An HIT Moment With … Tee Green

An HIT Moment with ... is a quick interview with someone we find interesting. Wyche T. "Tee" Green III is president of Greenway Medical Technologies of Carrollton, GA, which provides market-leading physician practice software and services.

Greenway just announced PrimeResearch. What kinds of practices will use it and what’s the benefit?

We believe that, in time, most practices will participate in active strategies that improve population health, such as conducting clinical trials and enrolling patients into electronic disease registries that enable researchers to drastically increase the speed at which new drugs or treatments are introduced, essentially saving time, money and lives.

Through our PrimeResearch network, physician practices that use Greenway solutions will have access to a vast network of clinical research, quality/safety initiatives, and composite clinical and financial analytics, all of which can increase revenue for the practices and foster the physician’s ability to improve the quality of care for patients.

How do you think economic conditions are changing the physician systems market and who will win and lose?

That’s a tough question as we aren’t quite sure at this point how it will affect the market. The good news for companies like Greenway is that we provide solutions that enable physicians to remove inefficiencies in their practice and increase the quality of service and care they provide their patients. Companies that assist practices in providing better care and increase their revenue by doing so should do well in this environment.

While the economy is slowing down, our company continues to grow. During the last quarter, PrimeSuite 2008 became a fully CCHIT Certified 08 ambulatory EHR, including certification for cardiovascular medicine and child health. In September 2008, we finished our largest month in company history with nearly $7 million in new sales.

Is interest growing in revenue cycle products and services for physician practices?

Yes. We see physicians not only interested in revenue cycle improvements, but in clinical and administrative improvements as well. A general trend we have noticed is that companies that deliver services that integrate and streamline the clinical, financial, and administrative processes of the practice are growing. Physicians want to be able to work fluidly on a single-database solution and are seeking products that allow them to do so.

What is your reaction when you see big hospital systems vendors buying into the physician practice market?

Smart move for them, I would think. I imagine hospital CIOs are pushing their HIS vendor to roll out usable solutions for their connected, and hopefully interoperable, ambulatory market. 

About a year ago, we launched PrimeEnterprise, which enables healthcare organizations such as hospitals, RHIOs, and IPAs to effectively manage today’s complex healthcare enterprise by streamlining the business process and improving the physician’s ability to make the most informed decisions. Whether these organizations are looking to centralize such tasks as clinical population management, streamline the sharing of clinical information or better manage accounts receivable amongst the many providers in their network, a community-based solution will enable them to better manage their workflow. Furthermore, recent Stark Law changes provide benefits for hospitals and other community health organizations that invest in healthcare IT like PrimeEnterprise.

A recent rumor speculated that the company has attracted interest from larger firms that could result in a sale. Does that match with your vision of where the company wants to go?

Certainly not. That rumor seems to pop up every other year or so. I can only speculate from where it comes. To be very clear, we are not talking with anyone about an acquisition of Greenway. Our investors are excited about our long-term plans, so we will continue to grow as a profitable private company. We should add our 1,000th practice in the coming months, and we currently have more than 20,000 users in 30 specialties and subspecialties in 48 states.

We started out in the small- to medium-sized practice market but during the last couple of years we have seen tremendous traction in the larger practice segment of the market. Our business plan is built on a long term relationship with our customers and we are very excited about our future at Greenway.

Francisco Partners To Acquire API Software

Labor management software vendor API Software, Inc. will be acquired by private equity firm Francisco Partners II, LP, the company has announced. Closing is expected within 30 days.

The Hartford, WI-based API’s product line includes applications for time and attendance, staff scheduling, payroll, human resources, education tracking, and access control. Its Payrollmation and ActiveStaffer systems are top ranked in KLAS.

J.P. Fingado, formerly of Cerner, has been named president and chief executive officer.

Monday Morning Update 10/27/08

From Rose Michaels: "Re: Epic. From a reliable source (you’re probably already aware) Epic will be implementing in Dubai. Not sure of the details but figured if anyone could get them, it would be you. Thanks for doing the fabulous work that you share with us daily!!" I’ve mentioned it a couple of times back when University Hospital first made their selection, but hadn’t heard anything since, other than I saw an Epic user group story that said folks had come from as far as Dubai. More information is welcome. Seems like a lot of big deals are in the Middle East these days, but of course they’ve got the cash and have always been fans of US-style healthcare (at least the kind we deliver to our ultra-privileged patients).

From Al Borges, MD: "Re: Magellan EMR. Jason Murdoch, MD was able to get in contact with John, the owner. The EMR formerly known as Magellan has run into some business problems relating to being a small startup in a vicious EMR world. Magellan EMR has not been scrapped but is on the shelf. John is a reputable guy and took the site down to not mislead people." John e-mailed Inga back after her incessant sleuthing (we help readers however we can). Dr. Murdoch concluded with, "Does anyone know if Inga is a hot, Swedish blonde?" I do, actually, and all I’m saying is that she is indeed hot (and talented, and fun, and smart …) Swedish and blonde? I’ll never tell.

From Cliff Williams: "Re: Lincoln Park Hospital. At a Chicago meeting, I heard the hospital closed up shop, literally an overnight decision. Without warning, they called nurses and told them to come in and get their final check and sent patients to other facilities. Done. Sign of the times?" The hospital couldn’t find a buyer after it failed to find financing due to its $15 million annual losses and high Medicaid patient load. Deteriorating margins and tough credit will take more struggling hospitals out of the picture, although better capitalized groups may take them over if they have a presence nearby. That kind of Darwinism isn’t necessarily a bad thing, but some of the bigger groups got that way by minimizing the amount of charity care they provide. As always, uninsured patients take the biggest hit.

And speaking of closing hospitals, Physicians Medical Center Carraway (AL) also locked the doors on short notice this week for the same reason – it couldn’t get funding. I’ve been warning of that kind of situation for quite some time, but nobody seems to be noticing that it’s happening now (both closings and scrapping expansion plans).

From Al Borges, MD: "Re: HIT stocks. HIT in the USA is still in somewhat of a slump as compared to ‘Other Technology Companies’. HIT companies showed an unweighted YTD average return of -22.4% vs -14.2% for the OTCs." Link. There are probably lots of caveats to the list. Stock price movement within sectors tend to be amplified in both the up and down directions, so looking back one year may not be enough since all you’re seeing is performance in a historically awful market. The companies on the healthcare list are also a lot smaller and more focused than those international giants on the OTC list (Merge Healthcare vs. IBM?) Putting GE, Misys (shouted out as MISYS on the list for some reason), McKesson, Philips, and Siemens on the HIT side certainly muddies the waters since that’s a tiny part of their business and GE and Siemens are highly exposed to general international economic conditions. And, is looks like they simply averaged the individual one-year change, lumping in obvious low-cap losers like Merge (-77%), Emageon (-74%), and whoever I-Many is (-76%) with the big boys (half of the HIT companies have a smaller market cap than the smallest OTC listed). The list is pretty, but I’m not sure it really contains a lot of insightful or useful information. And, lots of the bellwether HIT companies aren’t publicly traded any more because of acquisitions, going private, or preference.

From Mike Donovan: "Re: Bridgeport. Mark Tepping is retiring after a long and successful career, but Bridgeport Hospital does not use ProFit – it uses Eclipsys’ AM/PFM for reg and billing." Thanks for that. I admire anyone retiring in today’s financial thrill ride. I must have confused Bridgeport with a ProFit user, which is surprising since there are so few of them. I don’t know anything about AM/PFM. That’s the old SDK, right?

Welcome and thanks to new HIStalk Gold Sponsor Satyam Computer Services of Hyderabad, India. It’s a big company ($2.5 billion in revenue and 53,000 employees in 66 countries) with a strong US and healthcare presence. Satyam’s services include hospital systems, portals, telemedicine, application development and maintenance, ERP, and consulting services. The case studies on the Healthcare Practice site include a couple from the Centers for Disease Control and Prevention. Thanks to Satyam for supporting HIStalk.

Former Caritas Christi CIO Dan O’Neil is named CIO of Quincy Medical Center (MA). And speaking of Caritas Christi, it gets $100 million in funding from Ascension Health, which probably means they’ll buy it eventually (which is a pretty good example of what I wrote about struggling hospitals being bought by bigger groups, which I promise I wrote before I read this story).

A hospital manager in Ireland quits after signing an unauthorized $1.6 million contract for software that turned out not to work. The hospital found out about it when they got a bill, but could not get out of the contract nonetheless.

Apple takes out Microsoft’s dopey $300 million Seinfeld ad campaign in one devastating blow. And if you’ve missed Terry Tate, Office Linebacker like I have, you’ll like his new Get Out the Vote video (but Palin fans won’t like this one).

Inga and I are curious about 2009 marketing plans of industry vendors. If you’re a vendor marketing or advertising person, please complete our seven-question survey and we’ll share the aggregated results with you (company e-mail addresses only, please, so we know you’re legit). Surely you are curious (like we are) about what companies are doing in a volatile economy.

As a reader reported in an article comment, the FTC’s Red Flag medical ID theft rule has been delayed for six months.

I’ve mentioned the teen metal group Jessica Prouty Band before because her proud mom (who works in the HIT industry) sent over a CD that I liked. Check out the first video on the page from Hard Rock Boston – playing all those gigs has obviously made them tight and confident on stage (remember, three of them are 15 and the other is 13!) Anyway, they’re in a girl-led battle of the teen bands contest, so vote for them here by October 31 and they might get a shot at playing Hard Rock NYC. We could make it an HIStalk party if Fake Ingas are available.

I was watching a video on the Google Android operating system and API and thought the kid in the opening was a bit over the top: big hair, careful grunge look, and not very convincing as someone who would really get it. Turns out it was Google co-founder Sergey Brin, the #13 richest American, who’s worth close to $16 billion. He looks like a guy who might serve you coffee at Starbucks.

CPSI’s Q3 results: revenue up 8.4%, EPS $0.38 vs. $0.30, meeting expectations. Some of that was due to a tax change, but guidance was positive. According to conference call transcript, they’re doing a lot with Linux.

A University of Florida professor develops a "birthing computer" that uses wireless monitoring of uterine muscle electrical activity to advise doctors whether a Caesarean section is recommended.

Dr. Wes isn’t an ICD-10 cheerleader. "Imagine, 290 codes just for diabetes! Yeeeee haaaaa! Diabetes with foot ulcers on the right foot gets one code, diabetes with foot ulcers on the left foot gets another code, diabetes with foot ulcers on both feet, but not involving the shins gets another code… I mean, a new code for every nuance of disease! You get the drift! Isn’t this SPECIAL? Just think of the COST SAVINGS those clever bureaucrats have found!"

I admit I’ve never heard of Pop!Tech, a big-ideas organization (although I see Jay Parkinson was a speaker at its just-finished conference). They just announced Project Masiluleke, which will connect South Africans to HIV/AIDS information via mobile phones (daily text messages, reminding patients of follow-up visits for antiretroviral drug therapy, and patient-staffed virtual call center helplines).

A sad medical error in Ireland, where a resident performing his first unsupervised kidney removal ignores the family’s objections and removes a child’s healthy kidney instead of the diseased one. The doctor relied on an incorrect x-ray that was six years old because all the newer ones were missing and there wasn’t a convenient computer to look them up on.

An English arthritis patient can’t get pain meds or a referral because her specialist’s dictation, which was sent off to New Zealand for transcription, but never made it back to her doctor by mail. Seems like they could have sent the document by secure Internet connection instead of mail.

UPMC will lay off 500 employees this week. If they’re doing it, so will everyone other hospital (and every other business, most likely). UPMC made "only" $5 million in 2008 compared to $612 million the year before.

Shands HealthCare (FL) will close Shands AGH next year, citing anticipated big shortfalls because of Florida’s tanking economy, propped up until recently by unrealistic housing prices. It could be worse: they could be in Detroit, where employees of car manufacturers are being cut loose in giant waves, sure to hit hospitals there hard in uncompensated care.

A nanoengineering researcher at UC San Diego’s Jacobs School of Engineering wins a Navy grant to create a biocomputing "field hospital on a chip" that will monitor biomarkers in the body fluids of soldiers, detect common battlefield injuries, and then administer medications to treat specific conditions.

Varian‘s Q4 numbers: revenue up 15%, EPS $0.62 vs. $0.61, beating estimates.

A former hospital compliance officer is charged with defrauding her two former employers, a Hawaii hospital and a Florida HMO, by issuing millions of dollars worth of compliance contracts (HIPAA, charge master review, compliance training) to sham companies she ran herself. The HMO hired her even though she allegedly applied for the job using a phony name, fictitious work experience, and her former husband’s Social Security number.

Central Washington Hospital (WA) gets a local paper writeup for its use of a tele-interpreter company to provide remote Spanish interpretation via computer screen, cutting cost and wait times.

Vendor Deals and Announcements

• MEDHOST is now offering a patient self check-in kiosk option called Emergency Department Patient Access Self Service (ED PASS). MEDHOST’s first implementation will be at Northridge Hospital Center (CA).
• The Radiology Institute Imaging Center in Puerto Rico is adding Thinking Systems’ ThinkingPACS solution.
• St. John HealthPartners (MI) is purchasing licenses for the Web-based Cielo Clinic software to help manage their patient population and screen for chronic diseases.
• Robert Wood Johnson University Hospital (NJ) is deploying the Eclipsys access management solution. The hospital has been an Eclipsys client for 10+ years.
• Valley Medical Group (MA) has selected athenaClinicals for its 60+ providers. For the last eight years, Valley Medical has used athenaNet for practice management services.
• Arrowhead Radiology Medical Group (CA) is implementing McKesson’s Revenue Management Solutions for its nine physician clinic.
• NaviMedix has acquired TopLine Solutions, a provider of healthcare payment and collection solutions. NaviMedix has a solution that gives providers the ability to perform real-time financial, clinical and administrative communication with multiple providers.
• Olean General Hospital (NY) and Bradford Regional Medical Center (PA) have signed a letter of intent to integrate and create a new parent company.
• HealthFusion introduces a Web-based practice management system that integrates with HealthFusion’s clearinghouse services.
• Billing service Medrium acquires Wilmington Professional Associates. Though no terms were disclosed, Medrium recently raised $10.46 million in Series C funding.
• I like the clever name for MEDSEEK’s December 3rd webinar, “Do eHealth Portals Make a Difference to the Hospital’s Bottom Line: Calculating a Return on Information and a Return on Investment.”
• Presbyterian Hospital of Plano (TX) is laying off 17 people in the face of slower than expected growth. Presbyterian is part of the 18,000 employee Texas Health Resources.

E-mail me.

News 10/24/08

From rbsavage3: "Re: HealthVault. Microsoft scores with Aetna e-records pact. As a member of Aetna and an employee of a large hospital system, I’m not sure I like this. I wonder what the community thinks." Link. The deal connects Aetna’s PHR to HealthVault and adds a connection in the other direction next year. The pitch is that HealthVault lives on even if an employer change requires leaving Aetna’s coverage. I’m not sure how the information is coordinated between the systems, but I’m sure they’ve worked that out.

From Leopold Stotch: "Re: bikers. I know we’re all used to ‘Hospital X lost a boatload of personal information data’ stories, but you never know who you’re dealing with with the Mongols support themselves through identify theft." Link. Federal agents arrest dozens of LA members of the Mongols motorcycle gang on charges ranging from drug sales to murder after undercover agents infiltrated the group (which is an amazing story of bravery on its own). The former Mongols president, who wrote a memoir about his tenure, is a night shift CT tech at LA County-USC Medical Center.

From The PACS Designer: "Re: Web-oriented architecture. You are going to be seeing another fairly new concept gain some momentum in the next few years — Web-oriented Architecture, or WOA. While we have been familiar with service-oriented architecture recently, the move to WOA won’t replace SOA, but will provide an architecture that is resource-oriented rather than service-oriented. Since resource-based solutions are more plentiful, they will give the developers a quicker on-ramp to the Web and provide a easier way to test and use new Web applications." Link.

Inga did a little more sleuthing on Magellan EMR, although I’m not sure tracking down the founder will help if the company is kaput, which seems the case. Somebody put in a ripoff report about a problem with a non-medical software package from them. The founder is scheduled to speak at a technology conference this month. He was looking for a programmer last month. Inga e-mailed the founder and the conference planner but hasn’t heard back so far. She tried both phone numbers we found; one doesn’t answer, the other doesn’t have him in the PBX and the address for the company doesn’t come with their name in Google.

A reader asked about an acquisition rumor earlier this week. We’ll have an answer Monday when "An HIT Moment With …" features the company’s CEO answering five questions from Inga and me (and you just know what one of those questions will be). We haven’t seen the answers yet, so we may all be surprised. Our impression is that readers really like these abbreviated interviews and they are fun to do, so if you have an interviewee in mind, let me know.

I kind of hinted at this when talking about Greenway’s PrimeResearch EHR-to-research connectivity, so here‘s a coincidental prediction that’s similar: a patient’s tumor genes may someday be compared to EMR data to tailor patient-specific treatment, aka personalized medicine. I’m a cynic most of the time, but I think this is eminently doable. With an EMR full of patient data that can be linked to vast databases of other patient records, drug trial results, registries, etc. there is no reason to blindly go down the treatment tree in search of a winner for a given patient. Cancer is not one single disease. Even if you don’t buy the concept that evidence-based medicine works, the idea that looking at one patient in context with a bunch of similar ones to choose the best therapy is pretty compelling.

A Michigan doctor develops a disease database to be used in India, working with the Bill & Melinda Gates Foundation to make it available. NxOpinion apparently suggest a diagnosis from provided data. I don’t really understand parent company Robertson Technologies, but it lists a lot of management people, so maybe it’s big.

If you’re ever in Algona, IA, you might as well drop in and see the EMR you’re paying for. USDA gives Kossuth Regional Health Center $134K for it, calling it a "Distance Learning Telemedicine Grant," which sounds like a stretch. It actually sounds more like an portal-type project, but it’s hard to tell from the political high five-ing.

McKesson launches InterQual in the UK. I always called it case management software, although it’s now a bit more grandly portrayed as clinical decision support (i.e., "are you well enough to go home so we don’t lose money on your stay?")

I’m behind on e-mails, but I still like hearing from folks and, even though my replies are often long in coming (I usually try to catch up on the weekend), I read every one. A few folks have asked about the Brev+IT weekly newsletter and I had to admit that it’s "on hiatus." It was taking up a lot of time I don’t have and the e-mail spam filters were keeping readers from getting it. I may bring it back as a weekly HIStalk post if I can think of some other life activity to give up in its place.

I’ve also forgotten to recently recite the list of stuff you can do here, all to your right: (a) put your e-mail in the Subscribe to Updates box to get an instant e-mail update when I write something new (that list now has over 3,100 confirmed recipients); (b) click the "E-mail This to a Friend" to tell your friends about HIStalk, which I greatly appreciate because I want to be anonymously famous; (c) use the Search HIStalk box to sift through 5.5 years of HIStalk; and (d) click the ugly green Rumor Report button to securely and anonymously send me highly sensitive and scandalous information. And, some of the best parts of HIStalk live in the reader comments below each article, so click Show Comments to check them out.

My guest editorial in this week’s Inside Healthcare Computing, which the publisher said was "very sharp, well-written, and insightful" (I’m preening because I have perpetually low self esteem, maybe justifiably), is entitled Ask the Magic 8-Ball: Who HIT’s Winners Will Be in a Recession, Depression, or Whatever You Want to Call the Crappy Times Coming. Some of the 10 items I listed came from reader ideas here, like # 3: "Consultants of the non-PowerPoint variety. Nobody cares about a five-year strategic plan when financial survival into next week is questionable, so eloquent glad-handers or fresh-faced noobs need not apply for these gigs. We’re talking gunslingers here, the battle-hardened vets who simultaneously impress and scare the bejeebers out of you. When you want a system brought live quickly or a sleepwalking vendor slapped to attention, you need someone who looks and acts like Lee van Cleef in those old Clint Eastwood spaghetti westerns." I don’t put out unless you buy me dinner, so you’ll have to subscribe to see the other nine and to receive my routine literary emanations.

Allscripts posts its last results under the old company. For Q3: revenue up 17%, EPS $0.07 vs. $0.07, missing consensus estimates by a penny (or a pence going forward now that Misys is involved).

Speaking of Allscripts, if you want to support WakeMed in Raleigh, NC, watch this video sometime before Friday at midnight. Allscripts will donate $3 for each viewing to the Just for Kids Kampaign that supports construction of a new children’s hospital.

St. John HealthPartners (MI) signs for Cielo Clinic CQMS software from Cielo MedSolutions.

Bridgeport Hospital (CT) is looking for a CIO. I’m not sure what happened to Mark Tepping, who I’ve chatted with a time or two. Big Cerner shop including ProFit, its seldom-mentioned (and even more rarely praised) patient billing app.

This article describes what’s different about Mayo Clinic ("the Big House on the Prairie"). I like the point that there’s a "firewall" between the money and the doctors, who don’t even know or care what Mayo gets paid because they all receive the same salary after five years’ on the job. "We’re all salaried staff—paid equally. This is very good for collegiality, and people working together. The culture here at Mayo doesn’t encourage egos. There is not the same cult of personality that you find at other places.” I checked its tax forms and the highest paid people, all surgeons, make around $700K. Not exactly starving, but there are lots of boondock quacks swindling multiples of that from Medicare.

Congratulations to Cerner again on some damned impressive numbers. Companies are turning in bad reports left and right and there’s good old Neal chugging along like there’s no economic problems at all while expanding globally. That’s a big story. I noticed in the call transcript that the acquisition of LingoLogix was finally mentioned: "which strengthens our revenue cycle offerings immediately … the NLP component of this technology can change the landscape for clinical search by bringing clinical meaning to unstructured clinical documentation, helping aid research, clinical trials and potentially provide a bridge to interoperability constraints as the personal health record becomes more pervasive."

The local paper writes up McKesson Horizon Enterprise Visibility (which staff call "The View") at Oakwood Hospital & Medical Center (MI).

Patewood Memorial Hospital (SC) goes with Omnicell OptiFlex for surgery materials management, including preference cards and real-time usage tracking. I looked for a good picture but couldn’t find one.

T-Mobile’s G1 phone (powered by Google’s Android operating system) is now on sale. iPhone killer? Too early to say, but the T-Mobile part killed my interest. Medical apps on the iPhone are a big hit (partly because of the "store" concept), so maybe coders are working on stuff for this one.

Speaking of Google, the company joins the Continua Health Alliance personal health group. I should interview someone there.

Natividad Medical Center (CA) chooses the NeoIntegrate integration engine from NeoTool.

Some company is auctioning off "telemedical information management" intellectual property on October 30. Included: a smart card-based EMR, HIM workflow, and a implantable RFID chip reader. Actually, Ocean Tomo seems to be entirely reputable in the IP biz, even partnering with NASA, so maybe it’s worth a look if you’re a vendor. Maybe I should cover it live.

Houston emergency preparedness officials team up with the University of Texas School of Health Information Sciences at Houston, a biomedical informatics school, to develop a medical support system for disaster and to deliver more care by telemedicine. I didn’t know that open source guy Fred Trotter works there on its HealthQuilt project, an HIE prototype. I did know that UTMB has one kick-ass telemedicine program that probably leads the entire industry, yet is rarely mentioned, since we’re talking about the Gulf Coast of Texas.

I must have missed this: a new rule that takes effect in a few days that puts hospitals under FTC jurisdiction in requiring them to check for medical ID theft for patients not paying upfront. That sounds onerous.

Patty Miller, a Sunquest sales exec, is voted president-elect of the Central New York chapter of CLMA.

That’s all I have time for since I’ve now worked directly from the uninspired dinner I cooked for Mrs. HIStalk until boudoir time without a break. She just stuck here head in to see if I was still respirating, so that’s probably a hint. We’ll pick up here Saturday. Have a good weekend.

E-mail me.

HERtalk by Inga

From Janeen: “Re: RelayHealth booth. Did you come by? We were trying to keep an eye out for you at MGMA. We had a theater experience that involved a consumer/patient, physician and an administrator we were hoping you got to watch. Let us know if you saw it.” I did lurk by your booth a few times, and even chatting with someone about how PHR fits into the RelayHealth model. RelayHealth had an “exam room” setup with a cute doctor who explained the ins and outs of RelayHealth’s offerings.

Overheard in the San Diego airport: “MGMA was a really good show for us. Lots of traffic.” Standing in the security line, I stood in front of a guy from Fujitsu chatting with another vendor (sold lab coats, I think.) The Fujitsu guy said that MGMA and HIMSS were their two biggest shows and they were pleased.

On the other hand, I did hear a number of people say that attendance seemed a bit sparse. My opinion was I didn’t go to a single session that was standing room only and didn’t have to push through crowds at the exhibit hall. It wasn’t HIMSS, but there were folks everywhere all the time. With such gorgeous weather, I can imagine a number of folks stepped out for some sightseeing.

Anyway, I am glad to be home. I’m worn out from so much fun and long days in high heels (but I looked good.) I’m trying to tell myself that I’m tired because I am out of practice (not used to all that traveling, walking, sitting, wine-drinking, sleeping in a strange bed, etc.) and not because I am getting to be a 3-letter word that rhymes with cold.

Eclipsys co-founder and Carefx founder Terrence Macaleer joins Allscripts as VP of sales for Enterprise Solutions. I also see that Centra (VA) has selected Allscripts ED IS solution.

The VA contracts with Qwest Communications to provide $60 million worth of voice and data services to connect its 1,300 hospitals and other facilities.

More proof here that healthcare is not totally immune to economic troubles. Several new reports confirm that more of us are delaying doctor visits and tests, and skimping on medicine. Kaiser Family Foundation determined 36% of Americans are skipping recommended tests and treatment, up from 29% just six months ago. The number of prescriptions filled has fallen .04%, the first time in at least 12 years a drop has been recorded. Elective surgeries are falling; ER visits by the uninsured are rising.

Also suffering: Yahoo announces a 64% drop in Q3 profits and a plan to cut at least 1,500 jobs. On the other hand, Google’s are up 26%.

Sentillion adds a record 11 new customers and over 200,000 new user licenses in Q3.

E-mail Inga.

Readers Write 10/23/08

Submit your article of up to 500 words in length, subject to editing for clarity and brevity. Use your real or phony name (your choice). Submissions are subject to approval and become the property of HIStalk.

Personal Health Records are Durable Medical Equipment
By Manfred Sternberg, J.D.
Presiding Officer, Board of Directors, Texas Health Services Authority

There is little debate that knowledge and information have always been among a physician’s best clinical tools. Consistent with this fact, information technology (IT) should be viewed by the healthcare industry as a medical device. With the advent of evidence-based medicine coupled with advances of IT, we are in many ways on the brink of a golden age of medicine.

In the relatively near future, information supporting evidence based medicine will translate from bench to bedside at speeds never before witnessed. We will have more accurate information to treat health issues more appropriately, based on the data, than ever before.

Admittedly, IT is in many ways a crude medical device, but that is today. Many of the now traditional medical devices that were introduced into the healthcare market throughout history started off as crude devices; think about surgical tools.

Like other medical devices, this device is certain to evolve with use, experience, and continued development and innovation. Many predict that the use of this IT device by healthcare professionals will become the standard of practice, like scrubbing in before surgery. The legitimate debate generally centers on how and when.

As with other changes in medicine, the adoption of this new tool will be an evolution. It will not happen by just flipping a switch at the end of any given year, it will evolve. Consumers and their physicians must participate in this evolution for it to ultimately be successful. The consumer’s best platform to effectively and economically engage with the industry is a standardized personal heath record (PHR).

What is a PHR?

A PHR is an electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.

PHRs may also include information that is entered by consumers themselves, as well as data from other sources such as pharmacies, labs, and care providers. PHRs enable individual patients and their designated caregivers to view and manage health information and play a greater role in their own health care. PHRs are distinct from electronic health records, which providers use to store and manage detailed clinical information.

The Benefits of using a PHR

There is consensus among stakeholders that the widespread adoption of health information technology will lead to safer, more effective healthcare. Experts believe adoption of technology will reduce preventable errors, such as medication errors, increase compliance with recommended treatments, improve treatment for people with chronic disease, and contribute to lower health care costs.

Ultimately, this new tool will allow physicians to benefit from improved information about each patient, and consumers and doctors can share that information to make the best decisions concerning their healthcare. Better data (e.g. timely, personalized clinical and billing data) provides better results whether in the hands of a physician, patient, health coach, or measurement program Additionally, care coordination from a process management perspective is critical to improved results

Consumer Empowerment

Consumers have great interest in the subject of healthcare. It is the most searched subject on the Internet, yet the long predicted wave of consumer empowerment in healthcare has yet to arrive.

Consumers, as well as the business community, are generally unaware of the healthcare cost and quality issues and interoperability issues. Nor do they recognize that they have a new, long anticipated, role as purchasers seeking value in the healthcare delivery system. They tolerate the existence of numerous inefficiencies and cost in the healthcare sector far more than in any other market, because of and in spite of its relative importance and their inability to judge value.

Today, the consumer is unable to identify value without information on cost and quality. Quality cannot be identified without measurement and it cannot be compared without standardization.

Since the mass adoption of the Internet, the benefits of IT have embedded themselves into society as one of the most powerful tools that consumers have ever had. Endless information is now available in everyone’s home. Society has embraced this new found consumer tool, but comprehensive personal clinical information has not digitally made its way into the consumer’s hands. To some degree it is not readily recommended or available, yet.

How does a consumer get educated about their new role in their own health and their interaction with the healthcare delivery system? Who do they trust to guide them? Consumers trust their physicians far more than any other group in the Healthcare system. They certainly value their doctor’s advice, even if they don’t follow it all of the time.

Today, the consumer is effectively, unwittingly waiting on their physicians to recommend this new medical device for their health. Therefore, engagement of the physician is the key to fostering consumer empowerment.

What is Durable Medical Equipment (DME)?

There is no single authority, such as a federal agency that confers the official status of DME on any device or product. A fairly comprehensive definition of Durable Medical Equipment as contained in a Texas Group Policy is as follows:

Durable Medical Equipment is defined as being equipment that:

• can withstand repeated use; and
• is primarily and customarily used to serve a medical purpose; and
• is generally not useful to a person who is not sick or injured, or used by other family members; and
• is appropriate for home use; and
• improves bodily function caused by sickness or injury, or further prevents deterioration of the medical condition; and
• is prescribed by a physician.

A consumer’s PHR fits the definition as follows:

Durable Medical Equipment means

equipment : Noun. An instrumentality needed for an undertaking or to perform a service.

that:

• can withstand repeated use. A PHR easily withstands repeated use.
• is primarily and customarily used to serve a medical purpose. A PHR contains a consumer’s relevant medical information so many medical decisions can be made based on the contents of the record.
• is generally not useful to a person who is not sick or injured, or used by other family members. A PHR is not useful to anyone in the consumer’s family but the consumer and only the consumer can use it to track and support her health or coordinate her care when she is ill
• is appropriate for home use. A PHR is appropriate for home use or anyplace a consumer has a connection to the Internet.
• improves bodily function caused by sickness or injury, or further prevents deterioration of the medical condition. According to the trade association that represents insurance plans and the executives of most plans, there is consensus among stakeholders that the widespread adoption of health information technology will lead to safer, more effective health care. Experts believe adoption of technology will reduce preventable errors, such as medication errors, increase compliance with recommended treatments, improve treatment for people with chronic disease, and contribute to lower health care costs.

and is prescribed by a Physician; Can physicians professionally make this recommendation to their patients? It depends on whether they can professionally agree with the statement that “a PHR is a medical device that in certain cases can benefit their patient’s ongoing health or illness.”

If physicians prescribe a PHR for their patients, and the Payers collectively agree to pay the costs, the standard of practice in a community will change. Physicians will create a new business model in order to pay for their EMR system, and the power of a new medical device can be leveraged for the benefit of the consumer.

The PHR information must be stored in a secure way with patient privacy a cornerstone of the repository. Physicians must play a role in the central repository of this clinical information in terms of governance and oversight with appropriate financial compensation for their participation.

If every physician in Harris County, Texas prescribes a PHR for every patient that could benefit from such a device, it will be a catalyst for the creation of a clinical information database that would be owned and controlled by doctors and their patients.

The opportunity for today’s leaders is to take steps to enable our community to appropriately leverage the power and value of the data. To be sure, this is not as much a technology problem as it is a sociology issue. The first step is for the Industry is to acknowledge IT for what it is, a medical device.

News 10/22/08

From Elsie EHR: "Re: two I’ve not heard of. While reviewing the new 2008 CCHIT-certified EHRs, I saw two products I hadn’t heard of before … MedLink and SmartClinic. The web site of the latter looks a tad (how to put this delicately?) like it was created by someone whose full time job is not in the field of web design (I like the fact that the title of their home page is ‘home’). Oddly, despite being one of only ten 2008 CCHIT-certified EHRs, SmartClinic’s website doesn’t mention the certification." MedLink is here and VIP Medicine (the SmartClinic people) is here. I’ll refrain from snarky commentary on the latter except to say that you have to see it to believe it. I guarantee I could get an ultra-slick version done for a few hundred dollars (including graphics that are attractive and legible), so it seems like a poor investment to leave it hanging out there like it is.

From Ken Malansky: "Re: the former chairman of that fraudulent vendor you mentioned. He is GUILTY! I spent seven weeks of my life on that jury. The one holdout was star struck by his lawyer’s impersonation of Johnny Cochran." I thought they were going to retry him, but that was probably just prosecutorial chest-puffing after the hung jury in 2006. His attorney also represented Scooter Libby (where he parked his aging mother in her wheelchair where the jury could see him fawning over her), Eliot Spitzer, Exxon, Merck, and Philip Morris.

From Dave Dravecky: "Re: rumor. Heard at MGMA that GE is buying Greenway; can’t verify. Supposedly the VC guys want their money, the market is no good for going public, and GE needs a more up-to-date product."

From Salesgal: "Re: Sage. [name removed] got the axe." Unconfirmed. The person named was sales VP for the northeast, but I didn’t feel right about putting his name up here. If he’s gone (which I assume is the case) it’s embarrassing to him, and if he’s not, it’s embarrassing to me. Those who care will know who it is from the position (and whether it’s true or not).

From TalkoftheTown: "Re: Allscripts. I’m surprised you discount what McConnell says about the Allscripts/Misys headquarters situation. The guy has gotten more then 1.2 billion from the two companies for parts of what is left and it’s now valued at about 600 million. Which raises another issue on my mind – what was Allscripts worth when Tullman took over 11 years ago?" I don’t get the feeling that John is involved at all with the new Allscripts, so while his assessment about Raleigh may be interesting, I don’t know if he’s got any insider information now. I could be wrong. Most of the company is in Raleigh,I think I read somewhere.

From GirlGeek: "Re: Epic. Altru Health Systems, Grand Forks, ND, is switching from QuadraMed’s Affinity software to Epic. Altru is one of QM’s oldest clients dating back to the 1980s (or earlier?). Word is that Altru had to beg Epic to take them on since they don’t meet their bed count criteria."

From Al Borges, MD: "Re: Magellan EMR. Anyone know what has happened to them? Their website is dead. A physician who is still using the Magellan Writer can’t get in touch with them." I snooped around starting with the old domain name, registered by John Curtis of College Station, TX under the company name of BTQnet, a Texas corporation (custom software) with an Austin apartment address (the corporation is not in good standing with the state). He appears to have been at Quotient Integrated Solutions afterward (owned by BTQnet, I suspect) but their PBX doesn’t list him (this writeup says he ways still there in July). He’s on LinkedIn. Magellan was going crazy giving away tablet PCs back in 2005 and that’s all I ever heard of them. OK, can someone take it from there?

Just in: Cerner beats Q3 estimates: revenue up 13%, EPS $0.54 vs. $0.37. The company says it will exceed that in Q4. Well done.

A woman who waited 19 hours in Parkland Hospital’s ED and finally left without having her broken leg treated receives a bill for $162. They probably shouldn’t have let Parkland’s revenue VP go on record because he made it an even worse PR nightmare: "She’s not paying for waiting. She’s paying for the assessment she received." No she’s not, the woman says, who has no insurance and says she will not be sending Parkland a check for having a nurse take her blood pressure and tell her to wait.

McKesson will sell its specialty pharmacy business to Walgreen.

Listening: new AC/DC. It’s no Back in Black, but it’s good, straight ahead rock. I saw them live in the Bon Scott years — the guy in schoolboy knickers (guitarist Angus Young) doesn’t look any older even though he’s now 53.

RAND Corporation is all for NHIN and a unique patient identifier, but then again they’re not the ones who have to pay the hundreds of billions of dollars those would cost. The predict great cost savings and patient safety improvements, but they said the same thing about those EMRS that few doctors are using for various reasons unrelated to the quality of the doctors or the EMRs (poor adoption of which make NHIN and the identifier worthless since they add little value to paper charts).

Kaiser says HealthConnect is now live in 12 Southern California hospitals, bragging that its total of 22 hospitals serving 4.8 million members is the US civilian record.

Dr. Wes says it’s not an "electronic medical record," it’s "a sea of electronic medical servers," observing that every system at his hospital requires its own logon. Sounds like they need a physician portal at NorthShore to run Epic and those other applications mentioned.

Talyst announces its medication system (ordering, pharmacy, automated dispensing) for correctional facilities.

CareTech Solutions migrates the 80-server data center of Port Huron Hospital (MI) to its own Troy, MI headquarters in 36 hours as part of its outsourcing contract. The company has 1,000 employees and is bringing on many more. "Pretty much anything that has an electron running through it we are probably working on it," says Jim Giordano, president and CEO.

Arthur Clark is named VP/CIO of Haven Hospital (FL), coming over from John Sealy Hospital (TX).

A survey reinforces what everybody knows already: order sets improve processes and patient safety. The best time hospitals can spend in a clinical systems implementation or improvement is to develop an effective order set review process, starting with automatic inclusion and working toward evidence-based consensus.

Winchester District Memorial Hospital of Ontario, Canada signs for QuadraMed QCPR, document imaging, and enterprise scheduling.

ClearCount Medical Solutions, a Pittsburgh vendor of RFID surgical sponge counting technology, raises $4.1 million in Series A financing.

Daniel A. Krause, formerly of SciHealth, is named head of US business development for Satyam Healthcare.

Millin Associates announces a new practice management billing system for certain clinic types.

A new project named Wareed will electronically  link all hospitals in United Arab Emirates. Cerner is a participant.

A mob with iron rods storms and vandalizes a hospital in India, claiming that a patient’s lab tests were sent to an outside organization because the hospital’s doctors get a cut of the cost. The hospital says techs work only normal office hours and after hours work is always referred.

A man registering his pregnant wife online at Mary Washington Hospital (VA) finds that he can see the files of 803 patients on the site. The hospital said it was "an anomaly." The man got an invalid security certificate warning, then tried to delete some of the URL, which then took him to other pages that showed him the records of every patient who had registered online since December 2007.

Jack McCloskey joins Magruder Hospital (OH) as IT director, leaving a similar role at Floyd Memorial Hospital (IN).

NextGen Healthcare is named as one of the best places to work in the Philadelphia area.

Jobs: Epic Consultant, SIS Project Manager, Cerner PharmNet Consultant.

About 88% of American adults can’t make good health care decisions given the right information, an AHRQ study reports.

HLTH and WebMD cancel their $2.31 billion merger. I can never figure out that corporate mess where one owns most of the other and Marty Wygod is chairman of both companies. Conveniently, I have zero interest in both.

E-mail me.

Inga Live from MGMA

From Nasty Parts: "Re: political correctness. Did not realize the whole Obama thing was a done deal!” A couple of weeks ago I made one remark about Sarah Palin’s bangs and suddenly started getting hate mail from folks who treated that as a political endorsement. Yesterday I quoted someone else who mentioned “a possible role in an Obama administration” and suddenly I have written off McCain. I think everyone needs to take a deep breath and settle down. It will all be over in two weeks.

From Inga Wannabe: “Hi Inga. I am at MGMA and for some reason, several friends insist that I am Inga. I finally gave up and let them call me Inga. And, I actually decided it might be fun to be you.” Yea! We had a fake Inga at MGMA after all! By the way, it is pretty fun to be me. You are welcome to be Tina Fey to my Sarah Palin anytime (note to the crazy politicos: the previous sentence was not meant to be political).

From oneHITwonder: “Re: annoying texting. Man, I am so bummed out that I did not identify Inga in the relatively small CCHIT crowd. I will have to keep looking … hope she was not the annoying lady who was texting behind me during the entire session.” Likely not me since I sat up pretty close and (just like in third grade) would have been embarrassed if the speaker caught me not paying attention. As for the texting people, you have to remember that there are a lot of busy people in this world who believe the world may fall to pieces if they were unavailable to their underlings for an hour.

I got my first LinkedIn recommendation! “Not only does she give us great information, she also gives us humor, fun, and something to look forward to reading every day.” Thank you, Christianne for making my day. Mr. H and I, by the way, love to accept all LinkedIn requests.

It’s Tuesday afternoon in lovely San Diego. There is a reception tonight, but I don’t think my feet can handle any more standing or walking. I think I’ll go for dinner, a glass of wine, and an early night before I head for home in the morning.

Last night was a not an early night. I scored an invite to the Allscripts party, which was in a beautiful outside patio on top of the Hard Rock Café. It was pretty packed. Everyone seemed to be upbeat about the Allscripts/Misys thing, though it’s easier to be happy when you’re being provided all the free drinks you want. The only thing I heard anyone complaining about was the lack of food. Perhaps Allscripts decided to eliminate consumption synergies.

In a session yesterday, the speaker asked who had a hospital-provided EMR. Only about 10% of the hands went up, which surprised me a bit. I wish he had also asked if anyone’s practice had been offered the financial assistance from the hospital but turned it down. That’s the question I want answered.

I touched on this yesterday, but my impression is that the top concern for attendees is improving the bottom line. Hence, vendors are promoting many tools for increasing revenues and/or cutting costs. Even solutions like EMR are being discussed in terms of how it will help with pay-for-performance objectives. When I thought more about it, I remembered that the administrator is the one charged with taking care of the bottom line, so it shouldn’t really surprise me that they are less concerned with finding tools to make life better for physicians, etc.

A cool tool I checked out was from a company named Phytel. As I understand it, their Proactive Patient Outreach program works with any PM/EMR. It scrubs the offices’ data and finds all the patients meeting a particular set of criteria, such as all diabetic patients who have not had an office visit in over a year. Then it will call those patients, thus increasing revenue. Really simple concept, the technology works, and it produces results.

A couple of companies were promoting standalone products that calculate the patient-responsible monies at checkout and then place a hold on the patient’s card for that amount. Thus the patient has no surprises about the costs, does not have to worry about later paying a bill, and the practice is paid faster. Preferred Health Technology and mPay Gateway were the two I saw offering slightly different flavors of this concept. Both claim the PM vendors are lining up to partner with them.

One of the most entertaining moments of my day was a meeting with athenahealth’s Jonathan Bush, who gets excited about everything. He was clearly still pumped by a dawn surfboarding expedition. He’s about 100 IQ points higher than the rest of us, reflecting on recent industry consolidations and Marxist capitalism (consolidation is a predictable result of capitalism). We quickly jumped to his theory on software licensing versus software as a service, which is where he obviously believes the industry is heading. Finally, JB was gracious enough to say that HIStalk is about the only industry publication he reads (the always skeptical Mr. H says he probably says that to all the journalists).

A few other quick tidbits:

• I tried a couple of times to ask someone at the busy NextGen booth to explain more about their recent RCM acquisition. I never got a chance to talk to anyone in the know, but I did get a free t-shirt and a cool little flashlight.
• I spent a bit of time in Greenway’s booth and got the scoop on their new PrimeResearch product (they are excited about it) and quickly met EHRA chair Justin Barnes.
• Tried to check out PatientKeeper a few times, but every time I walked over there were busy, busy, busy.
• I met Sage VP Sharon Howard, who commented they were happy to be done with the turmoil a few months ago when her comments about some layoffs were misinterpreted. She thinks they did the right thing trying to be as forthright with the press as possible.
• I asked several attendees if they had an EMR and if they were on their first one, second, etc. Almost all claimed to still be on the first. Several vendors claimed they had replaced one competitor or another, but admitted that most buyers are on their first install.

Enough on my impressions! My wine is waiting. If you were at MGMA, please send us your thoughts!

E-mail Inga.

Inga Live from MGMA 10/20/08

Greetings from San Diego! It’s been years since I’ve been here and I had forgotten how absolutely perfect the weather is. Although, aside from the short walk from my hotel to the convention center, I haven’t had much fresh air!

I spent Sunday afternoon checking out the exhibit hall. Apparently there are over 350 vendors here to promote their wares to the 2,800 attendees. The traffic seemed pretty slow to me, and actually several vendors agreed. It’s Sunday as I write this, though, so it will pick up Monday.

None of the booths were over the top like you see at HIMSS. Cerner, McKesson, Sage, and Allscripts had some of the bigger booths, but there were plenty of small booths throughout. I also noticed what appeared to be 2-3 vendor no-shows.

One of my first visits was to Med3000/InteGreat, which was handing out cute little teddy bears. It probably would have been Mr. H’s favorite booth because two booth babes in black boots and white shorts were flagging those attendees who didn’t find the teddy bear to be an adequate draw.

Another memorable booth was Health Business Navigators. Everyone was wearing these silly white sailor hats, but they were being good sports about it and people were stopping. Plus if you sat through a five-minute overview of their ad hoc reporting tools, they gave you your own hat plus a $5 Starbucks gift card.

It’s been a few years since I had been to an MGMA meeting, but I seem to recall EMR being the buzz at that time. This year EMR is still hot, but revenue cycle billing services seem to be this year’s "it" product. Sage, for example, had a presentation by RCM expert Pam Moore, who is editorial director for Physician Advisor. I sat through her spiel, which was pleasantly generic and not a straight pitch for Sage. They also had really comfy chairs to sit in, and if you participated, you got your name in the hat for a $500 cash drawing (which, sadly, I didn’t win).

And speaking of comfy chairs, the Panasonic folks had this awesome massage chair. Full body massage. I want to marry the massage chair.

Anyway, my favorite booth pitch was Gateway EDI. If you gave them your card to swipe, they would donate $5 to Susan G. Komen for the Cure. Good stuff.

According to the exhibit information, Misys and Allscripts were each scheduled to have a booth. However, they used the original Allscripts space for all the demos (complete with the new orange, new logos, etc.) and turned the other into private meeting rooms. It’s actually pretty impressive that they had all the new branding in place a mere one week after the merger closed. I am sure the marketing guys were breathing a sigh of relief that there were no more delays in the merger.

Towards the end of my booth trekking, I stepped into the Workforce.com/OnBase booth. Tiki torches, thatch huts, and an open bar made it seem like a good stop (I actually did hang out at one of their tables for a bit, but drank only water). Unlike every other booth I popped into, no one really chatted with me for some reason. I kind of wanted to hear their story, but everyone seemed to be busy putting collateral up or conversing among themselves.

After a short break in my hotel room, I went over to the opening reception. Lots of folks there were using up their free drink tickets (I used mine up, too). They had an assortment of entertainment in place (my favorite was the lady making ice sculptures with a chain saw). I had fun chatting with a few administrators who were trading EMR implementation horror stories. I actually slipped out early lest I be tempted to find some after-party!

On Monday, I sat in on a CCHIT session. Not surprisingly, most of the attendees were looking for EMRs. Besides learning more about the certification process, there was some discussion on what other criteria CCHIT should consider. The audience recommended CCHIT consider adding more more portability requirements to make it easier to move from one EMR to another (when you dump the first vendor). Another couple of suggestions that I am sure would make vendors quiver: coming up with a certification process for physician PM systems and making EMRs more seamlessly integrate with PMs at a nominal cost. 

One session I missed: The Office: Manners Matter and Courtesy Counts.

I also  had a chance to hear Glen Tullman speak this a.m. The conversation was brief, but I heard enough to leave me convinced he really is passionate about this whole connecting healthcare thing. I’m sure he has shared his "connecting the community" vision hundreds of times, but  he still managed to sound genuinely fresh and passionate about advancing interoperability (between Allscripts products as well as other products). Someone asked him if he was making any plans for a possible role in an Obama administration or possibly as a senator. He stressed that he had signed a three-year agreement and wouldn’t have done that if he hadn’t thought long and hard about those options. He also said he has been vocal in his opinion that the HHS leader should be a physician and since he lacked that credential, it sort of hurt his chances. Of course, if that phone does ring, I imagine he’ll at least take Obama’s call. However, my impression is that he believes he has a chance to make a bigger impact in HIT staying in his current role.

I’m sitting in a session but I can’t absorb another fact about the benefits of interoperability. So, a few more notes:

• If you sit through a Navicure demo, you can get into a drawing for an Audi convertible. I am hoping to drive home.
• Magician fans could get their fill at the Greenway and McKesson booths.
• If advertising in the restrooms is appealing to you, you’d best stick to HIMSS. At least the ladies’ rooms were signage-free.
• Even though Medinotes is now part of Eclipsys, you’d hardly know it. Not only did they have separate booths, there was very little signage promoting the marriage.
• I prefer suits over those homogenous golf shirts. Don’t know if it is a trend, but a good number of the vendors wore "real" clothes and not those shirts that never fit the women well and in colors that real men would never wear. 

An HIT Moment With … Justen Deal

An HIT Moment with ... is a quick interview with someone we find interesting. Justen Deal was the Kaiser Permanente employee made famous when his November 2006 internal e-mail criticizing the organization’s HealthConnect EMR project was leaked out to the press. The CIO left, the CEO was publicly and somewhat arrogantly defensive, and HIStalk’s readers voted Justen Deal Industry Figure of the Year in the HISsies that year.

What has your post-Kaiser Permanente life been like?

In one word, interesting. Challenging at times, as well. It helps to have the perspective afforded by two years, though. Challenging in that the first few days, weeks, and months took a lot of patience, quite a bit of deliberation, a fair amount of persistence, and a ton of coffee.

Interesting in that I came to see healthcare information technology from a different angle. I saw the provider side, the needs, the costs. I saw the vendor side, the challenges, the risks. If you got past the headlines, I always defended Kaiser Permanente and the importance of the HealthConnect project, and on more than one occasion, I pointed out the strengths and advantages of Epic.

I eventually began working on Vieue, which has given me the opportunity to put some of that perspective to use. I know that no one company or person can solve every healthcare information technology problem, but there are a few we’re working on.

What good and bad effects resulted from your famous e-mail?

We’re just shy of about two years out, so, as I said, the time allows a bit more perspective.

The negative was that I ended up leaving Kaiser Permanente, which is an organization I believed in and still very much care about.

On the positive side, speaking about healthcare in general, I think there has been a small, but real shift in how electronic health record projects are assessed, in terms of their costs and successes. I think there still is a lack of thorough, public, critical analysis of the efficiency and effectiveness of electronic health record projects, but it has definitely improved, and I hope my e-mail played some small part in that.

HealthConnect is getting good press about improving patient outcomes. Are you buying it?

I think we all agree that smart, interconnected electronic health record systems can have an enormously positive impact on patient outcomes. The recent report that Kaiser Permanente is leading the nation in terms of breast cancer screening rates is great news, and it comes after more than a decade of work at KP specifically geared towards increasing detection. For 2005, the Southern California region achieved a mammography screening rate of 84%, which, as you’ve mentioned, has reached 87% according to the most recent data. By comparison, the current national average is 72%. 

Other regions have seen success, as well. In 1996, the Georgia region had a screening rate of 74%. In 1997, they implemented their Breast Health and Cancer Detection Program, and by 1999, they had significantly increased their rate to over 84%. The combination of building smart reminders into healthcare information systems and relevant patient workflows can obviously go a long way to improving patient outcomes.

Broadening your question just a little bit, I think the question for healthcare has to be whether we’re actually taking meaningful steps towards taking breast cancer screening rates up nationally, towards catching the hundreds of thousands of deaths every year caused by preventable medical errors, towards tracking and ensuring better compliance and follow-up on chronic conditions. I just don’t think we’re seeing the sizable shift we should be seeing there across the country, and I think that’s because the software isn’t as "smart" as it needs to be to catch, track, and prevent.

The other issue, I think, is cost. Across healthcare, we’re spending tens of billions of dollars on healthcare information technology, and the return on investment just isn’t there yet, until we are indeed meaningfully and quantifiably improving outcomes and reducing the cost of care. I worry about whether we’re wearing out our welcome with providers and insurers alike when we over promise, under deliver, over budget.

Lots of folks said you were highly analytical and well spoken in your HIStalk interview, but said they would never hire you because of the risk of a similar situation down the road. Has that been the case?

I decided fairly early on that I wanted to focus on Vieue, so I was thankfully spared any awkward interview moments. For any companies that might care about my particular perspective, though, I will say that I think it is critical to have a thorough, sincere, and independent compliance process, which can go a long way towards catching and addressing concerns proactively. I think it is a mistake to view compliance as a public relations apparatus, but the reality is a competent compliance process can often help prevent internal problems from becoming public problems, not through suppression but through correction.

Kaiser chairman George Halvorson is speaking at the HIMSS conference in Chicago next year.  If you were in the audience, what questions would you ask him?

I honestly can’t think of a single question.

Monday Morning Update 10/20/08

From Hoyce: "Re: inkjets. I wonder what these cartridges will cost?" Link. HP licenses its inkjet fluid technology to Home Dialysis Plus for mixing of dialysate and water for in-home treatment of kidney failure, saving the patients trips to the dialysis center. HP had already licensed the technology for administration of vaccines.

From The Blogfather: "Re: Cerner. Never let it be said that Neal Patterson makes idle threats. After bringing up the famous e-mail at the company meeting, he followed through and cut Cerner’s healthcare benefits in the middle of open enrollment. Cerner’s only contribution is $400 to an HRA account, leaving associates to fund the remainder of their care through old school FSA accounts." Unverified.

From The PACS Designer: "Re: Virtual Desktop Infrastructure. With the increased focus on virtualization, a term invented by VMware in 2006 is starting to gain some traction. Virtual Desktop Infrastructure (VDI) will be seen in the news more often now due to the virtualization efforts of VMware, Amazon, and now Microsoft with its soon to be introduced virtual desktop that runs in cache memory as a thin client. As more organizations look to reduce operating costs and simplify desktop application management, you will see more movement toward this thin client concept. The possibility of thin client PACS running on a virtual server that downloads the application to your cache memory could be a new trend in the years to come and would be a good cost saving application for smaller providers." Link.

From Fourth Hansen Brother: "Re: non-competes. They just got killed in California. Are people getting out of those that Epic writes?" Link. The California Supreme Court rules that employers can’t stop former employees from starting businesses or working for a competitor. Let’s face it: no court will stop you from making a living just because your former employer made you sign some questionably binding document as a condition of employment. Your problem isn’t the courts, though – it’s the new employer who doesn’t need the legal headache (or to make Epic mad if they depend on them). They’ll just hire someone else. If a former employee had the time and money to fight the non-compete, they would probably win and potentially set a precedent for everyone. I haven’t heard of Epic’s in particular, but I’ve heard that some Wisconsin attorneys were taking cases awhile back.  

From Lucy Ewing: "Re: physician contracts. Will doctors sign anything someone puts in front of them? A friend mentioned that a practice was getting terrible service from their billing service and planned to change. The billing service’s CEO freaked out and threatened to sue, pointing out that the contract they signed legally obligates them to send all billing through that company." I know doctors hate lawyers, but so does everyone else … until you need one. Like when signing a contract. 

The Raleigh paper just can’t accept the fact that Allscripts has moved the former Misys Healthcare’s headquarters to Chicago. The reporter pestered Glen to the point he finally said, "I wouldn’t rule out the fact that the headquarters may be here at some point in the future," surely just to get the reporter off his back. For some reason, the reporter then checked with John McConnell, who’s not part of the deal, and he fanned the dying HQ embers by saying Glen works for Misys and they’ve always liked Raleigh. My opinion: the important products going forward are Enterprise, Professional, Payerpath, and Connect. Everything else in Raleigh other than product maintenance (sales, administration, non-HealthMatics R&D) is way overstaffed under the new model. As tough as it is to hear, Misys brought little to the table except lots of indifferent customers, so it’s certainly not going to business as usual in Raleigh since Allscripts really needs to put up good numbers right away. I hate that "trim a tree to make it grow" stuff too, but that’s reality.

PatientKeeper’s Suzanne Cogan will speak Monday and Tuesday at MGMA (at Sage’s Booth 615) on "The Physician on the Go: Improving Revenue and Practice Operations with Mobile Applications."

I never heard of company Conceptual Mindworks of San Antonio, TX or its EHR product Sevocity (I must not pay enough attention to CCHIT certification since it earned Ambulatory 2007 in May). The name’s a stretch ("a combination of two words: seven, which signifies good luck or prosperity and velocity, which means speed or journey") but it looks of cool and is cheap ($800 startup per provider, then around $500 a month for EHR; another $200 for PM) with 24×7 support. They seem to have made their money from Air Force contracts.

Here’s a bit of McKesson history that I hadn’t heard. In 1938, its predecessor, drug wholesaler McKesson & Robbins Inc., faced bankruptcy after it was discovered that the CEO had cooked the books (he was actually an ex-con and swindler who used a fake name and medical background to buy the company). At an emergency company board meeting, word got back that the CEO had committed suicide. Said a Goldman Sachs partner who sat on the company’s board: "Let’s fire him for his sins anyway." The same thing happened with the HBOC acquisition, announced October 26, 1998 (maybe McKesson will be providing cake and punch for the tenth anniversary) except that McKesson’s executives didn’t kill themselves (only their careers – they were all canned after the fact) and the numbers were a lot bigger ($14.5 billion). The happy union was frenetically consummated on January 13, 1999 and the cooked books were discovered only three months later, sending $9 billion of McKesson market value up in smoke in a single day, leading to an entirely new meaning for Pathways Accounting. Everyone I knew saw it coming, so either I had smart friends or McKesson had dumb executives. Believe it or not, the adjusted share price still hasn’t recovered from that self-inflicted disaster: shares were around $82 in the fall of 1998 and are a little more than half that now. Cerner shares have tripled since then.

Jim Riley, formerly of Payerpath, joins MedAvant as sales VP, reconnecting with his former Misys boss Andrew Lawson, now MedAvant president.

Picis will be at CHIME’s Fall CIO Forum next week in Lost Wages, so if you’re going, drop by and tell them you appreciate their support of HIStalk.

While I’m on that particular soapbox, show a little sponsor love all around when you get the chance: click their ads to see what’s up with them and tell their executives that you saw the company mentioned on HIStalk. I’m a foot soldier working a hospital job by day, so I need some allies in proving the sponsorship value here. Thanks.

Sisters of St. Francis Health System threatens to cancel its WellPoint contracts because the Indianapolis insurance company isn’t paying on time. The insurance company blames its BlueCard claims payment software. WellPoint has been sued by investors who claim the company knew about the problem but didn’t disclose it. A representative of the company’s Anthem subsidiary says the problems won’t be fixed until February. WellPoint’s former CEO walked away with $23.9 million last year and the current one is getting $9 million a year. Why deliver actual care when pushing the paper it generates pays so much better? Adding value is so 1970s.

Gartner places Sentillion in its Challengers quadrant for Enterprise Single Sign-On.

Alberta, Canada (always reminds me of "Prince Albert in a can") will make health information available online to its residents.

Healthcare IT consulting firm Global Works Systems opens its new corporate office in Colchester, VT, which it points out is near its partners Allscripts and GE Healthcare.

I hadn’t snooped around MEDITECH’s site lately, so here’s your info tidbit: the cafe lunch in Westwood Monday will be grilled steak tips with sweet potatoes and Brussels sprouts. I bring that up because I’m one of the approximately five Americans who will eat Brussels sprouts (as long as they’re fresh and not frozen). I see they’ve posted all new (to me, anyway) color photos of the executives and they look like the kind of people I like (few ties, some are kind of nerdy looking, and everybody looks happy, maybe because they’re wealthy). It’s the most successful company in the history of the industry (which it happened to create – look it up) so I like to pay appropriate homage. The only blot on their otherwise perfect HIStalk record is that I can’t convince Neil Pappalardo to let me interview him even though he’s a rock star to me, but Howard Messing did an inarguably fine interview back in the early days of HIStalk that I really enjoyed.

A huge federal raid in the Cleveland area involves MetroHealth Medical Center. Several companies were searched, among them a local division of Siemens, which got contracts for both public housing and hospital work. FBI agents told the Siemens employees to clear out while they hauled out boxes. "He is an employee at Siemens, which handled a $33 million energy conservation contract with CMHA that Phillips helped shepherd through. McMichael is named in a federal subpoena involving Carroll and Greco. The subpoena indicates that agents are looking into whether contractors, including Siemens, had any financial relationship with the hospital administrators or whether any contractor did work at the men’s homes." Bribery (several billions of dollars’ worth) appears to have been woven into the corporate culture, according to former executives. Somehow they’re still in business.

The preview looks wickedly funny: Children’s Hospital, an Web series on the WB. Doctor in clown makeup: "I’m challenging you to a healing-power-of-laughter-off."

Vendor Deals and Announcements

• InteGreat and Nuance extend their partnership, giving InteGreat the ability to provide its clients with Dragon Medical 10.
• eHealth Global Technologies announces the release of the Image Exchange Service for RHIOs and HIEs. The product facilitates the exchange of medical images utilizing a DICOM-compliant viewer.
• Ingenix acquires business intelligence company Bull Services/Integris. Bull Services also offers consulting services, systems integration solutions, and outsourcing.
• QuadraMed’s former VP of strategic services Vicki Wheatley is now VP of consulting services for HIT consulting firm Just Associates.
• North Hawaii Community Hospital contracts with Phoenix Health Systems to provide IT management and infrastructure services.
• Physician-owned MSO Premiere Medical Resources (Ohio) selects Noteworthy’s NetPracticePM and NetPracticeEHR for its 92 members.
• iMedica signs a sales and marketing agreement with CySolutions, a provider of community health center solutions.
• Munson Healthcare (MI) selects Lawson Human Resource Management Suite and Lawson Business Intelligence to consolidate its administrative processes and support its HR and payroll functions.
• MedAssets announces the release of its Medicare Recovery Audit Contract solution that helps healthcare providers throughout the recovery audit process.

E- mail me.

News 10/17/08

From Jaitar: "Re: McCain. What’s with McCain repeatedly saying he wants to put medical records ‘online?’ Maybe he should also say he wants to put our financial histories online. He should get this straight – I’m not sure he is doing us any favors given the privacy hawks out there who leverage any public sentiment to slow down information exchange."

From HISWatcher: "Re: NextGen. Their buy on Practice Management Partners today and HSI a while back means they want to take athenahealth on in the RCM space. Should be interesting …" Agreed. PMP was doing great covering just a tiny part of the country, so they get a prime time slot with NextGen.

From Monsieur de Groot: "Re: hospital of the future. Here is a story about the "Hospital Room of the Future" that features Cerner products. Some of the entries in the ‘Comments’ page are  interesting." Link. It’s interesting (and scary) to see what’s inside the minds of average Americans when it comes to healthcare. 

From MC Hammersmith: "Re: CAROL. My colleague forwarded me the link. They give price and care information (with online scheduling) for procedures or care bundles. So far it looks like only a few providers have signed on, but I like the interface. I believe that the prices are still fiction, since they can charge whatever they want but will get what insurance pays, but, still looks pretty good for version 1.0." Link. I think I gave it a look and mention right after it launched. Looks pretty good. Actually, it looks very good once you dig into individual provider pages. I would use it.

Greenway launches PrimeResearch, a research solution that connects PrimeSuite EHR to clinical studies, quality and safety initiatives, and analytics. Researchers list their active studies on PrimeResearch, physicians choose those to participate in, and PrimeSuite runs a list of patients (de-identified using PHI scrubbing rules) that meet the study criteria. Now I’m not a practicing doc, but someone who is told me once that the biggest overlooked source of physician revenue is providing electronic information to companies doing drug or other clinical research. This guy, who was a really smart futurist and an MD/PhD, said that those organizations are happy to pay because they need quickly selectable data from big patient populations in electronic form, so it’s still cheaper for them than doing traditional paper studies. Finding patients out in the field, especially those with unusual conditions or demographics for niche drug studies, is nearly impossible otherwise, plus it does patients a favor by getting new treatments to market faster. I think it’s a great idea, one of the big benefits of having electronic data instead of manila folders. Expect that to really mushroom once genetic data is in there and more linkages between genes and disease (and drug responsiveness) are uncovered.

A medical helicopter crashes in the Chicago area while heading to Children’s Memorial Hospital from Valley West Hospital, killing three crew members and a 13-month-old baby. The helicopter, owned by the Air Angels emergency medical transport service in Bolingbrook, clipped an antenna guide wire and crashed in a field, killing the pilot, nurse, paramedic, and patient. The crash is the third involving Air Angels and the ninth in the past 12 months nationally involving medical helicopters. The pilot, Dell Waugh, was a two-tour Vietnam vet with two purple hearts who started a company after he retired from the Army, writing software for hospitals and creating instructional videos for drug companies. Condolences all around.

Mrs. HIStalk was having some impressive coughing fits but couldn’t get an appointment for several days at the practice we use, so I suggested she try the local back-of-the-drugstore retail clinic (because I was tired of hearing the hacking, but it probably sounded caring the smooth way I said it). The diagnosis: her first case of bronchitis, which we already knew since we’re medical types. Total time spent for visit and prescription pickup: 15 minutes. Visit cost: $60, but they took our insurance too, so it was $30 or something. Her grade for the experience: A+. She was the only patient there, the NP was experienced and efficient, and she was treated like an actual human being. She’s happy about it, but maybe that’s the Tessalon Perles talking. She’s cute as a button when she takes the cough syrup and makes that Robitussin face.

If you want to buy a "top of the line hospital information system" from India, this guy is selling one.

Listening: Montrose, hard-driving early 1970s rock with Ronnie Montrose and Sammy Hagar.

MacPractice, the Mac-based practice management system, has a new release and an iPhone interface. I would have told you how it looks since I tried to check out their demo, but of course the wiley marketers make sure you can’t actually see it without first completing a truly massive online form so they can pester you later (do they really need to ask what time zone you’re in when you have to give them your whole address?) You want people to watch your demo. You trust them to follow up if they like what they see. What’s so hard about that? I bet they sit around and moan that more people should be watching their demo.

HIMSS sent out its ballots today. My first rule of thumb: I never vote for anyone who isn’t FHIMSS. If they can’t take the time to qualify for HIMSS Fellow, what are they doing running for HIMSS national office?

Healthcare Growth Partners releases its Q3 HCIT Transaction Report. Download here (warning: PDF).

Rush-Copley Medical Center (IL) will implement McKesson’s closed loop solutions (Meds Manager, PACMED, Robot-RX, MedCarousel, Admin-RX). Notably omitted from the list: Horizon Expert Orders, since I believe the hospital went with Eclipsys SunriseXA instead, leading to some confusion about which loop they closed and what they closed it with.

Someone sent a rumor that Medsphere just laid off 15 people after moving to Carlsbad supposedly because of rapid headcount expansion. Inga asked the company about it and was told they don’t discuss rumor or personnel matters. I have my guess what that means and you’re entitled to your own. I don’t like to see anyone lose a job.

Bravo to the Project On Government Oversight (POGO), which tabulates information to remind government agencies which big contractors and companies have been guilty of major misconduct (hint: drugs, oil, and consultants). #1 by far is Merck ($5.8 billion) and GlaxoSmithKline ($4.2 billion). Surprisingly, McKesson is the fifth biggest offender at $996 million (thanks, HBOC). IBM is way up the list, as is Cardinal Health, Health Net, and the the usual contractors like Boeing, Lockheed Martin, and Northrop Grumman. Somehow BearingPoint came in way down the list with just $54.2 million (heck, CoreFLS was nearly ten times that amount of utterly wasted taxpayer dollars).

Nashville-based onFocus Healthcare, which sells enterprise performance software, completes a round of private equity financing. Here’s what impresses me: the chairman has a Carnegie Mellon doctorate (damn).

Grand Bahama Healthcare System will go live on its first Centricity Pharmacy install in a couple of weeks. You know the GE implementers are fighting to go there this winter.

CSC, new owner of Covansys and FCG, will hire 2,000 IT professionals in the next six months, all of them in India.

Taiwanese hardware vendor Unitech launches a healthcare PDA made from antimicrobial materials and offering both RFID and barcode readers.

State of Ohio CIO Steve Edmonson, formerly of Cardinal Health, will leave his position this week.

Rumor: GE Healthcare Financial Services has cut 30 salespeople, with more to come. And speaking of GE and its sudden problems related to its financial and healthcare units, the credit squeeze will hit GE and Siemens hard, the New York Times says, as hospitals finally have to adjust their capital-heavy ways in a down economy and with shrinking investment portfolios.

UVA goes with AtStaff ClairVia for staff and demand management.

Nuance says users are pumping 1.4 billion lines of medical transcription per year through eScription’s computer aided medical transcription system, with 17 new customers this year. John Halamka says it has saved BIDMC $5 million in transcription cost, while Orlando Health says turnaround time on clinical reports is down two hours just eight weeks after go-live.

Odd lawsuit: a man is beaten in the head with a yard-long log at a party in 2002, mistaken for the guy his assailant really meant to clobber. He is taken to the hospital, waits 90 minutes, and is later transferred to another hospital for emergency neurosurgery. He is paralyzed and  settles with the first hospital and its doctors and nurses for $8.5 million US, coincidentally the precise amount of the hospital’s malpractice coverage. And in Greenwich, Connecticut, eight women are suing the hospital and seeking class action status for allowing a drug-addicted plastic surgeon to perform breast reconstruction surgeries. The doctor turned in his medical license after being accused of injecting a patient’s painkiller into himself and later died of a heroin overdose.

E-mail me.

HERtalk by Inga

From Southern Rocker: “Re: Glen Tullman interview. Congrats on the interview with Allscripts. Seems like quite a coup to have a company of that stature select HIStalk as the forum of choice to communicate directly with the market.” Mr. H was pretty darned excited that Allscripts suggested it. So what if McCain and Obama won’t answer our e-mails? We got Glen. If anybody has suggestions about the format, time of day, etc. let us know so we can decide about future chats.

The X PRIZE Foundation and insurance giant WellPoint team up to develop a $10 million contest to improve health care quality and reduce costs. The finalists will have their proposals tested in state markets. Not to sound like Mr. H or anything, but don’t you just know the winner is going to have a solution that’s pretty health insurance company-friendly?

CTG Healthcare Solutions announces (warning: PDF) it will be providing implementation for a number of Epic Systems implementations. Interestingly, the press release provides such details such as it is providing “services to a major children’s hospital with a large pediatric research program” for $1.7 million, but, doesn’t name of the hospital. Another project is for “one of the nation’s largest faith-based integrated delivery systems… which operates hospitals, physician practices, outpatient clinics, health plans, and related health and human services in seven states.” I bet we have readers that could name those hospitals off the top of their heads.

Dan Nigrin, MD, MS, CIO of Children’s Hospital Boston, is mentioned in this article that revisits the question of which is better: CIOs who come up through the IT organization or those with a more diverse business background? Dr. Nigrin is not only CIO, but also an endocrinologist who went back to school for a master’s degree in informatics from Harvard Medical School and MIT. Obviously those are some pretty strong credentials. I also hear he owns a recording label and is an HIStalk fan. Doesn’t get much better than that.

An Employee Benefit Research study (warning: PDF) finds that 60% of us believe that centrally maintained EMRs shareable by authorized health care providers are extremely or very important. However, 62% indicate they are either not too or not at all confident that such records would remain confidential.

Mediware is expanding its stock re-purchase plan. In addition to the $4 million earmarked earlier this year, the board has authorized an additional $3.3 million. Stock is currently trading around $4/share, down from $7.25 less than a year ago.

QuadraMed is also repurchasing shares, though they are buying from a single shareholder. QuadraMed is buying 620,614 shares at $5.50 for $3.4 million. Though the stock closed at $5.85 Tuesday. It was close to $10/share when the company was listed on Nasdaq in July. The purchase represents approximately 7% of the common shares outstanding.

Teleradiology is the latest service being outsourced to India because of a US shortage of radiologists, particularly those willing and able to work night shifts. Other likely services soon to be offshored include telecardiology, telepathology, teledermatology, telephathology and robotic telesurgery.

Rick Norling, president and CEO of the national healthcare alliance Premier, announces his retirement as of June 30, 2009. The company earned the 2006 Malcolm Baldrige National Quality award under his leadership. His replacement has not yet been named.

According to a blog sponsored by the local paper, Lawrence Memorial Hospital (KS) has approved a five-year contract for Cerner to provide technical hosting services for the hospital’s clinical information systems. The transfer, scheduled to take place in April 2009, is predicted to save the hospital $1.5 million over five years.

Officials from a California elementary school claim HIPAA privacy rules prevented them from informing parents of a teacher’s sexual "reassignment." The music teacher, previously a woman, returned to school this fall asking to be addressed as Mister.

Last call for survey participants! If you are either a physician or a CIO/IS director and are willing to give me 10 minutes of your time, let me know. As a participant, you’ll get to hear about some of our latest scheming and have an opportunity to influence the future of HIStalk. Come on, you know you want to hear more!

E-mail Inga.

NextGen to Acquire Practice Management Partners

NextGen Healthcare Information Systems, a wholly owned subsidiary of Quality Systems, Inc., announced this morning that it will acquire revenue cycle management company Practice Management Partners of Baltimore, MD. Terms of the agreement were not disclosed.

PMP, which was founded in 2001, has 200 employees, handles 16 million transactions per year, and has annual revenue of $16 million from its service area of MD, DC, PA, and VA. Perry Snyder is the company’s founder and chair while Don Good, formerly of HCIA, is president and CEO.

Patrick Cline, President of NextGen Healthcare said "We have been very pleased with the demand we have seen for our revenue cycle management services, and while we remain committed to organic growth in all areas of our business, PMP will help to build out our RCM capability both geographically and with regard to capacity and talent. This acquisition also continues to build our base of recurring, visible revenue. Like HSI, PMP presents a number of strategic synergies." 

CIO Unplugged – 10/15/08

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

CIO reDefined. CIO 2.0 Ubiquitous Influence
By Ed Marx

I had the privilege of being a part of the CHIME faculty for a forum entitled CIO 2.0. Gartner representatives offered research and helped define the meaning of CIO 2.0. Faculty gave tangible examples from their unique experiences. In preparation, I had to do some introspection and analysis so I could succinctly convey my thoughts on the term and how someone could evolve from the traditional CIO to the technology leader needed for today and beyond.

I shared that CIO 2.0 presented the external manifestation of an internal transformation. It’s not about doing a couple of things differently in the workplace or changing the rhetoric or updating the eye glasses. Rather, it is a different way of interacting with life holistically, juxtaposed from traditional thought and action. It came down to five things I wanted to share with the forum. In an August post, I focused on one of these, Disruptive Leadership. This post will discuss Ubiquitous Influence.

People make too big of a deal out of which bigwig a CIO reports to. The prevailing belief foists upon us the idea that if you do not report to the CEO you have limited influence in your organization. Heaven forbid you fall into the legacy camp of reporting to a CFO!

In contrast, CIO 2.0 loses little sleep with regards to the reporting structure. They realize their influence is not confined to a specific reporting relationship vertical; it is instead ubiquitous, breaking out of silos and infiltrating the entire organization. While at University Hospitals (Cleveland), I reported to the CFO and arguably had greater influence on this prestigious academic health system than many of my peers who reported to CEO’s. It doubtless helped that I worked for a very progressive organization and one of the nation’s foremost healthcare CFO’s (Kevin Roberts, now with BJC). Choosing not to limit my influence to my silo, I reached across all aisles to gain bipartisan support for major strategic initiatives, which helped propel our organization from doldrums to national acclaim.

With my current employer, I report to one of two COO’s. Again, I do not allow the formal organizational structure to cap my influence. The CIO 2.0 masters talents that enable him or her to reach across all organizational verticals to bring about change, innovation, and strategic imperatives. If you find your impact limited, resist blaming the organizational structure and start learning/applying the skills and talents necessary to lead your organization to the next level.

Sometimes an org chart can paint a thousand words.

CIO 1.0

CIO 2.0

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

Readers Write 10/16/08

Thanks to all who participated in the live chat with Glen Tullman of Allscripts on Wednesday evening. It’s pretty cool that a CEO went on live with a blog and its readers (recall, too, that Glen was typing his own responses in real time!) Glen passed along a message to everyone that he was happy with the chance to connect. If you missed it, you can scroll through the transcript here.

From the Floor of the American Academy of Pediatrics Convention
By Willis Jackson

I’m tired and burned out, but here is the news from the floor of the AAP show from a veteran booth slut.

The traffic was not bad, as attendance was up this year. The Hynes Convention center is a bit awkward (multiple floors, each floor is "split" in the middle), but most vendors we spoke to thought it went well. The last few years, the AAP floor has not been strong.

The sharks are in the water. About 15-20 EHR/PM vendors who haven’t set foot near a pediatric show in the last five years are suddenly in the house. Some claim pediatric customization, but that just means growth charts and some templates they got from a practice. Why now? We all think that it’s the CCHIT money … the Feds, et al, have thrown the chum over the back of the boat and the sharks are circling. Meanwhile, the AAP’s COCIT committee can’t must enough $$ to get a decent program and none of these companies can be bothered to help underwrite them.

The Allscripts booth did not have a corrective sticker slapped over the logo on Monday morning. They also didn’t have many people stopping by, either. Misys, I believe, may be the only mainline EHR/PM vendor who WASN’T at this show.

Word on the street, and I heard this from more than a dozen folks, is that Office Practicum is "the only pediatric EHR to consider" right now. Personally, I have to concur. They have leapfrogged everyone, including (and especially) eCW, NextGen, etc. Every person spoke to who attended the EHR showdown said that OP crushed it, though one person gave a half nod to iMedica, if I remember correctly.

The GE booth was big, quite sparse, and usually empty as well. The sales people were on their phones rather than attending to customers. We presume they were checking the Dow.

A small group of well-known pediatricians is focusing on creating a centralized, Web-services driven clinical data repository for things like pediatric dosing, immunization algorithms, etc. Ultimately, it looks like the goal would be to pass the ownership of this desperately needed material to the AAP. If you don’t get it, imagine a quarterly HL7 download from the AAP against which all of your pediatric norms, etc., could be compared. Right now, it’s a mess. I’m hoping it works.

The nagging flies throughout the conference were the folks from Phreesia (phreesia.com – like "Frees Ya!" – get it? – they say it has to do with a flower, I don’t buy it). It’s the "Patient Check-In Company." They have a Tang-orange tablet (with a mag strip reader) that walks patients through the standard questionnaire process on the tablet. Your standard patient kiosk concept, except that it prints the report and the entire thing is ad-supported. Client after client, potential and otherwise, stopped by and said, "You have to go work with those guys. That thing is so cool!" So, we stopped by. And, no, they don’t interface with any EHRs or PMs yet. It prints the report. From their FAQ: "Q: How does Phreesia work with EMRs?  A: Phreesia is compatible with EMRs." By this standard, so are paper charts. And the mag strip – which would be really really cool for collecting co-pays and reading insurance cards – doesn’t work yet either. Yet again, a vendor has chosen to take the pharma+ money up front  rather than build a good product to interface with others. Wasn’t that the PCN model, almost 20 years ago?

Clinical Software Review -  Microsoft CUI – Introduction
By The PACS Designer

The Microsoft Common User Interface has been released for review and user input based on Microsoft’s Silverlight platform. This Microsoft CUI introduction requires you to download and install Silverlight 2 Beta 2 on your system. Once you download it,  reboot your system and launch the application to see how the Microsoft CUI works in daily practice. Here us the download link.

After logging off and relaunching your system, open the Microsoft CUI by clicking this link.

We are going to launch the "Patient Journey Demonstrator".  Once you are on the Patient Journey Demonstrator page, you are going to be navigating the "Explore UI" section first, so click the "Launch Button" under "Administration". Follow the steps below to learn the best method for navigating:

1. You will notice four physicians have their day’s schedule posted. The "Red Bullet" before Dr. Cox’s name indicates he is busy. Click the bullet to see the contacting options that are available to reach him.
2. Next, move your cursor over Dr. Cox’s box and drag it to the right and place it over Dr. Yu’s box. You’ll notice that the two doctors with green bullets are now first and second in the order of physicians. The "Green Bullet" means they can accept new patients in their daily schedule.
3. Dr. Cox has called to say he can’t see Hao Chen at 8:10, so drag Hao Chen to Dr. Gibbons at 8:10 so he can see the same doctor as his father, John Chen.
4. Click the "Clear Box" in the upper right hand section for Dr. Gibbons to see his entire schedule for the day. Also note that the other three doctors are on the right and can be clicked to see their daily schedules.
5. As the last step for this lesson, navigate by clicking the "Clear Box" of the other boxes so you can see the information they contain.

This ends the first lesson, come back to HIStalk to get the next lesson when it is posted. TPD will be doing a review of "Find a patient" next.

Rumor has it that Cerner’s Neal Patterson is trotting out his old "shot heard ’round the world" e-mail. You know, the pizza-and-parking lot one that sarcastically referred to EMPLOYEES instead of the HR-friendly “associates” because everybody was goofing off (I always write it as ASSociates because it sounds exactly what you’d expect dopey HR types to sit around dreaming up from their happy little floating HR cloud).

Somebody sent his internal-only e-mail to the press back in 2001, while the stench of dot-com smoke was still hanging heavy. Investors were spooked. Shares dropped fast and hard. Neal lost millions overnight while everybody was enjoying a good laugh at his "ready, fire, aim" approach.

Neal got the last laugh. Cerner headcount, profits, and his bankroll are immeasurably larger than they were back in 2001. And in a “goes around, comes around” kind of nostalgia, he’s supposedly proudly brandishing the famous e-mail to employees again, a shot across the bow as a reminder that he wasn’t kidding then and he isn’t now.

Here are some often overlooked facts about the original e-mail. Neal was griping about employees who were working less than 40 hours a week, which is an entirely reasonable bone to pick. He scolded his managers, not the slackers themselves, following the chain of command. It was a raw message intended for (and sent only to) the management team.

This is about as direct as you can get: "I think this parental type action SUCKS … what you are doing, as managers … makes me SICK … the majority of the KC based associates are hard working, committed to Cerner success and committed to transforming health care … this is a management problem, not an EMPLOYEE problem."

It wasn’t personal. It wasn’t even unreasonable (although the 60+ workweeks described are a bit much).

Neal isn’t some emotionless Wall Street hack brought in to push paper. He’s the founder, the owner, and the undisputed boss. When Cerner got too big for him to impose his will directly, he followed the chain of command in telling management to fix the problems he was seeing. Management by nastygram. That’s his right.

Everybody had great fun complaining and commiserating. Some EMPLOYEES left. Those with less backbone or fewer career options just kept whining safely out of Neal’s earshot while turning in fictitious timesheets.

Maybe one benefit of today’s economic meltdown is Depression-era common sense. Nobody promises lifetime employment. Nobody said work is always fun and fulfilling. Nobody promised that the boss might not occasionally behave like a horse’s ass in expressing disappointment in individual or group performance.

Employees with guts or valued skills don’t stick around to whine – they just move on. That’s how you hurt an unjust company (if there is such a thing) or an insufferable boss: you leave them, forcing them to forge on with a workforce of scared and compliant underperformers who have nowhere else to go. If the company thrives, you were wrong. If the company tanks, you were right.

Whether Neal is indeed rattling his e-mail saber again is irrelevant. The feel-good era of "associates" is over, if it was ever anything more than an illusion to start with. When jobs are hard to find, lots of people would love to have yours. Those would-be EMPLOYEES might even work harder, cheaper, or with less complaining. People tend to do that when they’re broke. That’s not to say that any particular company will start treating employees badly, but those who do will find it easier to keep them.

In that regard, Neal’s e-mail wasn’t the ranting of a tyrannical CEO. He was, as he often is, simply ahead of his time.

Live Chat with Allscripts CEO Glen Tullman – Wednesday, 10/15, 7:00 PM ET

News 10/15/08

Reminder: Allscripts CEO Glen Tullman will be live here in an online chat at 7:00 ET Wednesday evening. Several folks have left comments on his article or weighed in on the merger, so why not let Glen answer your questions directly? I’ll be posting the chat thing right here on HIStalk like any other article. You can set up a reminder for yourself right in the chat thing (I don’t know what else to call it, but it will make sense when you see it – picture above). I’ve practiced a little with it and I promise it’s fun and easy to use. Watch for the link or just go to www.histalk.com and you’ll see it.

From AHIMA IS DEAD: "Re: News from AHIMA – Seattle. One word – DEAD. Needs to be merged into HIMSS. No decision makers, no excitement, no pulse, no attendees." I know QuadraMed is there with some of those more modern technologies you’re interested in (HIM and identity management), so drop by their booth, tell them you’re probably the only HIStalk reader in attendance, and ask to be informed and entertained (no promises, but it never hurts to ask, unless you’re a competitor anyway).

From Duffy Dyer: "Re: Medsphere. The company put out a press release that implied that the VueCentric GUI was open source and part of its product, then had to retract it on Hardhats, saying they intended only to say that VueCentric was used in the Indian Health Service facility that just won the Davies." I’d call that press release a total disaster since it was nearly impossible to comprehend even without the gaffe. It must have been a slip because the others are OK and Schwartz PR is among the best that I’ve seen.

From Wilma Flintstone: "Re: Allscripts. Misys was supposed to be the acquirer, but all the top management is from Allscripts, the Allscripts name replaced the tainted Misys one, and it looks like from the site that the old Misys products like Tiger, Vision, Misys EMR, and even MyWay may be available only from resellers. The orange color might be what you get when you mix purple and red and the logo kind of looks like an M and an A (with the M in the shadows), but otherwise it looks like 90% Allscripts."

From Lula: "Re: Ingenix. You might be interested to know (if you don’t already), that Paul Sinclair, ex-senior VP of Cerner, resigned a few weeks ago and is now the COO of Ingenix Consulting. You can validate this via his Linkedin profile." You are correct. I didn’t know that. He had run Cerner’s professional services business for 12 years.

From Fourth Hansen Brother: "Re: shooting victims taken to closed hospital." I couldn’t find the online story to link to, but the text FHB copied says people took shooting victims to a closed Milwaukee hospital twice in a single night. Two men in their 20s were shot in unrelated incidents and in both cases, friends and family drove them to St. Michael Hospital, which has been closed for two years. Police advised everyone to call 911 instead of driving victims to a hospital.

I was Googling former IDXer Jim Crook to see what he’s up to, having forgotten that he’s now on the board of Vitalize Consulting Solutions. If you’re been around awhile (their employees average 12 years with their particular product) you might want to peruse their job listings, of which they have some juicy ones.

A new article by MEDSEEK president Peter Kuhn brings up an interesting statistic: scheduling a patient appointment by telephone takes six minutes (three each for the patient and the scheduler), while doing the same thing via a patient portal takes one minute (just the patient). That’s the same reason I buy online (and schedule appointments online) whenever I can.

This legal mumbo-jumbo, as best I can tell, is some kind of preliminary argument about definitions in McKesson’s lawsuit against Epic that claims MyChart infringes on McKesson patients. In this round, McKesson was the clear winner, it appears.

Online doctor rating service MDX Medical/Vitals.com gets $4 million in VC funding. Inquiries are free, so I looked up John Halamka. The information is basic (specialty, hospital affiliation, medical school, publications) and the results screen includes ads (one for billing software, one a silly game advertising a drug). Why would regular people checking their doctor’s credentials be hot prospects for buying physician billing systems or prescribing Lunesta? The site has all the cute bubble graphics and the Arial Rounded font that embodies 2.0 anything (and that will be as dated as a ’76 Vega in a couple of years), but I’m not seeing $4 million worth of potential with all the similar sites out there.

Hospira acquires the EndoTool blood glucose monitoring system from MD Scientific.

Iron Mountain, apparently tired of making a ridiculously profitable living hauling truckloads of medical records to its old limestone mine for long-term storage, wants to "shift toward a more consultative approach in the healthcare space" by telling hospitals how to handle paper records. The obligatory President Bush/EMR/2014 boilerplate is inserted as a reference to how poorly hospitals are doing with EMRs. I bet they had a big presence at AHIMA.

TeraMedica wins an imaging informatics value award for delivering ROI to its customers, specifically for consolidating disparate PACS through partnerships and in-house engineering.

Carilion’s struggles to convert from a hospital to a clinic are detailed in the local paper. One nugget: they’ve put aside $66 million for a statewide medical information system.

A new Pennsylvania law bans mandatory nurse overtime. It’s too bad a law had to be passed preventing employers from making people work when they don’t want to (or who aren’t at 100%, increasing the chance of error).

HealthBridge, the Cincinnati HIE company, is considering expanding to other cities. It just extended its relationship with Axolotl.

I’m fairly knowledgeable about the use of barcodes, so I found this entry in Loftware’s blog interesting: how about a color-enhanced barcode that can store 1.2 gigabytes of content? As it points out, that could be interesting for easy, cheap storage of medical records, medical images, or even media. If you ask me, healthcare is just beginning to realize the potential of barcodes.

Now you know why subscriptions are free. Modern Healthcare launches its fancily titled "leadership forum," which it says will offer "unparalleled access to highly qualified healthcare decision-makers." Pieces of meat … uhh, provider attendees … can be happy that "educational sessions will not compete with exhibiting, providing maximum sales exposure and sales opportunities for exhibiting companies." Don’t hospital executives have problems to solve at home without attending the equivalent of a timeshare sales pitch? I’m a little hostile, but only because I thought Modern Healthcare was above that level of overt pimping.

The Raleigh paper moans about losing its Misys Healthcare headquarters to Chicago, also claiming without further reference that 44 jobs will be lost as a result. 

Hillcrest Medical Center (OK) will deploy the CareView bedside TV and workflow application. Looks like it includes patient monitoring cameras and recording, online patient viewing for family, Internet access, basic telemedicine, and movies. Tommy Thompson is on the company’s board.

Jobs: Production Control Manager (MA), Regional Sales Director NE (NY), Customer Support Analyst – EMR (PA), Application Manager, Epic Ambulatory (CA).

Dossia joins the Continua Health Alliance (Wal-Mart PHR meets home device monitoring). I thought Continua was going to be hot when it started, but I haven’t heard much.

Microsoft says it will stick with SpeechMagic for Amalga even though Philips sold that division to Nuance.

If you’ve ever been to a seminar talking about the drug supply chain, this is familiar. A former Cardinal employee pocketed $350,000 in kickbacks from a felon in buying drugs of dubious quality on behalf of Cardinal. Cardinal already settled for trading in the so-called secondary drug market. The article cites a case I knew about: a cancer patient died because someone swapped her Procrit labels to sell the lower concentration drug at full price. That drug came from the same guy the Cardinal employee was buying from, who also made $42 million (!) selling phony Lipitor. The program I attended was shocking: totes full of fake Valium coming through the Miami post office, Mexican dealers who buy the same expensive labeling equipment the drug companies use (even holographic label printers) for making convincing fakes, and thieves who had already cracked RFID just in case FDA requires tracking products. Forget Tony Montana’s crack dealing: the real money is in fake drugs for fake Canadian pharmacies and innocent hospitals who don’t know what they’re getting or where it’s been.

Philips misses Q3 estimates, blaming slow US healthcare business.

MedAssurant, a healthcare data analysis company, moves to Bowie, MD. One of the Roche family just invested $175 million in the company, so it must be hot stuff (and has 2,000 employees besides).

A Thai software company called International Medical Software has developed a large-hospital system in J2EE that’s being used in 12 hospitals. An ISP "pay per use" feature is coming.

Oracle CEO Larry Ellison says he’s on the prowl for acquisitions cheapened by the stock sell-off, expecting to continue the company’s one-per-month average.

Odd hospital lawsuit: an overweight 46-year-old woman arrives at the ED complaining of abdominal pain. The nurses and doctors start her workup, but she asks to use the restroom. Staff later find her 6-pound newborn daughter in the toilet. She’s suing the hospital (actually the newborn is suing) for lifelong care of the baby, claiming the medical staff missed obvious labor signs even though the woman herself didn’t know she was pregnant. She had cocaine in her bloodstream. An outside psychiatric expert summarized, "Chutzpah. This is America. You’ve got to love this country. This woman doesn’t know she is pregnant, but somebody else should."

E-mail me.

HERtalk by Inga

From Janeen: “Re: MGMA. Inga, I had to smile when I learned you were going to MGMA. Your friends from RelayHealth will be there. Should we have an Inga lookalike in our booth again?” For those who attended HIMSS earlier this year, RelayHealth did have a lovely Inga stand-in. Too bad Mr. H and I didn’t get our act together in time to provide our unique brand of Fake Ingas, celebrity galas, and giveaways for MGMA, but it was a last minute decision. Anyway, one reason Mr. H is sending me on this field trip is to brush up on the latest in the ambulatory space. We’d like to be better versed in that area to appeal to our readers from that world. Janeen also reminded me that RelayHealth has a PHR offering, with their model connecting to the consumer via their provider. I do plan to stop by to see their plans for working with HealthVault.

I’ve stopped opening my 401K statements recently because all those down arrows make me depressed. On the other hand, I bought gas for $2.69 a gallon this week, so go figure out what it all means. Last week, before the close of the Allscripts-Misys deal, Dr. Borges asked why I thought Allscripts stock was falling if the merger was suppose to be such a great thing. I asked an expert (and HIStalk fan) Sean Wieland, Piper Jaffray analyst and industry mover and shaker, for his impressions since I clearly don’t have the economy figured out. To paraphrase Sean’s comments, this isn’t the time to rationally explain the movement of any stocks because all stocks are trading independent of their fundamentals right now. However, one factor possibly affecting shares of Allscripts was the trade x-dividend. Shareholders through October 10th are scheduled to receive a dividend. The tax treatment of dividends can be a little messy, so some stockholders may have elected to sell their shares in advance to avoid the tax implications. On Monday, Allscripts opened at $4.40 and closed at $5.47; Tuesday it closed at $5.40.

Ingenix announces the winners of its 5th Annual Top 200 coding hospitals. The award recognizes facilities based on the completeness and accuracy of their medical coding practices to bill Medicare for inpatient medical services.

The Health Resources and Services Administration announces plans to hand out $18.9 million to 25 community health organizations for EHR implementation. It seems like a lot until you remember it’s just a drop in the bucket compared to the billions our government is shelling out to our banks and automobile makers. This latest EMR incentive is in addition to the $290,000 per practice that the CMS promised last week to primary care groups with 20 or fewer physicians.

Alegent Health selects LYNX Medical Systems, a Picis company, to provide outpatient facility coding services to its five Omaha metropolitan area hospitals.

I don’t watch a lot of TV, but I do remember that old commercial (for Vicks-44, I think) where the good-looking guy says, “I’m not a doctor, but I play one on TV.” Maybe advertisers will resurrect it from this statistic: 26% of Americans say they get a big part of the health information from TV, particularly TV dramas (not PBS, not even TLC).

Eclipsys announces that the University of Michigan Health System recently deployed Sunrise Acute Care across its 913-bed system and has seen a 29% decrease in medical errors. Additionally, the health system claims a 40% reduction in the time to administer urgent medical orders.

Healthgrades’ 11th Annual Hospital Quality Study concludes that patients have a 70% better survival rate when treated at one of the nation’s top-rated hospitals compared to the lowest-rated ones. Across the board death rates are declining at the 5,000 hospitals studied, but the drop is faster at the top performing hospitals.

E-mail Inga.

Emageon To Be Acquired by Health Systems Solutions, Inc.

 Health Systems Solutions, Inc. of New York, NY announced Monday evening that it will acquire medical imaging vendor Emageon of Birmingham, AL for $2.85 per share or $62 million in cash, a 37% premium to its share price at Monday’s close.

HSS, traded on the OTC bulletin board, has a market cap of $20 million. Chairman and CEO Stanley Vashovsky was quoted as saying, "This transaction will offer us the ability to leverage Emageon’s best-in-market products as well as broaden and strengthen our management team with some of the industry’s most respected leaders. Our ability to bring together innovators in healthcare technology and unleash their entrepreneurial and creative talents will result in cutting-edge solutions that will improve clinical care and significantly improve customer profitability."

The company announced that it will seek Nasdaq listing following closing of the deal, which is subject to shareholder approval.

Emageon settled its proxy fight with Oliver Press Partners LLC in June, giving the investment manager three seats on its board. It announced evaluation of strategic alternatives at that time, including sale of the company. The company’s share price has dropped by 80% in the past year.

An HIT Moment With … Leah Binder

An HIT Moment with ... is a quick interview with someone we find interesting. Leah Binder is CEO of The Leapfrog Group of Washington DC.

Healthcare IT insiders and clinicians often criticize Leapfrog’s choice of CPOE as a technology that benefits patients, given that most medication errors that cause serious patient harm involve drug preparation or administration, not ordering, as in the recent Corpus Christi example with heparin. What overwhelming evidence makes CPOE so compelling to Leapfrog that those critics aren’t seeing?

Our fidelity is not to CPOE per se, but to any and all evidence-based best practices for reducing medication errors and improving patient safety. It happens that CPOE emerges as a clear winner in the evidence. We offer a bibliography on our website.

Among the studies: a study led by David Bates, MD, Chief of General Medicine at Boston’s Brigham and Women’s Hospital, demonstrated that CPOE reduced error rates by 55% — from 10.7 to 4.9 per 1000 patient-days. Rates of serious medication errors fell by 88% in a subsequent study by the same group. Another study conducted by LDS Hospital in Salt Lake City by David Classen, MD, demonstrated a 70% reduction in antibiotic-related ADEs after implementation of decision support for those drugs.

Recently there were two small studies suggesting CPOE might not be effective, but our expert panel discounts those studies because they took place in hospitals that deployed CPOE in six days — a ridiculously short time period for implementing any kind of complex system change.

Our experts read the peer-reviewed research. If there are better ways to reduce medication errors we welcome the opportunity to consider it.

Would you say that Leapfrog has had the influence on outcomes and healthcare purchasing that were expected when it was formed in 2000?

Leapfrog’s influence has been nothing short of astonishing in light of its short history. The central tenets of Leapfrog’s mission — transparency, good measures of quality, and rewarding good performance — have literally transformed mainstream health policy in the United States. Leapfrog led the way in innovations and policy priorities, among them:

• Leapfrog was the first to issue a never events policy, in 2006; now CMS has begun issuing regulations that Medicare will no longer pay for certain hospital acquired conditions, and all national health plans, and more than 60% of Leapfrog-reporting hospitals have followed suit with never events policies of their own.
• Leapfrog’s focus on paying for value and performance is now a mainstream philosophy. There are over 200 pay for performance programs in the country, including Leapfrog’s own Hospital Rewards Program, which at least one health plan intends to roll out nationally.
• Leapfrog’s commitment to transparency of quality information was one of its most controversial elements in 2000; today there are a plethora of report cards and other public information purporting to reveal comparative information among hospitals. Nonetheless, Leapfrog’s report on hospital performance remains by far the best and most useful: up to date information, evidence-based, and reported in a way that offers a meaningful comparison among institutions.
• Drawing on members’ experience, Leapfrog has influenced the design of CMS’ value-based purchasing initiative as well as HHS Secretary Mike Leavitt’s Executive Order incorporating four “Cornerstones of Value-Driven Health Care.”
• Leapfrog has significant influence in the National Quality Forum, including most recently approval of Leapfrog-sponsored measures on hospital efficiency.

Leapfrog has also seen progress in hospital quality among hundreds of reporting hospitals and raised the bar on patient safety. A recent peer reviewed study from Harvard School of Public Health, consistent with others that have been published on Leapfrog, concluded that hospitals reporting adequate performance on the Leapfrog Hospital Survey have better outcomes than other hospitals in the United States . 

We have not finished our work by any means. Next steps: support and incentivize providers in achieving higher performance, and engage even more employers. Some of our plans: develop best practices for implementing new IT infrastructure that ties to safety, deploy one nationally standardized pay for performance program based on the Leapfrog Survey, support hospitals more in achieving higher Leapfrog standards, and reach out to consumers and employees in new ways to support them in making decisions about providers. 

We are also going to formalize our partnerships with more of the employers now using Leapfrog (the vast majority are not formally members), issue more detailed guidance on implementation of never events, continue our robust partnership with policymakers and like-minded advocates to advance value-driven purchasing, advance a more streamlined and outcome-oriented set of performance measures, and ultimately, of course, improve the quality and safety of care.

All the evidence to date suggests we are on the right track and that we will be very busy in the years to come.

Where does Leapfrog’s mission fit in tough economic times?

There are many questions about who will be in the White House and what will happen to our economy, but one thing can be predicted with near certainty: the Leapfrog vision for health care reform will be a centerpiece. It has to be. Employers and other purchasers of health care will continue to reduce and in some cases eliminate employee health benefits as their profits erode and health costs escalate. In turn, employees will become more price conscious, and shop for the best value. Shopping for value in health care is what Leapfrog is all about.

With all the groups who want to oversee or audit provider performance, why should hospitals participate in Leapfrog’s programs?

Four reasons to start:

1. Because employers and purchasers of health care want them to. Purchasers pay for more than the care of their employees; they also subsidize the care of other patients when reimbursement for their care is inadequate, such as the uninsured.  Over 4,000 employers and counting participate with and use Leapfrog, and there is no other source of hospital data that employers point to as “their” exclusive survey. The least hospitals can do is devote 40-80 hours of staff time to giving employers the information they ask for, and in the process build trust and good relationships with their regional employers and employees.
2. Because it is useful. There is no survey tool that offers a better compendium of the best practices in patient safety, and some of the survey content is like getting high-priced consulting for free. For instance, our evaluation tool for CPOE is unique in the nation and offers invaluable information about the performance of IT systems.
3. Because it is harmonized with others. The measures in the Leapfrog Survey are consistent with NQF-endorsed measures and safe practices, IHI’s 100,000 Lives Campaign, and the Joint Commission.
4. Because you’re going to see market share and financial reimbursement changes tied to performance on Leapfrog. It is happening now. Many hospitals that perform well on Leapfrog feature that performance on their advertising, particularly in competitive markets. Some employers use Leapfrog scores to determine co-pay levels, and this has a very dramatic impact on patient flow. As changes in our economy and health system are emerging, we see these trends accelerating.

What were the surprises, good and bad, since you took the job?

The biggest “good” surprise is the influence of Leapfrog in Washington health policy circles and among hospitals. I was in Washington for one year about 14 years ago, and the change since then is incredible. 

For instance, at that time, the idea of report cards comparing providers was considered fairly radical and opposed by a wide variety of provider stakeholders. Today, everyone seems to agree it’s a good idea, and they just argue over the format (a very big issue, but still, the progress is substantial). Leapfrog is present at every significant stakeholder forum and regularly consulted by leaders in all branches of government. When Leapfrog summons people for a meeting on an issue, the who’s-who of leaders and experts show up. And among hospitals, where Leapfrog has its share of both passionate supporters and harsh critics, our influence is unquestioned. The visibility enables us to get things done in ways that would be impossible otherwise.

The second biggest “good” surprise: there are thousands more employers involved with Leapfrog than our membership roles would suggest.  That’s also the biggest “bad” surprise — we need them to be counted formally among Leapfrog’s membership, which helps assure we can sustain this remarkable visibility at the national level.