healthcare deals with these challenges and attacks these themes. Looking at American healthcare in the context of healthcare reform right now, the challenges are the same. It’s decreasing levels of reimbursement and revenue to hospitals and the individual providers. Healthcare reform is trying to squeeze out $400 to $500 billion in savings from Medicare over the next ten years. The aging population, the decreasing resources — whether you’re talking about the nursing shortage or the shortage of primary care physicians to the consolidation of hospitals and practices — technology is perfectly positioned to help with a lot of these problems and changes.

When I looked at the opportunity at CareFusion, I found a company that I felt was perfectly positioned to address these challenges with a very, very unique set of solutions. What I did in my former company was focused on pure IT. It was software and solutions. But using that as an example, our software worked best when it was connected to an anesthesia machine; when it was communicating to a physiologic monitor; when it was getting information from a balloon pump or an infusion pump or a pharmacy system. There was more than just a pure healthcare IT play going on.

There was what I like to call this hidden kingdom of healthcare IT. That’s the medical technology. Information technology only works when it’s full of information, when it’s full of data. Most of that data comes from the patient. In the high-acuity areas of the hospital or in the areas of the hospital where patients are the most sick or most vulnerable, more often than not, that data is coming from a device. It could be coming from an infusion pump or a PCA pump. It could be from the pharmacy and the dispensing cabinet. It could be from the ICU, where the sickest patients are connected to all sorts of medical technology. 

When I looked at this opportunity, I saw a company that had products and services aligned with those same themes and those same challenges that healthcare faces. Medication safety and medication management, looking at infection prevention from the standpoint of central line or respiratory ventilator-associated pneumonia, supply chain management, portfolio IT assets, and most recently, the announcement that CareFusion is looking at ways to make hospitals a little more eco-friendly in dealing with the problems of hazardous waste disposal. 

Looking at their technology portfolio and their IT portfolio, I saw an opportunity to work for a company perfectly positioned to make a difference in those themes and in those areas where healthcare needs help.

Some would argue that healthcare IT is still enamored with IT basics, like having someone enter data and someone else pull it back out on the other end. On the other hand, companies like CareFusion were engineering-driven and not very good at developing software, where they were happy just to get relays to click and solenoids to move. Do you see those worlds coming together to help take care of patients?

I do. Before I took this position I was reviewing something that most of your readers are probably very familiar with, the KLAS rankings of the different IT solutions in the hospital space. My former employer had various solutions that were ranked in KLAS, so we watched these things very carefully. At the end of the year, KLAS puts out their Best in KLAS overall IT vendor rankings based on multiple products that KLAS ranks.

Probably no surprise, Epic was ranked Number One as Best in KLAS. Do you know who was Number Two? It was CareFusion, behind Epic by only two-tenths of a point. Number Three was more than four points away from CareFusion. I’m looking at this saying, here is a company that everybody thinks of as Pyxis machines and Alaris pumps who’s ranked neck and neck with the IT vendor that has taken the IT world by storm over the last few years. There must be a reason why.

As I learned more about what CareFusion does, I uncovered the reason. It is exactly what you alluded to with your question. The Holy Grail of what CareFusion is trying to accomplish is exactly what you say. When someone is adopting an information technology solution at the point of care, where someone is documenting care or making note of a lab result or entering something about a patient, how is that going to affect a drawer that opens or pump that’s infusing a medication or a fluid into a patient or a ventilator or some of the other things that CareFusion does? 

Here’s a scenario. Imagine you have a person who is on an anticoagulant and they’re getting PTT and INR studies done regularly. There’s an order to administer another dose of heparin or Coumadin. The nurse is going to follow the order. The lab results come back and their INR is therapeutic or maybe it’s even higher than what you would like. The nurse goes through the dispensing cabinet. They haven’t had a chance to go to look at the patient’s lab results. The dispensing cabinet says, “By the way, you’re about to take out that drug for a Mr. Jones, but I’ve just checked and the lab is saying that Mr. Jones’ INR actually is a little higher than you’d like it do be. Maybe you want to hold off on that dose. Call the physician.” That’s how that interplay needs to happen, and it already does. 

That’s what was surprising to me as I investigated what CareFusion was already about. The part of CareFusion that does a lot of their IT and analytics and surveillance was a company called MedMined that they acquired a few years ago. It was traditionally a company that did antibiotics infection surveillance in trying to improve antibiotic stewardship. It is now expanded throughout CareFusion’s different vertical businesses to provide notifications at the point of dispensing drugs or at the point of administration, regarding things beyond just antibiotic and infection surveillance, but looking at lab results, electrolytes, anything that could affect why or why not you’d want to dispense a drug. That’s just one example, but it’s a great example of that convergence between IT and devices. 

I spoke earlier about data coming from devices to the IT system. There’s an example of data living in an IT system like a pharmacy system or a lab system that’s now affecting the way someone interacts with the device that you wouldn’t traditionally consider part of IT. But think about it. I know you’re a fan of the Apple iPad, as am I. As a matter of fact, in your Monday Morning Update for just this past Monday, you had a little one-liner that AirStrip Technologies was shown in the very first iPad 2 TV commercial. The iPad is a device, the magical device that Steve Jobs has sold us all on. Incidentally, there are still lines every morning outside the Apple store in San Diego to get one, which is incredible to me. The magic of the iPad is it’s a beautiful device and the apps, the IT, and the hardware, together working in an ecosystem that’s very disruptive. 

Using the iPad example, look at how the iPad has just taken the medical world by storm. Doctors can’t stop showing up to work without their iPads. It’s caused CIOs even outside of healthcare, in businesses like here at Carefusion … our CIO’s got to figure out, “How do I integrate these iPads and these iPhones into our workflow? We’re a Windows-Exchange shop.”

It’s the same sort of revolution that I think it needs to take place. People need to recognize that all technology, not just pure information technology or software, is part of the information infrastructure of a hospital and a health system. It is that interplay between devices and information systems that will define how things become more efficient and adoption increases.

You’re right, we get really excited when we’re able to do very simple things. The adoption of technology and information technology in healthcare is behind many of industries. When you find the appropriate way to integrate information, data, actionable knowledge at the point of care, wherever that happens to be — whether it’s on the screen of a device or on the screen of a workstation — so that it’s less disruptive and more integrated into the very busy workflow of a nurse or a physician, then you’re going to see the adoption increase, the efficiency increase. Things like safety and quality should follow.

When people think of advances in banking technology, they don’t think of what goes on behind closed doors, they think of ATMs and online banking, the sharp end of the stick. In healthcare, nurses are the most vested at having tools, but nobody’s really doing much for them even though they provide most of the care.

Absolutely, yes. I’ll give you another example, because I had this conversation with someone here at CareFusion yesterday. It was the philosophical argument — where does certain information belong? Does it belong in the traditional IT system, or does it belong within a medical device or on a screen that’s part of a medical device? 

I said I don’t think that you can just make blanket statements like that. I think the information, the actionable knowledge that’s going to make a difference at the point of care — like you said, especially for the nurses who really feel the brunt of a lot of this — is wherever it best fits within the workflow.

I know we were talking about nurses, but I’m going to use a non-nursing example because this is off the top of my head. It’s what we talked about yesterday — the respiratory therapist. My former employer had an ICU information system, which is great. I’m an intensivist, loved it. Part of the feature set was that you could create customized flowsheets and a respiratory therapist could look at information on that customized flowsheet.

But more often than not, a respiratory therapist in the ICU walks right up to the ventilator. They’re used to having a clipboard sitting on top of the ventilator where they’ve got information about that patient and then a screen on the ventilator. They’re not going to want to change their workflow and have to go look into a screen.

Imagine if on that ventilator screen, you can see the blood gas results that you’re most interested in, or any other information that makes a difference. Maybe it does need to be on the information system screen. Maybe it needs to be on the ventilator. For me, it should just be integrated into the workflow that makes sense because the biggest problem is adoption — physician adoption, clinician adoption.

Getting people to adopt technology or IT or otherwise is difficult when you ask them to do more stuff. When it’s integrated into their workflow, then it becomes a pleasure to use this stuff.

I assume that the fact that CareFusion hired you is an indication that they’re interested in backing away from that engineering label and getting more into mainstream IT. How do you see that changing what goes on at CareFusion, especially when it comes to healthcare reform?

I think what CareFusion hiring me signals is that they want to take a balanced approach. Not so much that they want to try and become identified as an IT company versus an engineering company. I think they want to take a balanced approach that reflects some of the things that I have been saying — that there is medical technology and information technology working together can have a tremendous impact on quality, safety, cost and efficiency.

That’s the message that they’re trying to send, not just by hiring me, but by creating the portfolio of products and solutions that they have created over the last few years since they spun off from Cardinal. The way they go to market with these strategies and the integration that they are building between their different vertical platforms to show that there is this place where devices and software can play together and play together nicely, creating real benefits for patients and for providers and for hospitals.

I alluded to a couple of things about healthcare reform earlier. We talked about the fact that this is a plan that’s supposed to cost a trillion dollars. That’s what we were initially told — everyone knows that most government programs go over their initial cost estimates. But if we stick to that figure, a trillion bucks, roughly half of that is supposed to be realized through savings in Medicare and other CMS expenditures, Medicaid, etc. 

The ACO rules and regulations were just published. It’s like a fad. We’ve seen this before. You look at the HHS estimates for the adoptions of ACOs, and they’re saying that in their best estimate, somewhere between 1.5 to 4 million lives will be covered within the ACO model by 2014 with savings of roughly $500 million — with an M — dollars.

So they’re saying, “We’re hoping four years into the ten-year plan for healthcare reform we’re going to have maybe four million people in the ACO model.” That’s not even 10% of the roughly 44 to 45 million Medicare beneficiaries that are covered today. Savings of $500 million? That’s not even a drop in the bucket when you’re looking at half a trillion dollars in Medicare savings. 

It makes me wonder why we do this to ourselves in healthcare. Why we elevate these fads and get crazy over them without looking deeply into the facts and say, “Gosh, yeah, this is an interesting thing. Maybe it will end up leading to real savings and real changes in the way we deal with healthcare.” But in the end, it always goes back to the same things. It’s quality, safety, cost, and efficiency.

For me, healthcare reform represents one really important thing. Whether you agree with the way it was enacted, whether you agree with the provisions, whether you think the costs are right, or ACOs are great — and I’m not saying I have an opinion one way or the other — I’m just curious as to way everyone’s so crazy about an ACO model that we’re not yet sure will create significant savings.

What healthcare reform did is announce to the world in a very public way that the United States is finally acknowledging we can no longer afford the system that we have on the cost curve and trajectory that we’ve got. Not only does it endanger CMS and HHS, it endangers the entire federal budget. It endangers the economy of the United States as a country. It’s a very real problem and it’s a big, big part of the discussion that we now see around the Republicans’ new budget proposal trying to cut over five trillion dollars from the federal budget over ten years. This is a big deal. It could bankrupt our government and really make a huge impact on the American way of life, so we have to do something about this. 

Technology is the way that other industries have found the means to become efficient and look at ways to improve quality and safety while becoming efficient and spending less on the things that don’t matter — redundancy and paperwork and overhead and the things that don’t matter. There’s a way that we can refocus healthcare on taking care of patients. I think technology plays a huge part in that.

The last thing I’ll say on my little political diatribe. You know, we don’t have a healthcare system in the United States — we have a disease intervention system. Most Americans wait until something is broken or bleeding or falling off before they show up in the ED and get very expensive care for a problem they should have taken care of years or months before.

I think all of those themes that continue to merge about quality, safety, cost, and efficiency lead us to a remaking of this system in a way that keeps us healthier and tries to avoid getting to the point of disease intervention until it becomes more inevitable. And again, technology — and maybe not even in the inpatient setting — can play a huge role in all of that.

I think that’s what’s important about the ACO model or about healthcare reform or about Meaningful Use. It’s not the few million dollars in incentive payments here or there, or whether or not it’s going to be a million or four million lives covered in an ACO model. It’s the fact that we need to do something to move our healthcare system towards providing healthcare and using technology to become more efficient, to take better care of patients while not going broke in the process.

From my perspective — obviously I’ve got a very inpatient focus perspective as an anesthesiologist and intensivist — a company like CareFusion, from within their perspective mostly focused in the areas of the hospital where things like supply chain management and medication safety and infection prevention — it’s a really, really interesting place to be with all the stuff that’s swirling around.

If you looked out five to ten years, what should technology vendors in general and CareFusion in particular be working on to start to move the needle on patient outcomes and costs?

Five to ten years? Wow, I’m going say a word that is very overused in our circles, but I’m going to try and define what I mean by that. I think it’s a level of interoperability that makes sense.

It’s not just creating interfaces between different systems because they don’t exist now, and maybe we need to have everything tied together. It’s creating an interoperability between medical technology and information technology that provides actionable information at the point of care so that the providers who are being asked to do more with less can make the right decisions, can keep their patients safe, can deliver the highest quality care in a way that is most efficient and most cost effective.

I gave the example of the respiratory therapist or the nurse who’s trying to dispense a medication and it’s contraindicated because of a lab result. The examples go on and on from there, and maybe some of them are very, very clinical and safety-focused. Maybe some examples are more focused on collecting data for retrospective analysis. A patient who’s admitted for a non-infectious disease-related diagnosis and the Pyxis machine notes that they had a central line kit removed, and then three days later, the Alaris pump sends a signal that they’re getting an infusion of antibiotics and there’s no reason why they should based on their diagnosis. Do we now start to see markers for infection? Do they have a central line infection? Can the infectious disease nurse be prompted to go and check on that patient to see what’s going on?

The examples go on and on how you can start to tie devices and information technology to create an ecosystem that is much more efficient than what we have today. It’s not just creating interfaces using HL7 because we think it would be great to connect this system with that one. It’s really creating a web of connected devices and connected systems that allows us to be very efficient in delivering the safest, highest quality care that we can, and saving money in the process.

Monday Morning Update 4/18/11

From RTLS Battle: “Re: Awarepoint. Word is the company outdueled Merge to buy PCTS, a workflow software vendor in Charlotte, NC, with former Allscripts VP Jay Deady (Awarepoint CEO) beating out another former Allscripts VP Jeff Surges (Merge CEO). Deal to be announced next week. Wonder if they’ll split deep dish pizza in Chicago any time soon?” Unverified. PCTS offers the Amelior product line that includes ED and OR asset and patient tracking, hand hygiene systems, and temperature monitoring. They are a business partner of Awarepoint.  

From The PACS Designer: “Re: net collaboration. InformationWeek has compiled a list of the 15 Top Collaboration Apps that promote working together using the Internet. With all that is going on with Meaningful Use, this compilation of collaboration tools is good for institutions who want to progress to the next level of efficiency, which is meaningful structure.” Most of the apps listed involve some flavor of project management in what would have been called a hosted Intranet a few years ago (I guess that’s not a commonly used word these days). I notice that Cerner is listed as a user of Jive Engage (a social media monitoring tool) for its “social network experience,” since the whole point of social media is to sell stuff, of course.

From Katrina: “Re: Healthcare Informatics Executive Summit. I work for a vendor and registered, but was told I needed to either come up with $7,000 of program sponsorship or bow out, which I did. I’m warning other potential attendees about the small print stipulation.” The keynote speakers that Healthcare Informatics won’t allow you see for your $1,095 registration fee are Farzad Mostashari of ONC and Carolyn Clancy of AHRQ, both paid with your tax dollars, so that’s a bit insulting. Maybe you could just register as yourself at XYZ Consulting, pay with your credit card, and put it on an expense report. That brings up another gripe: the registration form requires entry of your job title and employer. Why should someone paying their own registration fee have to provide that information? If my employer isn’t willing to pay for my attendance, why should they (and the conference organizer) enjoy the benefit of having their name on my badge?

From KS: “Re: Epic. Consultant advertisements are popping up at MSN airport. They, of course, also spell it EPIC. Wonder what they think EPIC stands for?” Maybe they’re just shouting the name because they’re so excited about the money they’ll rake in if they can just find some consultants.

From Tango Charlie: “Re: Epic. Duke will announce next week and Wake Forest is suppose to go Judy, too.” Unverified. Duke is going with at least Epic ambulatory, it seems (and as history has shown, hospitals don’t often stop there). Wake Forest (above) was on the list of hospitals attending Epic training for unnamed modules a couple of weeks ago that a reader sent my way.  

Nearly two-thirds of respondents like the idea of biometrically verifying the identity of those claiming Medicare and Medicaid healthcare benefits. New poll to your right: how is the federal government doing against Medicare / Medicaid fraud?

My Time Capsule editorial from 2006: RHIOS Are Taking Away Resources From Better Projects. A snip: “Do you like insurance companies enough to let them control patient information?”

Three free press release tips for you PR and vendor types: (1) always put out press releases in PDF format rather than .DOC, for about a thousand reasons that I hope I don’t have to explain to people who supposedly are experts at media; (b) never put a press release out on a national wire service but not simultaneously on the company’s own site – isn’t that kind of the point? and (c) if you’re going to mention a hospital, include the city and state it’s in. I could add dozens more, but these came up today.

Above is the latest history (is that an oxymoron?) from Vince Ciotti.

Shares in for-profit hospital operator Community Health Systems drop 14% in after-hours trading Friday after the company announces it has been subpoenaed by HHS in conjunction with an investigation of its Medicare and Medicaid billing. Rival Tenet Healthcare, which in December rejected an acquisition offer by CHS, accused CHS of billing fraud in a lawsuit it filed against CHS. HHS wants to review CHS’s ED practices and the algorithms in its Pro-MED ED physician documentation software, which may test that company’s claim that it “Meets and exceeds all CMS Physician Evaluation and Management Documentation Guidelines, ‘maximizing’ reimbursement” depending on how CHS set it up.

CMS is threatening to stop payments to University of Chicago Medical Center after finding that conditions there pose an immediate threat to patient safety. A prominent patient died after a medical error involving a dialysis catheter-caused embolism. Not to be cynical, but oversight organizations react a lot more forcefully when patient harm involves someone wealthy, famous, or the subject of splashy media stories. I’ve worked in hospitals involved in high-profile medical error cases and it was obvious that organizations such as Joint Commission, state hospital inspectors, and HHS don’t like having the hospitals they oversee embarrass them in the press, so their reaction is sometimes overly hostile and critical. I would question the effectiveness of any watchdog group that pronounces conditions dire only after they read about them in the newspaper.

A Rhode Island physician will be in line Monday morning when CMS opens the virtual doors for Phase 1 of the Medicare ARRA incentives. Douglas Foreman DO, a family practice physician who uses the Ingenix CareTracker EHR and its Meaningful Use dashboard, says he has met the 15 Core requirements and seven of the 10 Menu Set items (of which five are required to qualify for the incentives).

UCSF says it’s turning on Epic outpatient, with a price tag of $160 million vs. the originally estimated $60 million due to an expansion of the project’s scope (there’s more to the story I can’t see since I don’t subscribe to the San Francisco business paper).

My new favorite iPad app: the just-released Bing search (the irony of a Google-competing Microsoft app written exclusively for an Apple device duly noted). Not only is it stunning to look at, you touch the microphone icon and can immediately speak your search terms with good accuracy.

The Florid-based developer of the Electronic Medical Assistant software for dermatologists gets a $4 million investment from the British company that owns the Speedo swimsuit product line. Modernizing Medicine was founded by a dermatologist and the co-founder of the Blackboard online learning system used by colleges. The EMA software costs $6,000 upfront and $650 per month. One of its users says he can create 30 notes in 25 minutes.

The military’s TRICARE system team announces that its Blue Button functionality has been expanded to allow users to download include lab results, patient history, and visit history.

A post on Geek.com nominates this as one of the most inopportune times for a Windows update. It’s a picture of a woman’s hospital monitor during labor taken by the dad-to-be, a computer science professor. Perhaps the hospital’s biomed folks should take a look at the device since enabling automatic Windows updates on an FDA-regulated system doesn’t seem like a good idea.

Michael Kirsch, MD, is a pretty funny writer (he even looks a tiny bit like Jeff Foxworthy). His list of Apps I Want includes: “Medical Coding App. This turns your iPhone into a high voltage device, similar to the Invisible Fences that are used to restrain pets to a given area. Tap the App and then place the iPhone in your front pocket. After seeing a patient, if you code higher than you should on your EMR, you will get a light shock. The intensity will increase until you have expressed remorse, atoned and coded properly. I expect that Medicare will provide incentives for using this technology in the coming years.” 

A $5 million malpractice judgment against a Canadian hospital is thrown out when the hospital’s lawyers notice that 321 of the 368 paragraphs of the Supreme Court justice’s ruling were copied directly from the closing arguments of the plaintiff’s attorney. There appears to be some legal debate as to whether the judge crossed some unspecified line or whether that simply means the plaintiff’s legal team did the job they’re paid to do – create sound, well-referenced arguments that, if they win, must have had significant influence on the verdict.

Bizarre: the Texas patient who received the first US face transplant obtains a restraining order and files suit against a British tabloid that insists he sold them his story rights for $2. The man, who lost his eyes in the accident that necessitated the surgery, admits that he signed a document from the company, which told him they wanted to write a human interest story to be run in a women’s magazine. The tabloid has created TV programs that include “Is This China’s Fattest Kid” and “Legless Dancer TV Hit.” Maybe the biggest question is why a face transplant warrants tabloid coverage. How big of a page-turner could it be, especially when Charlie Sheen is out there spreading his Adonis DNA?

The OR of River Park Hospital (TN) goes live on Shareable Ink after a two-week project (kickoff meeting to go-live). They plan to expand its use.

Former iSoft CEO Gary Cohen files proceedings to delay the $188 million sale of the company to CSC, saying the company is required to give his family investment group four weeks’ notice before selling it. He previously said he was considering making his own offer to buy the company.

NPR runs a fun piece criticizing ACOs that includes four ACO jokes: (a) I don’t know how to define an ACO, but I know it when I see it; (b) We have tried ACOs already — they were called HMOs; (c) The three greatest mythical creatures are the abominable snowman, the Loch Ness monster, and ACOs; and (d) the true meaning of ACO is Awesome Consulting Opportunities.

Rochester RHIO says it’s the first HIE to allow patients to upload their advance directives and healthcare proxies so they can be viewed in an emergency.

Everybody’s fighting to protect their healthcare profits, it seems. Case in point: for-profit ambulance companies are fighting with the powerful firefighter’s union over who gets to provide those ultra-expensive (and often Medicare-paid) ambulance rides when people call 911 for whatever conditions they personally deem worth spending someone else’s money on. It would be interesting to study the outcomes of ambulance-transported patients to determine how often their medical needs justified it.

In the UK, designated early adopter Pennine Care Foundation Trust pulls out of NPfIT after years of delays in adding mental health capabilities to iSoft’s Lorenzo.

E-mail Mr. H.

Time Capsule: RHIOs Are Taking Away Resources From Better Projects

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 February 2006.

RHIOs Are Taking Away Resources From Better Projects
By Mr. HIStalk

I’ll confess that I’m paying minimal attention to the RHIO craze. Everybody’s starting one, conferences are showcasing speakers who’ve done nothing more than announce theirs, and tiny grants are getting the whole industry atwitter. It’s like living the dot-com frenzy all over again, irrational exuberance and all.

I’m not against RHIOs, but they’re as annoying as CPOE was awhile back, taking resources away from projects that could provide more benefits to patients without the minefields.

I recently interviewed Denni McColm, an award-winning CIO of a 74-bed rural hospital no different than 80 percent of those out there. Oh, except that they’re 100 percent paperless and 100 percent CPOE, something virtually none of the celebrity CIOs and Taj Mahospitals have been able to accomplish. I’ll listen to her, thanks.

First, Denni believes that organizations should be banned from using the word “interoperability” until they can bring their own electronic information to the table. If your IT house isn’t in order, RHIOs don’t need you. Anything short of everyone contributing information equally will cause the whole concept to collapse like an imploded 1960s Las Vegas hotel, so paper jockeys need not apply.

Work instead on projects that will help your patients more than the begrudging swapping of routine lab reports with your cross-town competitor. Or, integrate all those systems you already have. Your admission ticket should be a checklist of what data elements you can supply electronically right now.

Second, Denni advocates a patient-centric RHIO model instead of the common payor-centric one. Do you like insurance companies enough to let them control patient information?

By patient-centered, I don’t mean personal health records. People are too irresponsible to reliably collect and store data with life and death importance. On the other hand, they could be given control over the trusted information generated by hospitals, physician practices, and other providers.

Suppose information resided in an Al Gore-type lockbox that contains everything from discrete electronic data to scanned documents fed over the Internet. Either the patient controls the key (similar to a password) or only they can initiate data delivery to a provider. If they don’t want you to see it, you won’t.

This model makes most privacy concerns go away. It avoids the largely unsolved problem of how you assign some sort of universally mandated patient identifier (aka “political suicide”) to sort out the throngs of people sharing the same name. The patient simply says, “send my data to Dr. Jones” and it’s done. They keep control and there’s no arbitrary “regional” service area beyond which lies a medical no-man’s land.

Maybe some RHIOs work this way. Like I said, I don’t follow them. And, if I can’t see a quick and obvious patient payoff, I probably won’t start following them any time soon. I’ve got plenty of challenges working on clinical system projects that will hopefully save lives right now.

HIStalk Interviews Ritu Agarwal, Director, Center for Health Information and Decision Systems

Ritu Agarwal, PhD is Professor and Robert H. Smith Dean’s Chair of Information Systems at the Smith School of Business of the University of Maryland, College Park, MD. She is also the founder and director of the Center for Health Information and Decision Systems (CHIDS), a research center within the business school.

Give me some background about yourself and about your organization.

I’m a professor of information systems at the Smith School of Business at the University of Maryland. I’m also the director of the Center for Health Information and Decision Systems. I established the Center in 2005 before health IT became trendy.

The mission of the Center is to investigate how technology can be used to transform healthcare fundamentally. We’ve been involved in doing research for the last six years or so on this topic. We work with a variety of partner organizations from the business sector, the government sector, and not-for-profits.

I saw on your Web site that you are working on a number of projects. What are the top two or three?

In our portfolio, we have a couple of projects around health information exchanges, which I think are extremely exciting and important. One is a project with the District of Columbia Regional Health Information Organization. We spent about a year doing an assessment study, which involved a wide range of data collection from different stakeholders. Based on that, we developed a generalizable model that can be used to assess any health information exchange.

We’re currently still engaged with the DC RHIO in helping them evaluate the usability of the technology and the value that it’s generating for all stakeholders. This is going to be an ongoing effort as more and more people join the collaborative and more hospitals and clinics come online.

The second project, which is just getting kicked off, is part of the Office of the National Coordinator’s Health Information Exchange Challenge Grant. We’re working with the Chesapeake Regional Information Systems for our Patients. That is the Maryland health information exchange. They’re in the process of rolling out an intervention which involves direct integration between acute care in long term facilities for exchange of continuity of care documents as well as advance directives. 

We are responsible for the research around the assessment of this particular intervention. We’re comparing how quickly the information can be transmitted, whether it’s reducing hospital readmissions and a host of other outcomes across the set of intervention hospitals compared with a pilot group of hospitals. I think both of these projects are going to provide some important insight into how health information exchanges can be used to deliver more value into the healthcare system.

We’re also working with the eHealth Initiative. They collect data from health information exchanges every year as part of their annual survey. We’re doing some econometric analysis to understand what the predictors of health information exchange sustainability and operational maturity are. We’re looking at financial break-even and looking at what specific aspects of the business model and the revenue structure help predict whether the exchange will be sustainable or not.

Are people showing interest in your findings? How would you intend those findings to be used?

Yes, absolutely. I think they have a lot of implication for how health information exchanges are going to structure their business models in the future. The grant money is going to run out — it’s not infinite. 

Clearly there are examples of health information exchanges that have managed to attain some level of sustainability. The Delaware case is one example. Vermont is another example. They have specific revenue structures and business models that provide some kind of value to all the participants that motivates them to join the exchange. Certainly this is going to be an important aspect in the future.

In terms interest in our findings, I would certainly think so. We made a presentation at HIMSS last month on the DC RHIO evaluation. There was a lot of interests in that. Several people have requested a copy of the report. We’re just in the process of working with the HIE to put out a policy brief on some of our findings around their data, and I think there will be significant interest in that as well.

Another project listed was AHRQ-funded research on EHR usability. What thoughts do you have about that in terms of EHR adoption?

I have interacted with a lot of doctors in the last five or six years around this whole notion of EHR usability. I’ve also seen so many of the products that are out there in use and my own research in the past in usability and other domains. I’ve done research around Web site usability for the retailing industry, for example.

Suffice it to say that usability is probably one of the most important factors that drives any individual’s adoption, especially when you think about how these products are going to be used. Many of them might be used while the doctor is actually interacting with the patient. The last thing you want is the workflow to be awkward or in any sense disruptive in the doctor-patient relationship or engagement.

The answer to your question, “Is usability important?” is a resounding yes. One of the things that we are doing in this project is developing a very simple usability toolkit that physicians can use in an ambulatory setting in the physician offices to figure out whether their EHR is working for them or not. If it isn’t, what specifically they might be able to do in terms of either changing their workflow or making some modifications to the EHR. 

I think it’s going to have a big impact. ONC has significant interest in looking at the usability of EHR products. That’s going to become an important criteria in their certification processes as well. It’s not just the functionality, because all these products are loaded with lots and lots of functions. They probably have a least 80 or 90% overlap in functions, but there’s a lot of variation in usability.

Usability as a condition of “do you want to buy this product” is one thing, but what about usability in the context of “are patients safe based on sound usability principles?”

Both adoption as well as safety are the two important outcomes. I’d say safety trumps adoption. Clearly if the physician is not able to interpret the information that’s coming out of the EHR, or if the EHR is awkward to use in an emergency situation when it’s absolutely imperative to get to the correct information, then the patient safety compromise is completely unacceptable.

But even if the EHR was being used more in a non-real time fashion, just simply to record data after the interaction with the patient is over — even then, usability becomes a concern. It has an implication for how much time the clinician, whether it’s a physician or nurse assistant, spends in updating and accessing information. It’s supposed to make them more effective as well as more efficient.

Are you studying anything related to using government incentives to encourage providers to adopt technology they didn’t want and how that might impact their chance of success?

One of the studies that we’ve done has been around this whole notion of physician identity and how that’s changing as a result of technological innovations and the ARRA mandates and pressure from the government and other important agencies. It is eventually in the interest of the entire system and all the stakeholders if physicians willingly adopt this technology, rather than believe that it’s being something that’s being imposed on them. There has been lots of prior research documenting misuse, ineffective use, sabotaging of this technology when individuals perceive that it’s not their volition or choice to use it. 

The important thing is in the messaging and marketing around these technologies. There has to be a very clear articulation of value to everybody who’s required to use it.

One of the things that we have not been able to do very compellingly yet, which we’re trying to do, is to be able to walk into a physician’s office and say, “Look, here are some reasons why this technology is going to make your life better. It’s going to improve your effectiveness. It’s going to help you take care of your patients better. It’s going to help you improve patient safety. It’s going to help you improve effectiveness,” 

In other words, there’s not enough evidence yet around the value of electronic health records and such technologies. But one recent study that came out of the Office of National Coordinator which was published last month in Health Affairs seems to suggest that now the evidence base has started growing. I think now we have a better story to tell.

That study had some problems, being a meta analysis written by folks who clearly had a bias. And hospitals, where employed physicians were already mandated to use electronic systems, haven’t seen the kind of numbers they hoped on raising quality or lowering cost. Is an interest of  yours proving the value of these systems?

We have a lot of interest in proving the value of these systems. As with every other research organization, we are limited by data availability. We have started on some specific granular studies around individual systems in hospital as well as physician practice settings.

For example, we did a study at Children’s National Medical Center, early findings from which were also presented at HIMSS, with a group of pediatric physicians looking at the readability of clinical documentation system and how much that improves readability over just regular handwritten notes. So you know, those are more micro-level studies. We have several of those ongoing. 

But we also have some studies at the hospital level, where we’re using some of the HIMSS data and combining that with quality measures to try and establish if there is a relationship between different types of information technology investments that the hospital makes and different measures of quality. But it’s going to take a few years before, as a community, there’s enough understanding and data for these affects to start appearing.

I should also point out very quickly that we had similar issues around information technology in general at the turn of the century. There was a very famous economist who said, “You see computers everywhere except in the productivity numbers.” It took a while before there was enough macro-level data to be able to establish that causal link. I think we’re getting there, but I’m not going to say in the next one year we’ll have the definitive answer on health IT value.

That makes it tough to sell a small physician practice since it involves a leap of faith.

Many of their concerns can be allayed with the appropriate kind of assistance and help. There is a learning curve, but they’re not horrendously difficult. Sometimes you get overwhelmed with the complexity of an EHR system, but I think there’s ways to help doctors assimilate it into their workflow.

Part of it is that there has to be a clear understanding of how both the technology and the workflow need to evolve to fit each other. What ends up happening is that the doc sees the technology and then says, “OK, here’s how I do my business. Here’s how I do my all my clinical work and administrative work.” That’s almost like a square peg in a round hole.

You’ve done some work with personal health records. What’s your feeling on where those are and where they’re going?

My own personal opinion is that this next generation of healthcare consumers that’s going to enter the system in the next decade or so … it’s almost a cliché now, it’s a very highly technologically savvy group.

I think personal health records have a big role to play in how people take the control of their own health and wellness and well-being. I personally believe that personal health records or some equivalent is going to be a significant application in the next five to seven years. The question remains is, how should these applications be designed so that they have the same level of exponential growth in adoption as in something like a Facebook?

Has anybody studied what it would take to motivate consumers to use personal health records? They don’t seem very interested.

One of the ARHQ-funded projects that we’re currently working on is learning best practices and principles from the design of other consumer products that can be applied to health IT. We’ve identified 24 highly successful products in other domains. We’ve been examining their development methods and processes that have been used in their construction, their fee, what are some principles and best practices that could applied to consumer health IT as well.

I’m also currently involved in a project with the Air Force medical system and personal health record to users at one of the major Air Force bases, 40,000 users. What they’re discovering in the early stages of the research is that the consumers love it. They love it, they are delighted with the idea that have access to their personal information, that they can update their medications and allergies and everything else. That product is slowly being extended with different kinds of devices to help them monitor their blood pressure if they are hypertensive and various other services depending on their disease condition. I see a growth in personal health record type of technology — consumer health IT in general.

If you could work on any healthcare IT project that would have wide impact on both cost and outcomes, what work would you undertake?

I think I would love to study the comparative effectiveness of health IT interventions. There are resources and funding for that available, but I think a better understanding of how these health IT interventions are assisting people with managing their disease conditions as compared with traditional therapeutic regimens.

Let me just give you an example. We all know that social networks and social influence plays a major role in how people take care of themselves. The moment you use health information technology — or any information technology, for that matter — to connect up people in social networks, suddenly you have the exponential effect of a lot more influence on the focal person. It would be fascinating to study how those types of interactions, social interactions, coupled with health IT stack up in terms of critical effectiveness and cost of care, as compared with just traditional therapeutic regimens of, “Take this prescription for 20 days.”

A lot of interesting work and has been coming out of Kaiser since they have the captive audience of users. I would think that’s a pretty rich mine of data to look at if you could get at it.

Absolutely, yes, that is an amazing repository they have. We’ve had some conversations with Kaiser in this regard, but we’re not quite there yet in having access to the data.

Do you have any concluding thoughts?

I’m quite a passionate believer in the importance of health information technology interventions. I think they can help healthcare achieve many of the goals that they’re all trying to achieve of being safer and more cost effective. I also think that the system has a major problem with the incentive alignment now. Health information technology can have an impact only when it’s coupled with other complimentary changes at the system level — some alignment of incentives around payment reform, some around insurance reform. That has to take place for health IT also be influential.

News 4/15/11

Top News

Healthcare IT is one big reason that private practice docs are taking down their shingles and going to work for hospitals, according to experts interviewed by The New York Times. Unlike the Hillarycare era, there’s no turning back this time since reimbursement is encouraging that kind of vertical integration. The predicted result: less competition, leading to higher prices (although Kaiser is a mentioned as a disrupter in offering cited higher quality at lower cost). The experts seem pretty sure that quality will improve (like in Mayo or Kaiser, with salaried physicians), but not so sure costs won’t go even higher.

Reader Comments

From Hypocrisy: “Re: Judy Faulkner. She was quoted as saying at an ONCHIT Policy Committee meeting, ‘What is showing up in blogs — I have seen and sometimes been told about this — is that we have to be careful of an apparent conflict of interest. That is if, in fact, the primary spokesperson for PCAST does have products that would benefit tremendously by this, do we get into — and I know we’re not supposed to judge — the uncomfortable position of an appearance of conflict of interests.’ She’s apparently talking about Microsoft’s Craig Mundie, discussed a lot on HIStalk as a PCAST committee member. Presumably she does not see a conflict of interest herself in serving on the committee.” I didn’t see the quote, but it’s interesting if accurate. Just to clarify for those who don’t follow the confusing cast of government players, Judy wasn’t actually on the PCAST committee that made recommendations to the President that pretty much had HealthVault or Google Health written all over them – the only for-profit company employees on it were Craig Mundie from Microsoft and Eric Schmidt from Google. Judy is on the HIT Policy Committee, which has for-profit members from Kindred Healthcare, WellPoint, Gastroenterology Associates (a private doctor), and Epic (Judy). I wouldn’t think she carries the level of influence over that group that some have said Craig Mundie had over the PCAST report.

From Ludacris: “Re: rogue Meaningful Use. A vendor is e-mailing consultants offering a ‘private label’ EHR they can sell under their own name for a split of the revenue.” The company’s address appears to be a mail drop and the principals aren’t listed, although I found the CEO’s name elsewhere. The vendor’s Version 1.0 product is certified as a Complete EHR Ambulatory and the offer claims companies that want to private label it get their own name on the list of certified products. I suppose ONC didn’t address that issue – where the same product could be sold by multiple vendors under multiple names, each rightfully claiming to be offering a certified product. Certification was intended to reduce buyer risk, not buyer confusion, and some would argue that it has accomplished neither.

From Dingin: “Re: Epic. You mentioned Oakwood and Singing River. Both were at a recent class in Verona, along with others you probably already knew about: Nebraska Medical Center, Providence Anchorage, Contra Costa, Norton, MUSC, Wake Forest Baptist, University of Cincinnati, and Driscoll Children’s.” I confirmed with MUSC that they’re going only with the ambulatory products, dropping McKesson Practice Partner since it doesn’t work well with MUSC’s TELUS Oacis Health Data Warehouse, but keeping Horizon Clinicals on the inpatient side.

From Lorenzo: “Re: ICA. What’s going with them? Rumors of problems.” Not so, according to our Informatics Corporation of America contact. “We have just won Wyoming Medicaid HIE through our partnership with ACS, just selected as VOC with Central IL HIE, and we are hiring as fast as we can to keep up with recent wins of Middle TN eHealth Connect and KHIN. We’ve grown by 100% since the beginning of the year and we expect to grow by another 50% by year’s end in employees. Our funding is solid through our primary owners and we are working as hard as ever to meet customer demands. Go-lives of major clients are scheduled over many of our clients in the near future. Nothing could be further from the truth.”

From HISwalk: “Re: magazine. Does anyone else think this slide show paints a ridiculously rosy picture of several vendors given their current situations?” I’m not a fan of online slideshows when a simple list would have been much easier to read, but this one’s OK (the information it contains was provided by Vince Ciotti’s firm, so I’d trust it more than if the usual sideline reporters undertook their own analysis). I would say the list contains some opinion, some analysis that’s not quite current, and focuses on revenue (which was the point) and not necessarily profit or market trends. I don’t link to other HIT sites or rags since I don’t use them as sources, but you can probably Google your way to it if you’re determined to check it out.

From FACA: “Re: ONC Policy Committee. There’s a Webcast meeting on EHR usability and accessibility on April 21 at 9 a.m. It’s a public hearing, so questions are welcome.” The agenda is here. The presenter list is interesting. For some reason, the government, like others, capitalizes Epic (Epic does not spell it EPIC).

HIStalk Announcements and Requests

This week exclusively on HIStalk Practice: PracticeWise, a new  column by practice consultant Julie McGovern (who stirs up some discussion in her first post). Reefdiver weighs in on the value of certification in the EHR selection process (readers are opinionated on that topic, too.) KLAS  extends a free offer for HIStalk Practice provider readers. AMA tells CMS what physicians find most burdensome. Dermatologists ask patients for fashion advice. Americans want their physicians to use EMRs. So far, only six states have issued MU incentive checks. In honor of Leonardo da Vinci’s 558th birthday and because it makes me happy, please sign up for the e-mail updates while you are catching up on the latest HIT ambulatory news.

On the sponsor-only job board: Clinical Project Specialist, Software/Implementation Engineer, Healthcare Implementation Project Manager. On Healthcare IT Jobs: EHR/ePM Implementation Project Administrator, Coordinator Clinical Trials.gov, Project Manager – NextGen, Software Product Development Manager.

Acquisitions, Funding, Business, and Stock

Allscripts CEO Glen Tullman earned nearly $8.5 million between June 1, 2009 and December 31, 2010. That breaks down to $4.1 million for the 12 months ending May 31 and $4.5 million for last seven months of the year.

Streamline Health Solutions reports Q4 earnings: a net loss of $1.8 million compared to a profit of $1.6 million a year ago. Revenue fell from $6.3 million to $4.9 million.

In India, Michael Dell chats with local reporters on a number of topics, including healthcare IT:

We are #1 in healthcare IT globally. We acquired a company called InSite One, the leader in cloud-based archiving of medical images. We have taken that expertise all the way back to our product groups and created new offerings. IT in the healthcare industry is siloed. The CIO can’t make them work together. We have created vendor-neutral archives by speaking to medical equipment makers. We capture all the data and store locally or in our cloud archive.

Add Medicomp Systems to the long list of EMR vendors that have been sued by Prompt Medical Systems over the years. PMS has no Web presence, so I assume its primary output is legal rather than technical. It appears to be the brainchild of Bernard Milstein MD, an ophthalmologist, UTMB professor, and founder of The Eye Clinic of Texas who patented the use of CPT codes in computer systems in 1994 (even though AMA holds the copyright to the CPT codes themselves). He appears to be backed financially in his litigation lottery by an investment banker and securities company founder. None of the previous cases made it to court from what I can tell, so I’m sure PMS is banking (no pun intended) on the EMR vendors paying them to go away rather than risk being tied up endlessly in an expensive legal action.

Sales

The US Military Health System selects Mediware’s blood transfusion management system for 68 military health sites worldwide. MHS will also deploy Mediware’s LifeTrak and InSight to track donor records and product inventories in 28 blood donor facilities.

Palomar Pomerado Health (CA) chooses GSI Health’s HIE solutions to connect PPH hospitals and affiliated physicians.

Cooper University Hospital (NJ) awards a contract to MedQuist for computer-assisted coding technology and outsourced coding services.

Girard Medical Center (KS) signs with Cerner.

Regional Medical Imaging (MI) chooses Merge Healthcare’s radiology information system, expecting to receive $600,000 from Meaningful Use incentives for its 13 radiologists. Merge says 90% of radiologists are eligible for MU money and it will pursue certification for its RIS to help them earn it.

Announcements and Implementations

Kaleida Health (NY) says it is actively adding EMR capabilities across it hospitals and clinics. Its $20 million Cerner implementation should be complete by the end of 2012.

Tift Regional Medical Center (GA) goes live with RTLS temperature monitoring and asset tracking from AeroScout.

athenahealth creates a “burn unit” to handle physician practices that have been burned by old EMR systems and are looking for new solutions. CEO Jonathan Bush says about 35% of his company’s new EMR clients are replacing old EMRs.

ODIN announces EasySpecimen, an RFID-based pathology specimen management system, licensing the technology from Mayo Clinic.

England’s Department if Health announces completion a project to move all prisons to a single electronic medical records system, allowing them to transfer records when inmates are moved. The article takes jabs at NPfIT, saying the prison system has more detailed information than NPfIT’s Summary Care Record.

Government and Politics

CMS’s healthcare fraud enforcer (a pediatrician and lawyer) says he’s going to crack down on criminals, many of them working out of South Florida, who are scamming Medicare and Medicaid for up a quarter trillion dollars per year. Much of his arsenal involves smarter payment software that can detect fraud more quickly, needed since the fraudsters are using electronic billing systems to commit their crimes. Says one expert, “The crooks know now that these computerized payment systems are their best friend. They will study carefully the art of billing correctly, they will produce electronic transactions that are perfect on their face, but it’s just a pack of lies.” An irony: Florida Governor Rick Scott was CEO of the company (Columbia HCA) that admitted to extensive Medicare fraud, costing the company $2 billion to settle.

ONC’s got some job openings for a program manager and three policy analysts.

Innovation and Research

CalPERS claims its integrated healthcare pilot saved $15.5 million between January and October 2010. Pilot participants include Blue Shield of California HMO, Catholic Healthcare West, and Hill Physicians Medical Group. The organizations’ combined efforts led to a 17% reduction in patient readmissions, a half-day reduction in the average LOS, and a 50% drop in stays of 20 days and longer.

West Wireless Health Institute awards its $10,000 developers’ challenge prize to a skin cancer detection app. The physician developer, who is a veteran and a melanoma survivor, created the iPhone app for his own self-examination.

Other

CIOs say their organizations will qualify for Meaningful Use incentives, but not as early as they predicted a few months ago. In an August 2010 CHIME survey, 28% of responding CIOs predicted qualifying for funds by April 1 compared to 7.5% of CIOs participating in a survey last month. About 32% of the CIOs expect to qualify by September 30, 2011 and an additional 58% anticipate Stage 1 qualification by the end of the 2013 fiscal year. Only 26% of community hospital CIOs believe they will qualify for stimulus funds by September 30, 2011.

Strange: a “stunning blonde” in her 20s, bidding over the Internet, buys more than $50,000 worth of items ranging from a stuffed owl to furniture at an auction in England. The auctioneer called her to arrangement payment, only to have the telephone answered by a doctor, not surprising since she’s a hospital inpatient committed under the Mental Health Act. Her credit checked out, but the hospital won’t let her pay, so the auctioneer says he’ll sue the hospital.

Umass Memorial Healthcare pulls 10 employee kiosks out of service when they discover that anyone walking up to the kiosk could view pay stub information from the previous user. The IT people changed the software and removed bank account information, then put the kiosks back out.

Associated Press gets punked: a couple of anti-corporate troublemakers float a phony press release with GE’s name on it, saying the corporation will donate its $3.2 billion tax refund to the US Treasury since the American public is upset at learning that GE paid no taxes on $14 billion in profit. AP ran the story without doing anything more than clicking on the link to the convincing-looking but phony Web site, only to pull their news item down less than an hour later.

A reader sent this in for Inga and her shoe-loving followers.

Sponsor Updates

• Advanced Endoscopy & Surgical Center (NJ) contracts with Wolters Kluwer Health for its ProVation MD procedure documentation and coding software.
• Design Clinicals and the AHA are hosting a Web demo April 21 entitled Electronic Medication Reconciliation: Achieving Stage 1 Meaningful Use and Full Compliance Joint Commission Standards with MedsTracker. 
• Concerro creates a cute video that compares workforce management tools to paper-based systems, à la the Mac versus PC commercials.
• eClinicalWorks announces that 2,000 practices have successfully upgraded to Version 9, eCW’s ONC-ATCB  certified MU version.
• Access announces a new version of its e-Signature solution to help providers create paperless registration and bedsid consent processes.

EPtalk by Dr. Jayne

This week marks the 150th anniversary of the start of the American Civil War. What does that have to do with healthcare IT, you ask? Maybe more than you think.

I was listening to NPR when Adam Goodheart, author of 1861: The Civil War Awakening, was interviewed. Charleston, South Carolina (which I’d love to visit if the right invitation presents itself) was the scene. Miscalculations on both sides about who would flinch first ultimately pushed events past the point of no return.

Towards the end of the interview, Terry Gross asks, “Some states today want the right to basically be able to nullify federal legislation in their state and not obey it. For example, not to follow the new health care policy that Congress passed. Do you see that as like a contemporary expression of similar divisions dating back to the Civil War?”

This was just a tiny part of the interview, but it really struck me about how divisive things are in health care politics right now. I certainly don’t think we’re on the brink of Civil War, but we are a house divided.

Acceptance of recent federal legislation is love/hate. There’s confusion on whether Meaningful Use will be repealed, revamped, or replaced. For the first time, I recently heard physicians (who had previously stalled on implementing an ambulatory EHR because they weren’t sure the Meaningful Use final rule was ever going to be final) state that they were holding off on going paperless because they feel healthcare reform (and the accompanying MU legislation) will be repealed.

I think many people agree that this train has somewhat left the station. There’s no guarantee that it might not stop somewhere along the tracks, but it already has pretty good momentum. (Anyone seen the movie Unstoppable with Denzel Washington? Watched it recently — a good diversion from reading yet another stack of documents about forming an Accountable Care Organization.)

It will be interesting to see how quickly challenges (to not only federal, but various state legislation) make it to the United States Supreme Court. Given the current makeup of the Court, I wouldn’t lay odds on any outcomes just yet.

Most large healthcare organizations that depend on Medicare payments aren’t willing to take chances or play the game of wait and see. They need to implement certified systems now and demonstrate Meaningful Use so that they can not only receive incentive payments, but prevent the stick that will ultimately follow the carrot. Whether incentive legislation will be repealed or only partially implemented, we don’t know, but I’m pretty sure the Centers for Medicare and Medicaid Services won’t forget the idea of cutting reimbursements by using lack of technology as an excuse (at least not any time soon).

A lot of people are excited about the billions of dollars flowing into the health IT industry. I envision industry lobbying that will rival Big Pharma in intensity and scope if the effort to repeal recent legislation gains any serious traction. There are plenty of consultants waiting to deal with the things that happen when physicians and hospitals select and implement hastily, not to mention vendors that will be poised to sell replacement systems as the industry consolidates.

There you have it. If you’re ever confronted with an SAT-style question asking for a modern-day analogy to the Civil War, please feel to plagiarize, no citation needed. And if you can recommend a conference that will give me an excuse to visit South Carolina, let me know.

Contacts

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

Readers Write 4/13/11

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

Thoughts on the Department of Defense/VA
By Arturo

Back in the 1980s, Congress, responding to the clamor for greater productivity and using the private sector should the private sector be more efficient (hence leading to such things as outsourced waste pickup and selling of municipal-owned utilities), mandated a competition for selection of the information system to be used by the VA.  And so there was a competition involving EDS, McDonnell Douglas, SMS, and the VA (if I recall properly). 

At that time, the VA VistA system was, in many respects, kludgy, somewhat proprietary (after all, what OS or application isn’t somewhat proprietary in one way or the other for the general population?), had a user interface not particularly friendly to many end users, and quite disjointed. 

By disjointed, I mean that various modules were written at different locations, sometimes with different standards and feels, and that was simply not a standard or uniform implementation of the system throughout the system. There was no such thing as a general release of the system.

The competition ended up with the selection of the VA system.  Now, I’ll never really know if it was the right decision, but I suspect that it really wasn’t. 

Shift forward a couple more years and we had another competition for the Department of Defense TRIMIS system – CHCS (Composite Health Care System). The selection didn’t compare apples to apples in the beta implementations (a single site installed by each competing vendors). The winner in this one was SAIC, which had used the VA system as its basis.

The SAIC bid for the five-year deployment came out about a half billion dollars lower than its nearest competitor. Interestingly enough, SAIC required another $500KK to complete its implementation and the DoD had a system that really wasn’t ready for the future — a database that wasn’t SQL compliant, a more or less command-driven system (MUMPS at work) that wasn’t ready to meet the demanding needs of clinicians, etc.

Eventually, sometime in the first half of the 1990s, as I recall, there was a DoD RFP for a clinical workstation.  I believe that this ultimately led to the 3M proposal for a clinical workstation and clinical data repository which was to become the foundation for DoD’s computer-based patient record system. (3M continues to support the DoD repository – a good thing, I suspect.)

Then came CHCSII.  Now I guess that it’s AHLTA.

And throughout all of this, we just don’t have a tight linking of DoD and VA EHRs.

Now we could talk about some of the inflexibility of VistA, its inability to provide workflows and screens tightly linked with different disciplines, the need for a more robust database manager, or the fact that VistA (and the VA) just didn’t know how to deal with female veterans. Or why the VA delivery system was perceived as being substandard for so long before emerging as a leader in preventative healthcare (although why did we have the disaster with veterans returning from Iraq not so long ago?)

Is it time to use a commercial product for the DoD and VA? Or should the DoD and the VA have taken the lead long ago in providing a robust EHR for deployment throughout our healthcare delivery system? Or if VistA was so good, why didn’t more provider organizations deploy it sooner? 

Something for thought. And, Epic, despite all of its success — is it really the right product or is it really any better?

Filling in the Holes in Your EMR/EHR
By Tim Elliott

With all the hype about electronic medical/health records (EMRs/EHRs) and pressure from internal folks (everyone from the executive team to various committees), hospitals often rush into their EMR projects without seeing holes between their systems, people, and departments. These typically get filled in later, often with inefficient manual processes. This approach reduces the productivity gains delivered by the EMR and frustrates the IT/IS team, clinicians, and administrative staff members who thought they’d be leaving paper pushing behind.

It’s a good idea to get people from each department that’ll be using the EMR to analyze the potential gaps in their areas well before vendors come on site instead of waiting to find and address these gaps later. Involving experts from outside your organization in the process is often beneficial, because they have the objectivity that it can be difficult to get when you’re running through processes you’re involved in. They’re also not going to be worried about hurting anyone’s feelings, which can be a concern when analyzing your colleagues’ daily tasks.

If you didn’t do this before going live with your EMR, it’s not too late. A good place to start a post-deployment review is to ask yourself and your team the same questions that you posed during project planning. By getting feedback from multiple departments (patient registration, HIM, clinical areas, etc), you’ll figure out how the EMR system is working well in some ways, and how can it can do better in others.

Again, consider why you’re doing what you’re doing. What are your goals for people, processes, and systems? How do these impact your overall initiatives, such as patient safety and disaster planning?

Don’t accept a process that isn’t working just because of a vendor’s limitations. If something’s not working right, call them and tell them exactly what the challenge is and what you need to achieve. Chances are they’ve heard a similar question before and will get right on it. Maybe you need a custom workaround, additional functionality in a newer release you didn’t know about, or a couple of extra training sessions for your staff.

We vendors spend lots of dollars on building products that solve problems. It pains us to see customers not using all of the tools we created to make their facility run smoother. Maybe you don’t want all of it, but if you need additional functionality, please ask. If your vendor is worth their salt, they have it, can build it, or will include it in a future release if several facilities share that same challenge.

We want to help you to cut your costs, enable your staff do their jobs better, and improve your patients’ care and safety. Often, the first step is you picking up the phone.

Tim Elliott is founder and CEO of Access.

News 4/13/11

Top News

  UnitedHealth Group unites its health services businesses under the Optum brand and renames Ingenix to OptumInsight. In addition, Prescription Solutions becomes OptumRx. UnitedHealth says the brand unification makes it easier for the market to understand the company’s full capabilities and helps align market engagements. I say the name change makes it easier for me to be confused and I’ll need awhile to align the name in my head. Mike Mikan will serve as CEO of the Optum group, while the CEOs of each company will remain the same.

HHS launches a $1 billion patient safety initiative aimed at making hospital care safer, more reliable, and less costly. The Partnership for Patients is a public-private collaborative and will work to decrease hospital-acquired infections 40% and reduce hospital readmissions 20% by the end of 2013. If successful, HHS predicts $50 billion in Medicare savings over the next ten years.

Reader Comments

  From P. Cockroft-Gault: “Re: open source biology. Love this guy’s drive and motivation.” Stephen Friend, MD, PhD, a former Merck SVP of cancer research, quits his job to start a non-profit to turn genomic analysis into a “wisdom of the crowds” type project, putting more intellectual horsepower behind unlocking genetic secrets and making the results non-commercial. “Our hallowed academic institutions have become factories for people who are trying to keep their own employment, their tenure … the whole reward structure keeps people from sharing the data that makes that connection …We’ll make it or not depending on whether our community of interest goes viral,” he says. In the TEDx talk above, he says the era of defining a disease by its symptoms is over since much more information is available at the molecular level.

From Veronica: “Re: Epic. Judy’s making noise in Wisconsin.” An article says the Greater Wisconsin Committee PAC is funded by children of George Soros, labor unions, and “Madison liberals who don’t unionize their own companies” (that would be Judy).

From Harold: “Re: John Caswell. I thought it would be nice if you mentioned his passing. He was with Compucare/QuadraMed for more than 28 years and will be missed by many in the industry.” Sorry it took so long to get this up, but I was waiting on confirmation from QuadraMed since I found nothing online. John David Caswell, 53, died on April 1, 2011. Details, guest book, and memorial contribution information can be found on the funeral home’s site. They did a nice job on his tribute video, set to Steppenwolf’s Born to be Wild. Condolences.

From Ling Cod: “Re: Black Swan moment. That book suggests that humans are wired to explain complex, chaotic events with simple theories that make them sound plausible even though they don’t predict anything (like reasons that stock markets crash). I challenge your readers to think about the Black Swan moments that may affect the alleged rapid adoption of EHRs and the possibility that, within a couple of years, providers will find the compliance wasn’t worth the aggravation. Possibilities: (a) some or all of the stimulus could be revoked, or (b) CMS may make EHR adoption mandatory with no further incentives if you want Medicare / Medicaid money.” The gauntlet has been thrown down. Feel free to add your thoughtful comments or submit something to me directly. The Black Swan reference, by the way, is the title of a book taken from the fact that experts had all kinds of convincing reasons that swans are always white (chief one being that they’d never seen a black one), which sounded great until a black swan was found.

HIStalk Announcements and Requests 

Listening: Royal Hunt, a Danish progressive band. Hits the spot in a Dream Theater kind of way.

Bored? Feeling as though the whole world is a tux and you’re a pair of brown shoes? My suggestions: (a) put your e-mail address in the Subscribe to Updates box to your right and feel immediately spiritually connected to the 7,288 folks who get my spam-free e-mail updates the instant I write something new; (b) do all those friendy / likey / connecty things on Facebook and LinkedIn, which will let you ride the vast social network that Inga, Dr. Jayne, and I enjoy (not really since we’re anonymous, but we get some superficial satisfaction as long as we don’t think too much about it); (c) send me news and rumors suitable for mongering; (d) peruse the sponsor ads to your left or their links to your lower right and investigate their offerings while feigning deep interest; and (e) use your considerable interpersonal influence to send new readers my way by telling people how the information you regularly glean from HIStalk has made you wealthy, self-actualized, and simply irresistible. Thanks for reading.

Acquisitions, Funding, Business, and Stock

EMR/PM provider ClearPractice forms a strategic partnership with Prognosis Health Information Systems. The companies are collaborating to offer an integrated SaaS-based EMR solution for rural and community hospitals and their affiliated physicians.

A quote from the CEO of Aetna provides some insight into the company’s $500 million acquisition of Medicity:

We recently bought Medicity, a health information exchange (company). We’re using that as a platform to create a data exchange. We will shift risk (financial responsibility for medical costs) to the provider system. We’ll provide them cover with capital as re-insurers. We will be the Intel-inside, if you will. We have dozens of these conversations going on with major systems. We spend $400 million a year on new developments: We are as much a health information technology company as an insurer.

Sales

The VA selects Authentidate Holding Corp.’s Electronic House Call solution as part of its home telehealth program.

The 49-bed Seymour Hospital (TX) purchases ChartAccess EHR from Prognosis.

Oakwood Healthcare (MI) signs a $60 million Epic deal, at least from what I can tell from the half-sentence teaser that Crain’s Detroit Business allows non-subscribers to read.

Methodist Dallas Medical Center chooses RemedyMD for its joint registry.

People

The Indiana HIE hires James S. Hill as VP of sales, tasked with managing sales operations, including market competitiveness, pricing, and strategy. I have to admit I was surprised the HIE world has matured enough to warrant a VP of sales.

Resurrection Health Care (IL) names Bradley Howard, MD its first-ever CMIO to lead its Epic EMR implementation.

Kent McAllister joins fellow Sage Healthcare alum Lindy Benton at Medical Electronic Attachment / National Electronic Attachment (MEA/NEA). McAllister, a former VP of client solutions for Sage, is MEA/NEA’s new CIO. Benton is Sage’s former COO and now serves as MEA/NEA’s CEO.

Healthcare analytics vendor Sg2 names Steve Lefar as president. He previously founded compliance and risk management software vendor MediRegs (acquired by Wolters Kluwer in 2007) and was an Allscripts SVP before that.

Capella Healthcare (TN) names Alan Smith as VP/CIO. He was formerly with Vanguard Health Systems and Cerner.

Announcements and Implementations

El Centro Regional Medical Center (CA) implements eMix for the secure transmission of radiology images and patient reports.

Dell launches a mobile clinical computing solution for Meditech. The product leverages technology from VMware and Imprivata’s OneSign SSO technology.

Here’s what happens when you let HITECH drive your IT projects instead of common sense. Carthage Area Hospital (NY) replaces its Meditech system with CPSI, saying it had to “move quickly to ensure we would receive the $2.8 million in stimulus funding.” So quickly, in fact, that they didn’t have time to train staff or work out billing kinks, resulting in a flood of complaint calls from patients. They say they’ll get everything fixed within a few months.

Government and Politics

The Foundation for the National Institutes of Health brings in HIMSS to help it run the mHealth Summit conference, the third of which takes place in Washington, DC in December. I have mixed feelings about that. I went to the last one and while it wasn’t nearly as fun as the HIMSS conference, it was refreshingly wonky and geeky, with mostly academics and non-profit developers sharing ideas with barely a break between sessions and a small, low-key exhibit hall. I’m sure the HIMSS involvement will bring the glitz, vendors who will dominate the entire conference, and the booth babes. I may go since I haven’t been to anything this year other than HIMSS and I like to get out of the house on occasion.

A proposed but floundering bill in Florida would require insurance companies to cover telemedicine services.

Innovation and Research

HCA Johnston-Willis Hospital (VA) wins a patient care innovation award for its Cancer Survivorship Program, which includes specialized software developed with Varian Medical Systems to generate care plans, schedule visits, and create a comprehensive summary based on evidence-based care. Above is their quite nicely done Pink Glove Dance.

Technology

 

Nashville Medical News profiles Shareable Ink, which moved its headquarters from Massachusetts to Tennessee a few months ago. Shareable Ink President and CEO Stephen Hau provided this comment on the local tech talent pool:

We’ve built an impressive team in Nashville with top-notch, local talent. On the technology front, there are strong candidates in Nashville, but they are few and far between. While I’m not worried about finding the next five strong engineers, sourcing the next 50 will be a challenge.

Other

In honor of National Volunteer Week, 15,000 McKesson employees will build 28,000 care packages for deployed military in Iraq, Afghanistan, and other regions. The initiative is in affiliation with Operation Gratitude and is part of McKesson’s annual Community Days corporate volunteer program.

Singing River Health System (MS) seeks to borrow $37.5 million to upgrade its EMR. Jackson County supervisors are considering issuing a bond to finance the purchase.

Occasionally readers will forward me photos or links of interest. I enjoy most of the items, especially since I work out of my house and some days those e-mails are my only link with the “real” world. Quite often the submissions have little to do with HIT, but serve to assure me that I am not the only one who reads the stuff I write.  Thus, thank you to the thoughtful HIT traveler who enjoyed this bottle of wine and thought of me. Good to know I am not the only one who believes shoes and wine are two of man’s best creations.

Here’s the latest installment of Vince Ciotti’s HIStory.

Fortune’s list of “ridiculous job interview questions” includes one from Epic: “You have a bouquet of flowers. All but two are roses, all but two are daisies, and all but two are tulips. How many flowers do you have?” Pretty easy, and not as ridiculous as my favorite ones, from Intel (“Explain quantum electrodynamics in two minutes, starting now”) and Capital One (“Using a scale of 1 to 10, rate yourself on how weird you are.”)

Sponsor Updates by DigitalBeanCounter

• Consulting magazine names Aspen Advisors one of “Seven to Watch” in 2011 and beyond. Mr. H interviewed Aspen’s founder and managing principal Dan Herman earlier this year.
• Clairvia adds Care Value Analytics, a new tool that aligns data from individual patient experiences with an organization’s clinical and financial objectives.
• Capario partners with Data Media Associates to offer customers customized patient statements, statement mailing, and a  payment portal.
• Hawaii’s Public Safety Department selects eClinicalWorks for its EMR at its seven correctional facilities.
• Bridgehead Software will provide data backup and protection solutions for The London Clinic.
• MD-IT merges with MDnetwork.
• Brad Swenson, VP and national healthcare leader for Winthrop Resources Corporation, is participating in the American Bar Association’s Spring Meeting this week in Boston. He’ll serve on a health law roundtable.
• PatientKeeper releases a white paper entitled Toward Meaningful Usability: Five Keys to Creating Physician-Centric CPOE.

Contacts

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

Curbside Consult with Dr. Jayne 4/11/11

There’s been lots of buzz this week about the Care Connectivity Consortium. This initiative by Geisinger Health System, Kaiser Permanente, Mayo Clinic, Intermountain Healthcare, and Group Health Cooperative has been noted everywhere from The New York Times to Yahoo and MSN.

I can’t wait to see how this collaboration unfolds. Those of us who have spent the last several years knee-deep in Health Information Exchange know how difficult it can be to actually make this happen.

I’m interested in seeing details on the pre-work: consent, governance, and ownership. It’s challenging enough to get a productive HIE live that meets the legal hurdles of a single state, let alone meeting those of a disparate group covering Pennsylvania, California, Minnesota, Utah, and Washington (which just represent the headquarters states, not all the states where care is delivered, which will also have to be addressed).

The warm and fuzzy scenario presented in The New York Times piece: “A person walks into a clinic in Phoenix, say, and, with permission, her records from her hometown physician’s office in San Francisco are efficiently summoned with a mouse-click.” If only it were that easy!

Having been involved with attempts to jumpstart a regional HIE, I know that wading through the legalese for the patient consent and trying to fit it on a single page reminded me of the scene in the cult classic The Princess Bride, where the bad guy has a machine that sucks years of your life away.

The consent language for many data exchange projects can be nearly unintelligible for the lay person. I suspect the forms will become “just another form” that patients shuffle through and sign if they want to receive care, whether they understand it or not.

(Kind of like the paperwork in the Emergency Department – do they think patients actually read that? I don’t think so. They sign it because they are sick, hurting, and in need of care. When you just want to see your doctor, you don’t care about the HIPAA Notice of Privacy Practices, Patient Financial Responsibility statement, or anything else other than being treated.)

I’d like to see the details of how they’re going to do this. I’m sure it will be more than the proverbial single click – like documenting the patient’s consent or opt-in status, validating patient identifiers, etc. And once you have the patient identified, how useful will it be? I hope the Consortium goes “all in” with this and uses fully discrete data that can be exchanged and consumed by receiving physicians’ EHRs, not just another view vault application that’s the electronic equivalent of asking physicians to review paper documents from multiple institutions.

I applaud the groups’ ability to work out shared goals among the CEOs before it became too public. Kaiser’s CEO George Halvorson is quoted as saying, “The CEOs had to make sure the CIOs didn’t think this was crazy or impossible.” Probably a good idea, as this may have been a non-starter if too many people were at the table before the basics were agreed upon or if the CIOs opposed it.

But now that the basic agreement is done, what about the CMIOs and the actually physicians and caregivers who will have to use the system on a daily basis? I hope their input will be considered starting immediately, if this has not already happened.

How real-time will it really be? How are they going to handle corrections and errors? What about monitoring and maintenance of potential duplicate patients? Sensitive information, such as drug use, HIV status, sexual history, and the like? Patients who change their opt-in/opt-out status to avoid sharing certain information?

The devil will definitely be in the details. The answers to these questions, coupled with ease of use, will determine the success of this initiative (assuming the technical piece can be carried out in a timely and fiscally responsible way).

The New York Times pointed out that the groups also have insurance products. Collaboration could be seen as an attempt to compete with the lines of UnitedHealth, Aetna, and Wellpoint. Halvorson is quoted as saying, “This is totally focused on care.”

I really want this to work and be successful in a big way. This could pave the way for many other collaborative efforts that could be game-changers for the physicians in the trenches. The groups intend to exchange some data by the end of this year, so it should be fun to watch.

If any of the CMIOs from the Consortium organizations are HIStalk readers, I’d love to chat with you about the gory/geeky details of the project (preferably over a glass of wine and some chorizo fondue, but I’ll settle for Skype). Drop me a note if you’re interested in chatting.

E-mail Dr. Jayne.

Monday Morning Update 4/11/11

From Man on the Street: “Re: Association for Clinical Documentation Improvement Specialists conference in Orlando. They expected 575 attendees for their fourth conference and actual attendance was 660. An overwhelming majority of attendees are either on Epic or say they’re moving to Epic.” MOTS included some photos, which I always like.

From Ogie: “Re: ISH. Acquired by PwC.” Unverified, but I’m really hating those company names. They aren’t universally recognized brands like GE or IBM, so hacking down a perfectly good and understandable name into gibberish doesn’t seem like much of an accomplishment, especially if your name (like that of ISH) results in a scattershot of unrelated Google search hits.

From EMRconsultant: “Re: acquisition. A Minnesota / Louisville-based HIS is being acquired soon.” Unverified.

From The PACS Designer: “Re: Nimbula Director. It’s a new class of cloud infrastructure and services system (IaaS) that provides a flexible and secure public cloud with advanced data center security tools.”

It’s the weekend (at the time I’m writing this, anyway) so that means less formality as I use the “old” format instead of the new one. It feels like Hawaiian Shirt Friday.

My Time Capsule editorial this week, once again from 2006: Do Technology Surveys Rate the Hammer or the House? These are fun reading for me since I wrote them so long ago it’s like reading someone else’s work.

Results of my Quick Poll on the departure of John Gomez from Allscripts: 39% of respondents said it will have little or no long-term company impact, 30% said it will have some, and 31% said it will have a lot. I’ll be running these polls when big news comes up. Poll results plus the usual reader comments will provide a quick and interesting industry reaction to events.

Congratulations to Boston, hereby officially named the Capital of Healthcare IT (as it should be, in my opinion). Perhaps I should start a drive to have it commemorated with a monument or something, maybe on the Meditech campus. New poll to your right: should Medicaid and Medicare require biometric identity verification of patients seeking healthcare services?

Kaiser CEO George Halvorson talks up the new Care Connectivity Consortium it formed with Mayo, Geisinger, Intermountain, and Group Health to share patient data. I’d say it’s more of a demonstration project than a true patient benefit since those organizations probably don’t have many patients in common. Here are some excerpts from George:

We are all using our EMRs to improve care and support the delivery of care. We are all learning how to use that wonderful new tool — and we are all interested in sharing what we are learning with the world … The problem with electronic is that when patients go to different doctors for their care, they still tend to have separate records — and that can create electronic silos instead of paper silos … So we are now committed to creating similar linkages with the new set of elite medical groups to create a process that works first for our patients and then — if we do it well — for the world … This is important work. If someone doesn’t figure out how to create links between electronic medical records, those records will not be linked. It will not be done until someone does it. Who better than us to do it? We are patient-focused and we know what can be done and we know what should be done with an EMR. Almost all other care sites are just getting their toes in the water. Some are getting their feet wet. We are swimming. So this is a good contribution for us to make. Instead of keeping our advances and our learning secret and special only to us, we are sharing what we know because we want care to be better for everyone.

By the way, I can’t find a Web site for Care Connectivity Consortium, which seems strange. I searched and careconnectivityconsortium.com is not registered, although the .org variant was grabbed by an anonymous registrant on the day of the announcement.

I ran across a copy the IRS form for HIMSS for 2008, the newest one on file so far. Steve Lieber’s total compensation: $731K (slightly out-earned by Dave Garets, who was running HIMSS Analytics at the time). I’ll have to remember to check back to see if they file a new form soon. The annual conference represented $19 million of its $41 million total revenue.

Those DoD people just can’t stop disagreeing with decisions made elsewhere, but at least they’re finally willing to make fat cat contractors rich in ways other than developing custom software. The VA announced plans to move forward with developing an open source system to be shared by both organizations, but DoD says they’ll look first at commercial software and will consider in-house development only as a last resort.

Six-campus, 305-bed Central Texas Hospital (TX) chooses inpatient EHR and revenue cycle systems from the US affiliate of Mexico-based eCareSoft, expecting to meet Meaningful Use requirements for 2011-2012. eCareSoft says small hospitals can go live on its products in 120 days.

Merge Healthcare appoints Cheryl Whitaker MD, MPH, FACP as its first chief medical officer. I assume that’s the same Cheryl Whitaker, MD who, along with her physician husband (there’s an interesting story and comments behind that link), is a close friend and advisor of the Obamas, not that there’s anything wrong with that. Merge is in Chicago, a city known mostly for dead people electing ethically challenged politicians, at least until the apotheosis of its junior Senator Obama.

The local paper in Middletown, OH runs down the status of electronic health records in local hospitals: West Chester Hospital, implementing Epic. The Fort Hamilton Hospital, implementing Epic. McCullough-Hyde Memorial Hospital, live on CPSI. Atrium Medical Center, live on Epic. Mercy Hospital Fairfield, live on Epic.

Shares in for-profit hospital operator Community Health Systems gained only 9% from 2008 to 2010, but CEO Wayne Smith’s total compensation nearly doubled in that period, rising to $21 million in 2010.

E-mail Mr. H.

Time Capsule: Do Technology Surveys Rate the Hammer or the House?

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 January 2006.

Do Technology Surveys Rate the Hammer or the House?
By Mr. HIStalk

A disclaimer: I’ve worked at three organizations that were named Most Wired. In no case did we really believe that our IT was any better than anyone else’s, but we sure bragged about our victory at every chance.

The Most Wired survey season is upon us again. Eager candidates yearn for the recognition and improved job prospects they think the award will bring. Past-winner CIOs wake up in a cold sweat after having nightmares of opening the magazine and realizing that they’ve become a Former Most Wired (e.g., loser), while their cross-town CIO competitor bags a spot on the list and waves the rag triumphantly in their face.

I’ve seen the survey encourage the same sort of rationalized fabrication usually reserved for aggressive vendors imaginatively completing RFPs. Said one of my former employees to whom I turfed off completion of the survey form, “The survey’s vague enough that it’s not really about what we’re doing, it’s about how badly you want to win.”

For others, the survey’s detailed questions invite casual answers just to get the damned thing sent off in time. Think of those annoying “qualify for a free subscription” cards that require an hour of your time just to get a worthless rag that you’ll throw out unread anyway.

As I read over the 2006 survey form, I’m encouraged that it asks some really good and meaningful questions. If they’d just spot-check some winners and expose a few frauds, I’d be behind it 100 percent. Still, it is evolving fairly well.

As I remember, the original survey measured what you have. The emphasis was on buying stuff: wireless networks and PCs, for example. The vendor sponsors of the survey aren’t exactly against that concept, and even today, the incessant message is, “Good hospitals spend a lot on IT, bad ones don’t, so which one do you want to be?”

Today’s survey is more along the lines of, “How much of the stuff that you bought gets used?” Better.

Where it hasn’t gone yet is, “Did all that stuff make you better at patient care?”

If technology is something to be admired and honored with awards, then what’s the payoff, other than getting some cool Most Wired shirts? We should see a positive correlation to improved patient outcomes, reduced costs, and a happier work force and medical staff.

Indeed, lots of glossy paper will be sacrificed after the survey trying to prove some frankly questionable premises on why “Most Wired” means “Best” (unconvincingly, if you ask me). Was information technology the cause of the improved outcomes effect, or did they simply coexist in an unrelated way?

Maybe we’re doing this wrong. The hospitals I admire are those with tiny IT departments and budgets who, nonetheless, manage to meet non-IT criteria and instead are best in patient care.

I don’t admire carpenters with cool hammers. I reserve that judgment until I see what they’ve built with them. Maybe a few of the Lesser Wired could teach us all some lessons, after which we could still buy the cool stuff if we’re really convinced it would make us better.

HIStalk Interviews Geoff Brown, CIO, Inova Health System

Geoff Brown is SVP and CIO of Inova Health System of Falls Church, VA.

We crossed paths when I asked you about Inova’s system selection, which is underway. What are the strengths and the weaknesses of the systems that you have and what you’re hoping to gain in considering alternatives?

I would probably start out by saying, as opposed to the strengths and weaknesses of it, I think we were an early adopter after Stark relaxation. We jumped in pretty early with an offering. That was back in the days where people tended to prefer to keep their current practice management solution. EMRs were being thought of a separate component, with some people having the option if they wanted to go with an integrated product. Most were more comfortable with their own scheduling and billing systems, whether they were sourcing that or they were doing it out of their practice and had relationships already going. I think that really goes back to around 2007-ish or somewhere in there.

As we went forward, we found two or three things. First of all, the model to market and drive this to the physician community was certainly a different market for us, in terms of the teams you needed in place to go and meet — not with the physician, the physician would want to have it, and that was a key starting point — but typically a lot of these smaller practices had contracted resources that might come in periodically each week. Others might have a secondary support staff that might be an extension of family or relationships. Others might have formal contracted relationships.

There was a significant amount of education that had to happen. As a result of that, over a period of a couple of years, we really learned really how to go at it and to attack that market with various offerings and solutions.

Somewhere along the middle of this, sometime midway in 2009, we didn’t see any requirements for the EMR component not to be integrated with the practice management solution. After the initial kickoff, we got clinical EMR modules moving forward, interfaced with practice management. People started realizing the benefit of, “If I’m going to do this, I need to make sure I do it with a product or a solution that would allow me to automate my workflow on the scheduling and practice management end of the loop, as well as be certified in a go-forward mode with CCHIT at the time.”

That’s really the front end piece of that. Up until we started doing work around the health reform space, you really didn’t have a real huge need to manage your integrated workflow differently. Ambulatory to EHR, the interface process could work fairly effectively for most people.

What’s really made it more important for us to have an integrated solution in place is that we have a very large physician community network. As a result, we want to make sure that we’re able to have a way to extend out the clinical workflow more effectively than we can do now.

We’ve attacking it from a couple of different spaces. I won’t say it’s a weak point, but we’ve been involved largely with HIEs that will certainly meet the CCD-32 standards around interoperability and exchanging from an interface perspective through our HIE in delivering results back and forth to the practices. That process works good, but what we discovered — and this has been a different tier of maturity for us, having jumped in a little early, at least here in our market — is that you can’t make that data actionable now. As much as everybody talks about the Continuity of Care Document and the exchange process, many other vendors weren’t really doing that at the time.

We’re just now starting to see the practices being on release versions that will support that. We’ve been just doing the push-pull type of results delivery, versus having a really smart bi-directional type of a population of clinical information that can be discrete in nature in that you could put rules around and make it actionable in other ways.

That’s really a desired state we hope to get to. I think there are two tracks to get there. You can do it through the standards that we’re all moving toward — HIE standards that have been put in place — or you could have an integrated solution. That really is what drove it for us, as opposed to vendor weaknesses and strengths in large markets. We will never have a situation, I believe, at least in northern Virginia, where there’ll be just one solution.

When you signed your deal with GE three years ago, you said that would be the only product you would directly support. What did you learn from that experience?

The GE product would be the only one we would put subsidy assistance around. It was the same platform as our inpatient product. That had the promise of further integration and interoperability progression. Had we had another hospital information system platform, that we would have wanted to stay with whoever that vendor was, simply because of the promise that as releases were released out to us from an upgrade perspective, you know they would be tackling more and more of the interoperability gaps. By definition, you would be bringing your base of EMRs forward in that vein. That’s really why we said that. 

Our story to the community has always been that if you worked with a certified EMR, we would work to provide the interfaces to our environment so that you could move to an electronic process with us. We’ve been that way from Day One, but obviously we wanted to press and have at least a certain base of physicians on what our desire tool was, because that certainly would allow us to move a larger piece of the base forward at any given time.

I saw that you just signed what sounded like a pretty big deal with Oracle for business intelligence and that your CEO was saying it will support “value-based personalized healthcare.” What does that mean and what’s the actual nuts and bolts that you’ll need to work with Oracle to make that happen?

We’re doing like many systems are doing. We’re going down a track where we think the future of medicine is your ability to use analytics to help you actually move further and further toward personalizing care, whether it’s through the improvements that are happening in the genomics environment … again, there’s a huge amount of data that you would have to process and then convert into a format that can be used as good information and can be driven by analytics teams around interpreting that information. So that’s one track. 

I think the other area that makes this an important track for us is we are a large system with many disparate applications. As a result of that, we think that there will always be a number of research databases and other applications that fall outside of our traditional transactional systems that are managed through IT. As a result of that, as you’re moving toward better standardization, better evidence-based practice, that you need to pull out … an example of that might be a process we are developing an in-house what we call Inova Broker, which allows us to take data between a disparate environment into our core hospital information system and coded allergy data.

We learned is that allergies are collected at various access points within our organization. However, we had different standards of practice around how comprehensive that was, and when changes were made, how we managed those changes through all of the other key points in our operation. There’s been rigor around how we populate things — how we actually map from one application to another so the data is normalized.

The Oracle HTB project is allowing us to build a repository that has mapped information from each of these applications. We can then write use cases to identify patterns of patients based on certain results. We give our case management folks and others a front-end look at patients we might need to manage across our system, as opposed to waiting until the end of the day and doing queries. We may be able to do some of this identification real-time up front and get a start on making sure we meet some of the quality core measures we may be emphasizing. 

As we build this infrastructure around our partnerships and around the data that we generate or exchange within our HIE framework, that will be a central hurdle for us to manage that. We hope to offer opportunities for our community physicians if they participate and follow certain policies that we hope to establish. For those that like to participate in forms of research or clinical trial work, they’ll be able to be a part of this ecosystem here.

It sounds like the projects that you’re working on are based on strategic organizational decisions at the Inova corporate level. Backing up to that, what are the main elements of Inova’s strategic plan and what IT functions get handed down to you to support them?

We’ve had a number of strategic planning sessions. As a result of that, we have mapped where we needed to be as an organization. Some of the things you see and hear us doing are around just being able to manage the flow of patients more effectively across our continuum of care. We actually were doing that well, but if you were to ask me if it was all connected in a way that would be seamless to patients, be workflow smoothly for our physicians as they’re trying to manage their patients … there are some opportunities for us to improve on the handoffs from the hospital environment out to the various ambulatory care settings that we manage, whether that be the physician practices, whether they be home health, or whether that be even some of the joint ventures partnerships we have where patients flow from one setting. 

They might not be exclusively in an Inova setting. However, the appearance and the workflow is a coordinated workflow. When they get scheduled, maybe there are multiple steps that can be eliminated in that chain if you had an accident or you needed to have an MRI done.

In some settings, you might have to schedule something unless it’s an emergency, a few days later or a week later. However, we’ll give you the ability through this network or this ecosystem to look at other options if you’re willing. We have these resources available across the continuity of care that we manage with our partners and within our organization. We can give patients and physicians options to get people being seen now or same day, same week, etc. based on the convenience factor for them.

It’s really a whole process around just making the healthcare more fluid. Making access for our patients work more effectively, and in doing so, increasing utilization in ways that we would never be able to address.

You’re on the board of Nova RHIO. How important is interoperability on what you’re trying to accomplish at Inova?

We’re doing a pilot project right now in the ED. It really is around patients when they present in the ED. We’re able to go out as they’re being triaged and check their medication list and compare it with what they’ve told us. The importance of that, based on their allergies and other information that we may or may not have or that they presented just now, is to have a much better profile on the front end.

We’re also talking about other projects in the RHIO that are geared toward getting patients online more effectively with versions of their health record. What we found is the community — folks like you and I, we’re close to it, but when you get into certain elements of the community, people have access to all types of services. But it’s very challenging for most of them to really operationalize those things. The RHIO is coming up with a series of electronic solutions that might be a service or benefit to providers, but also have an element that helps drive it in the Northern Virginia community to a point that they’re able to have their information and access it very easily and share throughout the Northern Virginia space.

At a state level, there’s a certain amount of reporting that will need to happen on a monthly basis. Virginia was one of the states with an HIE grant. What we decided to do, at least here in the state of Virginia , is that Virginia will never be an HIE of its own, but it will require any HIE that is doing business in the state to report to them on whatever the cycle will be and that they comply with certain standards and report to those standards. Virginia can then take all of those feeds and then bring them together in a way that will allow us to do one report out for the Commonwealth.

That’s the real direction that we’re headed here in Virginia. The RHIO will be one of many RHIOs. We have three that actually do work now in the state. I won’t mention them by name, but there are three organizations that have been doing some work. We think there are others that are signing folks up now as well. They can go about the business of competing and having the best programs with the providers that they’re able to sign, but we’ll record them through a single series of standards into the state.

The state will then be responsible for getting their information out as the federal reporting or electronic reporting really start to kick in. The Northern Virginia RHIO’s mission s to help the citizens here in Northern Virginia maximize their ability to receive good care and also manage whatever their requirements are.

Any final thoughts?

It’s a very challenging time. What we’ve learned in being early players with some of the commercial products is that there’s a tier process of maturity that needs to happen between a health system and its community of providers — physicians and other relationships. For instance I’ve learned that your best customer sometimes in this EMR arena is someone that has played around with having electronic solutions, regardless of what product they had. They’re much more educated the second time around the workflow requirements, the commitment to the practice, the commitment to the communication and network activities that have to be in place to make the process work effectively and efficiently.

That’s what we’re starting to see now. That informed client or customer or physician group that has been dilly-dallying in the early days of the EMRs or EHRs. Now they’re going in this second pass much more aware of the type of services they need to have in place, the type of technology support they need to have in place, and quite frankly a lot more aligned and around those individual physicians that are looking to modernize and update their practices to take advantage of these new technologies. That’s the one change that I’ve seen, and that didn’t happen overnight. That happened through levels of maturity you get with moving toward any new platform.

Mostashari Named ONC Head

Farzad Mostashari, MD, ScM has been named National Coordinator for Health Information Technology effective immediately, according to an announcement on the ONC Web site and ONC’s Twitter feed. He was Deputy National Coordinator for Programs and Policies under David Blumenthal.

Mostashari was previously with the New York City Department of Health as an assistant commissioner. He holds a medical degree from Yale and master’s in population health from Harvard.