Monday Morning Update 1/17/11

HERtalk by Inga

From: Florence Bascom “Re: Selling for Epic. A rumor I have heard about their sales team is that their sales executives are not commissioned – which in itself would make it an extremely unique model compared to other HCSW orgs.” Mr. H mentioned his desire to talk to a former Epic sales rep (anonymously of course.) Comments like the above add to the intrigue.

From: Lu Wolf “Verizon vs. AT&T. David Letterman’s take on why fewer drop calls isn’t necessarily an improvement.” Very fun. Now that Verizon officially announces wireless service for iPhones as of February 10th, a predicted 26% of iPhone owners will likely switch from AT&T over the next year. I won’t be changing carriers, primarily because I live in a region where AT&T has much wider coverage. But seriously folks: why isn’t there an option that includes easy workflow, a fast network, and no dropped calls?

The SEC settles with Reza Saleh, a Perot Systems employee accused of insider trading when Perot announced its sale to Dell last year. Saleh, a longtime friend of Ross Perot, agreed to return all the money without admitting or denying any allegations. The SEC will also ask the court to impose financial penalties which could be as high as $25.8 million.

The local paper recognizes athenahealth’s $5,000 contribution to the Waldo County YMCA (MA). athenahealth donates a portion of its profits to organizations that enrich community health; what I find particularly cool is that athenahealth allows its employees to vote for which charitable organizations receive contributions.

Nearly one-third of malpractice claims are the result of mistakes that could have been caught by a surgical checklist, according to a new study out of the Netherlands. Researchers linked the reasons for 294 lawsuits with specific items on checklists and found matches in 29% of the cases. Could this be correct: checklists have been found to save lives and now money, yet only 25% of US hospitals use them?

Sage Healthcare will participate in  a series of workshops sponsored by the Florida Medical Association. The workshops, which include 18 sessions across nine cities, will offer guidance to doctors selecting and implementing EHR systems to meet Meaningful Use requirements.

Sierra View District Hospital (CA) initiates its $13 million, four-year  Meditech EHR implementation. The hospital plans to go live on its first phase by November.

I’ve been very unsettled the last few days, after learning my zodiac symbol has changed. Could it be that I am not adventurous, energetic, enthusiastic, confident, quick witted, selfish, quick-tempered, impulsive, and  impatient, but instead, compassionate, romantic, imaginative, intuitive, selfless, secretive, weak-willed, and a compulsive workaholic? In other words, am I no longer a self-centered, life-of-the-party diva,  but instead just a nice person who works too much? Unsettling, indeed.

Coastal Connect HIE plans to go live with patient data exchange by mid-February. The alliance, which is sponsored by the Coastal Carolinas Health Alliance, includes 11 hospitals along the coast of North and South Carolina.

Catholic Health Initiatives (CO) CEO and president Kevin E. Lofton says his organization will invest $1.5 billion in EHRs and other IT systems between 2010 and 2015. Cerner systems are deployed in larger markets and Meditech in smaller facilities.

Clinical integration provider Valence Health hires Dan Iantorno as VP of information technology.

In his last post, Mr. H mentioned that he and Mrs. H were escaping for a much needed getaway. He checked in with me long enough to share this: “We’ve been here barely more than a day and we’re totally relaxed and pampered. I needed a break more than I realized.” He also added that he took my advice and is sampling the beer, which seems to compliment the gourmet grub and ease the pain of his overexposure to sunshine. Sounds perfect.

Thankfully WNA never seems to rest, sharing news of gamers who hacked into the server of a New Hampshire radiology practice. Seems the Scandinavian infiltrators were hunting for more band-width to play Call of Duty: Black Ops. Per WNA, “They never saw it coming.”

Baylor Health Care System announces its intent to register for stimulus funds and demonstrate meaningful use of EHR. Baylor CIO David Muntz says his organization has spent over $250 million implementing EHR over the least 10 years and that five of its hospitals have successfully standardized its “processes and technologies based on a certified electronic health record.”  My translation for that statement is that Baylor has fully implemented EHR (Allscripts Sunrise, I believe) in five (of 26) hospitals. The remaining facilities will continue rolling out EHR over the next two years.

E-mail Inga.

EPtalk by Dr. Jayne

I’m shamelessly pandering to Meaningful Use with EPtalk, since indeed I am an Eligible Provider. It doesn’t have the same catchy ring as HIStalk or HERtalk, though. Like many physicians, I take issue with the term “Provider” in general. If they needed a word or phrase to summarize those of us on the front lines, the least they could have done is make us “Patient Care Jedi.”

To those of you emailed your greetings and warm wishes, thank you! After several years as a HIStalk reader with the occasional comment or rumor sighting, being on the other side of the screen is a bit strange. I feel like I know you all personally. As a physician, I’m deluged with information from all kinds of sources, but other than FDA drug recall notices, HIStalk is the only one I allow to deliver to my inbox rather than routing into a folder for later. Clicking that link and finding my own writing is quite a thrill!

Several of you have asked for additional details about my background, specifically related to HIMSS, memberships, vendors, and conflicts. There seems to be a common theme about objectivity. Like my other HIStalk BFFs, being part of this team gives me the opportunity to speak candidly about the products on the market today. I have hospital privileges at multiple facilities, so my user experiences have been diverse. I’ve seen (and been forced to care for patients with) the good, the bad, the ugly, and the horrific.

In the interests of full disclosure: Like Mr. HIStalk and Inga, I’ll be attending HIMSS as a regular attendee. My “day job” employer pays for an individual HIMSS membership (as well as my specialty society, the local MGMA chapter, and the Southern Medical Association). A previous employer made me a Life Member of the AMA. Although I’m not currently on any national task forces or committees, that doesn’t mean I haven’t been in the past or might not be in the future. I do serve at the state/regional level in advocacy efforts. I’ve not been employed by any software or hardware vendor. I have never been convicted of a felony and my blood type is O positive.

Now that we have that out of the way… I saw an invite to an AMA continuing education seminar called “High-Reliability Safety: Applications to Healthcare” that’s being held on Wednesday the 19^th. More info here.  They’ll be talking about embedding a “safety management system” in the healthcare environment. Unfortunately, I’ll be attending another tres exciting Meaningful Use Committee meeting at my institution, so if any readers happen to attend, email me with the interesting tidbits.

Multiple media outlets have been talking about the CDC report on EHRs in physician offices. National Coordinator for Health Information Technology David Blumenthal featured it under the extremely optimistic headline “EHR Adoption Set to Soar.” American Medical News was a little more restrained with “Physician EMR use passes 50% as incentives outweigh resistance.” Blumenthal goes on to celebrate the 41% of office docs and 81% of hospitals planning to apply for incentives, but goes on to note that many small practices “still need to learn about the opportunity they have.”

My thoughts on it: take it with a grain of salt. There are quite a few of my peers who are blissfully ignorant about this whole issue; maybe that’s not so bad. As for the study itself, the data was gathered via a physician self-reporting mail sample. Those of us that interview patients know what happens when patients self-report health behaviors – they either double it (exercise) or reduce it (alcohol) so that there’s no way of knowing what the patient is really doing. I think there might be a little bit of creative reporting by my peers here.

The survey looked at full vs. basic systems and although the headline “Physician EMR Use Passes 50%” sounds sexy, a closer look at the numbers reveals that 25% have a “basic” system and 10% have a “fully functional” system. The data doesn’t quite capture what portion of physicians have a system with bionic capabilities installed but are only using it to do the IT equivalent of crushing beer cans. (I recently visited a physician who was using her laptop as a base to stabilize an avalanche of journals, mail, and catalogs. She owns a gold-plated system. It was a shame.) If you dig deeper into the features that allowed a system to at least meet “basic” requirements, you could meet that with a word processor and some scanning software.

Bottom line: if a patient-care study had results like this, physicians would be extremely skeptical about its conclusions.

E-mail Dr. Jayne

News 1/14/11

From Just the Fax, Ma’am: “Re: CSC’s healthcare group. From the confidential e-mail, ‘The market conditions in the overall economy have impacted our ability to build pipeline and to close on those opportunities we have been able to identify and pursue. As a result, financial performance is far below our commitments and we have been directed to improve our forecasts by reducing costs.’ The action: non-billable employees and those billable with less than 40% productivity must take 10 days of PTO or unpaid leave between January and April. IMHO – significant cause is inability to staff opportunities due to implementation consultants leaving right and left.” Unverified.

From The PACS Designer: “Re: XR-EXpress. An interesting image and data viewing software app for the iPhone called XR-EXpress has been released by New Mexico Software. You can manage cases, orders, and patient records easily and also check patient’s exam results.”

Listening: brand new rock-punk from Cage the Elephant from Bowling Green, KY. They’re barely old enough to shave, but they sound good, with some rawness that hints of the Strokes or Pixies. 

On the Jobs Page: Senior Project Manager, Director of Consulting – Healthcare IT, Allscripts V11 Implementation Consultants, Sales Representatives. On Healthcare IT Jobs: Epic Program Director, Enterprise Architect, IT Systems Analyst, HPP Functional Analyst.

Some of the nicest people you’d ever want to know are with Encore Health Resources, starting at the top with industry long-timers Ivo Nelson (chairman) and Dana Sellers (CEO). Encore sponsored the great HIStalk HIMSS reception at Max Lager’s in Atlanta last year, with Ivo, Dana, and our pal Amy getting elbow-deep in the minutiae with me to make sure you had a blast (Ivo made the executive decision to go open bar instead of drink tickets, which saved quite a few of you a small fortune on the overage). They now want to support us even more by becoming an HIStalk Platinum Sponsor, which I appreciate. Everybody knows Ivo – he founded Healthlink and sold it to IBM in 2005. I’m pretty sure EHR (get it?) is following Healthlink’s trajectory of unbelievable growth, solid reputation, and happy consultants (the company is already racking up awards for being a great place to work, so check out their job listings). Encore provides services such as strategic planning, system selection, implementation, optimization, health analytics, and project management. I interviewed Ivo a year ago when nobody (including me) had heard of Encore — he provided some surprisingly heartfelt and profound answers that are worth a re-read, which I just did. Thanks to Encore Health Resources for supporting HIStalk.

William Beaumont Hospitals (MI) expects to get $10.3 million in HITECH money.

I thought of something I’d like to write about: what it’s like selling for Epic. Surely there’s a former Epic iron-mover out there who would talk anonymously. The company claims they do no marketing and implies that their sales process is simple, but there must be more to that story given the large number of big deals they’re signing.

I’m whisking Mrs. HIStalk away for short hiatus somewhere warm and sandy this weekend (Inga’s terse but sincere directive: “Don’t drink the water. Do drink the beer.”) Inga and Dr. Jayne will be handling the Monday Morning Update so that I might travel laptop-free, although I’ll have the trusty iPod Touch for sneaking an occasional, furtive glance at e-mail.

I’ll be closing the HISsies voting in a couple of days, so if you got an e-mail link, use it soon. If you weren’t on the HIStalk e-mail subscriber list as of last Saturday, you can’t vote, sorry. Tying the poll to an e-mail address prevents the usual Internet vote fraud since only those I’ve e-mailed can vote (it worked the same way last year). I know that method excludes those who read by RSS reader or who just cruise over whenever they feel like it, but that’s the only way I could come up with to prevent companies from urging candidate-specific company voting and to hopefully block robo-voting scripts.

ONC’s David Blumenthal hits YouTube to pitch EMRs, citing survey results in hopes of eliciting the bandwagon effect among fence-sitters.

WSJ covers the growing number of patients ordering their own lab tests online, with heart-related tests being the most popular. One patient’s seemingly backward approach struck me as funny: “She says she would call her doctor if she got a worrisome test result.” Most states require a physician order, but the lab companies are hiring doctors to sign them after a quick review of the online request. Sometimes you do wonder, though: do certain tests or medical items really require a physician’s supervision for safety, or is that just a way to prop up the price?

Welcome to new HIStalk (and HIStalk Practice) Platinum Sponsor MD-IT. The Boulder, CO company is the leader in medical documentation for physician offices and clinics, offering them an alternative to “EMR interfaces that require you to become data entry clerks” in creating an using electronic clinical notes. The big picture includes the preferred form of data entry, a chart viewer, e-prescribing software, Internet access to patient records, and provider-to-provider messaging. Specific options include dictation transcribed by medical language specialists; front-end speech recognition as a standalone application or Word add-in; a Web-based platform for creating, storing, and sharing clinical notes; and several EMR options (built into its platform, interfaced to an existing EMR, or a package including the Ingenix CareTracker PM/EMR) that it says let doctors “dictate your way to Meaningful Use.” The company offers its services through a nationwide network of regional offices. Thanks to MD-IT for supporting HIStalk and HIStalk Practice.

As I’m prone to do these days, I moseyed to YouTube to see if MD-IT had anything there. Above is a demo of a doctor using its software.

HHS will open the 45-day comment period for potential Stage 2 Meaningful Use objectives next week. The proposed objectives and measures for Stages 2 and 3 are here (warning: PDF).

Randall Stephenson, AT&T chairman and CEO, tells a Brookings Institution panel that robust broadband will change the healthcare model, particularly monitoring and diagnostics. The head of Time Warner went for the funny bone in his assessment of healthcare bandwidth needs: “We’re just thinking about making more doctor shows.”

EHR users speaking at the Implementation Workgroup of the HIT Standards Committee are concerned about meeting Meaningful Use requirements, mostly involving timelines, cost of compliance, and lack of government guidance. Some I found in my skimming:

• RECS don’t have consistent standards.
• Using a computer during a visit requires doctors to develop an entirely new approach to the patient visit and the time required to document it.
• One practice couldn’t pay its owners because of the cost of an unexpected server replacement.
• A hospital system said it couldn’t get straight answers about some of the requirements, spending 15 hours per week and tens of thousands of dollars in attorney fees. They submitted 21 questions to CMS, with 10 marked as solved even though only one was answered. They submitted eight to ONC and got four answers.
• Several hospitals and practices had to develop their own reports even though they are paying the vendor for a certified product. Those reports had to be changed as CMS and ONC clarified the requirements.
• Customers are being forced to buy software they don’t need. Example: a hospital has its own integration with Google Health, but interpretation suggests they’ll have to buy the unneeded product of their vendor since it was used by the vendor to earn Complete EHR certification.
• The same hospital interprets the regs as requiring them to re-certify their own tools, such as file transfers, every time they apply an upgrade to their EHR or interface engine, with a cost of $8,000 to $10,000 each time.
• From a recent clarification, hospitals must own software that can meet all Meaningful Use requirements, even if defers those requirements for Stage 1.
• Intermountain Healthcare says they don’t think they’ll make the Stage 1 deadline in time at all hospitals, saying they have “a huge and seemingly insurmountable challenge in front of us as things stand today.” They’re not getting timely answers to their questions from ONC and CMS.
• One hospital using a certified vendor with certified quality reports says they’ve had to create their own reports anyway, which they called “an onerous, difficult and time consuming process.” They added, “It is our understanding that only one Epic customer has been able to successfully run all of the Eligible Hospital MU reports.” They’re delaying their attestation.
• One group’s pediatric practices have too few Medicaid patients to quality for incentives, so they aren’t really incented to use EHRs.
• A hospital informaticist expressed concern that too many EHRs are earning certification for Stage 1 that may not be around to move to Stages 2 and 3. He also suggested that usability should be incorporated into the certification process.
• The most entertaining comments came from James Fuzy of Mississippi Health Partners. He says EMR interfaces are too expensive and not standardized and suggests giving hospitals money to do the connectivity because they have the expertise. He doesn’t like mandatory statewide HIE participation since they would have to pay for it even though they have their own HIE. He suggests a Meaningful Use Guide for Dummies since doctors don’t know what it means and most don’t think they money will ever be paid anyway. He says that insurance companies buying HIEs is like “the fox now guarding the hen house” to use the information to direct care; he instead suggests that if insurers want patient data, make them pay the providers for it.

A Weird News Andy diversion: a hospital in what sounds like a dangerous part of Chicago has decided it will no longer accept ambulance patients, saying it can save $25 million per year and increase its outpatient business.

A self-serving Council for American Medical Innovation poll finds that 58% of respondents want the federal government to spend more on medical innovation. As Inga would say, the same percentage also like babies, puppies, and world peace. Never ask if people want something, especially if it sounds noble; the real test is to ask them to hand over the cash to pay for it.

Interesting: a woman whose Wii Fit Balance Board shows her leaning to one side gets checked out, resulting in a diagnosis of Parkinson’s disease. She said, “It’s quite amazing that a computer game was able to point out there was a problem.”

GE Healthcare’s CEO says “the US has snapped back” and it can grow profits 10% per year, although the snapping back seems to refer to increased healthcare spending, which is really not much of an accomplishment unless you like to watch a country slowly going broke.

Transcription software and services vendor iMedX, fresh off several acquisitions, raises $2.5 million in equity financing, increasing its total to $17 million.

The federal government sues New York City’s government for running a Medicaid mill, saying it authorized 24-hour home care for patients without obtaining documentation of need and costing federal taxpayers tens of millions of wasted dollars.

Drug shortages are driving hospitals crazy, but it’s not just them: FDA intervenes to help prisons obtain imported sodium thiopental after domestic supplies run short, delaying death row executions. They’re testing new drugs for their people-killing power.

E-mail me.

HERtalk by Inga

From Wilbur: “Re: Arizona shootings. Bad news on top of horrible news from out here in the great Southwest. Dumb, dumber, dumbest.” University Medical Center fires three clinical support staff members for accessing the medical records of victims of last weekend’s shooting. Officials say they are not aware that any confidential information was publicly released. The hospital has a zero-tolerance policy on patient privacy violations (cheers).

From Claude Noel: “Re: Manitoba eHealth. Saw a weird negative post about the project. Actually the project is going extraordinarily well. This is a very cool project that has had surprisingly little problems with implementation thus far.”

From Z-man: “Re: Moses Cone. I hear that as part of their contract with Epic, Moses Cone has to hire 92 FTEs that Epic screens and approves. Crazy, but I think it is a formula that works.”

NorthShore University HealthSystem launches Epic’s MyChart application for the iPhone, iPad, and iTouch.

Ten Sisters of Mercy Health Systems hospitals are targeting to begin their 90-consecutive-day Meaningful Use validation on April 1. Mercy says it has invested more than $450 million for EHR across its 28 hospitals and has the potential to earn $140 million in incentives.

Honolulu physicians practicing near Kapiolani Medical Center at Pali Momi are forming an HIE and will use the Wellogic Community solution to connect with labs, pharmacies, hospitals, and other providers.

Also from the Aloha state: The East Hawaii Region of Hawaii Health System Corp. commits to meeting an end-of-year deadline to implement EMR (Meditech, I believe). East Hawaii Region hospitals are eligible for more than $7 million in stimulus funds.

HP wins a 52-month, $30 million contract to create a statewide Medicaid HIE for Texas. The project includes creating an electronic health history system for all Medicaid patients.

Former Surescripts exec Kate Berry is appointed CEO of National eHealth Collaborative. Interim CEO Aaron Seib will continue with eHealth as a senior leader.

Are you curious how Gastorf Family Clinic (OK) managed to get their $42,500 stimulus check just two days after applying? A big thank you to Practice Manager Darrell Ledbetter for sharing details on HIStalk Practice. Bottom line: they were committed; their vendor (e-MDs) had the software in time; and they had solid assistance from their REC. Ledbetter says this initial payment alone almost covers what the practice paid five years ago for their EHR set-up.

Other goodies on this week on HIStalk Practice: an interview with Practice Fusion CEO and founder Ryan Howard, who shares some details of his company’s unique business model. Primary care docs and specialists have communication problems that aren’t necessarily improved with HIT. Nuesoft introduces its Nuetopia service and publishes another fun video. You know the drill: sign up for e-mail updates while you are over there. We are about to hit 1,000 confirmed subscribers. I promise to give you a free HIStalk Practice subscription if you are lucky subscriber # 1,000.

According to ONC, recent surveys indicate that 81% of hospitals and 41% of office-based physicians intend to seek Meaningful Use stimulus funds. Only 14% of office-based physicians say they are not planning to apply for incentives. David Blumenthal says these numbers indicate that the Meaningful Use process is increasing the willingness of providers to adopt EHR systems and that, “we are seeing the tide turn toward widespread and accelerating adoption and use of health IT.”

At this week’s advisory HIT Standards Committee meeting, several HIT gurus spoke out in support of including medical images in the next stage of Meaningful Use. Blumenthal agrees that it raises a number of questions worth tackling.

Alvarado Hospital (CA) sends layoff notices to 249 employees, or about 25% of its staff. The layoffs, which begin March 13th, affect 91 nurses, 10 pharmacists, and 13 technicians. Sad situation, but at least the financially troubled hospital gave workers 60 days’ notice.

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

• HealthTrust Purchasing Group aligns with 3M Health Information Systems to offer clinical documentation improvement consulting services and software and 3M IC-10 transition planning services to HealthTrust’s network of 1,400 acute care facilities.
• Picis receives certification for its EDIS, perioperative, and critical care products – all are  compliant with Stage 1 Meaningful Use measures.
  Edwards Air Force Base (AFB) replaces its PACS with McKesson’s Medical Imaging PACS under a new contract with the DoD.
• Nuance announces that 100% of ED physicians across St. Anthony’s Hospital Group (Centura Health) are using Dragon Medical to document patients’ medical reports.
• Memorial Hospital and Manor (GA) chooses ImageNow document management, imaging, and workflow from Perceptive Software for its HIM and registration departments, hoping to phase out paper medical records weighing an estimated 830,000 pounds.

CIO Unplugged 1/13/11

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

Crisis Reveals Leadership

I finished my first week as CIO exhilarated. I slipped out early and headed for a haircut (I had hair back then). The grating buzz of the “emergency broadcast system” disrupted WTAM’s sports update. A power outage that began in the Northeast had hit Ohio. This was not a test.

Out the window, I watched traffic come to a halt. Electricity stopped, rendering signals colorless. I called my family and staff, but cell networks were overwhelmed. I returned to the office.

They say nothing in life is certain except death and taxes. I differ. Crisis is a sure thing. By definition, life is a series of crises, and a showcase of our ability to react. Death, sickness, raising teenage daughters….

Life and career choices determine the number and severity of crises you might experience. But one thing remains true: you will have them. Great leadership will minimize the volume of crisis, but every leader will encounter one. Preparation and execution determines how healthily you emerge.

No course, audit, or survey can tell you as much about your leadership than a crisis. If you want a test that shows what you are made of, crisis will reveal your abilities. Those who aspire for greater responsibility must understand that to whom much is given, much is required. The higher your position — be it family, church, community, or work — the higher the probability that you will be leading in crisis. Be prepared.

I have mishandled some crises and led well through others. In each case, I came to terms with my abilities. Failures and successes totaled, here are things I learned. Master these so they become part of your core leadership abilities.

Take Responsibility Immediately

Do not blame a vendor or an employee. You are the CIO. Crisis happened on your watch. Take responsibility and focus on resolution.

Leadership

• Chain of Command. Ensure everyone knows chain of command, especially when multiple teams are involved working on solutions. Given sleep cycles, you do not want lack of clarity to slow progress.
• Battlefield Promotions. Expend your energy working with the motivated, not trying to motivate the worker. Make on-the-spot promotions as needed. Now is not the time for staff development.
• Fit Leader. Sometimes a crisis can span multiple days. You have to be fit to be effective. Don’t argue with me, argue with science. Most can perform well for 24 hours, but notable performance degradation begins thereafter.
• Visibility. You must be on site. Make a point to lead all customer calls (except on sleep rotation) and walk the floors of impacted hospitals. Walking floors is mandatory for all the command center commanders (my directs).
• Deploy Listening Posts. During a crisis, it may appear that the sky is falling. You’ll hear exaggerated reports. Your plans will be incongruent with reality and spread panic and fear. Having your own listening posts will help discern reality and lead to quicker resolution. Another reason why personally walking the floors is critical.
• Ask the Right Questions. We live in an instant society with on-demand entertainment and microwave food. We often don’t have all the pieces necessary to solve a problem that might arise. The delta between the immediate need for an answer and the time it takes to find the right solution frequently generates stress. In this scenario, stress begins to ebb when you finally start asking the right questions and start getting the right answers. And, like any good jigsaw puzzle, the pieces naturally begin to fit together… as they were intended to.

Processes

• Operations. I am most familiar with ITIL. The operational process you choose to leverage is immaterial, but having established and routine processes is a key success factor during a crisis. You do not have time to reinvent the wheel.
• Downtime Procedures. Again, establish and practice.
• Disaster Recovery/Business Continuity. Most organizations have a DR plan, but few have BC drills. Conduct BC drills quarterly. This enables you and your staff to better handle the stress and drama of an actual crisis before it happens.
• System Access. Avoid single points of failure. In an emerging world of ubiquitous electronic health records, you must have devices and systems pre-deployed to ensure access to data in a catastrophe.
• Business Resumption Plan. While key to focus on solutions, you must also direct your staff and customers on business resumption planning well before the solution is in place.

Practical Logistics

• Food. Assign someone to ensure a steady food and coffee supply. Let your key people focus on tasks, not noisy bellies.
• Sleep. Have a rotation for rest, like airline pilots on international flights. Have comfortable places for people to sleep and nap if staying on premise.
• Command Center. Stand up a center within one hour of calling a disaster and staff it 24/7. Should stay open 2x length of actual event. Do not shut down prematurely.
• Assist Customers Impacted. Constantly ask, “How can we serve you? What else can we do?” whether IT related or not. I deployed staff to delivering water supplies and purchasing fans. Double or triple the number of staff on site. Visibility in crisis is crucial. Keep high staffing levels until the customer signals enough. I saw firsthand how our clinicians reacted to seeing a significant presence on the floors with questions like "How is the system working? How can I help?" This reassured our clinicians that we were taking the crisis seriously.
• Communications Plan. Strong communication fills the void that otherwise gets populated with incorrect messages. Helps develop customer allies in solving crises, as opposed to antagonists. Publish your cell phone number. Start all communications by highlighting your organization’s mission. This serves as a common rally point for all involved. Be consistent in your messaging. Key messages might include accountability, transparency, action, calm, and hope. Execute your plan as published. Leverage multiple venues such as conference calls, e-mails, collaboration tools, portals, etc. Embrace corporate communications. They are experts in communications and can help you develop, adjust, and execute your communications plan.

Profit from Crisis

Document throughout, and take history of all actions and issues. This is critical in averting future crises. Resist the pressure to return an organization to status quo so you can profit from the crisis. Not seeking opportunities or pursuing the underlying cause of the crisis might leave your organization open for future conflict.

• Wiki. Open a wiki and encourage staff and customers to post notes real time. Use these for practical insights during the crisis to document key lessons learned.
• Document Lessons Learned. Encourage all customers to take notes during the crisis so they can make adjustments to the processes.
• Downtime Procedures. These may never have been exercised. The best time to make real world adjustments is while downtime procedures are active.

Engage Outside of IT

• External Expertise. It is a sign of strength to reach outside of your organization for help. If I sense the crisis is longer than two hours, I am on the phone calling peers and vendors.
• Guru Council. Set up a council of advisors to make sure your plans are logical and nothing is missing. Council members are not in the heat of the battle and can provide unstressed ideas.
• Vendor Management. Do not hesitate to escalate early and often. You have no time to dally. Let the level of severity determine when to go to the CEO.
• Engage Senior Leadership. Do not hide what is happening. Engage senior leadership immediately and keep them informed. Bring senior leadership directly into the loop with vendor senior management. This ensures your crisis will receive appropriate attention.

Internal

• Take care of your staff. Keep everyone focused on solutions not blame. Share all positive feedback as received.
• Have multiple teams working on multiple solutions. On two occasions, the primary plan failed to bring about resolution. Fortunately, secondary plans already underway saved the day.
• Ask for ideas from staff not associated with the crisis.
• Levity. Despite the crisis, you must work hard to ensure a calm atmosphere. Staff will think more clearly when you de-stress the environment. I recall Day Two of a crisis when someone began playing Christmas music and a sing-along started. It alleviated an otherwise tense situation.

Ending Well

When the crisis is over, the work begins.

• Send a Thank You. Personally acknowledge all those impacted, first your customers and then your staff. These might include nurses, medical staff, and practices.
• Root Cause Analysis (RCA). Figure out what happened and what can be done to avoid this same crisis. Do not skip this. Publish the RCA and include action and mitigation steps. Monitor for execution.
• Assimilate all lessons learned, downtime procedure modifications, etc, into enhanced processes.

We are all healthcare IT leaders, and my hope is that some might profit from the ideas posted. What ideas and tips do you have that I failed to cover? We will send a “crisis agenda” template to all those who post a new idea.

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.

HIStalk Interviews Jennifer Lyle, CEO, Software Testing Solutions

Jennifer Lyle is co-founder and CEO of Software Testing Solutions of Tucson, AZ.

Tell me about yourself and about the company.

I’m co-founder and CEO of Software Testing Solutions. We’ve been around since 1999. We specialize in building technology-based quality assurance solutions to hospitals. We provide an automated testing solution — focused on laboratories and the blood banks to date –– to help them test, re-test, and maintain regulatory compliance throughout those systems in a way that’s much more efficient, much more effective, and with a lot more coverage than was possible manually.

The hospitals I’ve worked at all tried to use off-the-shelf scripting tools to write their own software testing scripts, but all of them abandoned the idea because of some application quirk or Citrix problem. Or, they realized we would never get enough benefit to have been worth the analyst time required. How is your product different?

That’s absolutely true. I think the latest studies show that across all the companies that try, it’s only like a 37% success rate. It’s very difficult to take the tool off the shelf and to take people who are not automation experts and have them develop robust, maintainable, and reusable scripts.

That’s where we are different. My background is as an automation engineer. The other co-founders of the company were a programmer and a med tech. We were able to take our expertise and our years and years of industry experience of how to use that tool and build something that really became an expert in the functionality of the system under test, so it was completely reusable and maintainable for the client.

The other problem with automated testing tools as they come off the shelf is that the average medical person is not an automation engineer. They can’t sit down and figure out exactly how to programmatically get the script to do what they want or set up the variables to do the variations of the testing that they want. 

Our solutions have a very straightforward front end that makes the system look a lot like a Cerner application or a Sunquest application under test. They fill in the blanks and use drop-down boxes to tell the system how and what they want to test. We keep the underpinnings up to date, so as the system under test goes through release after release by the vendor, we maintain it. The user never sees the underlying testing tool. This way, they can use it from the very first time and use it for years and years. We have folks that have been using it for over eight years in testing and validation.

I assume that software vendors use automation for their in-house QA testing. Do they offer similar tools to their customers so they can do their own validation?

Not that we’ve found. The vendors work very hard to do a very good job of testing their application that they’re developing with the data that they have.

As you know, every hospital sets up their catalog and their procedures totally differently than the next hospital. The flags they’re going to use, the warnings they want turned on, and where they want them turned on vary. It’s hard for those application developers to write a scripting tool that’s robust enough to make it productive for the client.

We prefer to not partner too tightly with any one vendor, especially in the world of the laboratory and the blood bank. The regulatory agencies prefer that if you’re getting assistance in your testing that it not be from the vendor who’s providing the solution. They believe that the more eyes that are looking at the system with a different perspective, the better the chances are that you’re going to find errors. If the people who programmed it are the people who are testing it, it’s testing with blinders on.

Your flagship offering is for the Sunquest LIS, but you’re now offering similar products for Allscripts / Eclipsys Sunrise and Epic, right?

Right. We’ve just started a division called Ratio. The focus of that division is on meeting the testing and validation needs of hospitals implementing CPOE systems. We’re going to be in the GE market, the Allscripts / Eclipsys Sunrise market, and Epic and Cerner as well.

It just seems such a like a perfect, natural flow to go from the laboratory and the blood bank now into the CPOE area. We’re having such a massive rollout of CPOE systems that it’s getting very difficult for the hospitals to exhaustively test all the permutations of patients and orders, where warnings should fire, where messages should appear, and where something should be allowed but something else shouldn’t. Automation would serve that industry very, very well right now. We’ve got the technology to do that.

It’s laborious for analysts to have to do all that testing and documentation. But to automate the process, do you need the cooperation of the application vendors?

We make them standalone. We don’t have any tight relationships with the vendors. Our clients are the end-user hospitals. They provide access to the systems to help us develop our testing scripts and to help us understand the sets of conditions that they want to test — what therapeutic duplications they want to test, what allergies, what drug-diagnosis interaction.

That lets us tailor it to how the hospitals want to use it, since again, it varies so much from hospital to hospital of what they need and what they want. We really want to serve the end-user community here. The vendors are doing the absolute best job possible with testing their solutions in-house, but once those systems are out in the field, you have the variety that comes with the unique configuration of every single institution.

Hospitals would ideally test often, every time they or their vendor make a change. Is your product more of a turnkey solution than a toolkit?

It is turnkey. When we provide that the solution to the client, we train them on how to use it. It’s very, very straightforward and simple for them to use.

Maybe you’ve put a new laboratory interface in and you want to make sure your Epic lab orders are crossing correctly over to your downstream and ancillary systems. With a few clicks of the mouse, our solution will extract all of your lab’s procedures out of your Epic database and, with a click of the button, it will place the orders for you. Once the lab has resulted those orders, another button will go in and look them all up and take the screen prints of those transactions coming back. You can do your results review checking at the same time. We provide a basic set of the patient-procedure pairings or patient-medication order pairings that you want to do.

What we’d love to do over time is continue to work with other industry-leading groups to identify the most common serious medication errors out there so we can build an even bigger sampling of prepackaged conditions.  We can quickly tailor those to a site, let them test it that way, and also give them the ability to add their own. Such as, if in my institution, I want to make sure that if a patient comes in with these demographics and these particular drugs are ordered, I want to see this type of warning.

We want to do both. We want to give you that prepackaged capability, right now, right off-the-shelf within an hour’s worth of training … have it be there and be productive for you and have it grow with you as your institution changes.

I would assume the primary return on investment is to free up analyst time, plus the chance to avoid a software-caused medical disaster that could lead to a lawsuit. What ROI parameters do customers consider before purchasing?

You’re definitely looking at the time and labor savings. You’re looking at a much more accurate testing protocol because it is being done by a computer, not by a human. It allows you to thoroughly do regression testing, which is going to get your releases in quicker as well. As you mentioned earlier, that’s a big problem with the vendors coming out with new releases. It takes the client quite a while to be able to implement those and a lot of that piece is in the testing.

The other area we’re seeing more concern about is providing proof of testing and being able to document. There’s a stronger push by the government getting more into Meaningful Use criteria and mandating certain testing. Our tool provides great comprehensive documentation in the form of reports and screen prints that these combinations have been tested and have been exercised. We can repeat this again at any point that the hospital desires: monthly, quarterly, annually, or when they take a new release. Whatever they feel is appropriate for their site.

Who’s your competition?

We’re very innovative in this particular role. In this particular area, I don’t know of anybody who has this style of an automated solution. There are consultants that you can hire to come in and manually exercise your system and check on it. The Leapfrog Group has their great CPOE tool that you can use and take to see how you’re doing on that performance, but that’s a pretty limited scope of combinations that you’re going to be testing. 

I think this is the leading edge. This is the next place where we can take a great step with technology to make CPOE implementations faster, to make them stronger, to get the benefit out of them, and the Meaningful Use that we’re trying to get out there, and show that the patient safety element is still out there as we implement.

As CPOE is implemented properly, it drives the quality of care and efficiency. When it’s flawed, it can lead to more issues. If we’re going to do it, let’s do it right and let’s make sure it’s functioning as we expect.

What are the challenges and rewards of being a small company offering a niche product that is targeted to customers of specific application vendors?

We’re focusing on the key players in the CPOE world. We’ve leveraged off of our installed base from the laboratory and blood bank side, where a lot of those site have Epic and Allscripts / Eclipsys in them. We’re also developing it with another client for GE and for Cerner.

I think when we have those fully out there, that’s a good representative piece of the market. We’ll continue to look forward and build more solutions for other vendors out there as the client need appears.

You’ve been in business for ten years. What skills and characteristics does it take to succeed?

It’s very customer-focused. We need to deliver value to our end user. We have to make a difference in their software quality. They need to be able to see a meaningful return of their investment in the form of time freed up from the analysts. They have to feel that they are catching things that would have gotten into production and caused patient harm, and we need to provide this at a very cost-effective price point.

So far, that’s what we’ve been able to deliver. In the entire history of our business, we’ve offered a full one-year, 100% money-back guarantee to all of our clients. We guarantee to people who have invested in our product that this is going to work for you. If it doesn’t, then we’re going to make sure you have your funds back to go find something that will work for you.

Putting that hospital’s needs first, respecting their business, and earning a seat there and providing value is what’s kept us in business and kept with us very, very loyal customers.

Have customers contacted  you and said, “Wow … this would have been a disaster if your system hadn’t caught this problem.”

Yes. We’ve had a number of those in the blood bank. We’ve had a number of those with implementing CPOE and the results for review crossing back where certain laboratory flags on tests results were not being carried correctly back into the results viewer in the HIS system, so the physicians were not seeing appropriate results. All of which could have caused a lot of harm if they had gotten through.

Where do you see the healthcare IT industry going in the next five to ten years?

I think it’s explosively growing. ARRA and our move toward CPOE is going to give us an unprecedented opportunity to get more technology out there and to drive quality care. It’s going to provide some challenges along the way. I think as long as we keep making sure we’re focusing on solving the little challenges that come up as we implement these great steps, these great strides, we’re going to see a huge benefit going forward.

We just have to make sure that, as we implement it, it really is working correctly. The tolerance for error in our industry is very, very small. But I think we’re going to see care at great new levels and great more efficiency. That’s what we’re really looking for – patient safety and a more efficient use of resources.

News 1/12/11

From Chi-Town Native: “Re: HIMSS. Their swearing off Chicago as a site for the annual conference helped trigger an overhaul of McCormick Place operations. Now they’re returning in future years.” HIMSS scratches its cross-town pal’s back by dragging all of us attendees back to Chicago in the bleak dead of winter (they call it "spring” there once the vernal equinox is past, even during the snow storms) in 2015 and 2019. Being a skeptic, I still fully expect to find overpriced hotels, surly workers, and the bad weather that vendors love since it keeps everyone hanging around the exhibit hall. Still, I found a list of proposed changes that sound good on paper: outsourced convention center management, allowing competing electrical contractors, letting exhibitors do some of their own tasks like sweeping or plugging in a monitor without having team of nasty union workers threatening physical violence, cheaper setup and food services, and free WiFi everywhere.

From Jerry MindMeld: “Re: Detroit Auto Show. The Car of the Year is one nobody you know has driven. What’s the car equivalent of your EMR? Bentley? Produces a cloud of smog like a 1981 Le Car? A souped-up ‘74 Camaro that only one guy can fix?” I told Jerry that some applications are like concept cars: they look good when being showed off by hot models, but when you try to buy one, you find they don’t really exist. I drive a beat-up econobox that’s seven years old, so obviously I’m one of those Point A to Point B types.

From Hello Larry: “Re: eHealth Entitlement in Canada. Despite what Canada Health Infoway has said about speeding up the Manitoba eHealth project, it is essentially dead due to mismanagement, poor planning, and lack of vision. The health minister, in the December announcement that IBM will run the project for $22.5 million, said ‘there has been no progress made, no clinical EMR consultants hired, and once again Canada Health Infoway has dropped the ball on Canadian taxpayers.’” Unverified.

From Longtime Informatics Professional: “Re: stop the presses. ONC clarifies the difference between EMR and EHR.” Their definition is the same as mine: EMRs are electronic versions of paper treatment records, while EHRs focus on the broader health of the patient and extend beyond a single provider’s walls to share information from all clinicians who provide that patient’s care. Where we differ is that ONC seems to believe such an animal exists, so they use the term EHR universally. I believe that’s wishful thinking and therefore EMR is still correct in most cases (certification as an EHR notwithstanding since that implies theoretical product capability, not actual use). I might also quibble that the R in both acronyms suggest the records (database), not the application(s) that created those records, so I stubbornly stick to calling those data-creating applications “clinical systems” on the hospital side, with the collective end result being an EMR (you can buy applications, but not an EMR unless a single product covers every single hospital department, including diagnostic images). I’m open to reader suggestions for better names since I dislike both of these.

Healthcare Management Systems (HMS) hires two execs: Jack Holt (McKesson) as VP of client services and Todd Redmon (Dell) as VP of customer support.

A Computerworld article suggests that FDA may start regulating hospital data networks that connect FDA-approved medical devices. It points out the now-legendary four-day network outage at CareGroup (BIDMC) in 2002 would have been much worse had they not run medical devices on a separate network that stayed up. Said a GE Healthcare systems designer, “I’ve been to meetings of biomedical engineers. If you ask them if there are any cases where IT has disrupted patient care, all their hands go up.” I’ll argue from the IT side, though: some of those so-called biomedical experts, especially on the vendor side, don’t know squat about enterprise networking — they’re used to just happily plugging their stuff into whatever open network jack they can find without letting anyone in IT know, then high-tailing it when the campus network starts crashing. Maybe both observations highlight the need for IT and biomed to be a single organization, perhaps with FDA oversight when medical devices are involved.

Calling all data geeks: Heritage Provider Network is offering a $3 million prize for creating an algorithm that can analyze patient information to predict which ones will need hospitalization six months in advance, which would allow providers to intervene and save the health system billions of dollars. Teams of any composition can pre-register now for the two-year competition. If you’ve ever worked with neural network training, it’s kind of like that: teams get three sets of de-identified patient data containing inpatient and outpatient encounters, medication dispensing, and outpatient lab results. They develop their algorithms using the Training Dataset, which contains a binary flag indicating whether or not the patient was admitted. Once teams have fine-tuned their algorithms, they run them against a Quiz Dataset and submit their results to see how well they predicted admissions. Then comes the grand finale: qualified teams run their algorithms against a Test Dataset to see if their algorithms merely regress well against a known result or whether they are actually predictive (most of the time, perfect regression curves and neural networks turn out to be dumb when fed additional data points).

I hear that National eHealth Collaborative (the former AHIC Successor that supports the Nationwide Health Information Network) will name a CEO in Wednesday.

Thanks to new HIStalk Gold Sponsor Elumin Healthcare Solutions, Inc. The Sammamish, WA company offers management consulting (selection, contracting, implementation, technology, and clinical transformation), consulting services related to products from its vendor partners (Allscripts, Cerner, Epic, and HealthWare Systems), and the MyWay PM/EHR and Payerpath claims management as an Allscripts reseller. They’re an official Epic Consulting Partner, in case you were wondering. CEO Mark Williams has a long industry history, including time spent at Intermountain and Siemens Medical, so you’ve probably run across him at some point. Thanks to Elumin for supporting HIStalk.
 
Google CEO Eric Schmidt says if he wasn’t running Google and if he wanted to get involved in healthcare IT, he would go to the major research universities to find existing software that could be open sourced, concluding that , “My guess is that a platform like that would be remarkably different from the platforms we are using today.”

Thanks to the 692 folks on the HIStalk Update e-mail list who have voted in the HISsies so far. I’ll send a final e-mail reminder Wednesday and we’ll finish it up. As I predicted, a few readers complained as they always do that (a) the nominees were not much different than last year; (b) I must be involved in a romantic relationship with Judy Faulkner since she and Epic were on the ballot a lot; and (c) I must be clueless to have missed some obvious nominees. To reiterate: anyone could nominate and all I did was take the top four vote-getting nominees (or five in one case of a tie) in each category and put them on the ballot.

I’ve also received a few e-mails about HIStalkapalooza. You haven’t missed anything: the online “I want to come” Web page will go up somewhere around January 21 and will be mentioned here. A rather impressive roster of specialists is finalizing details, like how to make an IngaTini and what time the band’s going onstage.

An article by the now-merged Huffington Post Investigative Fund and the Center for Public Integrity questions the digital divide that may be created as providers with affluent patients are able to invest more resources in electronic medical records that those that care for low-income patients (although if I were a wag, I’d say rich organizations may find their higher income and productivity going down if they buy and implement unwisely). I hadn’t heard of this group: National Health IT Collaborative for the Underserved, formed almost three years ago by groups such as HHS’s Office of Minority Health, a big government contractor, and HIMSS.

NCHICA (North Carolina Healthcare Information & Communications Alliance) is soliciting abstracts for its annual conference at the Grove Park Inn in Asheville, NC on September 25-28. The Word application form is here and is due February 1.

Former Eclipsys sales SVP Jay Colfer joins Prognosis Health Information Systems as EVP of client solutions. OpenView Venture Partners made an investment in the company last month.

Butler Health System (PA) says it has personalized patient care by using a location-driven patient flow and communication solution that includes products from Intelligent InSites (RTLS), Ekahau (patient and equipment RFID tags), and Vocera (caregiver voice communications).

The Supreme Court will decide whether states are allowed to ban the sale of prescription data to drug companies. Vermont outlawed the practice, but was sued by data mining companies and drug trade groups because that particular lack of privacy protection makes them billions.

HIStalk links to Epic-related stories provided so many incoming hits to website of The Verona Press that its top stories of 2010 had to be separated into Epic and non-Epic lists. They nicely mentioned HIStalk specifically. Epic articles outdrew other big news stories about deer season, a sausage factory fire, and bear sightings.

E-mail me.

HERtalk by Inga

From Not Sheldon: “Re: Project Shoes. Last night’s Big Bang Theory TV show contained an idea for a smart phone application for a program where you can take pictures of cute shoes, and then learn where to buy them. Of course I thought of you.” I don’t know the TV show, but I love the app! It’s Shazam for Shoes! And speaking of shoes, Mr. H asked me if I wanted Dr. Jayne to provide some surgical shoe covers to help protect my shoe identity at our upcoming sponsor lunch at HIMSS. Of course I turned the idea down flat. I suppose he doesn’t see the sense in lugging a extra pair of shoes to Orlando when the shoes may only be worn an hour. I’m sure plenty of readers understand that sometimes it does make sense to pack six pairs of shoes for three days of travel.

Geisinger Health System (PA) will implement NextGate’s patient indexing software to enhance the sharing of clinical data across the organization.

Northeastern Pennsylvania HIE picks Covisint ExchangeLink to provide clinical messaging support for its participating physicians.

Southern Ohio Medical Center implements MetaCare IntelliDocs clinical documentation solution.

Keystone HIE (PA) and partner GE Healthcare announce plans to expand the region’s HIE to augment its chronic disease management capabilities. Area health case workers will have access to KeyHIE functionality to retrieve cross-team communications and receive auto-generated notifications of patient encounters.

IBM and Complex Medical Information Systems implement HIT solutions built on Lotus Notes Domino in several Russian public hospitals .

Spending for EHR by all providers is expected to grow to approximately $3.8 billion in 2015, with ambulatory EMR making up $1.4  billion of that number. A mere $2 billion was spent on EHR in 2009, including $633.5 million for ambulatory EHRs. That’s an overall compound growth rate of 11.5% and a whopping 14.2% in the ambulatory space. Just in case IDC Health Insights’ numbers are anywhere close to correct, you best hold on tight for the ride.

Michael Critelli, the former CEO of Pitney Bowes, is appointed president and CEO of Dossia, for which he had been serving as board chair.

Staggering: treatment costs for diabetes grew from $18.5 billion in 1996 to $41 billion in 2007. That includes $10 billion for outpatient care and $19 billion for prescription drugs. Nineteen million American adults were treated for diabetes in 2007, twice the number as in 1996.

With the hottie Dr. Jayne now on board, I am am more focused than ever on maintaining my youthful appearance, so this new, free iPhone app has come none too soon  Beverly Hills surgeon Dr. Payman Simoni created it to let users to see how they might look with a bit of enhancing. You can upload a photo of yourself and then play around to create a new nose, face lift, or the like. I went for the eyebrow lift. I think it makes me look more surprised than young, so for now, I’ll continue seeking the fountain of youth.

 E-mail (the un-enhanced) Inga.

Dr. Jayne

By now, you’re wondering, “Is Dr. Jayne really a physician? Does she actually see patients? Does she know what she’s talking about? Does she ever go out for cheeseburgers and beer, or perhaps the amusing house wine?” and other questions. The answer to all these (and many more) is yes! And so, Dear Readers, a bit more information about the newest HIStalk correspondent:

By day, you’ll find me in the CMIO trenches. By night — well, we’ll save that for another time. The life of a CMIO is never dull; there’s always a fire to be put out somewhere, and usually an angry physician behind the scenes holding a lit match.

I can’t blame them, though – they’re faced with tremendous changes that sometimes seem to threaten their core identity. Healthcare delivery didn’t change much for decades, but the past fifteen years have been Mr. Toad’s Wild Ride. Not only in the science behind the practice of medicine, but in how we are compensated, the equipment we must use, and the rules we must follow to care for patients. There are few industries that have gone through this pace of change. Physicians claimed E&M Coding was going to be the ultimate downfall of medicine in America. Meaningful Use makes that look tame by comparison!

My colleagues who view the profession as a calling tend to take this just a little bit personally. Each one of you has worked with these physicians. I spend a good chunk of time with docs like these, doing something between hand-holding and crisis counseling, depending on the person and the situation. Thank goodness for those psychiatry rotations that taught me never to sit between the agitated patient (or colleague) and the door.

When I’m not working directly with physicians, I’m exercising my clinical brain, working on evidence-based order sets, protocols, formularies, clinical reporting, training strategies, and making sure anything new is communicated in duplicate and triplicate for my colleagues who still refuse to read their e-mail (although I bet they use Facebook to see pictures of their grandchildren, but just won’t admit it.)

Speaking of Facebook, a shout-out to my new friends! I have a long way to go to catch up with Mr. H and Inga.

I also see patients, in an old-school, white-coat kind of way. I use the same systems that my colleagues claim I am using to interfere with the practice of medicine, force them into retirement, or otherwise torment them.

When I’m not handing out Kleenex or making sure we are doing quality clinical work, I exercise my technical brain. This is the part of me that loves playing “vendor Jenga” to see if we can actually make diverse clinical systems communicate with each other while using an amount of staff resources equal to half of what we asked for. Pull out the lower blocks and stack them on top – without toppling the tower! Tricky but challenging, and extremely rewarding when it works.

I enjoy working with our analysts and technical teams and helping them understand why (or why not) a particular piece of software is going to be accepted by clinicians or if we need to budget for our Implementation Analysts to start wearing Kevlar. And if they’re nice to me, I write my own SQL queries to get at information I want. And if they’re not nice to me, I might just play the “doctor card” and make sure they have no idea that I even know what Management Studio is. I also work closely with our vendors and doing the odd bit of development work and focus groups.

So, Dear Readers, now you know my skill set. Send me your provider-centric thoughts, questions, and conundrums. These will be answered in our new “Dear Dr. Jayne” feature – although I’ll be responding with a glass of wine in hand and you’re on your own for Kleenex.

E-mail Dr. Jayne.

 Sponsor Updates by DigitalBeanCounter

• Voalte partners with Rauland-Borg Corporation to integrate Rauland-Borg’s Nurse Call with Voalte’s iPhone communications solution.
• MED3OOO’s InteGreat EHR V6.4 earns ONC-ATCB certification through CCHIT. MED3OOO also announces the appointment of Jim Altenbaugh as VP of tech services implementation and training.
• Vocera Communications acquires Wallace Wireless, a developer of software to deliver pages, text messages, and alerts directly to smart phones. The acquisition is Vocera’s fourth since October.
• Lancaster Hospital selects ProVation Order Sets from Wolters Kluwer Health.
• Chadron Community Hospital contracts with Keane Healthcare Solutions for the full suite of Keane Optimum applications, including Optimum Clinicals.
• Geisinger Health System is using Precyse’s NLP coding software and  M*Modal’s NLP voice to text technology to enhance its clinical documentation and coding.
• Vermont Information Technology Leaders (VITL) selects Greenway’s PrimeSUITE EHR to leverage its REC; Colorado Regional Extension Center (CO-REC) does the same.
• Greenway also partners with DiagnosisONE to provide clinical decision support for its EHR deployments.
• NextGen releases v.5.6 SP1, offering several new enhancements such as clinical quality measures for Meaningful Use and 5010 healthcare transaction compliance.
• iMDsoft increases its global presence compliments of its MetaVision Suite, which went live at 45 sites, 11 countries, and in seven languages in 2010.
• OSF St. Joseph Medical Center (IL) renews its multi-year contract with GetWellNetwork and goes live with GetWellNetwork’s system integration for its Epic-based EMR.
• San Luis Valley Regional Medical Center (CO) signs a five-year technology outsourcing contract with CareTech Solutions.
• Holon Solutions will participate on an HIE panel at iHT2 Health Summit in Atlanta.
• CapsuleTech is hosting an enterprise device connectivity  webinar on January 19th.
• Nuesoft announces its Nuetopia service that combines its EHR, billing software, and revenue cycle management services.
• Bridgehead achieves a 40% year-over-year income increase for FY2010 thanks to its focus on the healthcare vertical.

HIStalk Interviews Dewey Howell MD PhD, CEO, Design Clinicals

Dewey Howell MD, PhD is founder and CEO of Design Clinicals of Seattle, WA.

How’s business?

Business is good. We’re seeing more and more interest in med rec and what we’re doing, not only with medication reconciliation, but some of the stuff we’ve added to our platform around Core Measures and a number of modules that extend beyond that med rec fit into organizations’ Meaningful Use plans quite well. Like every vendor in the space, we’re definitely seeing an uptick in business because of all the Meaningful Use discussion.

I think most of the readers know what medication reconciliation means, but in case someone doesn’t, can you give a description?

Medication reconciliation is nothing new. It’s something that doctors, nurses, and pharmacists have been doing for decades. It’s just the process of gathering medications when a patient arrives at your organization, reviewing that list, and making sure it’s accurate. Then every time you write new orders or change a patient’s care, you review that list again and make sure that they aren’t pieces of that list that you need to re-address. Finally, when you send the patient back home, looking over their home medications before they arrived at the organization, making sure the patient knows exactly what you want them to do at home or how you want them to proceed with any instructions around the medications. Again, med school, nursing school, and pharmacy school 101.

When we talked three years ago, you said hospitals were just checking off Joint Commission’s medication reconciliation box but not really improving patient safety because of low compliance with paper-based processes. Is that still the case?

We are primarily still seeing folks doing this on paper. That’s because so many of the vendor systems still haven’t provided electronic solutions and work flow that is manageable in the context of the other systems.

I think the real problem is that we consider med rec a very broad piece that touches nurses, pharmacists, and doctors. In many hospital systems, those functions are very different applications. To really make it work, you need a process that touches all of those users. That’s hard to do in the silo design of a lot of those systems.

Do you think that doctors are adequately involved or it is it just being turfed off to nurses and pharmacists?

I think as a hospital moves to physician order entry, doctors are by necessity involved, because at that point when they’re writing their orders, it’s at those points that the medication reconciliation needs to happen. If the doctors are doing that electronically, it had better be included into their electronic workflow.

A lot of nurses and pharmacists are still carrying the brunt of reconciling. That’s because it has been perceived as an administrative task. Just document it on paper so we can have it on the medical record that we’ve touched these meds and looked at them, as opposed to having it as a real integral part of the clinician’s thought process at the time of ordering.

The rules change as of July 1, right?

Joint Commission surveyed med rec for a few years in 2006. Then in 2009, Joint Commission stopped scoring med rec because hospitals weren’t able to meet the strict language of the mandate. Hospital after hospital was getting cited on their survey, so Joint Commission took a couple years off. 

They just recently announced that coming July 1, they’ll be re-scoring it again. They’ve revised the goal. They put out that goal for public review several months ago. Now it’s been finalized and published for scoring on July 1.

Do you think the nature of medication reconciliation will change with interoperability and HIEs?

I think it will. Medication reconciliation has been put into Meaningful Use. It’s in that discretionary set or menu set for Phase 1, but it’s very clear that it’s going to continue to be an important part of the Meaningful Use standards in Phase 2 and 3.

You mentioned HIEs. I think in an HIE environment, it becomes really critical to have a tool that allows you to reconcile medications across multiple sources. HIEs are great for bringing a wide variety of data, including medications, together from hospital after hospital and a variety of clinics in a connected community. But to make that data usable still requires a human reconciliation process because there’s a limit to what can be reconciled electronically by computer logic.

Compared to either paper or functions that vendors would typically call medication reconciliation, what are the key functionality points of your application and why is it superior?

The first one starts out on intake. We’ve taken a great deal of care to make sure that the medication list that’s gathered by nursing, or if they use pharmacy or pharmacy techs on intake, that the list is as accurate as possible. One of the first challenges with med rec is getting as accurate a list as is possible. There’s a component that is never going to be solved by any solution because patients don’t know what they take.

Whenever possible, if the solution can help with things like common misspellings get translated automatically and ensuring that the doses and the routes and the frequencies are relevant to that med. The idea is that the path of least resistance is medication sentences and orders documented on the med history list that makes sense. You don’t end up with these really dirty lists that the doctors don’t know what to do with and that don’t make clinical sense.

The other two pieces that have become critical are allowing the doctor to review that list at the time of ordering — not as a separate process, but an integral part of the ordering process. Just by doing admission med orders, med rec has been satisfied, as opposed to doing your admission orders, then coming over to a piece of paper or another system or screen and doing med rec. It should be integrated right into the way the doctor orders. That’s how we’ve done since Day One. 

The other really superior piece is translating that intent to the doctor at the reconciliation steps into a very usable, patient-friendly, complete instruction sheet for the patient. It tells the patient in very clear language what to stop, what to continue, and what’s changed. It all gets translated. Even free text stuff that the doctor types gets translated. A lot of folks will say they translate in patient lay language, but there’s a lot of sort of techie challenges around doing that in a practical way. We’ve been doing it that way for four years, so it ends up being really quite complete.

We have support for something we call minimal use workflow. In the new mandate, they call it 24-hour areas or something along those lines. It allows you to designate certain areas of your hospital — whether that’s the ED or day surgery or endoscopy, these outpatient treatment center areas — where you don’t have to do the full-blown reconcile and address every single med, but rather in an abbreviated process that really makes a lot of clinical sense.

You got more live sites then when we talked last time. What are you learning from them?

We have good coverage now around the country. I think what we’re seeing is that, similar to what we saw early on but it’s just been repeated many times now, if you engage your doctors in a process of medication reconciliation that makes sense to them, the process goes a lot better if doctors, nurses, and pharmacists are all engaged, as opposed to saying “this is a nursing problem” or “this is a pharmacy problem”.

You tell the doctors, “We’re not taking something that was previously a clerical job and making them do it. What were doing is enhancing the normal work and thought process that you do anyway, while at the same time, satisfying the med rec mandate.” With that kind of explanation and understanding, I think docs engage.

CIOs are worried about CPOE because it’s hard to implement. What advice would you have for the CPOE designers?

Our application is a great way to start off in CPOE and to meet that CPOE portion of Meaningful Use, because 30% of patients have to have at least med order done electronically. Across all of our sites, the organizations that are using our product meet that level of performance just by doing med rec and admission transfer and discharge. It’s a very easy to meet that part of the mandate.

Really? They meet the new more stringent medication reconciliation criteria plus count as a a CPOE order each time you do it on a patient?

That’s exactly right.

That’s pretty cool.

Yeah, exactly. We have a few of our newer customers and some of our existing clients that are specifically using the use of our product as meeting those two parts of the mandate.

Go ahead, I didn’t mean to interrupt you.

Vendors have struggled with CPOE.  When they put together those systems, they were so focused on medications and medication ordering, and I think it’s a real chilly feel for a lot of CPOE system. There’s a couple of reasons. A lot of CPOE systems were historically started with experience that industry had from pharmacy ordering systems, and doctors aren’t pharmacists, as you know. Taking something from pharmaceuticals and what’s dispensable and what’s on the pharmacy shelf to an order that the doctor expects is a very difficult process.

I think the approach that many vendors have had is that CPOE systems basically spend six to nine months building that abstraction or taking the order from the pharmacy level to the physician level. You end of making a lot of decisions in a conference room with a small group of people. Maybe they’re not all clinically relevant decisions, so you end of doing a whole lot of reiteration and it can be a big mess, depending on the expertise on your team and how much resource you have to build those systems.

We did something very different. We started out with a product from First DataBank called Order View. This was brand new when we started the company. We built our application from scratch around it. It’s a product that was specifically designed for CPOE systems. Going from pharmacy-level data, that First DataBank had been very good at obviously, to physician-level orders. What’s brilliant about the product is you have the ability to present data to the doctors in the way they expect to see it, but at the same time, you can turn that into a pharmacy-fillable order without a lot of effort. It comes out of the box ready to do that.

With CPOE, most of the real patient benefit involves medications. You can’t make a patient better with diagnostic testing or lab tests along and you’re not going to harm a patient in most cases by doing those incorrectly. Without meds, there’s not much of a CPOE patient safety story.

Absolutely right. I think that’s why going with a product like ours — that is really so focused on medications and has spent four and half years getting medication ordering right — as your initial strategy into CPOE makes a lot of sense. It’s where the big bang for the buck is, for two reasons. One, as you mentioned, in patient safety. And two, for physician usability. 

With CPOE systems, it’s an order of magnitude easier to make entering a nursing order or a rad or or diet orders — making that entry process easy for doctors is an order magnitude simpler than making a pharmacy order easy and effective.

If you look down the road, where do you see the company and the medication reconciliation piece going?

I think organizations realize the importance of medication reconciliation. I think as we’ve grown and gotten more market share, people are relaxing that here’s a solution to med rec that works. They don’t have to change their corporate strategy. They don’t’ have to change their HIE or HIS strategy and still implement this third-party vendor. My hope is we’re going to see a lot more traction in helping with that medication ordering space.

We talked about the inpatient all in this interview so far, but we actually have a fair amount of use in outpatient areas as well. Beyond that market penetration for medication reconciliation, we have a couple of development partners that we’ve built this medication reconciliation out to full CPOE. It was a logical next step for us, because as we just talked, we got the medication ordering and that very central portion of CPOE done right and better than most vendors out there have been able to achieve. It made sense to layer in the additional clinical modules to have a complete system.

So you’re now able to operate as an integrated CPOE system?

That’s right. It’s a standalone CPOE system that stands outside of the HIS vendor, but it integrates with the HIE or HIS strategy, sharing data back and forth as needed for effective CPOE. It’s pretty tough to have a fully standalone island CPOE system because there are so many dependencies, but coming in the very first part of Quarter 1, we’re going have our CPOE system up and running.

What kind of customers would be prospects for it?

Since we just have a couple of development partners and are just building out the project, we haven’t done a market analysis. My guess is it’s going to be the small- to medium-sized hospitals, a couple hundred beds and less, that maybe have a system where their docs have tried to do some portions of the order entry and it hasn’t gone very well, so they’ve really struggled to get adoption and they’re not sure how they’re going to get the doctors to become Meaningful Users.

Most organizations are in the very low percentages of adoption. These small organizations, to have a CPOE system that actually promotes physician adoption while at the same time being easy to employ without requiring a big, extensive build and implementation process, is a pretty attractive thing.

Any final thoughts?

We didn’t talk much at the beginning about how the medication reconciliation mandate has changed. I think it is probably pretty important to note that the mandate is a bit different from the original one. It gives organizations a little bit more flexibility. The thing I like the most about the changes to the mandate is it’s less prescriptive. It says that we recognize that med rec isn’t the same everywhere — it’s not even the same within a given organization. This enables organizations to meet the mandate, following the sprit of the mandate as opposed to following the letter of the law without it accomplishing much. That’s what I like most about the changes to the mandate.

Monday Morning Update 1/10/11

From EHR Geek: “Re: Vitalize. Mr. HIStalk, why didn’t you post the Vitalize purchase of Validus on your real page? It’s only on the HIStalk Fan Page of Facebook.” I was torn on that one. I had just blasted out the SIS news and I couldn’t decide if this item was of broad enough interest to justify another e-mail (I don’t want to give readers alert fatigue), so I just posted it as a Facebook status item until the next scheduled post (this one). That’s another good reason to Friend/Like us there since I usually post news blasts there, too. Anyway: Vitalize Consulting Solutions acquires (warning: PDF) Minneapolis-based Validus Consulting, which has around 60 consultants providing strategic advisory and project leadership services. Vitalize, which offers strategy, EHR implementation, revenue cycle, project leadership, and application / technical resources, says it’s now the largest privately owned HIT consulting firm, with more than 450 consultants. I hadn’t realized that former Allina Excellian (Epic) VP Kim Pederson, who I interviewed awhile back, is a Validus principal. I also didn’t realize until Googling something else that industry pioneer Bill Childs, who just won CHIME’s Lifetime Achievement Award, is a Vitalize VP (there might be no HIStalk if Bill hadn’t broken the HIT journalism ground with Healthcare Informatics). I know and like the Vitalize folks and I’m amazed at the company’s growth under CEO Bruce Cerullo, a long-time friend of HIStalk. 

From Jerry MindMeld: “Re: joke of the day. Dr. Blumenthal was at Congress yesterday during the reading of the Constitution. He looks over at the stenographer and realizes they are typing every word spoken for the entire day, every speech and every vote. He leans over to the guy sitting next to him and says, ‘Jeez, I wish we had that in my industry — it would make practicing medicine a lot easier.’" I’m here all week – try the veal.

From The PACS Designer: “Re: Dimdim. Mr. H, since you now can’t use Dimdim collaboration software due to Salesforce.com’s privatizing it, why not go to Yugma, which is another collaboration application on the web?” I will give it a look. The biggest differentiator among the Webinar-type tools is how well they record and archive the session, especially the audio portion. I also liked ReadyTalk. I’m kicking tires because I really like the idea of providing some kind of education at a higher level of quality than you usually see (i.e., less of a commercial pitch).

From Leopold Stoch: “Re: Paul Levy. Stepping down as CEO of Beth Israel Deaconess.” I guess John Halamka’s boss is down to blogging as a job for now, but I’m sure he will have many opportunities.

New HIStalk contributor Jayne (or Dr. Jayne if you or she prefer) introduces herself below. What sold me on her: (a) she writes well and in a non-stuffy HIStalk way; (b) she’s funny; (c) she has a great education and medical experience; (d) she works in an informatics role, but still maintains a medical practice, so she knows a broad swath of the industry; and (e) she’s an HIStalk fan and gets what we do. E-mail her your greetings if you like. We thought a recurring “Ask Dr. Jayne” feature would be fun, so let’s have any questions you’ve always wanted to ask an informatics doc (what does she think of EMRs, how important is usability, how does she interact with the EMR in the exam room, etc.) Her brand new Facebook is looking a bit bare, so I’m sure she could use a friend or two there.

Listening: Young Fresh Fellows, a Seattle-based alt pop band that’s been around for 30 years. I played their 2009 album and immediately bought it for the gym iPod, which almost never happens. Their music is hard to categorize – sometimes its Pixies punkish, sometimes REM jangly, but it’s always fun (extra points for using “bereft” in a lyric and then rhyming with it).  

I’m intrigued by these poll results: 52% of readers plan to keep the same job and employer in 2011, but a full 42% are expecting to land a better job, either with the same employer (18%) or a different one (24%). Only 3% expect to move to a worse job, with about the same percentage saying they’ll retire or quit this year. New poll to your right: what are your plans for the HIMSS conference?

Thanks for your HISsies nominations. I’m e-mailing out survey ballots this weekend, so watch your inbox and please vote. Thanks, too, to readers who nominated Inga and me for several categories even though the instructions said not to.

HIMSS government relations VP Dave Roberts posts the organization’s priorities for the new Congress, the main ones being keep HIT bipartisan and keep the HITECH money flowing despite all the good reasons it shouldn’t. He also lists what he says are the priorities of HIMSS members, such as establishing a Meaningful Use grievance process and spending even more taxpayer dollars, this time on “health IT action zones.”  He asks for feedback.

Say hello to new HIStalk Platinum Sponsor Shareable Ink. The Nashville-based company’s concept should resonate with quite a few hospitals and practices: you shouldn’t have to disrupt clinician workflow to move to electronic health records. Shareable Ink’s enterprise-grade digital pen and paper technology lets clinicians keep documenting the way they like without turning themselves into patient-ignoring keyboard zombies, yet it translates their work into digital, discrete, and shareable EHR data as if they’d labored over a keyboard instead. Anybody can implement it quickly since there’s no software running on site (it’s zero-footprint Saas) and there’s no boondoggle IT project standing in the way of hospitals and practices anxious to move to EHRs and collect their HITECH checks. It integrates (with registration, EHR, CDR, etc), it pre-fills forms from inbound interface data, and it makes paper smart with form-based electronic rules and outbound alerts (e-mail, SMS, page). You don’t have to force behavior change on set-in-their-ways ED docs and anesthesiologists (not to mention that 90% of hospital daily progress notes are, of course, written by hand and that’s a tough battleship to turn). It must be cool since T-System, whose paper forms (T-Sheets) are an ED mainstay, chose Shareable Ink to power its DigitalShare electronic ED encounter documentation system. Shareable Ink also just released an analytics package that lets organizations mine all the handwritten data it converts, so paper documentation from anesthesia, ED, and progress notes can be electronically reviewed for quality and efficiency metrics without chart pulls. Thanks to Shareable Ink for supporting HIStalk.

I turned myself on a little writing about Shareable Ink, so I headed over to YouTube to see if there was a demo. Here’s one from a year ago, as co-founder and CMO Vernon Huang MD (sounds like a fascinating guy: Hopkins biomedical engineering degree and GWU MD, practicing anesthesiologist, worked for Apple, was a Navy flight surgeon) shows how his sloppy doctor handwriting (sorry, Doc) is turned into an electronic record without his doing anything.

The Walgreens drugstore chain, in my mind, leads the way with consumer-friendly mobile apps for their patients / customers (text alerts, patient-scanned barcodes for prescription refills, health risk assessments, kiosks, EMR, e-Prescribing, etc.). The company’s CMO moderated a digital health session at the CES Digital Health Summit. Too bad the rest of healthcare doesn’t have such clearly aligned incentives (invest in technology, sell more stuff as a result, make more money, everybody’s happy).

Drug maker Roche files suit against a software company it bankrolled and intended to acquire. Medical Automation Systems had agreed to be acquired by Roche for $40 million, but then got a better offer from a competitor. Roche sued, saying it has right of first refusal and shouldn’t be required to participate in a bidding war. The company’s RALS software is used in the Accu-Check and CoaguCheck point-of-care monitoring systems to send results to hospital clinical systems. Wish you’d thought of it, right?

The promotional video for the just-announced new version of the Microsoft Surface coffee table thingy shows people collaborating over radiology images and ultrasounds. It reacts to both touch and objects, where it “seamlessly merges the physical and digital worlds.” It works like a massive iPad on four legs, accepting all kinds of gestures and manipulation. I have to say it seems cool and a pretty good deal, with the new version priced at $7,600 compared to the original’s $12,000 price tag. Imagine an EMR built for a screen that size run by touch – docs would love it. It would also be amazing for patient teaching, but you’d have to bring the patient to the Surface instead of vice versa (unless someone invents a SOW – a Surface on Wheels).

Speaking of the Surface, I found this old picture of MEDHOST’s ED dashboard running on it. I found pretty much no information on MEDHOST’s site about it, so I don’t know if they still offer it or if anyone ever bought one. It looks good, though.

Eris Medical Technologies, created in a Youngstown, OH incubator, will provide its erisRX charge capture management software to Florida Hospital Orlando. Founder Jennifer Wexler used to work at FHO as well as Orlando Health, while co-founder Kelly Bucci comes from Deloitte. 

We had a slip-up in Friday’s post due to a bogus news alert (old Web pages sometimes suddenly pop up as news – I’ve been burned by that a couple of times). Mark Briggs is still CEO at HIE solution vendor VisionShare, which he joined in May – the link we ran was to an older (undated) press release from when he took an earlier job.

J.P. Morgan’s healthcare conference runs this week. Ben Rooks wrote about why you should care (or not) in his HIStalk column from a year ago.

e-MDs says CMS’s first HITECH check for a physician practice went to one of its clients just two days after CMS registration opened. Gastorf Family Clinic (OK) got $21,250 each for its two doctors. They told doctors they’d get big checks and that one’s ginormous.

Speaking of HITECH registration, CMS says 4,000 providers registered for EHR incentives in the first four days after its site went live on January 3.

Inga and I have decided that we should have vendor tee shirts made for HIMSS that read, “Want to be profitably acquired? Sponsor HIStalk.” The list of sponsors recently completing successful transactions (these would be listed on the back) includes Medicity, Ingenix, Picis, Sentillion, Eclipsys, eScription, Sunquest, and now SIS. There are plenty more, but those are some of the larger and more recent ones.

Philips buys Pittsburgh-based medSage, developers of an automated telephone-based system for home health patients to reorder supplies. Their executive bios are fun: “Bob is the ‘Old Guy’ on the medSage Team … has been in the healthcare industry for over 30 years (our abacus will not go any higher) … Bob is the ‘Really Big Guy’ on the medSage Team. (If you have met Bob in person, you know what we mean!) For that reason, Bob is to be Mr. October, November, AND December in the 2009 medSage Team promotional calendar.” Let’s hope they keep Bob happy since if they don’t, it sounds like he’s got a couple of potential discrimination suits to choose from.

A judge overturns a community college’s dismissal of four nursing students for posting cell phone pictures of themselves posing with a placenta on Facebook. The instructor of the students told them it was OK to take the picture as long as any identifying information was removed, even though the students told here they planned to post the pictures on Facebook. The student whose case set the precedent for the others is worried about her reputation preceding her for an eventual job. “I am concerned that my name is all over the Internet. All you have to do is Google ‘placenta.’” She’s right – above is my Google News search result, complete with her smiling placenta pose.

E-mail me.

Why Me? 
By Dr. Jayne

Let me just start by saying that I’ve idolized Mr. HIStalk and Inga for quite some time. So when Mr. H posted that he was interested in finding someone to help out, I was tres excited. I put together a few thoughts, crossed my fingers, and clicked “send” with visions of IngaTinis dancing in my head. A few spins of the planet later, here I am, excited to be part of the HIStalk family!

Why did I want to write for HIStalk? First, I wanted to be able to provide a physician perspective on hot topics in healthcare IT. Now that Meaningful Use is finally here, understanding the real impact the new rules are having on patient care is going to be important. Who better to talk about it than someone who is actually seeing and treating patients?

Don’t worry though, I’m a serious IT staffer (also a shoe aficionado, so the chance to work with Inga was a huge part of this, but we’ll save that for later) who lately spends more time talking the IT talk and walking the IT walk than personally caring for patients. But I still see enough patients to be able to regale you with strange-but-true stories about what happens on the other side of the exam room door.

Second, I enjoy expressing my creative side, love writing, and am fluent in a variety of poetic forms. Healthcare IT words are just about as hard to rhyme as medical words; although it might be possible to rhyme “ruptured appendix” with “clustered index” it would have to be a really special poem to make that work so you’ll all just have to keep reading and see what I come up with. (A special shout out will go to the first reader who pulls that one off.)

Third, IT systems and patients are more similar than most people would think. When they’re healthy they’re happy and you enjoy going to work every day, and when they’re “sick” they can drive you mad. I’ve spent the last several years of my career trying to help bridge the gap between “the IT people” and “the clinical people” and being able to do that on a larger scale seemed cool. We all want the same things – and if I can give the “computer guys” and the “doctors that just hate the system” some tips and tricks to better interact with each other, then I’ve helped make all of our lives a tiny bit better.

Finally, a tiny part of me wanted a guaranteed invite to HIStalkapalooza (OK, maybe it was a very big part). Although I suppose as a team member I’m likely excluded from the “Inga Loves My Shoes” and HIStalk Queen contests, I might try anyway, so dust off those shiny taffeta ball gowns and the ruffled tuxedo shirts, and I’ll see you there.

Say hello to Jayne.

Norwest Equity Partners Acquires Surgical Information Systems

Surgical Information Systems announced this morning that private equity firm Norwest Equity Partners has acquired the company from Vista Equity Partners, its owner for the past four years.

“By maintaining our focus on the financial engine of the hospital, SIS has achieved year-over-year growth that significantly exceeds industry averages. We have also enjoyed success in the perioperative area during some of the most challenging economic conditions in memory,” said SIS CEO Ed Daihl. “Demand for perioperative-specific information solutions is rapidly growing, particularly in anesthesia solutions, and our new partnership with NEP represents the continued evolution of the company.”

The 50-year-old Norwest Equity Partners, headquartered in Minneapolis, manages $4.6 billion in capital, focusing on building middle-market companies. Its major limited partner is Wells Fargo & Co. The firm’s other healthcare IT investment is communications vendor Amcom Software. According to the announcement, the SIS executive management team will remain in place.

SIS executives we spoke to said that hospitals are focusing on the perioperative area in preparation for healthcare reform and potentially declining reimbursement since it contributes up to 60% of hospital margins. That makes the OR and anesthesia business of SIS a highly attractive investment, they told us, with anesthesia alone having a 24% annual growth rate.

The Alpharetta, GA company’s growth has been organic, with new customers, exclusive industry endorsements, and expanded technology partnerships. Its perioperative software was recently certified as a modular EHR.

SIS customers were notified by an e-mail today from Ed Daihl, who described the acquisition as “a new phase of growth that will benefit you with the accelerated delivery of new, innovative software solutions that will support your efforts to optimize the delivery of perioperative services.”

News 1/7/11

From Clarence: “Re: HIMSS. Isn’t the conference in Orlando?” Looks like someone copied over last year’s e-mail announcement for this year’s HIMSS Annual Leadership Survey. Doh!

From Lizzy Thin: “Re: GE Healthcare. Rumor is that several workers in Seattle were shown the door today.” Verified, thanks to my GE media contact, who proactively e-mailed me to tell me the following: “As a part of the continuous review of our priorities and opportunities, we’ve eliminated a limited number of positions due to overlapping responsibility. The majority of the impacted roles are based out of our Seattle office. This does not in any way signal a change to the updates that I’ve given you in the past few weeks. Though a difficult decision, we remain committed to the success of our customers and employees.” Condolences to those affected, with my rare positive counsel being that as bleak as it seems when the career rug is pulled out from under you (it’s happened to me), you are likely to eventually end up being glad it did because it forces you to re-evaluate and focus. Kudos to GE Healthcare for at least waiting until after the holidays and for being honest about it.

From John in the UK: “Re: shares in Fletcher-Flora Health Care Systems. Please, could you inform me of their value?” I contacted CEO Neal Flora, who says to e-mail him so he can verify that you are on their list of shareholders. He’ll then provide the information. His contact information is here.

From Student: “Re: Northwestern University. It’s considering changing the format of its online MS in Medical Informatics from live, synchronous meetings (with instant feedback and collaboration) to asynchronous. Students are concerned about the respectability and quality this will provide. What do you and your readers think of an asynchronous format only?” I think it’s fine as long as the pedagogy is made clear to the faculty, i.e. this isn’t just putting lecture notes online and giving online tests, which I’m sure they already know since the program isn’t moving from classroom to online for the first time. Synchronous learning isn’t convenient to students or professors, especially with the considerable number of non-US based students taking HIT-related coursework (the time zone challenge is tough, as are hospital people who don’t work day shift). Technology supports asynchronous learning quite nicely, with podcasts and video lectures being well suited for it. The key is student collaboration and engagement through asynchronous discussion, projects, and learning that supports multiple learning styles (especially tactile/kinesthetic, which in my experience is tougher in an asynchronous environment, but that just means the instructor needs to plan for it). My conclusion: it’s not only OK, it’s a good idea, provided the proper expectations for student engagement are given to instructors. I’ve always thought that synchronous learning was more show than substance, often mandated by highbrow educational institutions that were not only slow to move online, but anxious to show their superiority over competitors who actually make learning accessible. Today’s synchronous is yesterday’s sage-on-the-stage.

The first sizeable acquisition of the new year will be announced Friday, so look for my news blast as soon as I get the green light to send it out. I’m hoping I’m not tied up at work since that’s always my nightmare – I’m stuck in some meeting sitting on hot news that’s congealing while I impatiently check my watch every ten seconds. I’ve also been given a heads up that a consulting company will be making an announcement tomorrow. If you don’t get my e-mail blasts, now’s the time to put your name and e-mail address in the spam-proof Subscribe to Updates box to your upper right. Tomorrow will be another chance to one-up that smart-alecky colleague down the hall.

eHealth Initiative announces its new board members, including new chair William Jessee of MGMA and Micky Tripathi of Massachusetts eHealth Collaborative.

Motion Computing announces the CL900 Windows 7 ruggedized tablet at CES. Available in Q2 starting at under $1,000, Motion says.

This article impacted Weird News Andy, which he titles “You have WHAT in your colon? I don’t even want to think about how it got there.” A woman undergoing a routine colonoscopy for abdominal bloating is found to have a Blatella germanica in her transverse colon. For you lay folks, that means they found a cockroach in her large intestine, presumably accidentally eaten by her in her infested home. I would have included the picture, but I’m sure your mental one is graphic enough.

HISsies nominations will close soon … make your nominations now. Voting will start this weekend if I get time to put the ballot together and e-mail it out to the HIStalk subscriber list.

I was playing around with Webinar tools the other day and liked Dimdim, which has a goofy name but pretty cool technology. I just got an e-mail from my signup that it’s been acquired by Salesforce.com.

Jobs on the sponsor-only job board: VP Sales Central Region, Senior Software Engineer, Software / Implementation Engineer. That reminds me that I need to figure out why people who don’t work with engines are still called engineers. On Healthcare IT Jobs: Project Manager, McKesson HEO Analyst, Assistant Health Services IT Director.

Travis, the tech-savvy doc who writes HIStalk Mobile for me, is putting up some good stories. Up now: hospital support of mobile devices, next generation iPad speculation, Skype for telemedicine, practices offering online appointment scheduling, Sutter and MyChart, IDEAL LIFE’s health tablet, and more. Drop your e-mail in the Subscribe to Updates box on that page to make sure you don’t miss anything, and if you’d like to contribute guest articles, news, how you use your favorite health-related iPhone apps, etc. give Travis a shout. Thanks much to our sponsors there: AT&T, Vocera, Voalte, 3M, Access, Thomson Reuters, and PatientKeeper. Some of the most interesting technology in healthcare involves smart phones, messaging, clinical communication, health management via technology, etc. and we cover it all there.

I’ll have a new HIStalk contributor to announce shortly. She’s a practicing physician and informatics expert who nonetheless described herself in offering her services as a long-time HIStalk fan and “young, blonde, and love shoes, making the perfect bookend for you with Inga.” I knew her lofty credentials, lack of pretension, and obvious sense of humor would raise Inga’s professional jealousy, which they did, as Inga sniffed to me that our new BFF is “too smart and young and cute and perfect.” They are both wonderful, so readers will benefit as we are able to explore even more issues and offer more useful information. She will be contributing to all three sites (HIStalk, HIStalk Mobile, and HIStalk Practice) and will be on the ground with us at HIMSS. Since Inga is often insecure, I should say that I don’t value or love her any less just because we’re getting help to hopefully achieve higher levels of pretty-goodness. I may need your assistance in reassuring her, though.

LifeIMAGE, which offers a medical image sharing platform, finishes its second funding round with $12 million, raising its total to $17 million. I interviewed Hamid Tabatabaie, president and CEO, a few weeks ago.

4Medica’s Inpatient Cloud EHR and integration engine earn CCHIT certification as an EHR module using hospital criteria.

I don’t find this to be true, do you? A reporter claims that Microsoft Making Name in Lucrative Health Care Records Market. The article suggests that HealthVault is profitable, which it isn’t as far as I know. It also touts Amalga HIS, overlooking the fact that the company shut it down not long after it bought it. The sweeping, big-finish conclusion: “Whatever the reason, Microsoft’s strategy seems to be working – it’s making a name for itself in a sleeping giant of a market that’s only now awakening to the power of business technology.” I’m not saying they aren’t doing some interesting things, but I’d hardly say they’re leading a sleeping market, and some of what they are doing is more in life sciences than healthcare. At my hospital, Microsoft means Windows, SQL, Office, and now Sentillion.

Some scumbag steals three Internet Cafe computers from Brockville General Hospital (Ontario) over the holiday, shutting it down and leaving users (some of them palliative care and rehab patients) without. The hospital doesn’t have the money to replace them, but a local travel agency donated one and is challenging other local businesses to do the same.

I still think this software should win awards: still another patient is saved by a kidney transplant made possible by an application that figures out a complex series of transplants that gives the greatest possible number of donor-recipient marches from the available pool.

University of New Mexico Hospital is reviewing its emergency alert system after a gunman fires a shot inside, but the employee text and e-mail alert took 32 minutes to get out after police had showed up en masse. The hospital says their incident people couldn’t get logged into the Web-based alerting system. They also couldn’t get executive approval to blast the message. The hospital says it will  hire a consultant. Something to think about before the reporters show up. I bet employees were already burning up Twitter and Facebook.

The local paper covers IT raises at University of Missouri and the hospital, noting that 52 employees were promoted with raises in December alone. It suggests that a just-opened IBM facility in town may have forced the university to give raises to keep staff.

E-mail me.

HERtalk by Inga

From Joe Walsh: “Re: HISsies. I am aware that the HISsies are just a bit tongue-in-cheek, but how serious is the proposal for a Lifetime Achievement Award?” I’d say all the categories are as serious as readers want them to be, but that one in particular is totally serious. As Mr. H often mentions, 100% of the nominations and final voting come from readers. Many of our past winners have been touched by the recognition. Todd Cozzens, for example, was quite appreciative of Picis’s Best HIT Vendor award a couple of years ago, and even the irreverent Jonathan Bush seemed to love winning HIT Industry Figure of the Year. We also know some organizations stuff the proverbial ballot box in favor of the home team (at least before we starting sending ballots directly to the HIStalk subscriber list last year instead of letting anyone vote), but ever that suggests that folks consider the HISsies an honor. 

From Elmer: “Re: Kudos. Love your blogs. You guys are the glue to what’s going on in HIT.” Thanks, Elmer. As Mr. H will tell you, I’m chronically insecure and need loving encouragement every now and then, so your words are appreciated.

From AA CoolNeal: “Re: A MEDITECH rap song. Funny rap song composed (supposedly) by former MEDITECHers. I worked there for 10 years and the song does hit all the highs and lows.” Very clever. And reminds me of many things I don’t miss about working for a big company.

From Eero Saarinen: “Re: Cerner win. Columbus (IN) Regional Hospital has signed a contract with Cerner. No surprise; they’ve been in negotiations for many weeks. CRH has used Cerner PathNet and Apache for several years but the new deal is a near-total McKesson replacement.” Unverified.

University of Kentucky Healthcare and Central Baptist Hospital are among the first recipients of Meaningful Use incentive checks. Kentucky Medicaid has already issued a $2.8 million check for UK and $1.3 million for Central Baptist. An additional 25 Kentucky providers have begun the application process.

Partners Healthcare is borrowing $420 million for EMR improvements and debt refinancing.

Healthcare represented 17.6% of the US economy in 2009, with total spending of $2.49 trillion (with a “t”). That’s up from 16.6% of GDP in 2008. Reminds me of when I was interviewing for my first job in HIT. I wasn’t sure I wanted to leave my budding career in finance, but my soon-to-be new boss convinced me that the business of healthcare and computers was going to become increasingly important. Obviously he was right.

I see that Bill O’Toole, an occasional HIStalk contributor, is offering a complimentary white paper to providers considering the purchase of an EHR. He’s founder of the O’Toole Law Group, spent 20 years as corporate counsel for MEDITECH, and has a friendly writing style.

Spectrum Health (MI) launches its MySpectrum smart phone app created with the InterSystems Ensemble integration and development platform.

Saint John’s Health System and St. Vincent Jennings Hospitals join more than 80 hospitals as part of the Indiana HIE.

Maricopa Integrated Health System (AZ) renews its agreement with MedAssets for multiple Web-based, revenue cycle tools.

New on HIStalk Practice this week: a peek at Cerner Ambulatory. Hospitals buying up practices. A physician review of the Motion J3500 tablet.  A couple of my New Year’s resolutions. Health reform may boost house calls. HIStalk Practice traffic, by the way, grew 25% in 2010. If you haven’t stopped by yet, it’s time to check out what you have been missing.

Jennie Stuart Medical Center (KY) implements ChartWise:CDI for clinical documentation.

LinkedIn is rumored to be going public this year, making it the first social network to do so. Which reminds me: I am pretty social, so feel free to connect with me on LinkedIn or Facebook. Mr. H is not quite as social as me, but seemingly better connected, so make sure you friend and connect with him as well. And don’t forget to join the HIStalk Fan Club on LinkedIn and to like us on the HIStalk Facebook page.

Cleveland Clinic and MetroHealth Medical Center say they will begin sharing patient records using Epic’s Care Everywhere program.

Dr. Lyle Berkowitz, MD, another occasional HIStalk contributor and medical director of clinical informatics at Northwestern Memorial Physicians Group, asked us to give a plug to HIT X.0 (Beyond the Edge). That’s a new sub-conference that will run during HIMSS and focus on innovation and the future. One session that looks particularly fun is called HIT Geeks Got Talent.  Eight companies will be given 2-5 minutes each to show off their coolest, newest technology. A panel of judges will give feedback, then audience members will have a chance to text their vote for the best product. The call for contestants is still open If you have some bleeding edge technology you’d like to demonstrate. There’s no extra charge for the HIT X.0 sessions, but Dr. Lyle said attendees are advised to pre-register to get a guaranteed seat. Mr. H tells me he’s in and planning to sit on the front row.

A patient drives his Chevy Blazer through the doors of a Kelowna General Hospital (BC) after being told he’d have to wait 45 minutes to see an ER doctor. The hospital estimates damages of $15,000. I wonder if the hospital is now checking into one of those Web-based apps to display ER wait times.

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

• Imprivata OneSign is named a premier solution in SC Magazine’s 2011 Reader Trust Award competition, which honors best-in-class security products and services.
• maxIT Healthcare promotes Mike Sweeney to president, reporting to CEO and Chairman Parker Hinshaw. maxIT also names Reese Gomez executive vice president of solution management.
• McKesson takes top KLAS honors in eight separate categories, including Best in KLAS in Community HIS for its Paragon solution. Horizon Practice Plus also wins Best in KLAS for  Practice Management (26-100 physicians).
• The MED3OOO-owned CPU Medical Management Systems partners with Revenue Advantage to provide hosted interactive voice recognition applications to billing companies and healthcare providers.
• Allina Hospitals & Clinics chooses Greenway’s PrimeSUITE for providers in Minnesota and western Wisconsin largely due to Allina’s Epic-based EMR.
• YouTube Video: Using RXHub and External Med History in eClinicalWorks v 8.0.
• Carefx expands its presence in the UK by partnering with Northgate Managed Service, and agrees to deploy its Fusion healthcare interoperability platform with Cambridge University Hospitals.  Trillium Health Centre (Canada) also goes live with Fusion.
• AT&T includes MedApps as part of their ForHealth telehealth products and solutions.
• maxIT Healthcare appoints Mike Sweeney to President; he will manage day to day operations and will report to Parker Hinshaw (CEO).
• SC Magazine Awards names Imprivata as a finalist in the Best Multifactor Product category for the Reader Trust Award competition.
• CentraState Healthcare System chooses MobileMD for their HIE.
• Frank Stellato is announced as myHealthDirect’s Chief Financial Officer; he’s been with the company since July 2010 and was most recently CFO of MedAssist. Doug Cobb also joins myHealthDirect’s board of directors.
• Ochsner Health System (LA) goes live with Orion Health HIE.
• Lake Medical Group selects GroupOne Health Source to implement eClinicalWorks EMR system for its roughly 50 healthcare providers.
• Nuesoft has a nice entry on their blog asking the question: Are more doctors adopting EHRs?
• CynergisTek CEO Mac McMillian will present at the HIMSS Southern California Chapter meeting on January 13th in Orange, CA.
• North Highland acquires Insight Solutions Group.
• OnePartner selects MobileMD for its HIE.
• Nason Hospital (PA) will use tablet-based e-Forms completion from Access, integrated with MedSeries4 and the Soarian document management application.

HIStalk Interviews Jennifer Bordenick, CEO, eHealth Initiative

Jennifer Covich Bordenick is CEO of eHealth Initiative and the eHealth Initiative Foundation of Washington, DC.

Tell me about yourself and eHealth Initiative.

I’ve been working in health care quality technology for about 18 years. I started out working at a hospital. I worked with health plans and did QA for a number of years along with technology organizations. I started at eHealth Initiative about eight years ago and was appointed as CEO last January.

We are a non-profit, non-partisan membership organization. Our mission is to drive improvement in health care through the use of health IT. We educate, research, and advocate for the use of health IT to improve quality of care.

We’ve got about 210 corporate members. Some of them are influential groups in HIT. We are multi-stakeholder, so we’ve got clinicians, labs, vendors, and hospitals. Everybody is on board. We’re not really beholden to anybody, which makes it nice. We’ve got a nice multi-stakeholder consensus when we are advocating for a position.

I should probably also mention we’ve got the Connecting Communities Coalition, which is a group of about 260 regional, state, and local initiatives that work on health information exchange.

eHealth Initiative had a big part in getting healthcare IT into the stimulus bill.  I noticed that not many more than half of your 2010 follow-up survey respondents said care delivery had improved as a result. Is this going to be like England’s NPfIT or will taxpayers and patients eventually see a return on investment for all these billions?

Gosh, I hope not. I mean, it’s incredible that the federal government made this significant investment. It would be to all of our benefit for this to work, so I certainly hope this works. I think a good number of things are going to come out of it. So what’s the question exactly?

For folks who aren’t seeing the quality improvement, how do we know we’ll see it at some point?

I think the one thing you can say is that we’re going to start measuring it. We haven’t measured it before. If there are improvements, we’re going to see if there are. If there aren’t improvements, we’ll see that there aren’t any improvements. One of the things you can’t do is you can’t improve if you can’t measure it. So I think that’s the first thing — that we’re going to start doing that.

In terms of the money hitting the system and when we’re going to see the improvements from the federal investment, I would imagine that’s going to be two years down the line because the money hasn’t come out yet. But I do think that the market has already started to move significantly and it’s significantly accelerated the adoption of technology.

People are talking about it. When I started doing this 15 years ago, it was not cool. Nobody new what health IT was or HIT. Now there’s a sense out there that is important, and not just that this needs to happen, but that it has to happen.

A couple of years ago we were really fighting and advocating and trying to prove to Congress and to the market why you should do this, why you should invest in this. Now we actually have the investment. So now it’s kind of, how do we do this to make sure that it works?

Most of the poster children for health IT have been organizations that already did it without having the government help pay for it, bigger organizations like Kaiser. Is there concern that maybe this doesn’t scale down to the vast majority of providers that aren’t as big or as savvy as a Kaiser?

I think that’s a valid concern. I mean, the folks that have been successful in the past are the names that we’ve all heard of. But it’s like any new field or industry. You always have those early adapters.

I think that we’ve seen just in our survey of Health Information Exchange over the last seven years … we’ve seen the numbers grow and grow. Especially in and industry that is growing and learning from itself. I think you’re going to see more names up there. There’s definitely more technology out there now and more successes stories then there were eight years ago.

A lot of the incentives encourage people to buy systems that are already out there that they had already passed on. Is there a concern that all of this came about before the whole concept of health care reform? We’re putting out a lot of automation just as we’re changing the goals as we realign care in a different direction around Accountable Care Organizations or whatever the next attempt to make it better will be.

Well, actually, if you look at the legislation and you look at what’s really happening, it’s complimentary, because you can’t move to Accountable Care Organizations unless you have an infrastructure that supports data and technology. I mean, you just can’t get there. You can’t coordinate care unless you can connect those organizations and identify those patients. You can’t do any of that without the electronic infrastructure. So you really need one to get to the other.

I think HITECH and the stimulus package create a foundation to build these changes on and the payment adjustments and the bundling and all that’s going to come about because of health care reform. If you look at the timing as well, the health IT changes should start to kick in before the ACOP. In theory, they should compliment each other.

A survey came out recently suggesting that hospital CIOs are less optimistic that they’ll be able to meet the Meaningful Use requirements. Are you worried that there may be enough skeptical providers out there that the incentives won’t be enough?

Yes, I am. I think the timing on this is quite aggressive. I think there are a number of folks that aren’t going to attempt this in 2011. I think there will be a number of folks that will just wait and hang on. I think we’re going to see a bigger number of folks for this in 2012 once the ground has cleared.

So yes, I don’t think anybody can look at this program and say it’s not aggressive. It’s incredibly aggressive. The timelines are aggressive. Everybody’s concerned about resources, money, and time.

You mentioned HIEs. It seems that there are still questions about if they’ve really found a business model that will work once the grant money runs out. What’s your thought on how HIEs fit into the picture?

My thought is that health information change initiatives have been around for a number of years. I mean, we’ve been tracking them for eight years. This program, the state-designated entity, just started this year. You’ve got 56 new state-designated entities that we’re just starting to track now. But even before they existed, there were groups out there doing this. I don’t think one is reliant on the other.

Your point as far as sustainable business model is incredibly valid. This has been the number one challenge every year when we survey folks — getting the model. The issue with health information exchange it’s a public utility and it helps everybody. So who pays? It’s a really difficult thing to figure out. What’s the right business model for that?

EMR vendors have been successful in basically having their products mandated, without any penalty or downside for them except having to pay for certification. Will they see any negative impact from the movement as opposed to all the positive impact they’ve seen so far?

It’s like any other product. People are going to buy it or they’re not going to buy it. If it’s certified or not, if the customer feels that it’s meeting their needs, if the physicians feel it’s the right product, they’re going to continue to buy it.

Despite the fact there’s a mandate, there’s a lot of competition out there and there’s a lot of vendors to choose from. Hopefully like anything else it will just move the way the market is supposed to move and people will compete.

The investment timeline is short. Does it inhibit competition and innovation by encouraging the purchase of systems that were build long before HITECH, possibly eating up provider budget money that could have been spent on more innovative systems that might not even be on the market yet?

I think there’s a fine line between standardization and innovation. We have to deal with it throughout this program…I will say there’s dozens and dozens of products that have been certified. So I think that there are a number of groups out there. There’s all the old favorites that we’ve all heard of but, there’s also a lot of new ones there. It might not create completely level playing field, but I do think there’s still opportunities for innovation.

What does it mean that we now have two big insurance companies that have bought HIE technology vendors?

I think they realized the need for an infrastructure for data and quality. They maybe positioning themselves for the ACOP piece, which is coming up. I think there’s a real recognition right now that people need to invest in data and quality. You can’t do a lot of the stuff without the data. I can’t comment too much on that because I don’t too much about the specifics. I just know probably what you know.

The issue about the data is who’s controlling it and with what kind of privacy and security. We know that some vendors have decided it’s OK for them to sell de-identified patient data without individual patient approval. We’re also trying to build a national framework around a set of individual state laws. 

I think what you’re getting at is the privacy and information sharing issues, which is of great concern to patients, providers, and everybody. Who owns the information? Who can you share it with? Who can look at my information? That’s a really valid issue and I think that’s important.

As far as whose technology creates the infrastructure … just because a road is built by a certain company, does that mean you’re not going to want to drive down that road? Probably not. We’re talking about HIEs, the infrastructure or the wires that are going to connect all these different pieces together. What’s going to be most important is the laws and regulations around privacy information sharing and not who owns it. Who created the technology, not whose application it is.

But when people start talking about technology, they’re all for it until they start talking about healthcare privacy, which brings out a lot of emotion. Will we ever figure how to ease the fears of patients about their medical data?

I think that we overcame it with banking. People exchange all kinds of information on the Internet right now, especially if you look at the younger generations. People put all kinds of stuff out there on Facebook and Twitter. I think there’s a different set of concerns growing up with each generation. I think that we are going to be able to adjust to privacy issues.

I think that the other thing is that people want mobility and convenience. Everybody wants the app on their iPhone that allows them to refill their prescription with the press of a button. People want that convenience, and I think at some point that’s going to override some of the other issues.

HITECH is mostly about making providers more efficient or more effective. Do we have a vision of population health, things like obesity, personal choices, chronic disease management, and lack of access to care that has nothing to do with making doctor encounters more efficient?

This is really the golden opportunity. This is the stuff that really excites me. Having the data to find a cure for cancer. It’s all about population health. And once we have the identified data where we can actually look at what works and what doesn’t work, I mean, it’s going to be incredibly valuable to all of us. I think everybody kind of understands that’s going to be good thing.

Part of the problem is that we really need to drive the agenda and the message and win the communication battle that’s going on here. We really need to be able to explain to patients and help patients understand health IT and how it’s a good investment and a smart investment. It’s going to make your care better. It’s going to help us find cures for diseases. This is a good thing. I think that’s the battle that everybody’s engaged in right now with a lot of this.

Do you think consumers are interested in that discussion?

I think that there are consumers that are interested. Like anything else, it’s the people that have the most interaction with the system. If you have a chronic care condition or if you have a lot of doctor’s appointments or you have children like I do, you’re always at the doctor’s office. You know there are convenience issues. There are real issues about your care. The more interaction that you have with the health care system, then the more screwed up you realize it is. I mean, let’s be honest.

So I think that, yes, we can explain this to people. I think it makes sense to people once they understand the issues. There’s always going to be privacy concerns. There are always going to be privacy advocates that say, “You shouldn’t do this.” There’s still people that say, “You shouldn’t do banking online” or “You shouldn’t use Amazon.com because somebody might get your credit card information.” There’s always going to be that element and that group that’s concerned about it. But we can’t let that … we have to deal with the issues and figure out what the policies are going to be surrounding that. Then we have to move forward.

You said something I agree with, that the value of HITECH is to get providers on the data grid so really useful things can be done with population data analysis, which is happening with Kaiser. Do you think the idea has been sold well that the HITECH benefits may be more societal than individual?

No, I don’t think it’s been sold well at all. I think that the message has not been clear. I think it hasn’t been loud. I think that we can all do a better job with that.

There aren’t enough examples out there for people to say, “Oh, I get it” or say, “I understand now — you need my information so you can figure out that this medicine works really well for people with my condition.” You know there’s not a lot. We don’t talk about that. 

That’s so important. There’s not a lot of people unless you interact with the health care system a lot who realize that, “Oh, OK, this is why my doctor’s EHR needs to talk to my specialist EHR — so I don’t have to lug my images across town to the radiologist. So they can get them and look at them and shoot back the results to me.” People either have to have a close interaction with the health care system or they have to have a more profound idea of why this is needed for the greater good. We haven’t done a good job of that.

I would think you are encouraged by what Kaiser has done, making it a cornerstone of their strategy and communicating in clear terms what they’re doing and why.

Yes, I think they’ve done some good pieces. I think United has done a couple of good commercials. There are definitely groups that are trying to do that. But more of us need to do that. It has to get down to the doctor’s level. The doctor has to understand why this important and be able to explain it the patient while they’re in their office.

What do we follow HITECH with?

What comes next? [laughs]. I think the data will reveal a lot. If we can figure out how we’re doing out there, that will lead us in the direction we need to go in. We’ll be able to see where we can improve, make care better, see where care is bad, see who’s doing it right and who’s doing it wrong. I think that’s really important.

I also think healthcare reform and the payment structure … that’s really the bottom line. If we can’t figure those out, we’re all going to be stuck in this hole for a long time. We’ve got to get to that point, and I don’t think we can without data. It’s going to be hard to argue why it’s needed unless we have clear-cut data. Payment reform is important and data is important.  

The one time that was tried with mammography, there was an uproar by patients who felt they were entitled to mammograms and providers whose income was threatened even though the information was scientifically valid. Can we ever separate politics from healthcare enough that all this data can be used to make objective decisions?

Gosh, we have to. People don’t want politicians in their bedrooms and they shouldn’t want them in their exam rooms, either. I think it’s really important that we find a way to keep politics out of it. HITECH was bipartisan. Republicans and Democrats agreed on this health IT stuff. For us to all of a sudden disagree on that – that would be really sad because I think both sides see the need for it. I hope we’ll be able to get through this.

News 1/5/11

From Stan: “Re: article in Applied Clinical Informatics on why people discount personal experiences with HIT. I think your readers might find the free download worth reading. Best regards from Switzerland.” The author, Jon D. Patrick from the University of Sydney, Australia, took heat for publishing user reports of ED system problems. His editorial says the problem reports of experienced system users are dismissed as unscientific anecdotes to protect IT interests, the organization’s investment, or its executives from criticism instead of treating those reports as an early warning system. While I don’t buy the idea that user IT perceptions should always be taken at face value, he’s right about the weird dynamic: the IT department and all the suits who signed off on the deal shoot the messenger because they are emotionally invested in it. They honestly believe that complaining users are troublemakers or fools who aren’t blessed with their big-picture vision (specific, serious IT problems are often dismissed on the basis of the greater good, of course). That’s like blaming a patient for daring to develop a post-surgical infection since it makes the surgeons look bad (which wouldn’t surprise me either).

From The PACS Designer: “Re: iPad 2. Sometime later this month, we’ll be seeing Apple’s next version of the iPad, being called the iPad 2 or 2nd Generation. Business Insider gives us an early look on what might be in the iPad 2 and what will probably be done to  the current iPad price. Sources in Japan are reporting that early production models seem to indicate that the iPad 2 will have two cameras, with the rear camera having the ability to record a movie when needed by users.”

From Healthcare Idiot Savant: “Re: Missouri State Senator Brad Lager from North Missouri (R-12). Recently started a new job — wait for it — in Government Affairs for Neal Patterson’s Cerner Corporation. Certainly there can’t be any conflict of interest there, right?” According to a bio in the KC business magazine, A bit of advice if you want to reach Missouri state Sen. Brad Lager: Try to give his e-mail inbox a break. ‘Between my Senate e-mail and my e-mail at Cerner, it’s about 1,000 messages a week,’ says the time-starved 34-year-old. As a measure of Cerner’s good corporate citizenship, the Northland medical software giant makes concessions to allow Lager the four-day legislative schedule he keeps from January through May. He’s back in the office at Cerner on Fridays as a senior strategic analyst in the Health-e Services group. I found some old documents that said Neal’s wife Jeanne donated $25,000 to his 2008 campaign for state treasurer.

From DigDug: “Re: taxes. We are hearing a rumor about tax changes for consultants who pay their own travel costs up front and are reimbursed by the client. There should be no tax implication, as the consultant is not claiming any deduction or tax relief for the travel, but we are hearing that the government now considers these reimbursements as taxable. Any insights?” I’ll use a reader lifeline here since I don’t know. Anyone?

From Lori: “Re: HIStalk. I’m writing to express how much I love and enjoy reading HIStalk! I stumbled upon it on Facebook and have been on it ever since! I enjoy looking at the industry as it continues to unfold. I’m able to do that now with HIStalk! Thanks again!” Thanks.

From NoName: “Re: evidence of an EMR implementation improving patient safety.” An article from East Carolina University and academic medical center Pitt County Memorial Hospital (NC) in Journal of Antimicrobial Chemotherapy finds that its inpatient Epic EMR implementation was accompanied by a 29% reduction in antimicrobial use. Clostridium-caused nosocomial infections dropped by 19% and MRSA infections went down 45%. The EMR doesn’t get all the credit, though: the article suggests that better pharmacist oversight of antibiotic usage, made possible by having immediate electronic access to patient information and orders, allowed them to intervene more effectively. However, order sets built into Epic did reduce the ordering of excessively high antibiotic doses. The good news is that all EMRs can support these efforts if hospitals use them appropriately, so not having Epic isn’t an excuse.

From Roy G. Biv: “Re: weird interview questions. One from Deloitte: how many ridges are there on the edge of a quarter? From my own experience, I’d say that’s about right as far as the average Deloitte consultant’s contact with reality is concerned.”

Listening: The Jessica Prouty Band, which I’m giving special attention since I know her mom, who spent time in HIT. This is a teen band, but you’d never know it since they play hard-rocking prog-metal (to my ear, anyway – think Within Temptation or Evanescence). They’ve toured, won a bunch of contests, and are playing Downtown Disney in California on January 15. I like their sound a lot.

I’m really excited to introduce a new HIStalker, DigitalBeanCounter. DBC e-mailed after seeing my cry for HIStalk help and will be doing some interesting things with us, starting with collecting and writing up sponsor news items in the Sponsor Update section. He’s got a ton of energy and a great attitude (the opposite of me, in other words). It’s great to have DigitalBeanCounter on our little team. I’ll hook him up with an e-mail address soon, but he was anxious to jump right in.

Speaking of which, thanks to the amazing people who e-mailed offering to help out. I’m still sorting through them, but as Inga told me, they’re all so good we want to work with every single one of them (seriously). My several hundred daily e-mail count has swelled lately to the point that I’m behind even after working through the holiday. Any perceived slight is unintentional – I just don’t have a lot of time left between my full-time jobs (hospital and HIStalk).

Former A.D.A.M. CTO Keith Cox is named (warning: PDF) CEO of the Health Information Partnership for Tennessee, which is using a $11.6 million federal grant to connect Tennessee’s RHIOs. 

Advocate Lutheran General Hospital becomes the second Advocate hospital to sign up for PerfectServe’s clinical communications system.

Reminder: HISsies nominations are open, so let’s have yours, please. Every year someone squawks when the final ballot comes out, claiming that I was clueless in omitting some obvious nominee for Best CEO or some other category. I remind them readers do the nominating – I just choose the most-nominated items for the ballot. For example, only one person has nominated Neal Patterson for the “Pie in the Face” award so far, so either Neal has changed considerably in your mind from his unbroken streak of past wins or everybody’s assuming someone else will keep the wheels of democracy turning.

I mentioned a new story about new Cerner contracts in tiny Idaho hospitals. Vince Ciotti of H.I.S. Professionals e-mailed me some thoughts and agreed to let me run them here.

Your Web site is so good and read so much, please don’t take this as a criticism, but as an attempt to set the record straight for your many thousands of readers…

Regarding your piece on Cerner’s $1.3M "deal" for a hospital in Idaho, I’ll bet that is capital (one-time) costs, which are rather low with Cerner’s "remote hosting" approach. This would include primarily implementation fees, and maybe some on-site hardware (e.g: med scanners).

Operating costs are another matter, since remote hosting (also known as ASP or SaaS) usually has a hefty fee per month for processing and storing data at one of Cerner’s two data centers in KC. It is probably six figures per year, and could approach seven figures depending on how many apps were purchased..

So, the TCO (total cost of ownership) over five years should be right up there with the fees most other large vendors charge (e.g.: Meditech, McKesson’s Paragon, Siemens Medseries 4, etc.) for a 14-bed hospital. The best bargains for such a small site are the "Big 3" in the small hospital market: CPSI, Healthland, and HMS. Their TCO over five years should be far less than Cerner, Meditech, McKesson, etc.

In addition, these small-hospital vendors have all apps a small hospital needs, including ERP, which Cerner usually turns to someone like Lawson or Microsoft, increasing their TCO even more. CPSI can even include an integrated PACS and Time & Attendance system, all extra with the "high-end" vendors like Cerner, Siemens, McKesson, etc.

Are the "high-end" EMRs any better? That answer could be a PhD thesis of 10 pages, but the bottom line is: one can achieve Meaningful Use with any one of them! Yes, Cerner probably has far more features than CPSI, but can a 14-bed hospital ever afford the IT and clinical staff to implement them? I doubt it…

This is not to knock Cerner. Millennium is an excellent clinical system, a worthy competitor to Epic in the large and Medietch in the mid-size hospital markets. But for a 14-bed facility, it’s like a newlywed couple starting out with a BMW. They’d be much better off with a Honda, and spend the difference on their kids (patients)!

Former Parkland Hospital SVP/CIO Jack Kowitt is named EVP of outsourcing vendor PHNS.

I mentioned a while back that I was surprised by a British survey that found that 84% of people there use their smart phones as alarm clocks. I bet they’re sorry now: a New Year’s-related software bug causes iPhone alarms to stop working at midnight, causing people to oversleep. At least most of them were off Saturday, I assume.

German mega-vendor CompuGroup acquires Belgian practice software vendor Belgiedata, continuing its worldwide expansion.

Care Innovations, a telehealth and independent living joint venture of GE and Intel, is operational with management in place.

Cleveland, desperate to replace lost manufacturing jobs, kicks off construction this month on the $465 million Medical Mart & Convention Center, hoping it can ride the coattails of Cleveland Clinic to bring high-paying jobs there (like every other city wants to do, but this one’s backed by clinic CEO Toby Cosgrove). Locals get stuck with the tab in the form of a quarter-penny bump in the sales tax. The project, which has yet to sign any tenants, will cost taxpayers up to $840 million over 20 years and competes with a similar project in Nashville that already has landed HIMSS as a renter.

Open source integrator EHR Doctors, which holds a contract to provide the Social Security Administration with its HIE platform for exchanging disability claims documents, says the agency has approved its C32 Continuity of Care Document.

AliveCor’s iPhone ECG is a snap-on back for the iPhone 4 that turns it into an ECG machine. Amazing, but not yet FDA approved. 

E-mail me.

HERtalk by Inga

From Bill Belichick: “Re: Meditech. They will be buying out ambulatory partner LSS and will oversee future product development and business planning. I believe it will most likely be announced by Meditech following their next board meeting this month. This will get Meditech right into the ambulatory market and add much credibility to the product line with the new Meditech branding. It will likely offer customers much more competitive pricing.” Unverified, that but sounds like a good strategic move.

Vitality’s GlowCaps are made available for $10 a cap on Amazon. The AT&T wirelessly-connected GlowCaps are intelligent pill vial caps that use light and sound as patient reminders. Adherence data is recorded each time the pill bottle is opened, then compiled as periodic compliance reports.

Telecare, a provider of wireless communication tools for chronically ill patients and their physicians, secures $4.46 million in a mixed securities offering. The company is headed by CEO and founder Jonathan Javitt, who has a pretty good track record of aligning with and/or building growing companies. Some of his previous enterprises include CodeRyte and Clinitek (now Siemens). He was also the founding national medical director and SVP for the United Healthcare division that is now Ingenix.

Imaging outsourcing firm Foundation Radiology Group raises $3.5 million, bringing its 2010 fundraising efforts to $9.5 million. The new funds come from Chrysalis Ventures and Health Evolutions and will be used for unspecified growth.

I’ve been amused and confused by all the responses to the Epic interview question about the cost of a pear. Mr. H and others used their programming logic to calculate the cost, based on the known prices for an apple, orange, and grapefruit. I would have replied totally differently, I guess, since I  have a much simpler sales brain and an IQ that’s a good 30 points lower than Mr H’s.  Anyway, I would have said that we don’t have pricing for the pear, then pose the question, “How much do you think the pear is worth?” Or perhaps, “If you are willing to buy all the fruit today, I am sure we can come up with a package price that would be acceptable.” Incidentally the question was originally posed to a project management prospect and not for programming or sales job. Maybe a PM would do a SWOT analysis on the pear to develop the right answer.

MEDHOST says that 12 facilities have now purchased OpCenter, the company’s executive decision support solution that was introduced a year ago.

CHIME and HIMSS name Charles E. Christian the winner of their 2010 John E. Gall Jr. CIO of the Year Award. Chuck is CIO at Good Samaritan Hospital (IN).

Texas Health Resources acquires the 420-physician MedicalEdge Healthcare Group, which marks the second-largest purchase of an independent physician practice in the US. THR can now boast more physicians than its chief rival, Baylor Health Care System (620 versus 500). THR is where HIStalk contributor Ed Marx serves as CIO.

Patient flow software provider Central Logic hires Jeff Porcaro as VP of engineering and technical services. He previously served in senior management for Symantec and Novell.

I sent an e-mail over the weekend about the HIStalk-hosted, sponsor-only lunch at HIMSS and another just now about our other activities during the conference. If the e-mails did not find their way to the correct contact, let me know. And if you aren’t a sponsor, I bet you’re wishing you were because you just know that what we’re planning is bound to be fun.

ONC issues a final rule to establish the permanent certification program for HIT. For the permanent program, organizations must be accredited and authorized by the National Coordinator and must conduct post-certification surveillance. I didn’t look into all the nitty gritty details, but you can find more specifics here.

Four nursing students are expelled from Johnson County Community College (KS) after photographing themselves with a human placenta and posting the picture on Facebook. The school’s director of nursing said the students’ “demeanor and lack of professional behavior surrounding this event was considered a disruption to the learning environment and did not exemplify the professional behavior that we expect in the nursing program.” One of the students is now fighting back in federal court, seeking an injunction against the school. The 22-year-old claims her future earnings from her chosen profession are at stake because of a “momentary lack in judgment.” As one who committed a least a minute’s worth of judgment errors at that age, I hope she is allowed to finish her degree.

In an another Facebook-related story, a thief displays more than a momentary lack in judgment by stealing a flat-screen TV from a gas station’s restroom (I will refrain from making comments about the stupidity of having a TV in a gas station restroom). A customer uses his credit card to pay for gas, then hides the TV under his shirt and takes off. The gas station manager uses the credit card information to look up the thief in Facebook and sends him a friend request. Thief accepts request, despite not knowing manager (clearly not the brightest bulb on the tree). Manager tells thief that if he returns the TV, he won’t call the police. Thief ignores the request and before long ends up in jail.

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

• Informatics Corporation of America is named a Top Healthcare VAR by Everything Channel’s CRN Magazine.
• Cancer Centers of North Carolina – Ashville implements iKnowMed EMR. iKnowMed is a division of US Oncology, which is now a division of McKesson.
• CynergisTek CEO Mac McMillan is presenting at the upcoming Security/HITECH conference sponsored by the SoCal HIMSS chapter. January 13th in Orange, CA, if you are in the area.
• MED3OOO announces a strategic partnership to form the Jersey Health Alliance. The Alliance, which includes a network of physicians and hospitals from Hudson County, NJ, will utilize MED3OOO software, consulting, and services.
• Cool video: Allscripts Android Patient File Overview.
• Sentry will attend the seventh annual 340B Coalition Winter Conference in San Diego.
• NTT DATA completes its acquisition of Keane.
• Aetna completes its acquisition of Medicity.
• Vermont Information Technology Leaders selects Greenway’s PrimeSuite as a preferred EHR partner.
• Michigan Health Connect (MHC) chooses Medicity to carry out its HIE.
• Nuance announces its Dragon Dictation voice technology is the secret sauce behind the LG Voice-to-Text app; offered free via the Windows Phone Marketplace.
• AT&T ramps its their presence in the HIT space.
• Payment Processing, Inc. partners with AdvancedMD, citing integration and security advantages.

HIStalk Interviews Beth Raucher MD, Chief Medical Officer, Lutheran HealthCare

Beth Raucher, MD is executive vice president and chief medical officer of Lutheran HealthCare, Brooklyn, NY.

Tell me about yourself and about the hospital.

I am a physician with training in internal medicine and infectious diseases. I’m the chief medical officer here. You can think of me as the doctor who represents both the medical staff, all the doctors in the hospital, and the administration. I have one foot in each door. I help the medical staff come to the hospital and move their way so they can do their patient care. I help the administration work with the doctors to meet their needs.

My role in the electronic health record was the lead physician on the project. I helped make some of the design decisions and work flow decisions, things that would work best for the hospital. I had previous experience doing that in another job before I came to Lutheran four and half years ago.

Yours is the largest hospital I’ve heard of that has implemented Medsphere’s OpenVista. You’re a teaching hospital, too. What parts of the system are you live on and how has it gone?

The part that we are on live now is order entry. All the providers — the doctors, the nurse practitioners, the PAs, the CRNAs, and anyone that’s allowed to write an order — put the order electronically into the system. The nurses pick up the order and the pharmacies pick up the orders through the system. Orders also go to the laboratory, radiology, dietary, and other ancillary services.

The other thing we’re doing now is that the nursing assistants are putting vital signs into the system. The doctors are seeing that in the system. That’s the patient’s temperature, pulse, blood pressure, and heart rate.

That’s a pretty impressive accomplishment going right up with full CPOE and closed loop to pharmacy. Most people struggle with those and save them until last. How did this project compare to the one you did previously at the other hospital and what did you learn from that?

What I learned there was that was a multi-hospital system. It was a little different because that project required us to get consensus in a couple of different hospital systems before we could go out there and train and implement it. But we used a lot of trainers and people who were on the floors super users and other people to help the doctors and the nurses at go-live.

We took that model that I had used successfully elsewhere and brought it here. We had a lot of super users, mostly from our own nursing staff. We had a few physicians.

In addition, we hired a bunch of super users from a training company who did the classroom training a couple months ahead of go-live. They were here at go-live and out on the floor, super users and the employees from the company, all wearing yellow vests. If you needed help, all you needed to do was look for someone wearing a yellow vest and you knew you had some help. They were there 24 hours a day, seven days a week for a full two weeks.

That’s an interesting approach. A lot of hospitals don’t understand that implementation is a hump that you need to get through, but then your labor needs go back down. Was using an outside company something you’d heard of elsewhere?

When we hired this company at my previous job, it was a relatively new company. I think that the chief medical information officer who I worked with at that implementation had done some implementations before using a lot of super users and possibly an outside company. I’m not sure. But he was very clear that you needed to have elbow-to-elbow support for the providers when we went live.

Between him and the leadership of the company, we figured out ratios of numbers of people we needed on each unit and super users. I was able to make a recommendation to do a similar type of thing here. It didn’t really matter to me what company, just that we had enough people. Go-live to me is the big show. You’re either going to make it or break it at go-live.

Did you replace other systems when you implemented OpenVista or was it purely paper to electronic at that point?

In the inpatient unit, it was paper to electronic. In the emergency room, we replaced their electronic system with this one.

What have you learned or what advice would you have for someone else trying to follow your footsteps in the CPOE journey?

You have to have great communication with your clinical staff. This was a long time in coming. From the time we signed the contract until we built everything and started training and implemented it, was about three years.

Medsphere was a young company. We were trying to figure out exactly what we needed to do when, so it took time. But you get the physicians on board in physician advisory committees. You get the nurses on board with nursing advisory committees. You keep them up to date.

This was probably a good time to do something like this because there’s no physician — unless they have their head in the sand — who would not know about electronic health records and Meaningful Use and the importance to the Obama Administration. In addition, a number of our bigger groups have already put these into their offices. It’s not like ten years ago when the physicians at Stanford said, “We’re not doing this.” That just wasn’t going to happen because timing is everything. This was the right time to do this. There’s no question about it.

We made it easier for the physicians. We gave the physicians three options for training. We didn’t put any pressure on them. We told them, “You decide what your skill level is and do what’s best for you.” We offered them Web-based training. We offered them classroom training with a proctor. We offered them true classroom training, where they went in sync with an instructor for four hours. They had their choice. 

All of them at the end of their training had to do a validation test. About a half hour or 45-minute test where they had to go through some exercises and show an instructor in the classroom — even if they had done the Web-based training in their office or at home — that they could do the basic things, like log on, find a patient, make some orders, and things like that.

But we knew that the hard stuff — like some of the harder orders, like complex orders like IVs with additives in them, or insulin sliding scales — that was going to come with practice. That was something that the super users and other folks on the floor were able to guide them through the first time they did those things.

When you choose OpenVista, what other systems did you consider? What led you to make the decision that you made?

I wasn’t here then. I had just come when the final decision was being made. But I know that they did go to other hospitals that had rolled out some of the bigger programs like Cerner, Epic, Eclipsys, and Mediware. I think they did do their due diligence in the two years before that with all those companies.

OpenVista was a funny story. The CIO apparently learned about VistA through some technology newsletter that he got and realized that you could download it free of charge. I think you could buy it for $17 or something like that because it was in the public domain. He downloaded it and realized we couldn’t do a thing with it [laughs]. It was too complicated. Then I guess Medsphere got out there and started to advertise. They met with them and decided to go with it.

Eclipsys and Epic all of those are probably, I don’t know, three or four more times expensive then what we’re paying for OpenVista because it is open source. What we’re really paying for is the support, the interfaces, and obviously the hardware we would have had to pay with any system. The training cost we would have paid no matter what system. It was something we could afford.

What parts of it do you plan to implement?

We’re going to implement all of it. We’re likely to go to medication bar coding next. Then, to full documentation, clindoc, with notes from the doctors and the nurses. The ED already is everything. They have clindoc and they have order entry. They replaced their system in full. Otherwise, it would have been taking a step back for them. That’s the likely scenario, but it’s not in stone yet.

Are there other key clinical systems that you use outside of OpenVista?

We went with their radiology system. Right now, we’re still using our interface to our laboratory system, which is Sunquest. We’re using their pharmacy system.

I think the reason we didn’t go with the laboratory system was because our system actually was more sophisticated and better then the one that the VA had. Theirs was sunsetting and they were going to be moving to one of the commercial laboratory systems anyway.

Do you have physicians who learned VistA at the VA and are happy to have a system that they already know how to use?

There were a couple of residents that rotated through the VAs as medical students when we announced that we were going to be using OpenVista. A couple of people had used or had read about it and heard that it was a great system. So that was very positive. There’s been a lot of national press about the VA’s system.

You mentioned Meaningful Use earlier. What are the hospital’s plans for it and how are you doing?

Just by going live the way we did, we basically have completed the option of CPOE. That’s one indicator we don’t have to worry about. On Day One, we were at 93% acceptance by the physicians. The other seven percent was only because there are physician extenders that enter their orders and it’s only measured by physicians. But in reality, 100% of our orders are being entered into the OpenVista system now.

The other parts of Meaningful Use – we’re looking into the software and we’re working with the company. Medshpere expects to be certified for Meaningful Use sometime in January, I believe. A lot of the validation for Meaningful Use for us will be in the clindoc part of the system. That’s where we’ll be able to get the data from to show Meaningful Use. We have some of it now, but we still have to go into that phase to be able to show the first stage of Meaningful Use. We’re hoping to do that before the end of 2011.

Many hospitals are concerned about their ambulatory strategy and exchanging information with employed or affiliated practices. What are you doing along those lines?

Our ambulatory practices were already up on another health record called eClinicalWorks. Our strategy now is to try to interface both systems so that we can share basic information like medications, allergies, previous visits, and those types of things. Which you know is very doable, and that’s working well. But they were way out ahead. They did a project with the City of New York and so they’re using that software very successfully.

What about interoperability? Are you working on projects involving health information exchange or any data sharing with outside facilities?

Yes, we’re working with a couple of other Brooklyn facilities on RHIOs and health information exchanges both. We’re working with a visiting nurse service and a number of the local community-based health programs. So yes, we’re actively involved in that.

Organizations will need data to prepare for Accountable Care Organizations and other reimbursement plans. What thoughts do you have about that?

You’re absolutely right. It’s going to be critical. We’re looking at everything that we build to make sure it’s discrete data and we’ll be able to get it out in a usable form. We have been doing chart review for some of the indicators that we have to do for CMS core measures for care of patients with heart attack, heart failure, and pneumonia. There are a bunch of indicators they look at to see what kind of care you’re giving and they publicly report those indicators.

Up to this point, it was chart review and we did that by hand. Now we’re trying to figure out how to use the electronic health record. As we build our screens, notes, and templates, we’re making sure we can get that information out in an electronic way and hopefully make life much easier for the data abstractors.

Any final thoughts?

So far, so good. I was very proud of our staff here. I really was. They just took it all in stride. We went live late on a Saturday. Those who came in on Sunday thought it was great. The masses came in on Monday and it was just a regular day. Challenging for everybody, but nobody stormed my office. It was great.

Monday Morning Update 1/3/11

From Mighty Mite: “Re: HISsies Lifetime Achievement Award. I like that proposed category. The name that comes to mind is Rob Kolodner, MD for his incredibly important work at the VA, his ONC work when Bush gave him a mission and no money, and his open source work, where he’s trying to build systems for poor countries that can’t afford $100 million systems (can we either, really?)” I can’t quibble with your pick. In the interest of offering choices, other names that come to mind are Octo Barnett, Neal Pappalardo, Paul Egerman, John Glaser, Bill Childs, and many more from the provider side, although their work maybe hasn’t been quite as non-commercial as that of your nominee. I’ll be interested to see who readers suggest. The HIT industry has finally been around long enough to have a history worth recognizing.

Nearly 2/3 of my survey respondents say their software vendors focus on releasing enhancements that help sales instead of current users (we could have another debate about why those desires differ). New poll to your right: what employment changes do you see for yourself for 2011? The poll takes comments, so leave yours if you want. My vote: same employer, same job. I get recruiter calls all the time like everybody else, but I’m really happy at the hospital where I work.

It’s hard to believe it’s 2011. It’s comforting that the person I kissed as the ball dropped was the same as last year and presumably will be the same next year (I like romantic predictability). I lost Internet connectivity for nearly a day starting Friday afternoon, but the broadband company was good enough to send a tech out on New Year’s Day to replace my modem while I was making chili and whipping up killer guacamole (probably because I have business class service paid for by the hospital). I was lucky during that Netflix-free period to accidentally spot an IFC marathon of the funniest TV show in history, The Larry Sanders Show, which is being DVR’ed as we speak. Hey now!

You know what 2011 means: it’s HISsies time. Nominations are open here. In a week or so, I’ll use the nominations to create the final voting ballot, which I’ll send to HIStalk e-mail subscribers only to prevent ballot box stuffing. I’ve deleted some tired categories and added some fun new ones. Winners will be announced at HIStalkapalooza and I always invite some of the big category winners to say a few words there (they usually pass since they don’t get the HIStalk thing, but what the heck – at least I offered).

Inga e-mailed sponsors about our little appreciation lunch at HIMSS and is sending out RSVP information this week. If we missed you somehow, contact Inga.

I need your advice as readers for my New Year’s resolution. I’m fortunate to not need to make a living from HIStalk since I work full time and have little interest in money, which gives me the freedom to do work that’s not necessarily commercial in nature (or even projects that cost me money, if I think they are useful to the industry as a whole, especially the provider-siders). What projects should I be working on? Education, sharing of best practices, innovation, social networking, charitable work, etc. purely for the benefit of hospitals, practices, and patients? I have limited time, but I do have connections and resources that could be put into play for the right initiatives. I need your help in identifying those possibilities. E-mail me if you have suggestions.

Cerner must be throwing out some low prices lately, even based on per-bed license charges. This article on Idaho hospital EMR projects describes Cerner, being implemented at North Canyon Medical Center for $2 million, as “an economical system that works well for smaller rural hospitals.” Syringa Hospital (a strangely satisfying hospital name) paid $1.3 million.

A reader mentioned not being able to find a 990 form (the IRS tax form for for non-profits) on the Patient Privacy Rights Web site. I asked Deborah Peel, MD and she says they’re putting it up, but she sent over a copy anyway. I’ve given it my usual look-over and there are no secrets: income and expense of around $200K, it pays one relatively modest salary to a full-time executive director, and Deborah Peel takes no salary, In fact, she’s the organization’s biggest individual donor, so it’s costing her money, not to mention time. I’m disappointed that HIMSS didn’t invite her to speak at the conference this year. I don’t necessarily agree with her in every case and sometimes she provides more emotion than hard data, but I’m glad she crusades for privacy and security since without her there might be no rational compromise. She’ll be the keynote speaker at the Computers, Privacy , and Data Protection conference in Brussels, Belgium (January 25-27). I spent time with her at HIMSS last year and she’s a hoot, not just smart and sincere, but cynically funny in an HIStalk-approved way.

New announcements from Medicity: (a) Children’s Dayton chooses Medicity’s Novo Grid to connect with its partners and affiliated physicians, sending out results, reports, and face sheets from Epic clinicals and McKesson patient accounting and receiving back lab and rad orders; (b) CHRISTUS Health will expand its use of Novo Grid to include ProAccess Community, MediTrust Cloud services, ambulatory orders initiation, referrals, and CCD exchange, all across seven states and extending to an additional 900 physicians; (c) Hoag Memorial Presbyterian Hospital (CA) announces that it connected 250 providers to its HIE in five months using Novo Grid; and (d) Medicity’s iNexx platform has been certified as a modular EHR by Drummond Group, qualifying its users for Meaningful Use.

Hospitals always announced their first baby of the new year, so I’ll proudly flash the picture of the first new HIStalk Platinum Sponsor of 2011: Marietta, GA-based Nuesoft (not to mention that they’re also supporting HIStalk Practice at the Platinum level, too). You saw their fun Lady Gaga parody video and the pic of their booth people dressed in hideous 70s fashions, but that’s not all they do. Their offerings include NueMD PM and billing software; NueMD EHR (CCHIT certified); Nuesoft Express management software for college health clinics; Nuevita student health clinic management and EHR; RCM and billing services for college health; and the Nuetopia medical billing service in which the company provides an EHR, PM, billing, EDI, clearinghouse, and services. NueMD, they note on their site, is Internet based, not just browser based. Thanks to Nuesoft for its support of HIStalk and HIStalk Practice.

Speaking of Nuesoft, they’re darned good at making videos. I ran across the one above on YouTube. If you’ve seen other fun, HIT-related videos, let me know.

A job site’s annual list of weird interview questions that gets picked up by newspapers everywhere includes one from Epic: “An apple costs 20 cents, an orange costs 40 cents, and a grapefruit costs 60 cents, how much is a pear?” You figure it must have something to do with logic and formulas since it’s a programmer test. Nothing related to word length or consonant count makes sense (since the first two fruits have the same number of each but different prices), but the formula of (vowels-1) x 20 works, which would price a pear at 20 cents. I’m lazy and immature, but the college tested my IQ as 162 back in the day, which offers no real benefit except I can answer questions like this.

A hospital in England starts conducting patient satisfaction surveys via iPads.

MedTech Publishing, which publishes Healthcare IT News in a business relationship with HIMSS (and also Healthcare Finance News), takes over the HIMSS-acquired Government Health IT. I wouldn’t consider that good news since I’m a semi-fan of the latter but not at all of the former (even though I don’t read either, so I probably shouldn’t have an opinion at all). HIMSS will continue running the Government Health IT Conference and Exhibition. Also part of the deal: MedTech will take over the dead tree publications related to the HIMSS conference that it has previously printed under contract (those papers that are always being thrust at you by cute girls in ball caps every 15 feet as you try to traverse the convention center, necessitating hilarious evasive maneuvers). Neil Rouda, MedTech founder and chairman, is being replaced, and rather vague wording suggests that HIMSS is buying a majority interest in the company. It’s not like they were running a lot of hard-hitting, industry-unfriendly stories anyway.

E-mail me.

News 12/31/10

From HISJunkie: “Re: SureScripts as an ATCB just for e-prescribing. How an e-prescribing clearinghouse be an objective judge about a vendor’s functionality? If I don’t use their clearinghouse, where does that put me? I think the certification process is going to get much stranger in the new year.”

From Athenahealth Win: “Re: win. They just took out a huge Allscripts/GE-IDX install. Should be announced soon.” Unverified.

From Limber Lob: “Re: Maryland Board of Physicians newsletter article on e-prescribing of controlled substances. I really enjoyed the first two and last two sentences. Another EHR skeptic!” It reads: “The health care community has lived through the initiation of electronic health records. They will, we are told, save time and money and reduce medical errors … Use of the term ‘interim final’ by the DEA suggests that this field, and the concomitant federal records, are evolving. For more information, go to the Internet.”

From Promises Promises: “Re: gag clauses. None here.” This document lists Allina’s terms and conditions for practices that want to use its Excellian (Epic) system. It says Excellian isn’t a substitute for human thinking and requires practices that want to use it remotely to: (a) verify its behavior; (b) don’t rely on it for anything critical – ask the patient instead; (c) don’t use it to communicate any important results; (d) look out for programming errors; (e) test it before letting users on; and (f) don’t disclose Epic’s trade secrets. You’d think they didn’t have much confidence in their $250 million implementation from all the disclaimers, but I’m sure that’s just the Allina and Epic lawyers expensively talking.

Listening: new from Ryan Adams (just to be clear, not Bryan Adams – this one’s from North Carolina instead of Canada and is married to Mandy Moore). Actually, the new double album consists of three-year-old tracks that had been gathering dust until he started his own record label and released the 80s-theme concept album a couple of weeks ago. Sometimes it sounds like U2, sometimes like Tom Petty, sometimes like The Cars or Spandau Ballet. I guess those are the 80s musical references at work. And Watching: Doc Martin on Netflix, which is a very nice British dramedy. If it’s realistic, the Brit GPs store paper medical record folded into a little 5×7 or so envelope, so they must not churn out the insurance- and lawsuit-required documentation like here. I could spend hours looking at and listening to Louisa (Caroline Catz).

I have Uri Geller sitting right here beside me and he’s telekinetically moving your fingers to the Subscribe to Updates box to your upper right, forcing you to type in your e-mail address and name so that you might live a fuller life in HIStalk one-ness. You will receive no spam since I don’t care about money enough to sell or rent the subscriber list to the many companies that keep asking. You will, however, get everything important in HIT as soon as Uri or I push the “send” button.

A family member got an iPad. I played around with it for a few minutes and liked it a lot (amazing display), although I think smaller tablets sold by competitors might be more my speed. It was nice to have a display larger than that of my iPod Touch but a bit much to haul around. I like the idea that you can get a no-contract AT&T data plan for it for $25 per month for 2GB (cheaper than an Aircard, but that’s in addition to your smart phone plan, unfortunately). I’m really happy with my iPod Touch despite still not having played any MP3s or videos on it (I take a second-generation Nano to the gym since I’m rough on stuff there). It is amazingly handy to grab the Touch from the nightstand and be checking e-mail or Web browsing at WiFi speeds within five seconds of having the urge to do so. Mrs. HIStalk probably hates it since on those rare occasions I watch TV with her, I constantly pounce on the Touch to recite trivia from IMDB about whatever she’s trying to watch or do the “alive or dead” quiz about some actor on the screen. The shows she watches aren’t very cerebral, so I think I may be more fascinating anyway, although I don’t have the nerve to ask if she agrees.

Ed Marx has updated his Why I Fired and Rehired Myself post, which he’s good about doing in response to your comments (even the nasty ones).

Here’s a shout-out for HIStalk pal Michael Christopher and CarePrecise, which offers a variety of ways to access the federal government’s healthcare provider database with data points on three million providers that include UPINS, Medicare IDs, state license numbers, phone numbers, separate tables of newly added and newly dropped providers, etc. They also have medical marketing tools for you vendor types. Michael’s a genius, so you get to talk to him if you buy something (I talked to him once as Real Me and not Mr. H and was mightily impressed, which doesn’t happen too often).

I wasn’t quite prepared for the immediate response to my casual blurb about maybe needing to hire someone to help Inga and me out. I expected to get an e-mail or two, but not from household name type people (VPs, retired CIOs, people who have published or edited magazines, etc.) Let’s just say I’m honored that folks at that level read HIStalk, much less want to help with it, and I want to hire every one of them because they all sound great. It’s a low-rent operation here, so we’ll see how it turns out (I’m behind on responses, but I’ll get there). Several did the same as Inga when she first contacted me years ago: listed 10 sassy, cynical, funny reasons I should hire them. Here are some of the ones I liked as showing a deep understanding of the HIStalk (anti) corporate culture:

1. I am considered a pain in the ass by 95% (or more) of people who know me.
2. I know the industry, the jargon, and where some of the bodies are buried.
3. I really, really want a cool avatar like Inga has, although I firmly insist on a bit of virtual Botox.
4. Smart-ass, I am (much more fun if you say it like Yoda). Above all, this is the personality trait that appears to be the key to the HIStalk inner sanctum.
5. I am certain that you’ll get more impressive volunteers to write for you than me. That being said, you shouldn’t pick them because they’re too busy and they suck in their own perceptions of HIT.
6. My husband says, “I’d hire you. You are smart and cute.”
7. But enough about me, let’s talk more about me.
8. I am a passionate sports fan, mainly that of European soccer. I will defend to the end the reason for soccer not blossoming in America is that our social fabric is built on competition, not community, and therefore we cannot support soccer on a national or regional scale. It has nothing to do with boredom or slow-moving play, as we support baseball and American football, which border on tedium with the amount of time-outs, commercials, and gratuitous jock-adjusting. Soccer is like the ballet — no matter how much you hate it, you know it will end at a reasonable hour.
9. Actually, in all candor, my experience makes me a perfect fit for this role, not OJ and the leather glove, but an honest-to-goodness Isotoner glove-type fit.
10. I always attend HIStalk events at HIMSS!

I think I’d need one of my attorney readers to help decipher the legalese, but it sounds to me like Cerner and Mayo Clinic prevailed in an intellectual property lawsuit they brought against a former Mayo physician. Mayo said he took his knowledge of a natural language processing application that Mayo was commercializing to Merck, which may or may not have planned to commercialize NLP software (depending on who you believe). Cerner apparently licensed the software from Mayo and sells it as Discern nCode. He wrote it in MUMPS for you haters out there. I lost interest at this point (earlier, actually), but if you didn’t, here you go.

Wolters Kluwer Health buys EMR training software developed by a research team at University of Tennessee. Its intended audience is schools of nursing for training students on EMRs. UT gets a cut of sales. The iCare web page is here.

Geisinger Health System (PA) notifies 3,000 patients of a data breach that occurred when a former doctor at one of its hospitals e-mailed information about his patients to his home e-mail account. Geisinger says it notified patients because the information wasn’t encrypted even though it’s almost certain that nobody else saw it. So there’s your first HITECH-related action and one that doesn’t involve EMR bribes – it requires providers to send breach notices to affected patients.

Thirty-six top-earning executives at the University of California are threatening lawsuits against the UC system if it doesn’t increase their retirement payouts. The university is changing its pensions (most of us would need a dictionary to know what those are) since they were underfunded by $20 billion by the perpetually fiscally irresponsible state. Among those signing the demand: UCSF CIO Larry Lotenero (paid $377K) and UCLA health system CIO Virginia McFerran ($477K), along with mostly hospital and investment management people. The bank bailout is going to look like a child’s allowance as states start going broke over wildly generous salaries and pension plans, loading their payrolls with double-dipping “retirees” and employees jockeying their positions for their last year before retirement since guaranteed lifetime payments are based on final salary.

Strange lawsuit: a mentally ill patient who had spent years in a psychiatric facility sues its operator, the State of New York, for nearly letting him die with an untreated infection. He wins, but the state asks the judge to give it his $1.7 million award in return for treating him without payment for 10 years. The judge agreed, so the patient got nothing.

Happy New Year!

E-mail me.

HERtalk by Inga

ONC names Surescripts its sixth Authorized Temporary Certification Body, but only for e-prescribing and privacy and security.

Central Florida RHIO names Jeanette Schreiber its new chair. She’s associate dean and chief legal officer for the UCF College of Medicine.

One week after hitting a last-minute snag, McKesson completes its acquisition of US Oncology.

I am back at home after a week of holiday merriment in the land of No Internet. I had intended to make it a working vacation, but underestimated how very slow my connection would be. After two days of pulling my hair out each time the connection dropped, I finally had to fess up to Mr. H that my escape from civilization was not going as planned and that, alas, HIStalk Practice would have to skip a day. Now, as I sit at my desk using lightning-fast Internet, I must say that I am surprisingly happy to back at work. I promise that my renewed attitude has nothing to do with the Help Wanted sign Mr. H posted during my absence, nor the fact that two dozen people more qualified than me are vying to become Mr. H’s new BFF. Actually I am pleased that so many people “get” how fun this job can be and I am hoping it will give both Mr. H and me more time to work on some other fun projects.

Speaking of fun projects: the upcoming HIStalkapalooza event during HIMSS. Mr. H spilled the beans on a few details and I must also make a couple of comments. First, I have high expectations for contestants in the “Inga Loves My Shoes” contest. It’s quite easy to participate – just pick out the most fabulous pair of shoes from your closet and wear them to the party. A trusted Inga stand-in will eye your feet and select the winning footwear. If shoes aren’t your thing but you want to impress the HIStalkapalooza universe (and definitely me), dress your very best and you will automatically be in the running for HIStalk King or Queen. Here is a tip for the soon-to-be-legendary King and Queen contest: if you are wearing a straight-from-the-booth vendor tee shirt,  you will not win this incredible honor. Those wearing tuxedos and chiffon will automatically make the semi-finals. Wearing pirate costumes or pink pants may only get you a Mr. or Ms. Congeniality award. I am trying to convince Mr. H that we need some amazing prizes for our lucky recipients, but no decisions yet. Meanwhile, I am dreaming of IngaTinis, red carpets, and dancing the night away.

An Ohio surgeon is sentenced to a year in prison for having his office manager pose as a doctor while he was out of the office. The office manager for Dr. Charles C. Njoku had previously been sentenced to three years of probation, including one year of home confinement. The two also must pay restitution of $131,000 for billing Medicare and Medicaid as if the office manager were the doctor seeing patients.

I would love to know which EMR this doctor uses. An internist treating a complicated patient complains that her EMR will not allow her to write an evaluation exceeding 1,000 characters. When the physician calls the EMR help desk for assistance, the tech replies, “Well, we can’t have the doctors rambling on forever.” And the industry wonders why doctors resist EMR adoption.

The mHealth market continues to boom, with over 200 million apps now in use. About 70% of people worldwide are interested in owning at least one mHealth application and are willing to pay for it. Countries with large populations and limited healthcare options, such as India and South Africa, are the most interested in mHealth. Look for the number of mHealth apps to triple by 2012.

Puget Sound Blood Center (WA) is launching the GCI ConnectMD private medical network to connect with Swedish Medical Center, Cherry Hill Campus.

Government auditors report that the CDC lost or misplaced more than $8 million in property in 2007, including a $1.8 million hard drive and a $978,000 video conferencing system. Whoops. The CDC says it has now instituted better controls and that 99% of its property was accounted for in 2009.

A computer tech in Michigan is arrested for allegedly violating state hacking laws and gaining access to his then-wife’s e-mails to confirm his suspicions that she was having an affair. Turns out she was, with her ex-husband. The wife (who is now actually the alleged hacker’s ex-wife) realized the computer had been hacked when personal e-mails showed up in a child custody pleading involving her first husband (hacker was husband number three). Computer geeks, lots of husbands, and adultery – it just doesn’t get much juicier than that.

Sponsor Updates

• Greenway Medical Technologies announces a new web site covering EHR adoption incentive programs.
• PatientKeeper is moving to new headquarters in Waltham, Massachusetts in a building adjacent to the Massachusetts Medical Society and the New England Journal of Medicine.

E-mail Inga.

Readers Write 12/29/10

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

The Role of Automation in Reconciling Patient Records
By Beth Just

Duplicate patient records have long been a serious problem for hospitals, creating the potential for missing or inaccurate patient information that can lead to life-threatening care situations. They are also a substantial drain on financial, health information management (HIM), and IT resources.

Industry estimates are that 3-15 percent of patient records at a typical hospital are duplicates. That number skyrockets to 30 percent or higher for facilities that have been acquired or merged or are part of an integrated network. Exacerbating the sense of urgency surrounding the elimination of duplicates is the impact they can have on a hospital’s ability to qualify for incentive payments under HITECH. In particular, duplicates artificially inflate the number of unique patient records, which are the basis for several Stage One criteria.

That is why eliminating existing duplicates and preventing the creation of new ones must be an integral part of any facility’s data management strategy. In addition to easing the burden of achieving Meaningful Use, doing so also eliminates significant cost drain. One three-hospital system determined that the duplicate volume for its health system was more than 17,000 records.

The estimated annual cost of those duplicates? Anywhere from $554,000 to more than $1.2 million for repeated tests and treatment delays, as well as incremental costs related to longer registration times and correcting duplicate records.

The challenge is that reconciling and eliminating duplicates is a cumbersome, manual process that requires staffing resources most hospitals cannot spare. What’s more, these processes do nothing to prevent future issues.

Traditionally, the reconciliation process is executed entirely on paper. Potential duplicate records are identified as patient charts are pulled. They are then assigned to the HIM staff, which must analyze previous charts and other information to verify whether they are actual duplicates before they can be eliminated.

Even if a hospital’s information system provides reports of duplicate records, the data they contain typically is limited to key identifiers, such as name and date of birth. More research is generally required once potential duplicates are identified.

Progress on reconciliations is also typically tracked on paper, leaving room for error and duplication of work.

By automating portions of the reconciliation workflow, hospitals are able to quickly and efficiently weed out existing duplicates and prevent new ones. By allowing multiple duplicates to be reviewed in a single view, automated processes also heighten user control over the merge process, lessen the time required to complete the process and enable more effective quality assurance before records are merged. High-level process will also support merging records in downstream systems while reducing manual steps and associated costs.

Automation can also reduce the time and resources required for reconciliation. The best systems will also automatically document decision validity, track productivity and generate comprehensive, user-friendly reports that provide a complete view of efforts and insights into problem origination points.

After six months of manually analyzing duplicates records, the previously mentioned hospital system chose to leverage the efficiencies of an automated reconciliation process to eliminate duplicates prior to its transition to a new clinical information system. Today, it relies on the software to maintain clean, high-quality patient records. The automated solution resolves upwards of 500 duplicate records monthly at each of its three hospitals – and it does so with fewer resources than had previously been dedicated to the process.

Beth Just is CEO and president of Just Associates.

How Healthcare Is Different
By Rambling Man

Healthcare is unlike any other industry for a ton of reasons, a few I found the time to ruminate upon this morning.

What industry does not know its costs? There are examples of providers performing this analysis, but most community hospitals, ambulatory care centers, and primary physician offices operate from ignorance of this information. How can providers negotiate payer contracts without this knowledge?  This information will become increasingly important as the industry evolves from traditional payment models with ones based on quality of care and outcomes. This begs the question: how will we measure quality care and outcomes? The answer will inevitably involve more consumer involvement.  

How will the industry respond to the increasing demands upon the primary physician? Today’s reimbursement models force physicians to fit more patients into their daily routine, while still making the same amount of income. This model will eventually change the face of healthcare, and perhaps for the better. Demands on physicians to stay current with new clinical data, juggle a schedule of seeing 36 patients a day, and “practicing the art” seems super-human and may be outdated. 

These demands, combined with an alarming decrease in physician ranks, will create a new layer between the patient and the science. This new layer may be satisfied with Nurse Practitioners or Physician Assistants, or a skill-set not yet defined that focuses on data gathering and psychological insight.

How can patients do to better the system? Medicine addresses our physical vulnerability and fear of death, which are the darkest of human emotions. Physicians must have a serious sensitivity towards the emotional needs of patients, and one could argue society’s reaction towards death has worsened in the last fifty years. 

For many, years of pain or confinement to bed are better alternatives to accepting the inevitable. We expect our physicians to be the best scientist and psychologist all wrapped up into one package, but how have we changed as consumers? We need to bear a larger portion in the direction of medical care, and the systems that provide medical information to the consumers must be simplified for all. Health data banks, where consumers store health information and pay for data analysis, will emerge and become the centers of our data. 

And finally, and arguably more difficult, is that we require a change in attitude regarding death. Fear of death is the motivation behind the largest portion of healthcare expenditures. Has our consumer psychology foregone quality of life in favor of quantity? Changing these attitudes will not happen overnight and will not be easy.  Each of us facing our ultimate demise need to do so with dignity and faith that death is a beginning to a larger chapter in our existence.

As I Stand With Nozzle In Hand
By Mr. HIStalk

Pumping gas is boring. There’s nothing you can except fidget and enjoy the fumes (which I do). The high point for me is spotting a squeegee in a nicely full container so I can at least pretend that my windshield is dirty and entertain myself for a few seconds by cleaning it (or curse the lazy clerks who’ve left the squeegee in a desert-dry container because they just don’t care).

Sometimes I read the stickers on the pump, like the last inspection date or how to find the emergency shut-off valve (daydreaming of heroically saving an entire neighborhood by stopping a spreading ocean of flame as I sprint confidently to shut down the pumps like John Wayne in Hellfighters). While scanning for those exciting tidbits the other day when I was in another state, a sticker on the pump caught my attention. Under a picture of a scowling, R. Lee Ermey-lookalike state trooper, it said Drive Off, Lose Your License.

I marveled at the political clout of the gas station owners. Shoplifting, walking out on a restaurant tab, or any kind of petty theft are all subject to a ponderous legal system with generally light penalties for first-time offenders. The punishment, if it ever comes, is generic and disjointed from the crime. But somehow the gas guys used their political grease to get politicians to approve a very specific (and severe) penalty for a specific type of theft affecting only them.

Obviously the R. Lee sticker was designed to get your attention. The Lose Your License part is a lot more dramatic than, Drive Off, You Will Probably Not Be Arrested and At Worst Will Get a Slap On the Wrist Months From Now Even If You Are Arrested, and That’s Assuming the Unmotivated Dry-Squeegee Clerk Cares Enough to Chase You Down the Street To Get Your License Number.

I was appalled. What does skipping out on a gas station tab have to do with the privilege of driving? That makes about as much sense as … uh oh … penalizing doctors for not using electronic medical records.

Gas stations could have eliminated their problem without judicial favoritism by simply requiring cash customers (are there really any left?) to pay before pumping. Just like EMR vendors could have boosted use of their products beyond the pathetically tiny percentage of busy, pre-HITECH doctors willing to use them by making them easier to use and designing them to increase doctor efficiency rather than accumulating interesting but not always clinically helpful data for insurance companies and the increasingly intrusive Uncle Sam to poke around in to find reasons not to pay for services already rendered.

Even though I’d paid at the pump, I decided to go into the C-store for a soda and some nutritionally devastating snacks (anybody for an jelly orange slice or a pack of those mini-donuts slathered with coconut gunk?) On the wall beside the “deli” (where the commissary-made sandwiches encased in their nitrogen-filled coffins are moved from totes to the refrigerator in a form of “cooking”) was the C-store’s health inspection sign.

I read those. If I’m going to a strange restaurant (especially if it’s Asian or Mexican), I’m going to seek it out right away to make sure the cooks at least occasionally wash their hands and don’t store the goat carcass designated for employee lunches in the same refrigerator as the desserts, at least during the inspector’s surprise visit. (As a second-level review, I always check out the customer restrooms since whatever disgusting state those are in is ten times cleaner than the areas customers can’t see, like the kitchen).

I want to see those health inspection signs on hospital and practice doors. Give me a letter or number score of how well they adhere to quality measures, as measured by a totally independent and fear-inspiring government bureaucracy (not the chummy Joint Commission, which has given hospitals glowing scores right before the state inspectors came down on them like the wrath of God for running shockingly lax operations). I would turn tail just as quickly from an impressively ornate medical provider’s facility with a C-minus score as I would from a $5.39 all-day Chinese buffet restaurant that doesn’t even own a trash can (but with illegal immigrant employees who probably wash their hands more than the average doc even though they’re deboning chicken thighs instead of probing people).

So thumbs-down for making up new penalties to encourage whatever behaviors the politicians and those who influence them have decided are desirable. Thumbs-up for letting businesses run their own affairs, but with mandatory full disclosure to their customers. Let the market decide whether and EMR-wielding C-minus practice is preferable to an A-grade practice using an IBM Selectric and one of those, “Sara, this is Sheriff Taylor” telephones that look like the far end of a clarinet.

But in the mean time, I’m thinking about applying a for a few paltry million of the HITECH bonanza to create an EMR awareness program for the paper-clinging providers. I’m calling up R. Lee Ermey, posing him in a government-looking suit and power tie, and putting him on stickers for manila folders that read Write Order? Lose Income.

News 12/29/10

From BeKind: “Re: Texas patient privacy breaches. Mentioned in this article.” It also mentions that JPS Health Network is spending $94 million on its Epic implementation.

From Jennifer: “Re: QuadraMed QCPR. Now fully certified!” CCHIT certified QCPR as a hospital EHR on December 23.

From Skinny Minnie: “Re: vendor gag clauses. A billing vendor’s new customer did a YouTube testimonial about why they switched from their previous vendor (service and cost). The previous vendor told the customer they were violating the terms of their contract, which says they can’t ‘disparage or denigrate’ them, and insisted they make their new vendor take the video down.” No link was provided, but I found a YouTube video featuring a customer of the same ‘new’ vendor explaining why they replaced the same ‘old’ vendor, specifically mentioning the monthly cost of each. Either the ‘old’ vendor missed this one or it didn’t get taken down after all.

From Alfonso: “Re: healthcare IT tools for Accountable Care Organizations. I ran across an article touting two companies that are attracting VC and private equity interest – MedVentive and AmalgaMed. Investors are looking at the next two years as being critical for capturing market share as payment reform in the form of ACOs restructures healthcare delivery.” AmalgaMed is a new startup founded by a couple of entrepreneurs with benefits management experience.

Genesis HealthCare System (OH) sells $20 million worth of buildings to pay for an EMR system, freeing up cash flow to fund mission-critical projects.

TPD has updated his list of iPhone apps.

Who knew that Tom Selleck was a cheesy-mustached technology thought leader way back in 1993? Or at least he sounded that way as he read the script that AT&T gave him for these old commercials. I ran across a mention of this compilation video on something called Dvice, from Syfy.

Inga and I have been swamped lately, with a ton of new sponsors, interviews, HIMSS planning, etc. I’m thinking I need to hire someone part-time to help out. I could use someone who knows the industry, writes really well, and enjoys dealing with cool people like our sponsors and contributors by e-mail and telephone. Pay won’t be impressive, but it’s a good chance to learn and to get your name out there. Those interested should do like Inga did years ago: e-mail me and tell me why I should hire you since my natural inclination is to just suck it up and work more hours myself.

Registration for CMS’s Medicare and Medicaid EHR incentive programs starts next week. Instructions and the link to the registration page (when it’s turned on) are available here. You can register now even if you haven’t implemented anything yet.

Weird News Andy notes that of the 20 least-efficient charities in the country, only one relates to healthcare: Charleston Area Medical Center Foundation (WV), which runs an administrative expense ratio of 49% and earns one star from CharityNavigator. In comparison from the most-efficient list, Brother’s Brother Foundation, which includes medical supply donation among its projects, runs an expense ratio of 0.0% and has earned a four-star rating from CharityNavigator (which is where I always look first before donating). I have to be honest: having worked for hospitals nearly all of my life, they’d be last on my list of organizations to which I’d donate. Charity is big business at that level, with highly paid foundation employees, lots of private club donor schmoozing, and constant trading of favors (like donors making their contributions contingent on hiring their company as a vendor or giving their worthless kids phony jobs). Not to mention that I would never fund a charitable cause that pays executives $1 million or more like many hospitals.

Cerner shares are continuing their generally upward trend, closing Tuesday at $96.01. You could have bought shares for $72 in September (or $16 in 2003).

India-based NIIT Technologies Limited acquires the Preferr patient referral system, developed by Visions@Work of Clermont, FL.

E-mail me.

HERtalk by Inga

Manatee Health System (FL) will spend $2.5 million to implement Cerner, with Manatee Memorial Hospital and Lakewood Ranch Medical Center making the switch in August.

St. Joseph’s Hospital Health Center (NY) will hire at least 25 people "with considerable information-technology (IT) experience, preferably in the health-care field." The additions will double the size of the existing IT department.

UPMC introduces a mobile version of MyHealth Connect, giving users smart phone access to UPMC Health Plan information. The initial phase includes details on UPMC’s provider directory. Future versions will include a virtual ID card and access to members’ PHRs.

US Oncology names Karen Gibson SVP and CIO of its technology services, reporting to EVP Asif Ahmad. She was previously CIO of Life Technologies and of GE Healthcare Information Technologies.

Sponsor Updates

• Cumberland Consulting Group promotes Mary Francis Shaw, Dao Dang, and Chris Wolfert to executive consultant.
• Allscripts CEO Glen Tullman will join the founders of Wikipedia and eMedicine to discuss the impact of the Internet on healthcare on January 6 at the University of South Florida Alumni Center in Tampa.
• CareTech Solutions offers a money-back guarantee to hospitals that try its Solution Found service desk offering.
• Picis will incorporate the AORN Syntegrity framework into its perioperative suite.

E-mail Inga.

CIO Unplugged 12/27/10

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

Why I Fired and Then Rehired Myself

The capstone of holiday seasons past has been The Plunge: leaping into the icy waters of Lake Erie wearing nothing but swim trunks. Each New Year’s Day, we Cleveland Triathlon Club members gingerly — if not insanely — worked our way across the snow and ice then charged into the lake. Once we reached waist-high water, we crowned our feat with a head-first dive. Like an arctic baptism, the Plunge symbolically washed away the old and welcomed the new.

A few years back, I used this event as the demarcation point for firing and rehiring myself. I plan to do the same as we head into 2011. I think we all should give ourselves the pink slip.

A few years ago, Intel was losing market share and profitability. Consequently, the company floundered. Knowing it was a matter of time before the Board would take mending actions, the leadership (Grove, Moore) discussed a particular phenomenon they’d observed. Nearly every time a company or division installed new leadership or brought in consultants, their outcomes improved.

Their conclusion: the new leader came in energized and with a fresh pair of eyes. Knowing they were being evaluated, he or she took their responsibility more seriously than the former, uninspired leader.

Subsequently, Intel’s old leadership had a brainstorm. Why not fire themselves and come back to the job as the new leaders? They said:

If existing management want to keep their jobs when the basics of the business are undergoing profound change, they must adopt an outsider’s intellectual objectivity.

They fired themselves over a weekend. After shifting markets (from memory chips to microprocessors), Intel became the clear leader in a very competitive market.

At that time, I worked for University Hospital. Although neither the hospital nor IT were in dire circumstances as Intel was, we needed to guard against complacency. I challenged my leaders to follow my example and take time over the holidays to reflect. Pondering how you would approach your position as a new employee is a healthy and worthy assignment.

Look at yourself as a potential candidate for your position. How will you evaluate the talent, change processes, and adjust the service mix? Should you alter your interactions with customers, your personal engagement, or your attitude? Will you embrace ideas you formerly rejected or feared? What strategies and tactics will you deploy to ensure business and clinical convergence with the health system? Do you have the fortitude to remove employees who add no value? Are you stretching the boundaries of innovation? Do you demonstrate courage despite resistance? How will you be a better servant…? The variations are endless.

To survive, you probably won’t need to change anything you’re doing. But to thrive means constantly reinventing yourself and operating differently. As a team, we embraced change, adopted an innovation-oriented culture, and began to walk in the fullness of our authority. What Got You Here Won’t Get You There.

Several other UH leaders fired and rehired themselves that New Year’s Day of 2007. The result? We experienced a dramatic shift moving from transactional to transformational services that had a net impact on our business and clinical operations. Our business, quality, and service metrics shot up to new heights. I experienced exponential growth, both personally and professionally.

Since I no longer live by the Great Lakes, I have to find a new point of demarcation. By the time you read this, I will have hang glided over the Swiss Alps (JungFrau). At the moment I leap off the mountain into the alpine chill, I will fire myself as CIO. An internal shakeup. I’ll let the present perceptions of my role plummet to the icy depths.

By the dawn of the New Year, I’ll find innovative eyes to view the future. Only then will I rehire myself.

Are you willing to give yourself the pink slip?

Update 12/30/10

Thank you for the comments, both positive and negative. I really liked the idea about being re-interviewed by your staff in this sort of process…have to incorporate that somehow going forward. Clearly I can’t respond to every comment, but as always, readers are welcome to contact me directly where we could further exchange ideas. Happy New Year!

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.