Monday Morning Update 10/18/10

From Improper Setting, Here: “Re: CVS is caught stocking meth labs.” A $75 million software bug? Drug chain CVS is fined that amount for illegally selling pseudoephedrine (generic Sudafed) from its stores in California and Nevada. The congestion remedy had been moved to behind-the-counter sales since it’s used to manufacture methamphetamine. Meth makers found that they could simply make repeated buying trips to CVS to accumulate enough of the drug, made possible by a CVS software bug that couldn’t detect repeat sales. The apparent personal best: one customer bought the drug 10 times in 53 minutes from a single CVS store.

From Alicia: “Re: IntraNexus and biometrics. A big piece missing in medical device integration is patient identification, where this might be useful to bind patient ID to medical devices, especially if what they say about vein print is true. Right now you need a myriad of systems such as RFID and/or bar code and it’s usually done indirectly by bed number association.” The shots above from Fujitsu’s PalmSecure illustrate the concept.

From The Purple Computer: “Re: UPMC. Say it and people will come. How many nurses are they giving up?” UPMC rolls out a $16 million “branding campaign” centered around bold, humanitarian healthcare thinking — a purple logo (“fresh and progressive, yet warm and feminine … distinguishes us from the sea of blue in the academic medical center and health insurance space.”) Obviously they’ve let the marketing people run wild. Non-profit hospitals have gone over the edge when they start throwing around terms like “space” to refer to healthcare delivery. If their hospitals aren’t already full, I doubt there are enough patients will switch just because they’re tired of the blue-logo places. Maybe their competitors (if any are left other than West Penn) should run their own UPMC ads during Unemployment TV hours (daytime judge, talk, and soap programs) to dump more uninsured patients onto the newly purpled.

From Jailbreak: “Re: EMR vendor VP. I wrote you before about a sales VP with a criminal record and am amazed his new EMR employer didn’t check references. Here’s a threat to me from the VP, who can’t even write.” I’ve omitted names and details, but the purported e-mail from the VP, nearly unintelligible, is kind of fun in an illiterate, ransom note kind of way: “Why are you such a [genitalia synonym omitted] and hide you indenty .. Law suit coming … You dam well i never stole nothing from you … I will make sure I get on EVERY doctor website (EMRUPDATE) for example to let them know how bad and far back the [company name omitted] technology is … will not even get a whiff of 2011 cchit and over the EMR SUCKS The statements will come from various doctors … NOMATTER what you do I survive.”

From DyingToKnow: “Re: HCA. Persistent rumor in KC this week – HCA is switching from Meditech to Cerner. What’s the real scoop?” I mentioned from a sound inside source that HCA is doing a small Cerner pilot, facing an extensive effort and cost to move to Meditech 6.0 and figuring they might as well explore their options. I think that’s the limit of HCA’s commitment so far.

From Volare, WoOh: “Re: Moses Cone. They had a 1.5 hour recorded demo of Epic on their physician page, but it looks like it’s been taken down. There is also a CEO video talking about the $80-120 million Epic investment over the next five years.”

From Yosemite Sam: “Re: Most Wired award. I heard that AHA is discontinuing it. Maybe the commentary on HIStalk made them see the light.” Unverified. It can’t be because the award is pointless since that’s always been the case, so I’ll go with the obvious: with Meaningful Use, who cares about a phony award sponsored by skin-in-the-game HIT vendors and magazines trying (but failing) to perpetuate the myth that more HIT is always better? If the rumor is true, the CIO dilemma begins: should you leave the Most Wired vanity entry on your resume once the award is sunsetted? Here’s the award that actually means something: use IT to improve patient outcomes and/or reduce your costs, in which case your reputation will precede you without your having to wave flimsy evidence of it around. Too bad there’s no profit involved in that to attract the interest of AHA, HHN, CHIME, McKesson, and the other Most Wired conspicuous HIT consumption cheerleaders.

From HIT Geek: “Re: Siemens layoffs. The timing of Siemens layoffs follows the fiscal calendar. They are often announced on or shortly before the fiscal year-end (9/30). This year’s round is no exception. It is numbers-driven, with no concern for holidays or employee morale.” You would think well-educated MBA-type VPs could use their legendary quantitative skills to look forward more than one quarter, but that never seems to happen with any company. It’s like, holy crap it’s year end and the numbers suck, so start dumping people.

From Hogs Get Slaughtered: “Re: Cerner and Ingenix. Gonna take on 3M’s monopoly and crazy, hostage-style pricing.” Cerner will integrate coding and PPS solutions from Ingenix with Millennium.

From Kay: “Re: patient estimation tools. Patients want to know what the cost of the service will be and how much they will owe. The time of ‘wait and see’ is over — not just what it costs, but how much they will have to pay. Thirty states require the hospital to provide cost information. Vendors that provide a quick and easy 270/271 transaction code check based upon the hospital’s charge master cost for the service and the patient’s insurance plan  would be able to provide the most accurate estimate for the patient. A cost estimate at time of scheduling, pre-reg, or registration will meet state requirements and help the hospital compete. Time-of-service collection of the accurate out-of-pocket balance reduces collection expense and bad debt. These tools also allow checking addresses and creditworthiness. With medical identify theft on the rise, being able to immediately know that the ID provided by the patient may be associated with ID theft protects the hospital from lost revenue and also prevents the contamination of the EMR.” Kay works for Iatric Systems, which offers this kind of solution.

From ePatient Advocate: “Re: PracticeFusion. The ad-supported vendor said at Health 2.0 that they are the largest and fastest-growing EHR. No breakdown on how many are getting ‘free’ (aka pharma ad-sponsored version) and if patients want their docs to be getting drug rep visits via their EHR.” There’s an overview and demo above, just in case you’re interested. I didn’t watch it all, but ads and patient data sales didn’t seem to be emphasized.

I’m back from a break. Thanks to Inga for capably covering while I was away. I’m sure I’ll inadvertently repeat some of what she wrote about last week, but I’ll catch up eventually. That wasn’t really me in the picture she ran, by the way — that was just some sly Inga impishness. And thank God she didn’t sent out minute-by-minute Chilean miner updates since apparently the entire world had two full days to ignore pressing problems while watching feel-good bios of oppressed miners now turned instant but probably short-lived superstars (the most interesting aspect of that story is that the mining company is too broke to even pay their wages, much less the dozens of millions it cost a previously safety-indifferent government to get them out to create the mother of all political photo opportunities).

I bet not many people can say they couldn’t wait for vacation to be over to get back to their jobs, but I can (especially my HIStalk “job”, but I even missed my hospital one). I missed seeing people in scrubs and white coats, feeling the on-campus energy, and doing geeky IT stuff.

Readers don’t have a lot of confidence in the ability of Windows Phone 7 to compete with iPhone and Droid, it seems. New poll to your right — another economy check. From your employer’s perspective, how is the economy doing compared to six months ago? All I know is that my IRA value went up 10% last month, which is nearly as fast as it was going down for the past several.

Chuck Christian (Good Samaritan Hospital) and Judy Kirby (Kirby Partners) win the CHIME Collaboration Award for writing the IT internal marketing book that I’ve mentioned here previously. Chuck co-wrote it with Kirby VP Steve Bennett.

Yuma Regional Medical Center (AZ) names pediatrician Bart Bernstein, MD as its CMIO. He will lead the 333-bed hospital’s Epic implementation, which is costing $73 million. I noticed that the hospital has put up a website hoping to recruit candidates for its 40 newly open Epic-related positions. For some reason, they spell Epic as EPIC, which I see often but don’t understand since even Epic doesn’t go all-caps (unlike Meditech or MEDITECH, whichever is correct since I can’t figure that out at all). My rule is that only acronyms get capitalized and neither Epic nor Meditech is an acronym. It‘s usually those UPMC-style run-amok marketeers that demand to capitalize words against all logic or to stick annoying symbols on them like a proud rancher branding his steers.

Getting a local paper Epic mention: University of Colorado Hospital, spending $67 million.

Listening: the brand new debut album from The Band Perry, three young siblings cranking out polished country pop that sounds more genuine than the usual Disney-style, photogenic and overproduced hat-wearing faux cowboys/cowgirls pretending to know who George Jones and Ralph Stanley are but whose impeccable makeup might melt at the sight of an actual mandolin or pedal steel guitar. They’re from one of my favorite small towns: Greeneville, TN.

Stuff you can do if you want: (a) add your item free to the HIStalk Events Calendar; (b) click the Like button on the Facebook widget to your right or friend Inga or me; (c) search the amazingly deep HIStalk archives using the Search All HIStalk Sites box to your right; (d) send me rumors, news, or a Readers Write article; (e) check out the other sites, HIStalk Practice and HIStalk Mobile; (f) support my sponsors by perusing the ads to your left and clicking any of interest to see what’s new with the folks who keep the virtual printing presses running here at HIStalk; (g) thank yourself on my behalf for reading and for telling others about HIStalk.

On the Sponsor Job Board: Healthcare Consulting Principal – Washington DC, Allscripts Consultants, McKesson Build Analyst. On Healthcare IT Jobs: Senior Analyst – Provider Integration, Application Specialist, Clinical Sales Specialist, Epic Project Managers.

It’s American Idol, EMR style. Intellect Resources, looking to quickly hire 90 short-term Epic trainers for Mount Sinai Medical Center, is running a one-day audition in New York on November 5. The job pays a fixed rate of $20 per hour and lasts for a maximum of 24 weeks.

The Milwaukee newspaper profiles Epic with some interesting facts, with the most interesting one being confirmation of our June report that Aurora is dumping its $150 million Cerner system for Epic, which will cost them an additional $100 million. A quarter billion dollars seems like a lot for an EMR considering that Aurora showed a $50 million loss two years ago and a $116 million loss last year. For that performance, the CEO was paid $2.3 million last year (including a million-dollar bonus), the COO made $2.2 million (another million-dollar bonus), two other VPs made more than $1 million (both with >$500K bonuses), and the CIO took home $739K (including a $250K bonus). All while laying people off, of course.

That article about Epic values the company at $2.6 billion, or just 3.3 times revenues. That seems about right given that Cerner’s market cap is just over 4x sales and is better diversified, although Cerner is probably less profitable for the same reason.

Gary York, the founder of patient visibility vendor Awarix that was bought by McKesson in 2007 (and who was also founder of imaging vendor Emageon, since acquired by Merge Healthcare) is named board chair of Emergency CallWorx, an Alabama-based 911 and incident management software vendor.

A Florida business paper does a nice profile on nurse communication system vendor Voalte, mentioning its rapid growth (20 clients expected by the end of 2011) and its legendary pink pants. Trey Lauderdale told me that Inga gets some credit for those since he asked us for advice before the company’s first HIMSS exhibit awhile back and joked about needing to stand out among the larger and better located ($$$) booths. I don’t recall the details, but Inga either dared them to wear pink pants or picked up on Trey’s joke that they were thinking about it and she ran it in HIStalk before he could change his mind. The rest is history, as the pink represents the company’s fresh culture. Shockingly, we don’t get asked for advice all that often despite having other colors on reserve for those occasions.

GE reports bad Q3 numbers as it tries to shed its GE Capital baggage. Net income dropped 18% and sales fell short of estimates, although Jeff Immelt says orders are picking up (I’m always wary when the audited numbers are bad but the unaudited anecdotes are rosy). GE says its performance was dragged down by the $1.1 billion it had to pump into a Japanese finance division. GE Healthcare’s performance was the only bright spot, with revenue up 4% and profits up 14%.

Speaking of GE Healthcare, it announces a CCD-powered tool for Centricity that allows exchanging basic patient information with non-GE EMRs.

A veteran is denied his request to return to active duty in Afghanistan when a Pentagon doctor using DoD’s AHLTA EMR sees his post-traumatic stress treatment records from the VA’s VistA system. The VA is treating the incident as a data breach since the AHLTA-VistA interface isn’t supposed to exchange information of that type. VA CIO Roger Baker actually suggested that doctors not enter progress notes into VistA if they can’t figure out how to keep it from being viewed in AHLTA. On the other hand, the VA wants to rewrite/replace VistA at huge taxpayer expense, so that kind of warning would help the argument, I’m just saying.

Speaking of DoD, the GAO says the $2 billion AHLTA EMR (double that cost by many accounts, up to $20 billion by some estimates) is mediocre at best (limited capabilities and performance problems) and will be replaced by 2015 with something called "EHR Way Ahead,” with $302 million requested for FY2011. Northrop Grumman got billions to develop and maintain AHLTA (the EMR formerly known as CHCS II before it was rebranded in a PR-company led attempt to hide its many warts), so I’m sure they consider themselves an obvious choice to take a second uber-expensive swing at the ball. In any case, regional droughts are being relieved by vendor and fat cat contractor salivation. I love these AHLTA comments from student doctors:

• My favorite are the contractors who keep explaining how much easier it is to use than a real chart. I wonder how much medicine they practice.
• They tell you that all you need to do to fix the system, is keep sending trouble tickets in. since when did software testing get added to my job description? i want out, and as far away from AHLTA as possible.
• I remember watching the PGUI instructor (similar to AHLTA) show us how "wonderful" that system was. He pretended the pt was there for an asthma appt. I kept track of the time it took just for him (the specialist) to enter the info and the time the computer was "thinking" (hourglass sign). It took 7 1/2 minutes.
• I was the last holdout and management basically had to come down and hold a pistol to my head to get me to stop writing 600s. I still order things in CHCS and document it later in AHLTA when I get around to finishing notes in the evening. This is the biggest turd of a program I’ve ever seen.
• I haven’t met an AHLTA contractor yet that I would hire to help anybody program their VCR.
• For new users, if you’re trying to add a consult and it keeps kicking it out, 95% of the time you can fix it by adding a med first (I like rectal Tylenol), then adding the consult, then go and delete the med. Ha ha of course the fact that I have to do this to work around the bug lets you know how screwed up AHLTA is in the first place.
• What I hate is that, while psych notes are require a "break the glass" thing to access, the actual psych/counseling diagnoses appear on the front of every note created. Thus some poor kid talks to a social worker about problems with his wife, and every subsequent note has "MARITAL PROBLEMS" plastered to the top of it.
• It’s funny, I think AHLTA is the most universally despised part of military medicine. Anything else: GMOs, Base Locations, volume of procedures, whatever, you’ll find someone who had a good experience. AHLTA the opinions just seem to vary between ‘it’s pretty bad’ and ‘I’m armed and hiding outside the programmer’s house’.

When anesthesiologists talk about patient safety, I listen, because that group is the only one of all medical disciplines that admitted their own problems and went off on their own to reduce surgery-related mortality by a huge percentage (see: Peter Pronovost). The Anesthesia Patient Safety Foundation has new recommendations (warning: PDF) for medication safety in the OR, indicating its willingness to surrender anesthesiologist independence in the interests of patient safety: (a) put pharmacists in the OR; (b) use high-alert drugs only as premixed products and administered by smart pump; (c) bar code check meds before administration and with decision support and documentation built in; (d) use case kits whenever possible and do not let providers prepare their own drug doses; and (e) establish a just culture for error reporting. Not to perpetuate a stereotype, but if surgeons weren’t collectively such pouting egotistical cowboys, they might save more patients instead of arrogantly standing in the huge patient safety shadow cast by their anesthesiologist colleagues.

Verizon expands its Medical Data Exchange beyond simple dictated notes to include images and lab results. It also announces new partnerships: MD-IT for applications, Alert Notification for communication, Amaji for clinical documentation, Tolven for applications, NLP for natural language processing, ZyDoc Medical Transcription for transcription. I’ve never heard of MD-IT, but I was interested that one of its founders and board chair is an MD/PhD who founded the company that claims to have developed the first antivirus software, later sold to Symantec to become Norton Antivirus. He also founded Cybertrust, which Verizon Business bought in 2007. I guess he didn’t need to practice medicine.

Nurses at Children’s Hospital of Oakland go on strike after management makes them pay 15% of the cost of their healthcare benefits, which have risen 80% in the past five years. The hospital says the nurses all make at least $136K per year and the benefits will cost them only $4,000. Can they really be paying staff nurses $136K?

E-mail me.

News 10/15/10

HERtalk by Inga

From: JimmyJoe “Re: UW Warning on Cut and Paste. In my prior life I became increasingly concerned about the quality and safety ramifications of mindless cutting and pasting. The practice also causes progress notes to grow and grow (due to cut and paste and add), making the record increasingly unwieldy and less useful. I informally polled a number of people in my position and all of them were equally concerned. None of them had an answer other than policies around not doing it without paying attention. It is important to remember that cutting and pasting is not really an EHR function, it is a Windows function. What to do, what to do?” I don’t have an answer either but it’s good to know you can always blame Bill Gates, should an auditor raise concerns about cutting and pasting in your EHR.

From: Bama Bubba “Re: RFID tracked hospital workers. I wonder if RFID-tracked hospital workers feel like cattle, too. Personally, I never bought the ‘inventory tracking’ rationale (excuse) for tagging workers.” Two Houston-area school districts, hoping to monitor the whereabouts of their students, implement “the same technology used to track cattle.” Despite parental concerns about potential health risks, administrators are pleased attendance is up.

From: Weird News Andy “Re: Medicare fraud-biggest ever. Leads me to wonder. . . Medicare get hits with fraud ALL THE TIME. Do private firms get hit with fraud as often and we just don’t hear about it, or is there something about people looking out after their own money that makes them more vigilant?” WNA asks a compelling question, prompted by news of a $100 million Medicare fraud case. In reading details on this case, it sounds as if the art of cheating Medicare isn’t rocket science. Maybe it’s not as easy in the private sector.

When I first read details of this same Medicare fraud case, I thought it had the bones for the perfect modern day Godfather saga. Federal prosecutors have charged a band of 40+ Armenian-American gangsters for billing Medicare over $100 million in fraudulent claims (Medicare paid $35 million of them.) The enterprise has been led by Armen Kazarian, whose role is similar to a Mafia godfather. He came to the US in 1996 and was granted political asylum based on a fabricated story that involved his father being doused with gasoline and burned to death.The fraud operations started with the identity theft of doctors, including their medical license numbers. The accused group then stole the identity of Medicare patients. From there, gangsters created 118 fake clinics across 25 states and began churning out fake claims. In most cases, Medicare was happy to pay. The story includes plenty of infighting, threats of violence for not paying debts, and  untraceable money transfers back to Armenia. The US attorney handling the case calls it the “single largest Medicare fraud ever perpetrated by a single criminal enterprise.”

Not a moment too soon: HHS awards TerraMedica a contract to assess fraud, waste, and abuse in Medicare claims using predictive modeling technology.

The St. Charles Health System (OR) selects Allscripts EHR and PM solutions for its employed and affiliated physicians. The Oregon Community Health Information Network’s (OCHIN) REC will provide implementation and training support for independent physicians. Allscripts, by the way, also announces its 2010 President’s and Circle of Excellence Hospital awards, which recognizes customers with documented strategies and superior outcomes using Allscripts technology.

eHealth Ontario awards CGI Group a $46.2 million contract to develop a new chronic disease management system. The solution will operate on AxSys Technology’s Excelicare platform.  AxSys, by the way, also just secured contracts with North American Management California and MSO of Puerto Rico to develop HIEs running on the Excelicare platform.

The Denver paper highlights the University of Colorado Hospital’s migration to Epic. The hospital says data integration is one of the major benefits of the $67 million project, which is expected to be completed mid-2012.

Halfpenny Technologies, which recently secured $2.6 million in VC funding, appoints four new execs to its management team, including Mitch Fry as EVP of business development, Daniel O’Brien as CFO, Roger W. Newbury, Jr. as SVP of sales, and Jim Sheils as VP of sales. Individually the group has worked for such employers as Sunquest, Misys, TELCOR, Touchstone Health, United Healthcare Group,  US Laboratory and Radiology, and dbMotion.

DB Technology and BridgeHead Software partner to offer a joint content and storage management solution. The combined solution leverages DB Technology’s document imaging component and BridgeHead’s data and storage management tools.

MEDecision earns accreditation from URAC for meeting URAC’s Vendor Disease Management, Vendor Case Management, and Health Content Provider standards.

Vocera Communications acquires voice technology vendors Clinical Health Communications (makers of OptiVox) and Integrated Voice Solutions (maker of VoiceCare.) Vocera also reports a 39% y/y growth for the third quarter.

Catholic Health Partners (OH) claims its saved over $8 million using Kronos’s time and attendance and productivity solutions. CHP attributes the savings to reduced agency and overtime use.

A reader tells me that Advocate Healthcare (IL) is now live on SAPPHIRE for patient registration and accounting in all nine of their facilities.

A class-action lawsuit filed in Arkansas accuses HealthPort of charging patients an illegal fee when requesting copies of their medical records. The lawsuit is not challenging the legality of HealthPort’s basic charge to retrieve/copy/send medical records. However, the lawsuit contends that the $1.71 sales tax imposed by HealthPort is illegal and in-state providers do charge sales tax for similar services.

St. Barnabas Medical Center (NJ) picks Merge’s AIMS, medication management, and patient portal solutions.

UMass Memorial Health Care announces plans to eliminate 350 jobs, or almost 2.6% of its workforce. The seven facility system expects to lay off 130 workers, freeze another 120 vacant jobs, and eliminate the equivalent of 100 jobs by reducing overtime and move employees from full to part time.

Hiring: the Cincinnati Business Courier reports that healthcare systems in tri-state area expect to add more than 100 people to help set up various EMR systems.

Verizon releases plans to expand its Medical Data Exchange platform beyond its core transcription exchange services; members will soon be able to share X-rays, lab results, and other digital records. Verizon will also begin offering IT consulting services for its Exchange members.

This week on HIStalk Practice: KLAS publishes a new report rating ambulatory EMRs by specialty; the Rhode Island Quality Institute picks several pre-qualified EHR and technology vendors for its REC; Ohio State Medical Association publishes a new social media toolkit for providers.

API Healthcare says it’s recently signed up more than 30 healthcare clients for its workforce management technology.

The Chesapeake Regional Information System for our Patients (CRISP) announces its statewide HIE is now live.

Pemiscot Memorial Health Systems (MO) selects Prognosis Health Information Systems’ ChartAccess EHR.

Despite taking some well-deserved vacation, Mr. H did manage to check in with me a couple times this week. Mrs. H apparently took this shot of him taking a moment to ensure the HIT world was still on track.  Maybe he’ll post a few more pics when he posts the Monday Morning Update this weekend.

E-mail Inga.

News 10/13/10

HERtalk by Inga

From: Penny Chenery “Data Innovations.” Data Innovations is taking on a huge amount of capital from an unknown venture capitalist. It is either an outright sale, or a large infusion of cash.” Investment firm Battery Ventures announces it just purchased the maker of software for managing clinical lab data for an undisclosed sum. Data Innovations also appoints former Lawson VP Mike Epplen as the company’s new CEO.

From: WALL-E “Re: Most Wired. I heard AHA is discontinuing the Most Wired award. Maybe all the commentary on HIStalk made them see the light.” Unconfirmed but I am sure that just reading the rumor will make Mr. H smile for a second or two. WALL-E wasn’t clear if AHA is no longer going to be associated with Most Wired or if the Most Wired award as a whole is going away. Send a note if you know.

From: Bertha Lindau “Re: Moses Cone. In case you’re interested, here’s a PDF where the Moses Cone COO talks about replacing GE with Epic.” The internal newsletter includes details from a brown bag lunch with COO Terry Akin, who has a number of interesting things to say about the transition. He points out that the health systems was unable to develop a fully integrated health record after their “big investment with GE” five or six years ago.  Akin calls Epic the “one company that has emerged head and shoulders above the rest” and claims that 99% of their physicians were favorably impressed with the Epic demo.

As WisconsinBiker shared June 23rd, Aurora Health Care (WI) is replacing its 15-year old Cerner system with a $100 million Epic solution. Aurora CIO Philip Loftus says that one the biggest advantages of Epic over Cerner is Epic’s fully integrated solution for both hospitals and clinics. Epic, by the way, is expected to end the year with $780 million in revenue, compared to $650 million last year and has an estimated market value of $2.6 billion.

Cerner may not be feeling the love from Aurora, but I bet the Kansas City Convention & Visitors Associates are big fans. This week’s Cerner Health Conference will generate $4.5 million for hotels, food, fuel, and related expenses as 6,000 users descend upon the city. Cerner took advantage of the event to announce several new alliances:

• A reseller agreement with SearchAmerica that includes the integration of Cerner’s revenue cycle offering with SearchAmerica’s financial services
• An alliance with Ingenix to  integrate Ingenix’s medical coding and prospective payment system (PPS) solutions into Cerner’s Millennium product
• A reseller agreement with MedAssets to market MedAssets’ web-based revenue cycle services

Here was an odd observation from one of the local papers: Cerner closed many of the leadership forum sessions to the media. Of course now the whole HIT world wants to know what Cerner was hiding.

Also meeting this week: nearly 1,500 Sunrise Enterprise users in San Diego. Attendees had a chance to see the new Sunrise Mobile MD iPhone application, which enables physician to access the Sunrise system. Allscripts also introduced Allscripts Developer Program, which allows clients and third parties to natively integrate their applications with Allscripts’ solutions. In December, clients will be able to search the Allscripts Application Store & Exchange to select or share applications developed through the Developer Program.

QuadraMed’s former SVP of corporate development Steven V. Russell joins digital pathology vendor Aperio as VP of corporate development.

A longtime HIStalk reader asked us to mention the upcoming HIT Leadership Summit in Atlanta November 9th. Silicon Valley venture capitalist Bob Bozeman (of Google fame) is keynoting the event, which aims to highlight Georgia’s leadership in HIT, plus drive statewide HIT revenue and job growth. There’s a pretty impressive list of HIT companies, universities, and medical schools participating in the event hosted by the Technology Association of Georgia (TAG), the Georgia Department of Economic Development, and the Metro Atlanta Chamber. I am happy to make the mention for Marty Mercer, who is on the TAG advisory board and a faithful reader. Plus I have a soft spot for attractive bald men.

So, Mr. H is vacationing this week, leaving me solo. I’m sure I have left out some earth-shattering HIT news, so give me a break and shoot me an email if you have some juicy news to share.

The Camden HIE (PA) goes live this week, connecting Cooper University Hospital, Lourdes Health System, and Virtua Health. Each of the three health systems is contributing $50,000 a year, plus the Merck Company Foundation is donating $50,000.

Vincent Marin joins Huron Consulting Group as CIO following 16 years with McKinsey & Company. Marin most recently served as director of IT services for the Americas region.

Novella Clinical hires Charles Lambert as its new CFO. Lambert had previously served as CFO for RCM provider Capario and Misys Healthcare before that.

Sponsor Updates

• CynergisTek CEO Mac McMillan, who also serves as Chair of the HIMSS Privacy and Security Steering Committee, will be a presenter at the Midwest HIMSS 2010 Fall Technology Conference next week in Minneapolis.
• e-MDs is playing an integral role in the creation of the HIT Certification program at the University of Texas. e-MDs’ CEO Dr. Michael Stearns serves on the curriculum committee and the company has donated their Solution Series EHR/PM system. Of the 34 students eligible for employment from the first graduating class, 21 have secured HIT jobs and seven have been hired by e-MDs.
• Medical Hills Internal Medicine and Pediatrics (IL) selects SRS Hybrid EMR for its 14 provider practice.
• Healthcare Coalition of Texas awards EDCO Group a contract to give its 17 healthcare system members to EDCO’s document management solutions.
• Sunquest Information Systems expands its international operations with the hiring of Dr. David Rossitter as director of customer operations in Norwich, UK. Rossitter most recently served as Interim Head of Operations for Astron Clinica.
• Frisbie Memorial Hospital (NH) contracts with Voalte for its integrated communication solution for the iPhone.
• Lourdes Hospital (KY) is working with Informatics Corporation of America (ICA) and Ulrich Medical Concepts to provide a bi-directional CCR for providers. Lourdes providers currently have access to the ICAare Clinical Portal;  bi-directional capabilities are being introduced for practices utilizing the Ulrich Medical EMR.
• PatientKeeper reports that its customers are processing more than 10 million physician charges annually with its Charge Capture application. PatientKeeper also just added US Memorial Health System (IL) as a new client and expanded agreements with Alegent Health (NE), Boston Medical Center, and the Robert Wood Johnson Medical Group (NJ).
• University Health System (TX) signs an agreement with iSirona to use iSirona’s technology to automate the delivery of patient medical devices to to the hospital’s EMR.
• Memorial Hospital (IL) selects Access Intelligent Forms Suite to complement its MEDITECH 6.0 Advanced Clinical/EMR system.

How does this happen: a Pennsylvania paramedic is charged with multiple counts of felony theft for stealing and re-selling as many as 15 ultrasound machines. Over the past few years, Juan Torres worked for a private ambulance companies and several ERs where various ultrasounds equipment was  reported stolen. The units,  some valued at around $35,000 each, were being offered on eBay for under $7,000.

E-mail Inga.

Healthcare IT From the Investor’s Chair 10/12/10

Health 2.0 2010 – Two Perspectives, One Attendee

I attended my second Health 2.0 conference in San Francisco last week and find myself suffering from multiple personality disorder as a result. My multiples (only 2) are the geeky, health policy, propeller-head Ben; and the Investor Chair Ben. Allow me to share both views.

What an amazing ecosystem (or is it an incubator)!:

Health 2.0 is easily the most forward-thinking conference I attend, and the sense of energy and excitement there amazes me. I even started following a Twitter feed for the first time! Yes, it’s a bit like the Internet conferences I attended in the dotcom days, but there’s much more of a focus on empowering patients, improving decision making and making healthcare better.

Unlike the e-health conferences of yore, while investors do attend, they’re not throwing money around. With over 1,000 attendees and close to 50 sponsors this year, the conference is clearly a success. Kudos to Matthew and Indu (who I actually think might be the best entrepreneurs in the room) for putting it together and creating a bit of a sandbox in which people can play.

Another industry veteran and I were musing that it has a similar feel (albeit smaller scale and way hipper) to the Microsoft Healthcare Users Group (MS-HUG) conferences we used to attend about a decade ago. That is to say, it’s an outstanding networking and business development venue. Yes, the term ecosystem was way overused, but there’s a degree of earnestness that I find alternately annoying and endearing.

As expected given the 2.0 theme, many of the “companies” are focusing on social networking and “user generated healthcare”. I’m not sure if tweeting what I eat or posting how many steps I take will change my behavior, but a number of the other attendees seemed to think so.

Bottom line for this Ben is, as a very smart entrepreneur turned venture capitalist observed, “Health 2.0 is a great chance to catch the vibe and see what people are thinking about five years out.” He went on, however, to say he’d likely invest elsewhere for the next few years as he waited for the market to catch up. This brings us to what did Investor Chair Ben think.

Let the Angels Sing (Because the VCs Aren’t Likely To)

All of the above notwithstanding, I saw few, if any, investing opportunities.

Yes, some of the sessions had interesting ideas, but I couldn’t shake the 90s Internet conference feel. Too many companies were more into showcasing how edgy and disruptive they were, then how lucrative, proprietary or sustainable they were. There’s this tone of self-congratulation that I find off-putting (but maybe I’m just old!).

While I wasn’t able to attend the DC to VC conference the day before (another part of Health Innovations Week), chatting with some folks from a major publisher who did, I was told that none of the pitches they heard talked about a business model or how they’d make money. Of the companies I saw or spoke with that did have a business model, as with last year, too many were focused on advertising revenue or were just too small in scale to attain institutional financing. That, perhaps, is part of the appeal and charm of Web 2.0 in general. It allows someone to develop a website or app in their loft or garage and perhaps make a few hundred thousand dollars a year doing it, quit their day jobs working for the Man and, best of all, in this case, improve the health status of a sizable number of people in the process.

This shoestring/boot strap ability is great and exciting, but it typically does not create something an institutional investor who wants to generate returns for their funds’ investors (and themselves) is likely to care about, hence my conflicting viewpoints. Did I see a few companies that were likely institutionally backable? Yes, but with the criteria of having reasonably high entry barriers and/or capable of generating $10-20 million in EBITDA (earnings before interest, taxes, depreciation and amortization – a key financial metric used by investors), I’d say less than five. It not being a venture forum event, I will decline to name them, but I’d be surprised if they were EMRs solely for iPads (how long will it take NextGen, Sage or AdvancedMD to develop their own?) or a service that allows me to get a text message of my last STD status to prove I’m healthy before I hook up (though the founder of Qpid.me did a great pitch).

Trying to integrate my two personalities, I’ll observe the following about Health 2.0 and its eponymous conference:

Health 2.0 is real and becoming mainstream. Sponsors included Cerner, RelayHealth (aka McKesson), OptumHealth (part of United, sister of Ingenix), and Sage (fka Medical Manager). These aren’t companies jumping on the bandwagon or trying for some gloss either; for the most part they have a commitment.

Part of the power and excitement are the low entry barriers and the ability to bootstrap on a shoestring (Inga, just which is the right footwear metaphor here?) For minimal cost and time, a developer or entrepreneur can make a difference in people’s health status/quality/access…

…but raising capital will be a challenge and a home run (or even a triple) exit isn’t a likely outcome.

There were some innovative ideas and great, exciting and high energy people…

…but more features and products than companies.

I’ll close with a link to a very worthwhile Forbes article written by some of the best HCIT VCs in the business. In addition to athenahealth, they’re currently invested in four private companies that I personally find fascinating. Their lessons learned are well worth noting.

Ben Rooks spent ten years as a sell-side equity analyst covering HCIT and related sectors before spending six years as an investment banker where he closed transactions ranging from $40 to 365 million. Seeking to make an honest living, he then founded ST Advisors, LLC where he works with healthcare companies and their sponsors, most often on issues around strategy, financing, and outcomes/exit planning. After all this time, he still can’t wait for HIMSS!

Monday Morning Update 10/11/10

From The PACS Designer: “Re: Windows Phone 7 launch. Microsoft has scheduled the Windows Phone 7 launch for October 11. If Windows Phone 7 is as good as Win 7 in combination with Bing, then we’ll see some interesting apps that could start to be used by healthcare providers and patients.” I’m not a big fan of the name for sure, and I don’t know how many people care about the Zune Hub. The Windows Phone Live cloud service seems cool. Overall, I don’t think it’s exaggerating to say that lines of would-be purchasers Monday morning (or lack of them) will tell you a lot about the odds that Microsoft will return to innovation relevance. I can’t imagine anyone giving up a recently purchased iPhone or Droid to get one — they’ll have to energize the fence-sitters. You don’t want to be slow to a market involving long-term contracts.

From Five Grand, Here: “Re: Harvard. Capitalizing on fear and anxiety, they’re going to the bank after promoting them. Even with a visit to the Harvard Faculty Club, am I the only one who thinks this is a rip-off?” The Harvard School of Public Health offers two-week program on HIT leadership for $4,995, not including hotel and dinners. Faculty includes Glaser, Halamka, and Middleton. Hospital people are so insecure and indecisive that I’m sure the mid-levelers with budget money show up (and probably add an intentionally vague note about their new Harvard “education” on their resume, which is part of what the $5K buys in their minds, I’d bet). The site says the attendee satisfaction is high. I’ll reserve judgment until someone who has been tells me their outcome, i.e. everything else aside, did their employer, who is likely quite different from Harvard, get their money’s worth in sending them? Sometimes expensive is worth it.

From Paisano: “Re: GE. I heard they’ve restructured the sales force. Any insights?” I don’t usually follow sales force restructurings, but anyone who wants to chime in can. I’m bored easily by endless territory realignments, new management bringing in recycled ideas already tried and failed elsewhere, and messing around with the sales function instead of fixing the real problem of underperforming products or executive management.

From Mark Wagner: “Re: HIStalk article EMR: One Size Does Not Fit All. Evan Steele made some accurate observations in his recent physician practice EMR post. There are many variables that influence the eventual success or failure of an EMR deployment at a practice. Practice specialty is absolutely one of them. Since HIMSS10, KLAS has been compiling a report that drills down on EMR vendor performance by specialty. As the need for more information by specialty was raised in this forum, it seems appropriate to also announce here that KLAS is releasing a first-of-its-kind ambulatory EMR specialty report on Tuesday. Beginning October 12, providers will be able to download a complimentary copy of the KLAS EMR specialty report and vendors can purchase a copy of the report. Mr. Steele correctly points out that KLAS only accepts evaluations from live users of a system. KLAS feels that live users are best equipped to report on current release quality, vendor responsiveness. and the level of customer support. Former users often share comments about failed experiences and KLAS reports that feedback when it is offered. KLAS welcomes research topic suggestions and questions about what we do and how we do it. Please contact us at info@KLASresearch.com.” Mark is the director of ambulatory research at KLAS.

From Mark: “Re: Meditech’s history. I love telling this story. Beverly Hospital was the beta when Meditech was introducing color terminals. Their controller and CIO went to visit Neil in the development building in Cambridge, which was actually two buildings, one old and one new, joined on a few floors. When you walked from the second floor of one to the second floor of the other, there was still a step because the floors weren’t the same height from the street. They went into the room where Neil was putting the final touches on the EPROM that was going to become the master for the new color terminals. All that was left to do was to pick out the colors that would be used for certain menus and pop-ups. Neil let the people from Beverly choose the color palette for hundreds of thousands of color terminal users.”

From John Smith: “Re: Ingenix. Layoffs in the payer and government group (the division that acquired AIM Healthcare). Rumor is about 100 people this past Wednesday.” Unverified.

HIE vendor Halfpenny Technologies gets $2.6 million in VC funding.

Thanks and welcome to North Highland, supporting HIStalk as a Gold Sponsor. The company, based in Atlanta but with 45 offices all over the US and elsewhere, does things differently. Instead of flying consultants out from a central location at the client’s expense, they have experienced consultants who work out of the same cities as their clients, or as they say, “Our consultants trade hotel rooms and security checkpoints for dinner at home and Little League practice.” Their results are real and measurable and their work is guaranteed. Thanks to North Highland for supporting HIStalk.

I was thinking about the impending Siemens layoffs, scheduled to start in early December. I know the Thanksgiving to New Year’s holiday season is long (15% of the year, basically), but companies could at least appear to be more humane by whacking their previously valued associates after January 1 instead of during the holidays. Cutting people loose right before Christmas means executives either don’t care or have let the situation become so desperate that the only answer they have for their own poor planning is to decisively overreact.

Carol from RelayHealth, who describes her specialty as “all-around-helping-providers-get-paid products”, offers a new white paper for readers interested in the point-of-service payment question asked earlier. You can download it here.

It seems that the IS department is going to be doing the Meaningful Use attestation work in most hospitals, although many clearly haven’t decided for sure. New poll to your right: how well will the Windows 7 phone compete against the iPhone and Droid?

If you’re an HIStalk sponsor and didn’t get your invitation from Inga for out little get-together in Orlando at HIMSS, e-mail her. We look forward to seeing you there.

Nuance and IBM are collaborating to develop Clinical Language Understanding, a healthcare-specific natural language tool to extract discrete data from clinician narrative.

Bon Secours Health System will use medical error tracking tools from Quantros.

BCBS of Nebraska chooses NaviNet’s provider communications portal for real-time eligibility checking and claims status and remittance.

I’ll leave you with one of the many amazing moments (this one from 1987) from St. Elsewhere, the best hospital drama ever. This is the memorable scene where Dr. Westphall expresses his opinion of the hospital administrator sent in by Ecumena, its new for-profit owner.

E-mail me.

News 10/8/10

From Rickie in the Shadowlands: “Re: Siemens layoffs. 475 jobs in Managed Services and Professional Services (including Soarian support) will be transitioned to India and Romania, with the first wave of layoffs 60 days from last Thursday. The VP emphasized that no job is safe.” Rickie included the internal e-mails from both the VP (I don’t know his name) and from CEO John Glaser (still feels funny to think of him as vendor CEO and not hospital CIO). John’s seemed sincere and personal. The VP used every contrived buzzword and trite phrase known to man, coming across as smug in leading off with the “clarity and applicability” of his memo, moving to “evolve our delivery model,” “drive value to our customers and position for mutual success,” and finally in artfully finding a soothing phrase to describe trucking off 500 American jobs overseas, “introducing additional geographic diversity.” It’s bad enough to lose your job without having to hear brain-numbing Management Muzak as the soundtrack.

From Hot Nurse: “Re: nurses. The IOM released a report Wednesday recommending that nurses take leadership roles in healthcare redesign as physician partners. Within hours, the AMA issued a rebuttal, saying that nurses don’t have the education and training that doctors have and they should not assume an equal role. The IOM had science in its hand in saying that nurse practitioners have outcomes equal to or better than MDs. Seriously, the best they can come up with is ‘nurses aren’t our equals?’ In fact, physicians don’t want this low-paid work and we can’t recruit enough primary doctors anyway. The physician image has gone from gods to captains of ships to pathetic in my career. They have not supported IOM’s patient safety initiatives (checklists, handwashing) or embraced IT. They don’t want to do primary care, but don’t want anyone else to, either, and they have no plan for the coming tsunami. Nurses excel at patient engagement, communications, and education, which MDs avoid since they can’t bill for it. Their last big proclamation was that they won’t read PHRs for patient histories because nobody will pay them to do it. The poor economy is bringing out the worst in them.”

From Capitulator: “Re: Meditech’s database. We have a data repository, but given the latency in populating it, would like to access Meditech’s database in real time. Can you enumerate the companies that provide tools to do this? I gather that Blue Elm is one of these but we were hoping for something less expensive.” I need some help from Meditech experts on this one. If you have some advice, click the Add Comment link at the bottom of this post and fire away. Thanks.

From Dr. Love: “Re: patient estimation tools or eligibility software used by hospitals. Would you consider this as a topic for the future? We are interested in products that we can use in our application with simple imports and exports.” I’ll have to punt on this question, too. Little help?

From Picka Penny: “Re: Iowa HIE announcement. The scope was changed by the state to 40 hospitals, meaning ACS’s winning bid is less than $3,000 per hospital per month. I don’t see how they can even buy hardware and pay the expenses of the employees who will have to work free.” Unverified.

From Beantown MD: “Re: your list of reasons that hospitals buying physician practices won’t work this time around, either. You are absolutely correct. It will not work for the reasons you describe, which were the same reasons for the failure in the 1990s. Since then I have not seen any real change in how doctors view this issue. And for the record, these reasons are about the same for why Disease Management works so poorly.” Thanks, Doc (he really is a doc – I just didn’t give his name).

Listening: new from Canadian grunge rockers Finger Eleven, a little softer than their older stuff, so I went back to The Bluest of Gray Skies. All of it’s good, though.

I’ll be mostly incommunicado next week as I take a slightly-deserved hiatus with Mrs. HIStalk in a tropical locale, so the fabulous Inga will be wo-manning the helm in my absence. I’m hoping for none of those “it was better without you” comments when I come back.

My pal Lyndsey from Nuesoft (she friended me on Facebook and Liked HIStalk, so that makes her my pal) sent over some pictures of their sales folk at AAP last week, dressed in vintage clothing representing client-server technology compared to today’s cloud computing. That’s one hideous leisure suit (I’m having disturbing Mr. Furley flashbacks) and a couple of cute Trekkie outfits. You have to be fearless to be in sales, evidently.

Adobe wins the Blue Button Developer Challenge, sponsored by Markle Foundation and the Robert Wood Johnson Foundation. The challenge was to create a Web-based tool that downloads information from the VA or Medicare to help patients manage and improve health. Adobe’s Blue Button Health Assistant extracts immunizations, allergies, meds, health history, labs, and military service histories.

Terry Ketchersid MD, VP and chief medical officer of Health IT Services Group, suggests the 2010 book above in response to the reader’s interest in a book about HIT and the future. I see chapters by familiar names Don Berwick, Don Detmer, Bill Stead, and Jon Perlin. Terry’s company sells the Acumen EHR for nephrologists (a very small group, apparently) and they produce an EHR blog for them, including Meaningful Use information. Terry also marvels that I have time to write HIStalk, which was exactly what I was thinking Tuesday evening when I came home from work, ate in approximately 120 seconds, and didn’t leave the chair for the next five hours until I was finished writing Tuesday’s post. Tonight was a breeze at just 4.5 hours.

Voalte gets a writeup in their local Sarasota paper for implementing its iPhone-powered voice, alarm, and text system at Wahiawa General Hospital (HI).

Inga mentioned the new Allscripts Homecare Mobile. Above are a screen shots I found on their site. It will run on Windows Phone 7-based smart phones.

The VA puts its previously mothballed pharmacy re-engineering IT project back on track after redesigning the project structure.

The Technology Association of Georgia and other groups are sponsoring an all-day HIT Leadership Summit on November 9 at the Fox Theatre in Atlanta. I had to dig and scroll to find pricing, but it looks like $39 for members and $59 otherwise.

IntraNexus will integrate PatientSecure biometric patient identification into its SAPPHIRE Patient Access Manager and Advanced Clinical Manager solutions. Registration or clinical staff will direct the patient to place their palm over a scanning sensor, which will retrieve their records if they’ve been seen previously. My first thoughts were addressed in the fourth paragraph: it can be used to identify John Doe patients and can validate the bearer of an insurance card.

Stockholm-based Elekta boasts of the #1 KLAS rating of its MOSAIQ Radiation Oncology/MOSAIQ Medical Oncology systems among oncology information systems. You may recall that the company acquired IMPAC Medical Systems in 2005, making it the world’s largest oncology software vendor.

Both Davies Award winners in the ambulatory category are e-MDs clients, the company says. I like this: The Diabetes Center of Ocean Springs, MS is the first non-physician provider to win the Davies — it’s a nurse practitioner clinic. I’m shocked that Inga offered no commentary about their attire, which I think is quite fetching and possibly deserving of an award in the clinical couture category.

Jobs on the HIStalk Sponsor Job Page: Management Consultant for Clinical Workflow, Project Manager, Regional Director of Centergy Sales. On Healthcare IT Jobs: Data Extraction Architect, IT Systems Analyst, Implementation Specialist, Product Manager.

I like this: Meditech quietly supports the Lesley University New Teacher Community. They got Neil Pappalardo, Larry Polimeno, and Howard Messing to talk about teachers who made a different in their lives and took the great pic above, which I’m appropriating with full credit to their site because I think it’s an excellent shot of some pretty amazing guys. Sounds like a man crush, I know, but you cannot believe the business accomplishments and social contributions made by the Meditech founders and executives over the years. Neil Pappalardo’s story would be a Hollywood hit, I’m convinced. I’ll willing to write it.

Among the Phoenix-area companies presenting at a December investor conference: ClearData Networks (healthcare cloud hosting) and WebPT (a Web-based EMR for physical therapy clinics). I figured I’d give them a shout out just to be nice.

A Microsoft executive proposes that PCs be blocked from connecting to the Internet if they don’t have a health certificate, drawing an analogy to vaccinations. A security expert, referring to Microsoft’s endless security updates, said, “There may be some who would say that Microsoft shouldn’t be on the internet until they get their own house in order.” I think Microsoft is right in identifying a need to protect the Internet a bit better, although the devil is in the details.

This might be a record: 24 laptops are stolen in a Troy, MI pain clinic break-in.

An MIT graduate student develops a health monitoring system that uses a webcam built into a mirror to determine heart rate. It measures variations in facial brightness, a technique that the student thinks will also work to determine respiration and blood oxygen levels.

A free Internet tool developed by a UK-based non-profit research group predicts the drug regimen response of AIDS and HIV patients with 80% accuracy, better than any other method.

Former national coordinator (back when the government wasn’t spending much on HIT) David Brailer is elected to the board of Walgreens. I will have to drop him a note to recognize my local store, where I stopped the other day to buy Halloween candy and found a delightfully garish and well-made Hawaiian shirt perfect for vacation for $6.99. That’s healthcare in America: the same store that sells prescriptions and medical supplies also carries heavily discounted Hawaiian shirts, cigarettes, and motorized Halloween skeletons.

E-mail me.

HERtalk by Inga

Robert Wood Johnson University Hospital (NJ) selects ProVation Medical MD software for gastroenterology procedure documentation at is ambulatory surgery center.

Medicity secures contractual commitments with five new health systems representing 12 hospitals.

RemCare, developer of a care coordination software product, raises an additional $1.9 million in equity and warrants, bringing its current round funding to $3.3 million. RemCare’s CEO is Ben Albert, a former VP of client services for PatientKeeper.

The Health Information Partnership for Tennessee selects Axolotl’s Elysium Exchange platform for its state HIE project.

RelayHealth introduces MedGift, which sounds like a cool departure from its typical RCM and HIE connectivity services. MedGift is a patient gift registry and social network that facilitates communication between patients and their friends and family members. In addition to providing communication tools, MedGift allows patients to register for personal needs, wants, and wishes based on their individual circumstances. MedGift was actually founded by a cancer survivor is a free service for patients and their families.

AT&T partners with eCario machine-to-machine wireless data and mobile connectivity for near real-time, remote monitoring of cardiac patients.

The Ohio State University Medical Center names Phyllis Teater CIO. She’s been serving as interim CIO since January.

Starting this weekend, downtown Kansas city will be packed with 6,000 Cerner health conference attendees. If you are one of them, send us a picture or a report from the front lines.

iMDsoft introduces MVdashboard, an ICU tool that displays clinical and administrative metrics graphically.

Emmi Solutions, a provider of Web-based patient communication tools, names David Pearah CTO and SVP of product management. He was previously VP of the e-prescribing business unit of Allscripts and the former director of product management at Nuance-Dictaphone.

Trey Lauderdale of Voalte sent me a note this week saying he’d be presenting at the DC to VC: Investing in Healthcare IT Summit. Even though US CTO Aneesh Chopra and HHS CTO Todd Park were featured speakers, I told him it probably wasn’t worth a mention — unless he could get a picture with one of those guys in the (in)famous Voalte pink pants. Todd Park obviously has a sense of humor.

Halfpenny Technologies secures $2.6 million in VC funding, which it will use to deliver its Lab Hub platform.

A compliance analyst at UW Medicine Compliance warns providers of these patient documentation shortcuts in EHRs that might raise concerns during an audit: (a) cloning (cutting and pasting) form previous encounters; (b) templates that include pre-filled “negative” terms for each organ system, and (c) macros. CMS is especially concerned when they suspect templates are doing the bulk of the documentation.

Ninety percent of CHIME CIOs participating in a recent survey believe their organization will qualify for Stage 1 stimulus funds by September 30, 2012. They expressed concerns, however, that staffing deficiencies could affect their chances at implementing an EHR and receiving stimulus funding. The release of the survey results coincides with CHIME’s annual Fall Forum. Now what will be really interesting is to revisit these same issues over the next couple of years.

Speaking of the CHIME meeting, Ed Marx tells me he won the CHIME Charity 5k. Ed also sent over this photo of David Blumenthal, who spoke in front of 600 attendees and stressed the need for the government and healthcare providers to address consumers’ privacy and security concerns.

When reality is crazier than TV: Actor Brando Eaton files a suit against a prop company, charging it failed to inform actors that a defibrillator on set was a “real working device.” A fellow actor on Miami Medical (a show I’ve never heard of, but that Mr. H says he’s seen filming at Warner Brothers in Burbank) applied the defibrillator to Eaton’s chest during a scene and it sent electrical charges through his body. Eaton was taken to the hospital and later needed treatment and counseling for “anxiety, flashbacks, and apprehension.”

Several employees at a Michigan hospital are reprimanded over a photo taken during a break and later posted on Facebook. One picture was of a nurse removing a splinter for another nurse while in an empty operating room. The pair were part of a group written up for “unprofessional” behavior. Unless I am missing something (like patients were left unattended or a patient’s photo was posted), I’m thinking we are getting a bit overly sensitive about policing social media.

E-mail Inga.

CIO Unplugged 10/13/10

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

Healthcare Passion Refueled

My passion for healthcare began in high school while working in environmental services at an outpatient facility (they called us “janitors” back in the 80s). From that point forward, different encounters have renewed that passion. The most dramatic experience was personal.

A Journey Home

Four years ago this month, my mom traded her earthly rags for a robe of righteousness. After a courageous four-year fight against the ravages of ovarian cancer, Ida Wilhelmine Marx bid us farewell. The entire experience had a profound impact on me not only as a son, but also in my profession.

My mom and I were tight. As I blindly plodded my way through adolescence, she represented mercy and grace. When I shoplifted, got arrested for joy riding (at 14 years old), set the house on fire, partied excessively, and flunked junior high, she was there. I’m convinced that if it weren’t for my father’s discipline balanced by my mother’s care, I would not enjoy the successes of today in my education, career, and family.

Radiance

Mom suffered much from illness her entire life. She took the cancer in stride: eight rounds of chemo, two rounds of radiation, and a couple of surgeries. Her sole desire before transitioning from this life to the next was to celebrate her 50th wedding anniversary. When we transferred her to hospice, it became apparent that she would be a few weeks shy of reaching her goal. With my parents’ permission, my brothers and sisters planned an early 50th anniversary party and vow renewal — the final celebration of Mom’s life. Knowing our world would change the following day, that night we put on a heck of a celebration.

Hollywood could not have written a better script. Hospice physicians agreed to give my mom life-sustaining nutrients and fluids through the big day (normally not allowed). They arranged for a “Sentimental Journey” pass: a limousine (ambulance) service for my mom and dad to the picturesque Cheyenne Mountain Resort in Colorado. Two paramedics waited in the background just in case their services were needed (they weren’t). They quipped how special my mom was because the only other person who ever received two paramedics as an escort was Dick Cheney when he came to town.

All seven of us children attended, plus all 15 grandchildren. My parents invited their closest friends. With the backdrop of the Rockies and all the majesty of a traditional wedding ceremony, I had the privilege of walking my father to the front. My oldest brother Mike had the honor of escorting my mom in her wheelchair to join my dad at the altar. She looked ravishing. My sisters had dressed her to the “nines.” Her dream was unfolding in real time.

Each of her children had a part in the ceremony, as did each grandchild. Assigned to deliver the sermon, I decided not to use notes, but instead prayed that God would intervene and deliver a message that would bless my parents and set vision for successive generations. The primary message: my parents had created a legacy of marriage that would impact not only the first generation (my siblings and me), but the grandchildren, and their grandchildren, and so forth. The fact that my parents stuck it out and endured a lifetime full of sickness and health is a testimony to the world: “Yes, it can be done.”

The ceremony ended with the exchanging of vows. A co-worker of mine had arranged for a Papal blessing of the 50th milestone as well, which touched my parents deeply. We printed the blessing in the renewal program. Unity candles, songs, prayers, and standing ovations lent to the evening’s incredibleness. But this was only the beginning.

One Heck of a Show

We then entered the adjoining room for a superb five-course meal. Taking advantage of the live music and dance floor, Dad rolled Mom out in her wheelchair to dance. My parents are fantastic dancers, and seeing my dad wheel my mom around was moving. Throughout dinner and beyond, we danced to our hearts’ desires. All four sons danced with my mom, who was clearly delighted. Even my son Brandon danced with her, to which she commented, “You’re not dancing. You’re just shaking your ass!”

Next came toasts, the garter ceremony, and all the similar accruements of a fine celebration. At that point, Mom addressed the room with loving words. Dad tried but fell apart. As a finale, guests and family formed a tunnel by joining hands. Dad wheeled Mom through as we hugged, kissed, cried, and spoke blessings.

Returning to her limousine, she was still beaming. My dad shared that as he laid Mom in her bed that evening, she said, “We sure gave them one hell of a show tonight, didn’t we?”

Timing

During her illness, I flew out often to visit her. I wanted to be at her side when she transitioned, just as she had been at my side so many times. I missed by eight hours, but that was OK. Over the years, I’d left no doubt in my mother’s heart of my care, admiration, appreciation, and love for her. Arriving shortly after her passing, I supported my brokenhearted father and assisted siblings with the funeral arrangements.

Kiss

My mom had taken her last breath shortly after midnight. Two of my siblings and my father were at her bedside and described that, while painless, her body struggled for every last breath. As a result, her mouth was stuck wide open. The hospice nurse explained that, given the timing, the mortician would be the only one able to close Mom’s mouth. My sister-in-law, an ICU nurse manager, validated this.

Meanwhile, my dad knelt at Mom’s bedside and held her frail body, the first time in months where he could hold her without causing her pain. He kissed her lips. Wept over her. Sometime in the next two hours, while they awaited the mortician’s arrival, Mom’s mouth closed…and she smiled. Comfort permeated the room and reinforced our belief that she had indeed transitioned to a happier place.

Passion Fueled

My mom’s battle allowed me to spend considerable time in various care settings. I observed the processes, evaluated technology, and pondered how things could be improved to benefit caregiver, family, and patient. The clinicians treating my mom lacked the communications and clinical decision support needed to deliver the highest quality of care. I was shocked by the lack of access to critical and timely clinical data. The wasteful amount of paper utilized and manual processing disappointed me.

I ended up creating medication reconciliation lists and pulling together charts. I swore it would never be this way in my work environment. As I took mental notes from the perspective of patient and family, my passion to leverage technology and transform the clinician and patient experience was renewed.

It’s this passion that drives me in my daily work. This is why I’m tenacious in advocating technology, why I continually innovate and collaborate with clinicians, and why I blog. This is why I advocate for stronger IT leadership. It’s the heartbeat behind why I spend more time with my people on leadership, customer service, process, and passion than I do on virtualization or cloud computing.

Until my people have a heart for patients and are in a position to empathize with their plight, the technology platforms, while critical, will be limited. The full potential of technology in the delivery of high quality healthcare comes with a transformed heart.

Thanks, Mom, for refueling my passion as a leader of healthcare technology.

What fuels your passion? What stokes your fire? Leave a comment below.

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

Readers Write 10/6/10

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

EMR: One Size Does Not Fit All
By Evan Steele

A recent comment on HIStalk, by a hospital CIO about what he identified as the best EMRs for enterprise systems and their physicians, highlights a problematic and all-too-prevalent misconception. The fact is, it is impossible to satisfy both hospitals and community ambulatory physicians with the same EMR product.  Furthermore, even the ambulatory market cannot be looked at as a whole. EMRs designed for primary-care physicians respond to a set of needs that are very different from those of specialists.

Enterprise EMRs simply do not work in high-volume ambulatory practices. This is particularly true for specialists’ practices. Many hospitals have had some success with Epic and other hospital-focused EMRs, but success has been limited when these same hospitals ask physicians — again, particularly the specialists — to implement these systems in their practices. A monolithic enterprise product cannot possibly support equally well such different workflows, patient care scenarios, and providers’ needs.

Within the ambulatory market itself, it is time to bifurcate the EMR discussion into two groups: EMRs for primary care physicians and those for specialists.

Industry analysts typically lump all EMRs into one category, which does not adequately differentiate the market segments or their distinct needs. The major EMR vendors have massive footprints in the marketplace, yet a small company like SRSsoft has the lion’s share of referenceable high-volume, prominent specialty practices in areas like orthopaedics and ophthalmology. Why? Because one size does not fit all, and it is impossible to satisfy the needs of both groups without compromising the needs of one.

The American Academy of Orthopaedic Surgeons (AAOS) acknowledged this issue in its recently released EMR Position Statement, pointing out that “Many systems are geared toward primary care medical practice, which can limit the utility of EHRs for specialty surgical practice.” It correctly suggests that “the different needs and uses of EHR by disparate medical specialties should be recognized.”

Specialists represent approximately 50% of the physician market, a sizeable segment that is largely being ignored. How are specialists to determine which EMRs are designed for their needs?

KLAS, the closest our industry has to a JD Powers–type of rating source, does not break out its ratings by specialty. This means that if an EMR vendor does well in the ambulatory primary care market and has high KLAS ratings, an unsuspecting specialty practice might purchase their product based on those ratings, only to find out that the product does not fit their unique needs. 

Exacerbating the situation is the fact that KLAS only surveys practices that have actually installed the EMRs. It does not survey practices with failed implementations. Since specialists represent a disproportionate number of the failures, the information is even further biased.

The result is that there are thousands of specialists who purchase EMRs from highly rated and/or household name vendors, but who end up with failed implementations and significant financial loss.

One size does not fit all. There are good EMR solutions available for every type of physician. It is incumbent upon the individual physician to research and identify the product that best suits his/her practice’s needs.

Evan Steele is CEO of SRSsoft of Montvale, NJ.

ClickFreeMD Comment Response
By Bob Gordon

Note: Mr. H here. I’m breaking my “no commercial pitch” rule this one time because Inga had questioned the business model of ClickFreeMD, which offers practice systems including billing for a flat monthly fee rather than the traditional model of a percentage of collections. Inga’s point was that the percentage model encourages the billing company to collect. CEO Bob Gordon was nice enough to e-mail Inga an explanation and we thought his response might interest some readers even though it is hardly unbiased. I’m not endorsing their product and I have no connection to ClickFreeMD.

ClickFreeMD leapfrogs the percentage-based provider business model. Consider the following:

• No start-up, implementation or training charges.
• The flat fee is lower on an equivalent percentage basis than most practices would pay for outsource medical billing alone and far less than in-source options.
• If the practice improves its revenue or we boost it (which we often can do), the equivalent percentage drops through the floor.
• The breadth, quality, and integrated end-to-end nature of our software, services, and support are unrivaled. Physicians are paying twice as much elsewhere for much less elegant solutions today.
• The flat fee sticks. If encounter or charge values increase, the flat fee stays the same and the practice captures cost free revenue. If it drops outside ordinary seasonality range, the rate is adjusted down pro-rata so our physicians’ earning power is fully protected.
• Importantly, the flat fee is backed by a performance guarantee that makes sure we work every claim or we rebate half of the flat fee. There is no equivalent protection in a percentage-based model. In fact, any claim that takes more than 15 minutes to resolve in a percentage system is probably costing them more than they are making, and hence billing company profitability is at some point in the collection continuum inversely correlated to increasing practice collections.
• Our contracts all have 90-day outs and low price match guarantees for comparable services.

You may ask how we do this. We have deep domain expertise from running billing companies, back offices, and technology companies for decades and have organized a Southwest Air-like discount fee, high-result business model that is very scalable. We expect that ongoing volume will feed a virtuous cycle for all, continuing to allow us to offer more for less while achieving top results.

One of the most striking things we are doing is the least recognized — giving the practice their flat-fee price, online and instantly, as well as their included services, without asking them to give us any information. Try this anywhere else like Athena and what we do in 30 seconds becomes a multi-day process that involves e-mail / telephone / online discussions and/or meetings and requires the practice undressing for the vendor. We are completely ONE-WAY transparent. That’s because we want the practice to decide if they want to contact us — after they are satisfied that this is a superior value for them and only then. We aren’t interested in lead nurturing them to death. 

This is about "more dollars for doctors" and great news in the group practice fight to sustain their independence. We are doing our part to create a reversal of fortune in the group practice community with a unique business model that raises revenues faster than costs, delivers immediate and ongoing savings, and provides the tools and support that allow them to be ready for tomorrow.  

Like the boiled frogs of lore, physicians have been nickel and dimed by payers, billing companies, and others, overpaying to under-produce for so long, they find themselves working much, much harder for less and less. We’re changing that and we’re passionate about it! Thank you for your consideration.

Bob Gordon is CEO of Click4Free of Chevy Chase, MD.

It’s Official: The Rush for Talent Has Begun
By Tiffany Crenshaw

In recent weeks, a number of existing and prospective clients have called me for a pulse on the healthcare IT recruitment marketplace and thoughts on how to attract quality resources. After a number of such calls, I decided to put my thoughts in writing and share.

Let’s start with the good news. Industry hiring is definitely picking up and employed candidates are now less afraid to make a career change then they were three to six months ago.

As for hot products, it’s no secret that Epic is hot, hot, hot. Hospitals are purchasing Epic left and right. Honestly, there are simply not enough Epic resources, especially Epic-certified resources, to go around, so the talent war is raging. Cerner recruitment remains modest but steady, while McKesson needs are starting to rebound after quite a lull.

In the ambulatory market, we are seeing more and more requests for eClinicalWorks and Allscripts. New names like Sage and Greenway are coming to light. And occasional needs for Meditech, Siemens, IDX/GE and Eclipsys are surfacing.

On the integration side, Cloverleaf and e-Gate skills are still in demand, but we are seeing more requests for Web-based and lesser known products like Ensemble, Symphony, and Rhapsody.

The hiring demand is highest by far for hands-on resources to design, build, and install EMR applications. However, there is a fair amount of activity for sales, project management, and training professionals, including go-live support.

CPOE, clin doc, pharmacy, oncology, and HIM are generating the most recruitment activity within the applications. Based on new client requests, we foresee growing needs for business intelligence, security, and report-writing resources.

In addition to employers’ desire for one or more of the skill sets mentioned above, most are adding clinical designation to the requirements. Over 50% of our job requisitions right now require clinicians. Pharmacists, nurses, and physicians with healthcare IT experience are in great demand.

However, post-recession hiring is creating challenges previously unheard of in my 12-year history recruiting in this industry. The process is now wrought with excruciatingly slow interview scheduling, shrinking employee benefits packages, little to no relocation assistance, and financially conservative offers resulting in more and more frustrated candidates.

Things have changed drastically since the lowest points of the recession. After the release of Meaningful Use requirements, recruiting mania has taken off. Everyone seems to have hiring needs. Candidates are getting called left and right by internal and external recruiters. Just check out a few of the job boards if you don’t believe me — you’ll see countless job postings. Furthermore, check out all of the recruiting firms with no previous healthcare IT experience trying to break into this market as experts claim abundant need for resources.

If your organization is currently or will be in the market soon for these in-demand resources, you may want to evaluate your hiring process, recognize that your competition is fierce, and take note of a few trends our candidates and clients have shared with us quite candidly over recent months.

• New car syndrome. Candidates are migrating to new implementations. Who can blame them? It’s more exciting to be on the ground level and see a project through from A to Z.
• Red carpet treatment. Employers who roll out the red carpet win. When weighing decisions between job offers, candidates almost always choose the employer who provided quickest response time and showed sincere interest in them. (Both response time and sincerity are simple and no-cost ways to roll out that red carpet.)
• Relocation blues. Relocation is a HUGE issue right now. Even if candidates want to move, they can’t do so because of the housing market. Kudos to all of the organizations willing to work around this by providing remote work, commuting, or coverage of interim living expenses.
• Communicate. Many, many candidates are feeling jerked around by potential employers because of lack of communication in the interview process. Here’s what they are thinking: “If I don’t feel valued as a candidate, how are they going to treat me as an employee?” On the flip side, these candidates are communicating with plenty of their peers. Too many hospitals and consulting firms are getting bad reputations as being lousy places to interview and to work.
• Too much is not always a good thing. In the quest for resources, too many organizations are panicking and calling in all of the troops — internal recruiters, employee recruiting bonuses, dozens of external recruiters and advertisements. Candidates get called multiple times by different sources all looking to fill the same positions. Not only do they end up confused, but all the activity makes candidates suspicious. They wonder what’s wrong with an organization that has such a hard time attracting and retaining talent?
• Get on board. We are hearing more and more horror stories about candidates showing up on the first day only to find their new employer is not ready for them. This gets them off to a bad start from the get-go. Employees stay longer and perform better when they feel welcomed and the transition process is smooth. The period of time between offer acceptance and start date can also be a black hole, when candidates are most vulnerable. Employers are losing candidates this far into the game because they aren’t communicating with them. If you don’t have a formal on-boarding program, now is probably a good time to look into it.
• Disconnect between human resources and hiring managers. As an outside firm, we work with both HR representatives and hiring managers. We hear complaints on both sides about the other on a regular basis — namely due to lack of response. The hiring managers want candidates fast. And HR wants answers fast. Throw candidates in the mix who get frustrated as well and it’s a nasty situation. However, we find that employers who really engage the final decision-maker in the process from beginning to end and set response expectations up front have the least amount of frustrations and the most successful outcomes.

In summary, you can safely say that the industry is quickly changing to a candidate-driven market and that the market is impacted heavily by post-recession recovery and Meaningful Use. It is official. The rush for talent really has begun.

Tiffany Crenshaw is president and CEO of Intellect Resources of Greensboro, NC.

The Coming Speed Bump in the EMR Market
By Jon Shoemaker

It’s no secret that there is currently a mad rush occurring, not unlike The Oklahoma Land Rush of the 1800s, where hundreds of companies both new and old are getting into the business of healthcare information technology. Some come with industry expertise. Others come to take advantage of the financial opportunity. Consider Best Buy, the consumer electronics giant, that will install your EMR using their Geek Squad. So much for needing clinical expertise!

I believe this climate of frenetic activity will cause the EMR market to encounter a large, steep speed bump in the next 10 years. It won’t be from all of the EMR installations or supporting all of these systems, as this will create thousands of jobs and supporting infrastructure that currently does not exist. The bump in the road will come when all of these new digital silos must talk to each other as required in Phase II of Meaningful Use (MU). It is the very selling point of these systems — simple communication and usability — which become the Achilles heel of these EMRs.

EMR’s to date are not installed with a common code structure for identifying exams, studies, or services, all of which will need to be exchanged outside of the office in Phase II of MU. The reason for this lack of standardization has nothing to do with EMR functionality or capability — it is that everyone is still thinking locally not globally.

To ensure true interoperability and exchange of patient health information, EMRs must be installed to satisfy the local requirements, but also with the forethought that they will integrate to larger systems. This requires standards and standardization. The absence of a standard will require the use of translation services so that HIE repositories use the same codes for exams performed across the region.

Translation services, while a viable alternative to standardization, require one-off knowledge for the database structure and logic for each customized local EMR as well as that of the destination repository. This level of granularity creates layers of complexity for maintenance and mapping. Any changes to local system will mandate updates to the translation engine. The support nightmare of constant mapping modifications to assure the proper codes are sent outbound or received inbound will be effectively unsustainable.

Once all of the paper silos are replaced by digital silos, there will be enlightenment of EMRs that were installed incorrectly, don’t address the clinical workflows of the office, and don’t communicate outside of the office with a standard communication protocol using standard coding methods. This will lead to a second phase of the EMR revolution will include translation services and reinstallation of EMRs to address workflow and data gaps. This will have to be resolved before integration to a larger HIE repository can take place.

If we begin now with standardization of workflow and codes and ensure they are addressed with current EMR installations, we will be in a better place in five years and users will see the true benefits of these systems. With our current strategy of “every man for himself,” we risk losing users’ confidence once these systems are installed and address workflow and physician concerns. Once we lose the users’ confidence, they will stop using the system and re-adoption efforts will prove Herculean.

As you begin planning your EMR implementation, there are hundreds of questions to ask. When it comes to meeting the long-term requirements of MU as well as realization of the true benefits of an EMR, here are a few to begin with:

1. Have we reviewed and documented our office workflow?
2. Are we using the new SNOMED codes?
3. Are we following standardized codes for services rendered?
4. Does the installation team understand clinical workflow or do they look glassy-eyed when we discuss medical terms?
5. Is our vendor of choice an IT company trying to cash in on the HIT initiative without clinical experience and knowledge which could place our business at risk?
6. How will this EMR connect us in the future to larger integrated systems?

Jon Shoemaker is senior consultant with Ascendian Healthcare Consulting of Sacramento, CA.

News 10/6/10

From StateHIECoordinator: “Re: Iowa. The state has issued a Notice of Intent to Award to ACS for the Iowa Statewide Health Information Exchange.” SHIEC sent over the award letter that went out to the eight bidders. It includes technical scoring and prices, but I’m not sure if I should run that since it may not be public information. The selection went down to frontrunners ACS and Medicity in the “best and final offer” round, with ACS winning on price.

From Maladroit: “Re: book. You mentioned a book on healthcare IT and the future sometime in the last ear. I don’t remember much about it except it seemed like a great book to help me understand a CIO’s perspective as he/she thinks about maturing their tech org. Do you remember the book?” Hmm. I’ve mentioned a few books, but I don’t remember this one particular. It might have been Ed Marx, too, since he’s well read. Readers, if you know the book or have others to recommend on that topic, let me know and I’ll run a list.

From Wax On: “Re: medical transcription acquisitions. The big buzz among the MT community at the recent AHIMA convention in Orlando was about Nuance acquiring both OSi and Encompass Medical Transcription. And in another deal, Keystrokes acquired Chartnet.” I’m appreciating the irony that the hottest technologies in healthcare IT appear to involve transcription. Voice and paper are hard to kill for good reason.

From Ex-Employee: “Re: CareTech Web Division. All sales staff let go last week. Management plans to eliminate the Web division and focus solely on outsourcing.” Inga contacted the company for a response:

On the heels of significant growth in its Web products and services segment, CareTech made the decision to adjust its go-to market approach for the Web business with an emphasis on balancing its growth with providing the best delivery service. The decision involved a shift in resources, including a reduction in the area of Sales, and an increase in technical resources for the Web Development and Account Management areas. The company remains committed to its Web products and services business, and is especially looking forward to the opportunity to see current customers and meet new ones at the 14th Annual Healthcare Internet Conference where CareTech will have an exhibit and speaking engagement.

From Long Time Reader, First Time Writer: “Re: MU. Several CIOs I work with are gnashing their teeth because their vendors are telling them they’ll only apply to have their latest software version certified. Clients on the now-current version will have to pay the vendor for an upgrade and service fee to get on a ‘certified EHR’. Some have said they are being quoted months to get the upgrade because customers that signed lucrative contracts with the vendor’s service arm are moving to the head of the line. Love the blog BTW.” I guess I’m seeing it through the vendor’s eyes – ONC made them jump through hoops to get their products certified and to get them implemented by a firm date, so somebody has to pay and not every customer can be the first to go live. I’d blame the government for trying to tie something as complex as EHR adoption to something as desperately made up on the fly as economic stimulus. But if you have a particularly egregious vendor example, tell me since I’m sure some are milking it hard.

Ingham Regional Medical Center (MI) helped start and fund the Capital Area RHIO, but won’t participate in it. The hospital and its parent company will instead join Michigan Health Connect, explaining that, “A lot of the larger systems decided to go that route so they wouldn’t have to participate in different RHIOs and repeat the investment over and over again.”

Inga trumped Weird News Andy on this article, although she kept it at arms’ length when she sent it my way, saying it’s “a bit icky for my taste.” It’s a little raw for me too, but if you’re fascinated to know the “Strangest Foreign Bodies Removed From Patients”, many of which seem to involve unusual sexual practices, feel free to check it out. I did, but I think I regret it now.

ONCHIT puts up a Certified Health IT Product List page. It doesn’t include the CCHIT-certified products yet.

The Government of Queensland will implement (warning: PDF) the MetaVision Clinical Information System from iMDsoft in the ICUs of 14 hospitals.

Blessing Health System (IL) will implement Patient Condition Tracker from Rothman Healthcare Corporation within Allscripts Sunrise Clinical Manager. Their nursing school will also participate in research studies involving the system, which turns 26 measurements and observations from the EMR into a single number called The Rothman Index that allows early detection of patients going bad. I’ll have an interview with the co-founder up shortly.

Jack Kowitt, SVP/CIO of Parkland Health & Hospital System, e-mailed to say he was happy that I was puzzled by an ARRA comment attributed to him by the Dallas business paper since he was misquoted. The article said the hospital “won’t seek federal stimulus funds because its electronic records upgrades started before the stimulus bill was passed,” which I thought was odd since HITECH payments aren’t linked to spending. I indicated probable reporter error, which was the case according to Jack: “The question was whether we were using any stimulus funds to implement the EMR. The response was, since we have already implemented, we would not. It wasn’t about MU money, which we are aggressively pursuing.”

It appears that CCHIT’s initial press release that listed certified products was incorrect. ChartAccess from Prognosis Health Information Systems was listed under EHR Modules in the hospital domain, but the current product list shows it as a certified complete EHR in the hospital domain, the only one other than EpicCare.

I got an e-mail blast from a seemingly desperate free HIT magazine today, urging me to post five comments to their online articles to be eligible for a giveaway (so much for highfalutin’ journalistic integrity – what’s The New York Times paying for sending in letters to the editor these days?) Since it mentioned their expert bloggers, I thought I’d check out the competition for the first time. All the blog entries I saw except one seemed to come from other sites – they’re just reprinting them on their own site like they were written for the dead tree people. Maybe I’m an amateur purist, but both the comment bribe and the reposted blogs strike me the wrong way.

Inga contacted the folks at Infogard to get pricing information for their ONC-ATCB certification services. Drummond and CCHIT are pretty transparent about what they charge and were very nice to give Inga the information so she could put a comparison together for readers. Infogard sent her a curt reply: “Unfortunately, we will not be able to provide our price list.” We’ll make sure to help keep their secrets when their press releases come out by not mentioning them.

A Forbes blog riffs on a New York Times article about EMR vendor ClearPractice, which I didn’t realize was run by big-time VC guy John Doerr (Google, Amazon) and his brother. They also oversee a Medicare Advantage insurance plan. The Forbes writer isn’t impressed with ClearPractice or its iPad version called Nimble, although he’s focusing on the business success and not the innovation or potential:

While electronic medical records are a promising tool, the piece lacks context. For a company like Dr. Doerr’s to have been around for a decade and only have 500 doctors using the software basically means it’s failed. Check out this list of EMR vendors by market share based on physician usage. In a rapidly consolidating market there are at least 10 and probably 50 different vendors with more than 500 licenses. The idea that the Apple iPad will somehow, with an assist from stimulus funds, revive the fortunes on an individual EMR company is optimistic to say the least … The other thing that struck me is that the piece made no mention of the history of hubris when Silicon Valley tries to cure health care’s ills. Remember when Netscape founder Jim Clark devised Healtheon on a piece of paper? Or AOL founder Steve Case’s mostly expired Revolution Health?

Meditech got specific about its expansion plans Monday, announcing its intent to purchase 135 acres in a Freetown, MA business park and to build a 180,000 square foot office building for 800 new employees. A local politician estimates the company’s investment there at up to $100 million.

The University of Louisville School of Nursing gets a $792K HHS grant to develop nursing informatics education. They’ll buy simulation lab equipment that includes a patient simulator, iPads, and EHR simulators.

Interesting: a company uses Salesforce.com to deliver and analyze patient EEGs, looking for similarities in a database of known EEG irregularities to suggest psychotropic medications to doctors treating mental illness.

MedAssets is holding its Business & Technology Forum this week in Orlando.

Weird News Andy’s contribution this time around: “1/3 off healthcare ‘reform’ … I wish.” A report (warning: PDF) finds that HHS has already missed a third of the deadlines mandated by the Patient Protection and Affordable Care Act, with another 29 coming due in the next three months.

And speaking of government efficiency, health insurance premiums for 8 million federal workers will go up 7.2% in 2011, which the government spins by saying that’s less than increases in the private sector because of savvy negotiating.

A company brings social networking to crutches, allowing Facebook friends of the injured to create custom “skins” for their crutches. The company will offer advertising materials in the ED and expects to co-brand with healthcare systems.

The Institute for Healthcare Improvement releases a white paper to help hospitals manage serious clinical adverse events.

An interesting analysis: hospitals are buying up primary care practices to prepare themselves to become Accountable Care Organizations, which could be the end of the line for small, independent practices. Hospitals are looking at increasing PCP salaries like a Wall Street analyst looks at price-to-earnings ratios, knowing that internists and family practitioners generate hospital revenues at nine times their average salaries, while expensive specialists generate a multiple of only five times their salary. For industry noobs, it’s time for hospitals to get taken to those 1990s cleaners all over again, because:

1. Docs sell out precisely because they don’t want to work  as hard for their new hospital employer as they did for themselves (duh).
2. Hospitals are notoriously bureaucratic and inefficient managers, making them particularly unsuited for running a low-overhead medical practice in every way from EMRs to personnel policies to regulatory compliance.
3. Private practice docs hate and distrust everything about hospitals except the money they have and don’t usually change their opinions or behaviors just because they sell them their practices.
4. Doctors resent taking orders and being told how to practice medicine, especially from suit-wearing hospital MBA-types who fancy themselves business experts despite always having worked for a paycheck instead of themselves, making it likely all these deals will fall apart in 4-5 years like they did last time around, with the docs scrambling to start up new practices without the benefit of a location, an EMR, or patients that they sold away to the local hospital in a frenzy of co-opetition.
5. Patients aren’t much more enthused about hospitals than doctors are, so they aren’t exactly thrilled to see the big sign go up over their friendly little doctor’s office knowing it’s the same folks with ED waits, bad cafeteria food, and terrible parking.

E-mail me.

HERtalk by Inga

From RDU Dude: “Word on the street is that Vern Davenport has left Allscripts.” Portly Gentleman sent us a note on October 1 suggesting Allscripts would soon announce some executive changes. He named names (Vern’s being one of two), but we didn’t run them since it didn’t seem right until it actually happened. The company confirms that the former Misys president and Allscripts exec has indeed moved on.

Over 50 practices in Tenet Healthcare markets select MED3OOO’s InteGreat PM and EHR as part of a Tenet/MED3OOO community-based EHR partnership.

Hearst Corporation appoints Gregory H. Dorn MD, MPH president of drug database provider First DataBank. He most recently served as EVP at another Hearst company, Zynx Health, and replaces Donald M. Nielsen, MD, who becomes chairman of the First DataBank Advisory Board.

Omnicell acquires Pandora Data Systems, a provider of analytical software for medication management. The Pandora solution is used by several HIT companies, including CareFusion, McKesson, Cerner, and will continue to be operate as a stand-alone product. Omnicell’s comparable product is about twice as expensive, so there goes your cheaper alternative, most likely.

Epic wins a five-year,  $14 million EHR contract from the US Coast Guard, replacing a version of the Department of Defense system. That could be a notable Epic foothold in government down the road.

Penn State Hershey claims its use of CareAware technology has contributed to a 90% decrease in manual charting during surgical procedures. Providers now average one minute of charting during surgery, compared to 10 minutes before the CareAware implementation.

I love and appreciate all our sponsors, but this is funny. I received a note from one today (someone in accounting who has probably never heard of HIStalk) asking us to re-issue an invoice. The reason: they had asked to pay their sponsorship over several invoices, so dividing the total led to a per-invoice amount of xxx.1666 (infinite decimal). We invoiced xxx.17. They’re asking to correct the remaining invoices to xxx.16 so that the yearly total hits the amount exactly instead of being four cents over. Who else wonders how that accounting department handles client issues?

The Institute for Health Technology Transformation publishes a new report that examines the current EHR landscape. I can’t say I gleaned much new information, but was struck by the authors’ comment that the EHR “landscape” is still in its “infancy.” Given that I was selling EHRs (or EMRs as we called them in the old days) years ago, I’m thinking there must be some inverse relationship between EHR-years and dog-years.

North Kansas City Hospital deploys Cerner’s P2Sentinel auditing solution to address the hospital’s Meaningful Use Stage 1 access requirement.

Miami Children’s Hospital will spend $67 million to implement Cerner Millennium. The hospital will also extend a 50% discount to community physicians who wish to implement PowerWorks EHR in their offices. The hospital expects the government to provide $7-$8 million in stimulus funds once Millennium is fully operational.

Here is some not-so-pleasant news: at the current rate, 2010 could be one of the worst years ever recorded for mass hospital layoffs. Blame the increased demand for charity cases, the decline in reimbursements, and a reduction in elective procedures. As of August, 8,233 employees lost jobs in 102 separate layoffs, according to the Bureau of Labor Statistics. At the current rate, 12,349 jobs would be cut by December 31st, compared to 11,757 last year.

Six Texas pharmacies file a lawsuit alleging CVS Caremark of violating patient privacy laws and unfairly competing with its rivals. The complaint highlights Caremark’s plans to establish a data warehouse that includes the names, demographics, and drug histories of patients, plus Caremark’s Rx Review program that is designed to use patient data for direct marketing to patients and physicians.

Sponsor Updates:

• Allscripts introduces Mobile Homecare, a smart phone application for physical therapists, nurse assistants, and other clinicians caring for patients in their homes.
• API Healthcare signs up Halton Healthcare Services as its first Canadian client.
• Quest Diagnostic partners with HP to offer a preconfigured solution that includes Quest’s Care360 EHR and HP hardware, services, and financing.
• Wahiawa General becomes the first facility in Hawaii to implement Voalte’s iPhone solution.
• Detroit Medical Center selects the iDoc document imaging system from CareTech Solutions for its eight facilities.
• The Nashville Chamber of Commerce names Informatics Corporation of America to its Future 50 Award list for the third consecutive year. The award is presented to the 50 fastest growing companies in Tennessee.
• Catholic Health Initiatives expands its partnership with Allscripts to include Allscripts EHR and PM for all of its 1,200 employed physicians and 7,000 affiliated physicians. CHI is also adding Sunrise EPSi Performance Management solution for its 73 hospitals and will develop its own HIE with the Allscripts Community Exchange solution.
• PatientKeeper deploys its new physician documentation product, PatientKeeper NoteWriter, to Mercy Medical Center (IA) and Alegent Health (NE).

E-mail Inga.

HIStalk Interviews Paul Hensler, CEO, Kern Medical Center

Paul Hensler, FACHE is CEO of Kern Medical Center of Bakersfield, CA.

Tell me about Kern Medical Center.

KMC is a 222-bed academic medical center. We have eight residency programs with the UCLA School of Medicine. We’re the only trauma center between Los Angeles and Fresno. It’s a county-owned facility.

You’re going to be going live soon on Medsphere OpenVista. You’re still on for November, right?

No, we’ve delayed it. We had a rather serious virus.

I heard about that.

It took our IT staff off of everything but getting the virus fixed for about three weeks. As we looked at moving back, we started getting into the holidays and so on, and really felt we needed five weeks of uninterrupted training. We decided to go live February 8th.

What would you say are the good and the bad things about the project?

I’ve been very happy with both sides. Plus, our employees have really stepped up and have done a great job with the builds and have not taken the shortcuts. For just what they were offered, the staff’s just put a tremendous amount of good work into it.

The Medsphere staff has been great to worth with. We started this off with the idea of it being a partnership, and I think it really has been.

How large is your IT staff and what capabilities do you have in-house?

The reason I’m hesitating is we’re moving to a model of the county IT staff taking care of the infrastructure that would move all of our servers downtown. Then we have a small staff left out here to deal with applications. I think out here we have about eight FTEs, but then we’re also supported by people who work at the downtown location. I think probably another six or so are totally devoted to us, as well as some other county IT staff that helps out on specialty things.

It’s difficult for a small- to medium-sized hospital to be looking at a $40 million expenditure for an EMR system. Do you feel that you had to give up something to go with OpenVista or do you have any regrets?

Not yet. We started integrated testing this morning. As of midday, it’s going very well. It looks like it’s a system that will work for us.

I was familiar with VistA from the VA. I wasn’t at the VA, but a lot of our physicians in San Diego worked at both our place and the VA. Physicians generally like the system. I think some of the things we’re giving up on bells and whistles are things that are distractions anyway. So far I really haven’t had any regrets.

The VA model’s a little different since they have somewhat of a captive audience of physicians and nurses who don’t really get to choose whether to use it. How do you plan to get, specifically, physicians to interact with the system?

Our physicians are employed.

All of your physicians are employed?

Yes. We won’t really run into a lot of the issues of Meaningful Use that community hospitals will. Basically, the physicians have really embraced it. They’ve done a lot of the work on the builds. I think they’re excited to see it come.

Are you replacing anything with OpenVista or is this all new?

The CPOE and the electronic medical record are all new.

Up until you go live, you’re purely paper?

Right.

You mentioned Meaningful Use. When you look at what dollars are on the table and your timelines, how are you feeling about the Meaningful Use possibilities?

Even with the delay it looks good. As you probably know, you really have to be up to speed on July 1 to get 90 days in before October 1. We’ll be live in early February, so that will give us several months of experience to see if we’re falling down in any areas before we do that last 90 days. I think that should go very well.

Would you have done it without the possibility of HITECH payment or was that the deciding factor?

I think that really pushed it a lot. It turns out, in looking at cost savings by having an electronic medical record, that will pay for itself even without the stimulus funds. But the stimulus funds really, I think, are what moved it to the front burner and it’s kept us on a tight timeframe.

You mentioned the cost savings. What kind of outcomes do you hope to achieve when you are fully electronic?

We’ll save about a million dollars a year in forms and paper and the storage of the forms and paper. Probably another million a year when it’s fully implemented on costs to the medical records department. That’s really just a little low-hanging fruit. We’re expecting a lot of operational savings, but they’re just a whole lot more hard to quantify.

On your team that’s implementing, I assume you have representation from physicians and nurses that are involved?

Oh yes, and everybody who will touch it is represented in the steering committee.

Did you do a lot of work with standardizing order sets or evidence-based medicine when you were building the system?

That’s really a lot of the work that’s going on. Our clinical people got much more involved in that than we originally thought we would, and they’ve done a lot of good work.

Are these physicians that are practicing physicians? Do you have a physician in charge of the project or is it just a collaboration?

There’s a physician in charge of the project. She’s one of our thoracic surgeons who’s also practicing. All of the physicians who are involved in the project are all practicing.

Do you have any that are naysayers? Are you hearing from those yet or are they just taking a wait and see attitude?

Really no one is naysaying the project. There’s little things here, little things there that they don’t like and there’s some compromises we need to make with some of the other systems that will have to interface to it that we’ll probably eventually replace. But no serious “let’s just pull the plug and forget about it” type of naysayers.

How do mobile devices fit into your strategy?

Actually, the whole input device is one of the things I was most concerned about because we don’t have experience with it and everybody has different ideas of what they should use.

The mobile devices just seem their screens are just too small. We had a device fair here and had all the various vendors bring in various devices from hand-helds to iPad-like devices, to regular PC screens and laptops and so on. I think most of the users pretty quickly realized they needed a much larger screen than an iPhone or something would accommodate. We ended up selecting laptops in some areas and PCs on carts for other areas.

Will you have remote access?

Yes, it will be Internet available.

When you look around the community, what’s the status of EMR adoption among the physician practices? Will this change anything?

I don’t see a lot of physician practice adoption yet. There are a couple of large groups or specialty groups that have electronic medical records, but the community has a lot of still-solo practitioners and small groups of two and three physicians that don’t seem to have done a whole lot yet.

I don’t know if they’re waiting to see what their respective hospitals do, or waiting for the ARRA funding or exactly what’s happening. Since we have an employed group, I don’t really focus a whole lot on the community physicians.

What about interoperability? Are you looking at that at all?

In terms of being able to share information with…?

Yes, among other facilities or regionally.

There are two very large federally qualified health clinics in our area. One of them is actually holding off on their electronic record. They may go with OpenVista as well after they see how we do. But we plan to, as soon as possible, have two-way communication with those clinics. We do some psych patients with Kaiser.

Probably insurance companies will be the next large thing, and then as the other hospitals come up with their own electronic records, we’ll expect to have interoperability with them.

Are you considering anything related to patients or consumers as far as a patient portal or any kind of functionality that patients would use?

You know, we’ve had discussions about it and that’s more of a long-term goal we’d like to do, but that won’t be available at startup.

As a hospital CEO, what elements of your overall strategies involve information technology?

I think that two of the differentiating factors for successful hospitals: one is imaging, which is fairly heavily IT related; and the other is IT and the ability to store and use information.

This obviously is the most important initiative we’re taking on this year, and I think, will be the framework for a lot of the quality, patient safety, and even financial things we do into the future.

When you look beyond Meaningful Use and ARRA and HITECH, how important will information technology be for hospitals that are trying to succeed under healthcare reform?

I think it will be very important for healthcare reform. It will connect the patient-home and the outpatient setting with the inpatient setting and with the ED so that there’s one record that caregivers in each of those settings can access. It will avoid a lot of duplication of testing. I think it brings together more, the medical group — even if it’s a virtual medical group — by the sharing of that information.

It also will give us a lot of information we can mine on how we’re doing with utilization, with quality, with patient safety. I think those elements will be very important under reform.

Do you think the OpenVista product is going to give you the technologies that you need to be ready?

Yes.

What are your biggest fears or biggest opportunities that you see coming from healthcare reform?

I think there’s just a lot of confusion left in exactly how the 3,000 or so pages of the bill are going to be translated into many thousand pages of regulation and what all that’s going to mean for us. As a county hospital, one of our issues is going to be will the indigent patients who we now see who suddenly have coverage. Will they continue to use us?

Is your fear that they will or that they won’t?

That they won’t.

Some are saying they’re never going to get their EDs cleared with all these folks who suddenly have an insurance card.

Well, they’re already using the emergency department, so it’ll just be that they’ll have a payer source all of a sudden.

The real big issue that concerns me though is having insurance coverage doesn’t necessarily give you access. Dumping another 20 million people with coverage onto the system that’s already pretty undermanned, I think, is going to create a lot of waiting issues and appointment issues. A lot of people who may not be able to find a primary care provider.

There’s a concern that just because you have insurance doesn’t mean you can get an appointment. Do you see there being new roles for extenders of primary care physicians, or will doctors move back into primary care?

We’re in a medically underserved area, so we already have a physician shortage. We are talking to our clinics about how can we use mid-levels — how can we be more efficient with the patients we see?

You don’t want to push patients through too quickly or have too much mid-level intervention because part of the spirit of it is that they have a Medical Home and a primary care physician who spends time with them and properly directs them, properly oversees disease entities, properly refers to specialists. If we get into a “let’s just hurry everybody through the system,” we’re going to go right back to high ED utilization, high inappropriate referrals to specialists, and patients with chronic conditions not getting their meds on time, and not getting seen on time and not having intervention done on time. It’s going to be a balancing act.

Do you think that healthcare reform is going to save money or improve quality or both?

I think there’s going to be several years of very turbulent years while it settles in. I do believe the country already spends more than enough money to cover everybody, but it’s going to be those transitional years where we go from reducing payment from people who are currently insured — since, in theory, those plans won’t have to cover uninsured — to a more even system where almost everybody has coverage. But I think it’s going to reduce the coverage for all of us and it’s going to increase the access problem for all of us.

Certainly there’s already some polarity of the haves and the have-nots when it comes to medical care. Not just insurance, but the quality and quantity of care available. Do you see that gap widening between the haves and the have-nots?

No. If anything I think it’ll probably shrink. You mean in terms of disparity among patients?

Yes.

No, I think that will probably shrink, and that’s probably going to be the problem for people who are used to having a full indemnity insurance card. As those plans drift down to looking more like Medicaid and more and more of the uninsured are covered, I think it’s going to be a leveling of the system. People who have lived at the high end of the system probably aren’t going to like it a whole lot.

Do you think it will create another class of patient and provider that go off the grid and use cash?

That’s what happened in England. There’s a National Health Service, and then there’s the private. Actually, private insurance service is down as well as private hospitals and private physicians. There could be some of that.

When you look out five to ten years, what are the hospital’s biggest opportunities and threats?

Health reform is both our biggest threat and our biggest opportunity. It’s the best of times or worst of times. We just don’t know which it is.

I think that there’ll be the turbulent years while we try to get used to regulation and people taking on different roles and our revenue streams coming from different areas. But I think ultimately, if we have good strategies and execute them well, it will be a real opportunity for us.

With our academic connections, we offer some of the advanced care in the community as well as the broader care, so it should be an opportunity for us in the long term. But I think it will be some difficult years getting there.

Equifax Acquires Anakam

Equifax announced after the market close Monday that it has acquired authentication management vendor Anakam. The San Diego-based Anakam has a significant healthcare presence, with products addressing online identify verification, credentialing, two-factor authentication, inoperability authentication, and secure collaboration. Former HHS privacy and security advisor Bill Braithwaite MD PhD is the company’s chief medical officer.

Equifax had chosen Anakam this past January to provide authentication for its I-Card product. Anakam’s solution was chosen last month by Buffalo-based HEALTHeLINK as part of HHS Beacon Community demonstration project.

The Atlanta-based Equifax says it will market Anakam’s Identity Suite with its IDverifier service as a single, integrated two-factor authentication solution. Rajib Roy, President, Equifax Technology and Analytical Services was quoted in the announcement as saying, “With Anakam, Equifax will become a premier provider of cloud-based authentication solutions.”

Monday Morning Update 10/4/10

From D.B. Platypus: “Re: ACO. The NorCal HIMSS chapter sponsored a CIO forum on October 1. A speaker showed this video. It had everyone rolling on the floor in a fit of hysteria.” I like it, although someone sent Inga a similar video that we posted on HIStalkTV that I like even better. My newest oft-repeated monotonic mantra from that one involving orthopods: “There is a fracture. I need to fix it.”

From CPAhole: “Re: Allscripts/KLAS. I’ve worked with numerous Allscripts/A4 reps and they did as they were instructed, sitting next to their clients as they completed the survey. KLAS outed the company. Of course Allscripts will take the high road and say they have a better system, but what else would they say?” Unverified.

From Lemmy: “Re: another stolen unencrypted laptop. Here’s the CIO’s internal e-mail from Harvard Vanguard Medical Associates.” I don’t recall seeing this previously, but the purported e-mail says that a vendor-owned laptop containing urodynamic testing data was stolen on August 3. It contained minimal information (name, date of birth, physician, MRN, and testing data). Massachusetts law required encryption starting March 1, 2010 as I understand it, so that might be a problem.

From Elaine: “Re: HIEs. I’m a new HIE manager within our health system and am interested in any data sources regarding interoperability discussions or lessons learned.” I’m sure people are reading who know a lot more than me, so add a comment to the bottom of this post if you can help Elaine.

From The PACS Designer: “Re: iPad’s little sister. Apple is working on a smaller 7" iPad for release early next year. This little sister iPad weighs only 1.1 pounds and will have front- and back-facing cameras. This smaller sized iPad may be of interest to our heathcare colleagues if they can produce it with a case that can be disinfected.”

Listening: Delain, female-led Dutch symphonic metal. Also, reader-recommended Pretty Lights, Boulder-based electronica (two guys doing something between DJing and playing) with some impressive live performances that mix several genres, mostly hip-hop and and synthesizer. Not something I usually like, but it sounds good (probably even better as a soundtrack to romance, I’m thinking without much credibility).  

Meditech says it will expand again, adding hundreds of new jobs to be housed in newly built Fall River buildings. Sales in 2009 were $234 million, up 38% from the year before.

This week’s internal e-mail blast from Kaiser chairman and CEO George Halvorson says the company has donated its internally developed clinical terminology translation engine to the US government, accepted by HHS Secretary Sebelius, CTO Chopra, and National Coordinator Blumenthal. From the example he gave,the Convergent Medical Terminology utility can convert 75,000 terms back and forth, for example between ICD-9, ICD-10, and SNOMED. It will be distributed as open source by the National Library of Medicine. 

Drummond Group issued the first ONC-ATCB EHR certifications, but CCHIT trumps them on quantity, announcing Friday that it has certified 33 EHR products (19 complete systems, 14 modules) in the 10 days since its program started. I’m not sure that will instill confidence in folks who have always questioned the rigor involved since they can apparently crank out three per day including weekends, but there you go. HIStalk sponsors that have newly certified products are Allscripts, NextGen, eClinicalWorks, T-System, and Wellsoft.

Transcription service outsourcer iMedX acquires FORE Transcriptions. And transcription software and services vendor MedQuist gets $310 million in financing, mostly from GE Capital, with the resulting announced dividend causing shares to hit a three-year high (strictly by investors looking to get the dividend – otherwise, borrowing money to pay a dividend isn’t exactly a robust growth engine). What’s with all the sudden interest in transcription companies?

Nearly two-thirds of respondents say KLAS reviews aren’t useful to providers, although I’m sure many of those respondents work for vendors ranked by KLAS as lower than #1. New poll to your right, requested by a reader: providers, which department will conduct and submit your Meaningful Use self-attestations?

Longmont United Hospital (CO) says VHA’s PriceLYNX vendor price comparison tool paid for itself immediately when a vendor was caught overcharging the hospital by $120K and returned the money. The materials manager says the software will allow him to negotiate price reductions of 8-20%, saving the hospital up to $4 million over the life of the contract.

This BBC article on real-time computing is interesting and scary. It says 50 to 70% of banks use it to perform algorithm-based trading of stocks and complex financial instruments. The example given is in trading stocks of two oil companies whose share prices usually follow each other closely. The software can check prices every 10 seconds and blindly buy Stock A shares if Stock B moves up even a tenth of a point. SAP says that kind of situational analysis may be useful in medicine, such as in monitoring the blood glucose of diabetics. Let’s hope the medical application is dissimilar from that of the money changers, whose computer-assisted self-destruction may yet take us all down with them.

Speaking of SAP, HP and “The Most Inept Board in America” choose the former CEO of SAP to be HP’s next CEO. SAP fired the Germany-born Leo Apotheker after a disastrous seven months as CEO, although some say he was the scapegoat for a terrible company strategy that predated him. HP is paying him like he’s a star: $1.2 million in salary, incentives of 200-500% of that with $2.4 million guaranteed, $72 million in options, a $4 million signing bonus, and $4.6 million in moving expenses (that’s a lot of U-Hauls). I’ll go with the summary of Oracle CEO Larry Ellison: “I’m speechless. HP had several good internal candidates…but instead they pick a guy who was recently fired because he did such a bad job of running SAP.” Their pre-Hurd CEO pick was an ultra-expensive termination, too: HP’s value dropped in half after Carly Fiorina orchestrated the company’s merger with Compaq. She was let go in an ugly fight about the time the company admitted that it spied on the personal phone records of journalists and its own board members trying to find out who was leaking information about its strategy.

The Dallas Business Journal summarizes the “long, expensive, and full of twists” EMR implementation projects of local hospitals. The hospital costs and associated taxpayer-funded EMR bribes: Texas Health Resources, $200 million, $70 million; Baylor, $200 million, $45 million; Parkland, $70 million and no stimulus funds. Parkland said they won’t go after ARRA money because their upgrades were underway before ARRA was passed, which seems puzzling since HITECH money doesn’t require spending anything, just demonstrating Meaningful Use (unless the reporter or I misinterpreted).

University of Virginia Medical Center goes live with Epic in its 140 clinics, with the big house going up in the spring. Cost: $122 million.

You, looking at the monitor – sign up for e-mail updates, Friend or Like us on Facebook, send me rumors. That would make me happy.

The VA will test 20,000 thin client devices using desktop virtualization, hoping to reduce maintenance and energy costs of its 325,000 PCs.  

In Spain, Andalusia will require hospitals to record birth records electronically within the first 24 hours of life, giving the child full health benefits that are independent of the mother and allowing pediatricians immediate access to the records. The centrally maintained information will support monitoring of infant morbidity and prenatal mortality.

The Canadian Medical Association says the $500 million that the Canadian government will give Canada Health Infoway in 2010 to goose EMR adoption isn’t enough. CMA wants another $423 million, which it says will increase adoption to 100%, apparent embarrassed over the high EMR adoption rates of other countries (Netherlands 99%, UK 95%, Australia 95%). I guess they weren’t consoled by US adoption, which comes in at anywhere from 4% to 40% depending on whose definition and survey you like.

My Health Care Manager gets a $1.2 million NIH grant to develop a search engine for geriatric health issues.

The bailout-happy federal government agrees to throw taxpayer money in the general direction of Massachusetts hospitals, especially Boston Medical Center, giving them $335 million. Cynics like me might point out that Massachusetts leads the nation in healthcare (percentage of insured citizens, use of electronic medical records, fancy hospital buildings housing bowtie-wearing academic doctors) and yet (or more likely, because of) has the highest healthcare costs. According to the article, Sen. John Kerry strong-armed CMS and Don Berwick to use our money without consulting us first, which I guess we might as well get used to as healthcare “reform” starts tapping an already wildly indebted Uncle Sam, who gets a lot of his healthcare ideas from Mass, even the fantasy that reform will somehow lower costs while insuring dozens of millions of new people. Maybe Uncle should be looking at the sensible, practical middle of the country instead of the extremes on the ends. From its most recent federal tax records, BMC paid its previous CEO $1.3 million and she got another $3.5 million when she left last year right before the hospital’s big profit turned into a loss. Somehow, that doesn’t make me feel better about my involuntary donation.

E-mail me.

News 10/1/10

From Allscripts: “Re: the note from Clinical Wisdom on KLAS. We agree that there is a conflict of interest in having vendors pay large fees to the same company that is producing the ratings. We reached the same conclusion a few years ago and discontinued the practice. After our recent merger with Eclipsys, we inherited an existing Eclipsys contract that was in place with KLAS, so the information reported by the writer was technically correct. However, we have now canceled that contract and we do not currently pay KLAS anything. We realize that is counter-intuitive as we currently are and have consistently been highly rated across many product categories by KLAS, but ultimately we didn’t feel it was right to pay a firm that was also rating our products. Over the last two years, we have re-invested those dollars in a ‘Net Promoter Score’ process, which is widely considered across many industries to be the ‘gold standard’ for measuring customer loyalty. Using this rigorous, statistically valid methodology (developed by Satmetrix and Bain & Company), we get client feedback directly in a very methodical way and then act immediately on what we learn. The bottom line is that we agree with the Consumer Reports analogy from the writer – KLAS should provide a full accounting and disclose what they receive from every vendor. In that same light, we would encourage other vendors to disclose how much they are paying KLAS – complete transparency is critical when you’re talking about the core technology that providers use to make decisions vital to every American’s health.”

From Ben Cannoli: “Re: IOM’s study of HIT best practices. The IOM report is incredible even after a decade. I’m glad they are leading. HIMSS has been weak, negligent, and pathetic on this issue, but I don’t believe they can strong arm the IOM.” Inga mentions it below. The IOM gets an ONCHIT grant to look at how HIT affects patient safety. It will cover some industry hot buttons: surveillance and reporting of HIT-related patient safety issues, discussion of the possible roles of federal agencies like FDA or AHRQ, and impact of certification bodies and trade associations (HIMSS, you’d expect). I’d bet that Don Berwick made this happen. I don’t know how much they’ll get done for $1 million, but I’m interested to find out.

From Digital Bean Counter: “Re: real-time claims adjudication. Is it taking off yet? Any big players?” Little help, if you know.

From VaHooGirl: “Re: Martha Jefferson Hospital. No longer a rumor – they are merging with Sentara to become its 10th hospital.” Verified.

From TuTu True: “Re: Mrs. HIStalk. A source tells me that Inga is Mrs. HIStalk. Be honest – true or false?” False. And to answer the other occasional rumors: (a) yes, there really is an Inga – it’s not just me pretending to be her;  (b) yes, she really is a woman, and (c) yes, the Inga picture at the end of her posts really does look like her since I paid some offshore artist $15 to draw it from a photo.

From Luke O’Scyte: “Re: correction about the Canadian government spending $500 million on EMRs. Please replace ‘spending’ with ‘wasting.’ I’m highly skeptical of the value that will be generated from that half a billion dollars.”

From Portly Gentleman: “Re: Allscripts. A couple of executive suite offices are about to become vacant.” PG provided credible names and I’m sure his information is correct, but I feel funny about mentioning names of people leaving jobs. Watch for announcements early next week.

From MSFTGUY: “Re: McKesson Paragon. Just went live at 391-bed Lake Charles Memorial. Several big hospitals have gone live on Paragon this year. Maybe folks have a choice between a system that doesn’t work and is only 1/3 of an HIS (Cerner) and one that’s ridiculously irresponsible to purchase (Epic)?” I did some work at that hospital once. Nice folks. None of the systems you mentioned are for everybody, so it’s hard to criticize their choice, especially if it was a lot less expensive.

From Perineal Flowers: “Re: [name omitted] is one of two finalists to be CIO of Tenet.” I’m expunging the name since I’d sure hate to get someone fired if they don’t land the rumored new job after all, but I did manage to contact them. They humorously (or so I assume) told me the rumors also have them going to Allina, Duke, and Partners, all of which have open CIO jobs along with Tenet. I’m pretty good at reading between the lines, so I think there’s fire underneath that smoke. We’ll see from which direction soon, I’m betting.

Listening: The Tyde, obscure, Byrds-like LA jangle surf. 

A scrappy Austin-based non-profit investigative publication runs a pretty good story on the ongoing sale of de-identified hospital patient data by the Texas Department of State Health Services. Among their customers: GE and a company that runs background checks for border security. Deborah Peel MD was quoted as saying that a HIPAA loophole allows selling patient data to any entity that claims to be doing “research”, which isn’t defined. Now this is funny: the only parties that stay anonymous aren’t the patients, but rather the people who download the free data files covering 1999-2003. The article wanders all over the place and is predicated on your believing that de-identified data can be re-identified (which it definitely can to some reasonably high percentage, but some people refuse to believe that fact). If newspapers weren’t going broke, they should fund a re-creation of that experiment where patient data was re-identified by linking to common fields from other government-sold databases, such as driver’s license records.

Here’s another fun tidbit from the Austin article, even though I don’t believe its accuracy. The guy who wrote The Long Tail estimates that free EMR vendor Practice Fusion takes in $250 million per year from selling the de-identified patient data stored in its systems, dwarfing any possible revenue it could make by selling software. It cites a Practice Fusion job ad on Craigslist for a Data Sales Director, someone with experience creating “an aggressive data monetization strategy” who can pitch to “pharmaceutical companies, medical device companies, insurance carriers, government entities …” and “establish a fair market price for EHR data and negotiate effectively with buyers.” That position is still being advertised on Practice Fusion’s site, but the language has been dialed back a lot.

Cerner caves in to patent trolls Acacia Research (“research” meaning “writing threatening lawsuit letters to companies to see who will pay up”) and will pay that organization for the privilege of selling PACS, which Acacia’s often-waved patent claims they invented. Acacia’s strategy is smart: they threaten to sue, but offer a license for less money than it would cost to mount a legal defense. Most companies pay up and the threatened suits rarely go to court, although Epic mounted a swift legal counterstrike for being threatened. I never heard how that turned out, but it doesn’t matter – I still admire their willingness to fight for what’s right.

This is brilliantly funny: You may know Ross Martin, MD as the guy behind the HITECH Operetta and Meaningful Yoose Rap in his role as President of The American College of Medical Informatimusicology, although he has a less interesting but probably much more lucrative HIT consulting job. He writes a hilarious letter to the editor of The New York Times for not publishing a previous letter of his, threatening a class action suit by rejected would-be authors and signing it, “Yours in the quest for wealth creation through victimization, President, Literary Mediocrity Association.” They whittled his piece down to a paragraph, but they did run it. I think the HIStalk audience is more appropriate for his type of humor than that little New York paper.

WorkflowOne, which claims to be “the nation’s leading name in healthcare document management,” puts that leading name on a Chapter 11 bankruptcy filing. Premier just renewed its contract with the company, claiming that “no one is better prepared to help Premier members reduce costs and gain efficiencies across their entire print lifecycle than Workflow One.” Doh! Still, the company has big revenue and EBITDA, so I’m sure they’re not going anywhere. It seems odd that they even filed, frankly.

Lots of good jobs on the HIStalk Sponsor Jobs Page: Eclipsys Pharmacy Consultant, Natural (Software AG Product) Programmer Analysts, McKesson Workflow Clinician. On Healthcare IT Jobs: Product Manager, Lead Epic Analyst, Senior Clinical Systems Analyst, Solutions Marketing Specialist.

Sharp Healthcare chooses Aternity Frontline Performance Intelligence to monitor application user experience.

Vanderbilt launches its first preventive genetic screening program, testing all cardiac cath patients for clopidogrel metabolism problems and storing the results in their EMR so that a different blood thinner can be used if needed, avoiding expensive and dangerous blood clots. Several other drug-affecting genetic traits will be tested as well. Now that’s just cool.

Several national pharmacy organizations launch the Pharmacy e-Health Information Technology Collaborative, which will work to get pharmacist-needed functionality into EMRs.

CMIO interviews one of my favorite CIOs, Denni McColm, from 74-bed Citizens Memorial Healthcare in Bolivar, MO (the only one of very few HIMSS EMRAM Stage 7 hospitals, a standout on the list dominated by big, rich health systems). CMH has a bi-directional CCR interface with Google Health that Denni says will meet Meaningful Use requirements, saying interoperability doesn’t necessarily required an HIE. They’ll use Google Health to make sure patients who ask get a copy of their medical record within the MU-specified timeframe.

ChartLogic earns EHR certification from Drummond Group.

iSoft convinces its bankers to reorganize the company’s debt. Shares are still at 13 cents. You would think those two events might attract takeover interest, but the company’s chair says conditions remain “challenging.”

A Chicago cardiologist will pay $20 million and spend five years in prison for defrauding Medicare and private insurance of $13 million, turned in by another doc who gets $3.5 million as the whistleblower. The cardiologist submitted 14,800 false claims that added up to more than 24 hours a day of work from 2002-2007, so he enjoyed a lavish lifestyle until the case finally ended. When the Feds raided his house, they found $6.7 million in uncashed insurance company checks.

E-mail me.

HERtalk by Inga

The Allscripts/Eclipsys crew sent over an invite to EUN 2010 Outcomes Through Innovation, which is the user meeting for Eclipsys clients. Wish I could go because it’s in one of my favorite cities, San Diego. The event is October 10-13 at the Manchester Grand Hyatt.

The board of governors of Good Samaritan Hospital (IN) approves the $400K purchase of McKesson’s PACMED and MedCarousel pharmacy packaging systems. At the same board meeting, the director of IS says the hospital is on target to earn nearly $7 million in ARRA incentives over the next six years.

St. Vincent’s Healthcare (FL) extends its seven-year partnership with TeleHealth Services. The health system will implement TeleHealth’s TV and interactive patient education solution at St. Vincent’s and St. Luke’s hospitals.

I noticed that Intellect Resources posted this article about the current shortage of IT professionals in the Nashville area. Middle Tennessee is home to a number of large HIT employers, including HCA, HealthSpring, Cogent Healthcare, and ICA. Several companies are working with on training initiatives at area colleges to help increase the pool of professionals with both healthcare and IT expertise.

Merge Healthcare adds two new perioperative solution clients: Exempla Saint Joseph Hospital (CO) and Kalispell Regional Medical Center / The Surgery Center of Northwest Healthcare (MT).

If you are headed to the American Academy of Pediatrics show this weekend in San Francisco, say howdy to HIStalk Practice’s Dr. Gregg Alexander. He’ll be directing the Pediatric Office of the Future exhibit, which will showcase technologies available for pediatricians. Dr. Alexander is pretty darned excited by the project, as evidenced by his  latest Intelligent Healthcare Integration post.

ONC awards the Institute of Medicine a $1 million contract for a year-long study of HIT’s effect on patient safety.

The Tiger Institute for Health Innovation celebrates its one-year anniversary and provides an update of its work to date. The Tiger Institute is a partnership between Cerner and the University of Missouri Health System to create new technologies. So far UMC has implemented bar-coded medication administration and is rolling out CPOE in a couple of months (not sure why that would be considered innovative) and is working on several prototype projects, including a mobile app that allows physicians to review clinical data and give orders via smart phones.

CIGNA and St. John’s Mercy Medical Group (MO) launch a 12-month accountable care organization pilot program. The pilot will target patients covered by a CIGNA health plan and receive care from one of St. John’s 165 primary care physicians. Physicians have the potential to earn bonuses for meeting quality improvement targets and lowering medical costs.

Mayo Clinic and five other health systems form the Mayo Clinic Center for Social Media, dedicated to the use of social media to promote health, improve healthcare, and fight disease. The Center will offer educational conferences and webinars and develop social platforms to share training and resources. The website www.socialmediahealthnetwork.org will launch October 25.

Baptist Health (FL) partners with Vitalz to provide provider-to-provider portal services between 13 Solantic Baptist urgent care centers and 40 Baptist primary care offices.

Texoma Medical Center (TX) implements Skytron’s RTLS to track and manage 200 hospital assets. When reading the press release, I was amused that either the hospital or vendor thought it was noteworthy to mention that Texoma is also using the RTLS technology to monitor vendor sales rep visits.

This week on HIStalk Practice: BlackBerry thumb, cell phone elbow, and Facebook depression; medical students say having an EHR is a very important factor in their decision what to practice; Phreesia and a few first impressions.

Sponsor Updates

• Fred Castillo, VP of healthcare mobility sales for AT&T and Eleanor Chye, executive director healthcare mobility product management at AT&T will participate in separate panel discussions at the CTIA Everywhere Healthcare event next week in San Francisco.
• Methodist Hospital of Southern California goes live with API Healthcare’s Human Resources and Payroll solution.
• Sharp Memorial Hospital (CA) selects GetWellNetwork’s bedside education/entertainment system. GetWellNetwork’s patient education and communications tools will be interfaced with Sharp’s Cerner EMR system.
• Susquehanna Health (PA) plans will add the perioperative information management system of Surgical Information Systems to its three-hospital system. Susquehanna will integrate the SIS solution with its existing Siemens Soarian applications.
• Albemarle Hospital (NC) selects the Access Intelligent Forms Suite to bar-code patient forms for auto-indexing via a document management system into its Meditech EHR.
• Ingenix CareTracker earns CCHIT Certified 2011 Ambulatory EHR certification.
• Zac Fritz joins My Health Direct as SVP of sales and marketing.

Here at HIStalk, we love well-intentioned works of charity. Thus, I applaud Cincinnati Bengals wide-receiver Chad Ochocinco for promoting contributions to Feed The Children. Ochocinco has his own personalized “OChocinos” cereal and includes a Feed the Children phone number on the box. At HIStalk, we’re also about getting the little details right, so bummer that Ochocinco didn’t get Mr. H to proof the cereal box. Perhaps he could have caught a certain typo before the box it hit the production line. Mr. H likes the occasional smut reference, so I’ll mention that the Feed the Children phone number listed was actually a phone sex hotline. Oops.

E-mail Inga.

Readers Write 9/30/10

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

"Granularity" — A Detailed Analysis
By Robert Lafsky, MD

“Granular” is turning into a buzzword. And that’s not a good thing.

It was a perfectly respectable, albeit not very useful term in the analog days, referring usually to a physical material composed of — you know, little granules. You’ll actually see it used sometimes as a descriptive term in pathology and endoscopy reports, and in general use it describes some thing’s particular type of grainy texture.  But then, of course, computer people got hold of it and gave it a much more specific, albeit metaphorical meaning, which I’ll get to in a minute.

Recently, writers in the mainstream media, with their ears always pressed to the ground and desperate for novelty, have picked up on this word and are starting to use it to describe more abstract things, in a way that fails to grasp the IT meaning at all. For instance, the other day political pundit Michael Gerson described a Karl Rove critique of Christine O’Donnell as “granular and well informed.” If you substituted “detailed” for “granular” in that sentence, you wouldn’t have changed the meaning a bit.

But IT people don’t use “granular” to mean just “detailed.” Hard copy or scanned documents can, of course,  be very detailed. I remember a couple of old docs from my training days who would sit with pen and paper and do beautiful two- or three-page, single-spaced handwritten reports on their patients with every bit of the history, physical, and labs on them. It was impressive effort, very detailed, but even if you found those reports now and scanned them into your EMR, the information in them wouldn’t be granular.

No, for a computer, detail is necessary for granularity, but it’s far from sufficient. The computer has to be able to do something with the details so that it can store them in an orderly way and then use them for searches and reports. That sort of thing, of course, is the “use” that at least has the potential to be “meaningful.”  

So if, say, a particular drug for hypertension is found to be dangerous for everybody over 60 with diabetes, I don’t have to go manually through a thousand records. They are recorded in a yes-or-no fashion in a database. I can query my system and get an immediate list of all my patients who meet those criteria, with their addresses and phone numbers.  

That’s granularity. Facts have to be detailed, but in a fashion where computers can take advantage of them.

Maybe this is obvious to the IT business readers out there, but I sure spend a lot of time in the doctor’s lounge painstakingly explaining this to medical colleagues. And granularity is at the heart of all the arguing about workflow issues in EMRs, as well as interoperability and the coherence of automated reports that rages in the comment sections of this website and elsewhere.

I can’t offer a resolution of any of these arguments. But to get anywhere, we need commonly defined terms, and granularity is a pretty useful one. General media people out there, if you mean “detailed,” say “detailed.” Leave “granular” for those that really need it.

Robert Lafsky is a gastroenterologist in Lansdowne, VA.

A HCIT System Architecture for Cloud Computing
By Mark Moffitt

Note: This article uses a fictional story about Google and Meditech as a backdrop to describe a healthcare IT (HCIT) system architecture for cloud computing.

(Oct. 1, 2020) Today marks the eighth anniversary of Google’s purchase of an obscure private company know then as Meditech that marked the beginning of the transformation of the HCIT industry into what it looks like today.

At the time, the purchase shocked everyone. Over the years, Meditech had repeatedly rejected any notion of a buyout by another company.Then Google offered $1.5 billion, more than a 50% premium on the estimated valuation of the company. The offer, it turns out, was too good to turn down. Neil Pappalardo of Meditech walked away with a $400 million payout. Google’s market cap at the time: $168 billion.

The Vision

Google’s vision for the future of HCIT was straightforward: provide all IT services to healthcare system as a cloud computing service at a price much lower than market rates as a strategy to capture 60% of the worldwide market by 2020. Google’s service included applications, data management, and integration. Google architected the system from the ground up for cloud computing, so they were able to offer the service at a much lower price while realizing higher margins than competitors.

Google bought Meditech for its customer base and use case models that had been hardened by use over many years. Google took Meditech’s functional specs and enhanced and implemented them in a new architecture. In addition, Google purchased several other HCIT vendors and integrated them to provide a total HCIT solution to customers.

Data Storage

Google did not use a relational database management system (RDBMS) as was common at the time, and instead used schema-less, key-value, non-relational, distributed data stores, aka as NoSQL.

RDBMS scale well, but usually only when that scaling happens on a single server node. When the capacity of that single node is reached, you need to scale out and distribute the load across multiple server nodes. This is when the complexity of relational databases starts to bump up against their potential to scale.

Goggle’s key-value data store model improves scalability by eliminating the need to join data from multiple tables. As a result, commodity multi-core server hardware can be used that are far less expensive than high-end multi-CPU servers and expensive SANs. The overall reduction in cost due to savings in database license fees and maintenance and hardware is around 70% when compared to using a RDBMS. Database sharding and the “shared-nothing” approach is ideal for managing large amounts of data at a low cost.

Three Data Types

Another concept introduced by Google was segregating data into three buckets — transaction data, results data, and analytic data — and managing each differently. Competitors at the time combined all three into one big, complex RDBMS.

Transaction data — what was ordered, when and by whom, what tests were performed, or what meds were given to a patient — are persisted to a transaction data store. At some point, all of the transactions related to a patient encounter are collected in a single electronic medical record file and compressed to about 10% of original size. Results are also contained in this file but not images, due to size, as was the case with the original paper medical record and film file.

The compressed medical record file provides an interactive view of the patient’s encounter to satisfy legal and payment inquiries. These electronic medical record files are stored securely in the cloud. Records are never transferred between organization; rather, access is authorized and the record viewed from the cloud.

Data is purged from the transaction data store once the electronic medical record file is created. The transaction data store remains a constant size and, as a result, it retrieves data faster and is easier to manage than if the transaction data store grew in size. Transaction data is concurrently stored in a separate analytic data store and is not purged.

Google partnered with several business intelligence vendors to offer advanced analytical services from the cloud using the customer’s analytic data store.

Results such as images, labs, reports, and waveforms are also stored in schema-less, key-value, non-relational, distributed data stores.

The three buckets — transaction data, results data, and analytic data — are each stored across multiple commodity server hardware using a “shared-nothing” approach. Scaling any individual bucket for a customer is almost as simple as adding server hardware.

Integration

Google used a derivative of their search engine technology to integrate a patient’s records and results across multiple providers and systems.

Application Development Framework

Google used an application development framework that was easier to build and deploy software. In a RDBMS, application changes and database schema changes have to be managed as one complicated change unit. Google’s key-value data store allows the application to store virtually any structure it wants in a data element. Application changes can be made independent of the database.

In addition, Google used a scripting language for code that changes most often — user-facing code. Both of these features combined to make software development easier and allowed applications to iterate faster. In software development, the rate of innovation is directly related to the rate of iteration.

Mark Moffitt, MBA, BSEE is the former CIO at GSMC in Texas and is working as an independent consultant while he searches for his next opportunity.

Software Upgrades – To Be or Not to Be? That is the Question
By Ron Olsen

The day your facility installs a new piece of software, you rarely think about the upgrades that will inevitably come later. You probably ask if such upgrades are included in the maintenance agreement, and then shuffle away that information for future use … or not.

Many times an upgrade is more than just a requirement from the vendor — it’s a welcome relief that offers bug fixes, provides additional functionality, and many times, increases productivity, which equates to money-saving. Hey, any time we humble IT/IS guys and girls can do something to keep the CIO happy, we’ve got to jump on it! That’s what IT should be all about — increasing the ability to save money and/or help other departments increase revenue streams.

Most of us have been caught in the XP vs. Vista vs. Windows 7 debate. The old adage, ‘If it ain’t broke, don’t fix it’ seems applicable here. XP works fine. Vista is, well, Vista. Windows 7 has generated a lot of hype. Windows 7 offers many enhancements, but if your organization’s PCs aren’t up to it, the new bells and whistles aren’t available. To get the full feel of the new Internet Explorer 9 beta release, Windows 7 is now required.

This is just one example of how an upgrade is never a simple, single-issue vote. There are dozens of interrelated concerns that an IT department must evaluate before pulling the trigger on a software upgrade.

And then the software compatibility issues. How many times have we heard from a vendor, “It’s not certified for (fill in any number of OS versions) yet!” This causes a push me – pull you effect. Some vendors are pushing you to move forward, and others you have to pull along with you.

Things to consider before upgrading your software:

1) Can you adjust your current processes to take advantage of new functionality? Many times we take an upgrade and claim there is not enough time to do a full evaluation prior to going live. Then, we certainly do not have time to go back and look again. This could actually cost your company money in the long run, instead of delivering the benefits of a well-planned project.

2) Downtime can be a deal-breaker for upgrades. No department ever wants to experience downtime unless it’s unavoidable. How will each department test the new upgrade? Do they have a full test system to work with? If all of the issues are thought out beforehand and these questions answered, upgrading shouldn’t be that painful.

3) Does hardware need replaced? Could this be a great opportunity to replace some old PCs and servers? Is this the catalyst that moves your facility to server virtualization …finally?!

4) What vendor software (enterprise forms management, ECM/EDM, etc.) will need to be upgraded simultaneously?

Thoughtful software and hardware upgrades are usually embraced by end users and the C-level alike. Personnel get new PCs that increase productivity, which keeps the Powers that Be happy once they’ve overcome the initial sticker shock. Just the idea of new PCs gets most staff members feeling like the hospital is moving forward technologically.

Server virtualization condenses the physical footprint of the server room, decreases power and cooling costs, and in most cases, reduces server administrative duties. And with your software running faster with full functionality from vendors’ latest compatible releases, IT/IS will (hopefully) get less end user complaints. Hey, it sounds good in theory!

Just make sure you plan well in advance; get buy-in from department heads, super users and (if you’re lucky) an enthusiastic executive; and communicate openly with vendors and you’ll be good to go.

Ron Olsen is a product specialist at Access.

News 9/29/10

From Waterkeeper: “Re: CPOE reality. Another example.” A study finds that electronically preventing entry of CPOE orders for concomitant use of warfarin and sulfa drugs did great at preventing the potential drug interaction, but also delayed treatment in patients for which the simultaneous use was appropriate, causing Penn researchers to stop the study early as being unethical. Says the lead author: “[It] worked extremely well, but putting it in place actually hurt people … it’s naive to think that CPOE 1.0 is going to be perfect. This is a clarion call for continual evaluation of whatever we’re doing in terms of electronic interventions.” You’ve read it here in various interviews, but it’s worth reiterating: CPOE isn’t done just because it’s live and doctors are using it. That’s where the scientific work should begin, but unfortunately usually doesn’t as everybody declares mission accomplished and moves on to some other fire du jour that requires extinguishing.

From EMR Salvage Here, Can’t Bill There: “Re: downtime in Pittsburgh.” Included was an August e-mail to providers purportedly from Medical Service Associates, apologizing for problems in which a network failure led to the discovery that backups couldn’t be restored from either their own two backup systems or the two of their vendor. At the time of the late August e-mail, they still hadn’t restored anything from before the downtime. All unverified and most likely not the final word on the situation there, but my takeaway from experience is the same as always: backups don’t work at least half the time.

Inga e-mailed our sponsor contacts today about a little get-together we’re having for them in Orlando at HIMSS, separate from our Monday night HIStalk reception (nothing too fancy since it’s on a blogger’s budget, but sincere nonetheless since we really appreciate our sponsors). Response has been brisk, so if you’re the boss and haven’t heard about it, check with your internal person before we run out of space. If your company is on the fence about sponsoring HIStalk, we can probably make room if you sign up soon. Plans for the Monday night reception are progressing nicely as well. Expect a big evening that will go a bit beyond our usual food, drinks, and HISsies (running until late, so pace yourself). Stay tuned.

New readers sometimes get confused about who writes what on HIStalk, e-mailing the wrong one of us about something the other wrote. Here’s the deal: Inga writes the part starting with “HERtalk by Inga.” I write all the rest. I do most of the interviews, but I should mention that Inga did the most recent one with Doug Ardoin. And it’s all Inga on HIStalk Practice. Clear as mud, right? She and I are kindred spirits anyway, so we’ll figure it out.

Medical office patient check-in vendor Phreesia completes a $20 million Series D equity financing round. Jumping in is Ascension Health Ventures, the $325 million strategic healthcare venture fund of Ascension Health. 

Strange: a hospital trauma nurse gets a 2 a.m. call on her cell phone from the California Donor Network, with which she’s familiar because of her job. They tell her that her brother has died and they need her permission to harvest his organs. Agitated, she goes to her other brother’s house and they call their sister-in-law to console her, only to hear the sleepy voice of her I’m-not-dead brother asking what they want. The hospital had given the donor group the wrong contact information, that of a patient with the same name but spelled differently. The hospital can’t explain the mistake except to say that the information was wrong when they switched computer systems in 2005. The coroner’s office claims they would have caught the mistake before taking the organs of decedent with the wrong family’s permission.

HHS’s open source CONNECT program wins the 2010 Wall Street Journal Technology Innovation Award for health IT. Runners up are diagnostic image sharing platform vendor lifeIMAGE (I interviewed CEO Hamid Tabatabaie a couple of weeks ago) and Disease Precursor Identification from Ingenix, which identifies people at risk for chronic diseases. 

Munroe Regional Medical Center (FL) says it dropped ED-door-to-balloon time for heart attack patients to 48 minutes, below the national average of 62, by using incident command management software from LiveProcess to manage the Code Blue calls.  

A Weird News Andy find: NewYork-Presbyterian/Columbia University Medical Center admits that someone accidentally opened up a server containing ICU patient information to the Internet. A patient’s family ran across the information via a search engine and told the hospital. I can’t decide which is more annoying about the hospital’s name: that it’s absurdly long with dashes and slashes or that they insist on conjoining New York into a single word for no apparent reason. 

RIM previews its BlackBerry PlayBook tablet device. Like the Torch, I doubt it will generate much consumer interest, especially since it may work only on WiFi, not 3G/4G. That’s speculation since it’s not coming out until next year, making the video a bit premature in its lost cause of convincing iPad prospects to hold off. Businesses will probably like it, though.

The National Quality Forum endorses performance measures and preferred practices for care coordination. Among the latter is electronic medical records.

Ed Marx has updated his Tool Time post with responses to your comments.

Here’s another bad HIT press release, replete with enough odd phrasing, incorrect punctuation, and bizarrely missing information (like the names of the company’s president and the customer who are both quoted) to make it seem highly unlikely that the writer speaks English as a first language. Not that there’s anything wrong with that, but the company is in Minneapolis, where English is pretty common (albeit with a cute accent, like in this horrible, sappy movie that I just played from Netflix for Mrs. HIStalk while I pretended to watch while daydreaming).

The Canadian government will spend $500 million on EMRs in the next fiscal year, with $380 million of that going toward implementation.

ClearPractice announces GA of Nimble, which it says is the first comprehensive EHR for the iPad. It connects to the company’s cloud-based system by WiFi or 3G. Or maybe it’s not the first after all: an updated press release omits the “first” reference and fixes other unspecified errors in verbiage. The release came from a PR company, but it’s never encouraging (in a “Quality Is Job 1.1” kind of way) for a software company to let obvious mistakes get out the door. And in another tactical error, there’s a beautifully made demo video on their site (where I grabbed the screen shot above) that you’d be watching right now if they were smart enough to make it embeddable like everybody else does who wants widespread exposure for free (it’s called YouTube, people). Now I’ve lost interest.

Deborah Peel, MD of Patient Privacy Rights comments on an Information Week article about healthcare data breaches.

I don’t need a cell phone, but I’m thinking about getting the new model of the iPod Touch for running apps, checking e-mail where there’s a WiFi connection, and playing music and video. Good idea or not? I thought it was perfect until I read that Apple had to downsize the camera resolution from 5 megapixels to one to fit into the slim case. Still, it seems like a good deal for $299 for the 16 GB model.

Mohit Kaushal, MD joins West Wireless Health Institute of EVP of business development and chief strategy officer. He was a key player in developing the healthcare portion of the FCC’s national broadband plan, which includes mobile health, when he worked for that organization.

Bob Mitchell, former editor of the dearly departed ADVANCE for HIE, interviews John Glaser about his new job as Siemens Healthcare CEO.

Deaconess chooses Omnicell for medication management.

The Greater Dayton Area Hospital Association (OH) signs up with the HealthBridge HIE.

It’s funny today how many car problems are fixed with a software update. The same is true for implantable defibrillators, for which a new upgrade checks for electronic problems that indicate wire integrity problems that could cause patients to be shocked inappropriately.

Costs of Care, a Boston-based non-profit whose goal is to reduce healthcare costs by giving providers pricing information as they make medical decisions, announces a national essay contest. The best anecdotes from doctors, nurses, and patients illustrating healthcare cost awareness will earn $1,000 prizes. The judges are former HHS secretary Mike Leavitt, Atul Gawande, Tim Johnson of ABC News, the dean of the Harvard Medical School, and Mike Dukakis. Entries are due by November 1. The group, founded in 2009 by medical resident Neel Shah MD, plans to create smart phone and Web apps to provide pricing transparency.

A nurse at Seattle Children’s Hospital kills an ICU baby by mistakenly administering a tenfold overdose of calcium chloride. A 15-year-old died from a narcotic overdose at the same hospital last year.

InterSystems announces Cache’ 10, which adds database mirroring and a high performance solution for Java applications.

I’m totally behind, so be patient if you’ve e-mailed me. I’ll be vacating soon, which will dig the hole I’m in a week deeper, and then attending the mHealth conference to make the backlog worse, but my lack of timely response doesn’t mean I love you any less (that’s my go-to excuse when Mrs. HIStalk catches me paying insufficient attention to her or her movies).

E-mail me.

HERtalk by Inga

From Jellico Jerry: “Re: reality check. Loved your point today about Cerner and Epic, and which deals Cerner won vs. Epic. Cerner won sites with no $$ (UHS, Tenet). Although they are still significant wins, they are very different client bases.” In case you aren’t up to speed, KLAS recently reported that nearly 70% of 2009 hospital EHR purchases were for Cerner and Epic. A reader then noted that if one were just reading HIStalk, you’d think Epic had “cleaned everyone’s clock.” We countered saying Epic got the bigger, more lucrative deals that really count. Anyone who’s dealt with either or both companies knows that Cerner will darn near give the software away to avoid losing a deal, while Epic won’t discount a penny.

The Ohio Health Information Partnership (OHIP) names its five preferred EHRs from the 40 that were considered: Allscripts Professional; eClinicalWorks Unified EMR/PM Solution version 8; e-MDs Solution Series 6.3.0; NextGen Healthcare EHR; and Sage Intergy suite 6.0. Interestingly, OHIP requires that the selected vendors conduct all technical support within the United States.

Quality Systems, NextGen’s parent company, strikes a deal with Pricedoc.com to incorporate PriceDoc’s online search marketing tool into the NextGen Practice Management system. Pricedoc.com is basically a medical version of the travel site Priceline.com, giving patients the chance to name the cash price they are willing to pay for particular procedures or services. Sounds like the deal gives Pricedoc.com access to NextGen’s PM client base and Quality Systems gets a spiff when physicians and patients connect.

T-System releases DigitalShare, a new solution made possible through a strategic partnership with Shareable Ink. DigitalShare allows clinicians to document patient encounters on T-Sheets using Shareable Ink’s digital pen to capture the data. I first saw the technology at MGMA a year ago and made the Mr. H-esque observation/prediction that it would be great technology for the ER.

Lehigh Valley Health Network selects QuadraMed’s Quantim computer-assisted coding solution to help prepare for its ICD-10 transition.

Confer Health Solutions acquires MediHealth Outsourcing, an HIM and clinical revenue cycle company.

Providence Health & Services hires Summit Healthcare to provide dictionary management and data migration services as it moves to Meditech 6.0. Providence also purchases Summit InSync and Summit Scripting Toolkit technology.

GE was the overall leader in the US ultrasound market last year, according to Millennium Research Group. GE increased its lead over Philips and Siemens and now holds about 27% of the $1.2 billion US market.

Former Cerner Eastern US general manager Greg White is promoted to VP and managing director of the company’s Middle East, Africa, and India region. He replaces Rich Berner, who returns to KC as VP of client development.

Axolotl introduces Elysium Discover, a suite of reporting and analytic tools for HIEs.

Northwestern Medical Center (VT) goes live this week on its first phase of Meditech.

ChartWise Medical Systems signs a strategic agreement with 3M Health Information Systems to integrate 3M’s Grouper Plus Software the clinical documentation tool ChartWise:CDI.

Frederick Jelinek, one of the pioneers in the field of voice recognition, died earlier this month. I had never heard of him before reading this article, but he’s credited with enabling computers to understand English. While that accomplishment is significant in and of itself, Jelinek’s challenging background makes his work even more laudable. He was born in what is now the Czech Republic and his dentist/physician father died in a Nazi concentration camp. After his death, Jelinek’s mother moved her family to the US. He graduated from high school and took a job working in a factory to help support his family Jelinek later enrolled in night classes, studied engineering, and eventually earned a doctorate from MIT. He spent his career with IBM and Johns Hopkins University, creating the bones for today’s voice recognition systems. Isn’t that a great story?

Friday marks the first day of the hospital payment year for implementing certified EHRs and using them meaningfully. Guess it would help to have some certified EHRs out there.

Sponsor Updates

• eHealthAlign selects ICA as a strategic partner to technology and infrastructure for its multi-state HIE.
• maxIT Healthcare earns a spot on Modern Healthcare magazine’s list of Best Places to Work in Healthcare.
• Voalte VP Trey Lauderdale will participate in a panel discussion at next week’s CTIA Everywhere Healthcare event in San Francisco.
• MEDecision announces that its Nextalign iEXCHANGE 8.0 solution is now generally available.
• BridgeHead Software wins a contract with The Rotherham NHS Foundation Trust for healthcare data and storage management.
• Picis and The Sullivan Group (TSG) will integrate TSG Clinical Rules risk management solution with Picis ED PulseCheck.
• HealthEast Care System (MN) implements Ingenix Web.Strat medical coding technology, integrated with its McKesson HealthQuest billing system.
• EDIMS announces that its ED EMR clients can access the admission review service of Proven Healthcare Solutions, which offers a 30-minute guarantee.

E-mail Inga.

HIStalk Interviews Doug Ardoin MD, Physician-in-Chief, Memorial Hermann Healthcare System

Charles Douglas Ardoin Jr, MD is physician-in-chief of Memorial Hermann Healthcare System and president of Memorial Hermann Medical Group of Houston, TX.

What are your responsibilities at Memorial Hermann?

I’m involved with physician integration, physician strategy, business development, physician employment, that kind of thing.

Is Memorial Hermann considering creating an Accountable Care Organization?

Absolutely. Our goal at a company level is to continue to follow what changes, or what additions get addressed through those statements throughout the law that said, “The secretary shall.” We’re waiting to see what kinds of things may occur between now and January 1, 2012, but our goal is to definitely be prepared.

Here’s what’s interesting about this whole ACO thing. There are bundle payment demonstration projects going on around CV surgery. There are some of these ACO pilots that are occurring right now.

What I think is really interesting about this whole concept of Accountable Care Organizations is where in the law they describe what kinds of entities will be able to participate in some of these ACO demonstration projects, or will be able to call themselves Accountable Care Organizations.

What hasn’t come out yet, and I’m sure is going to have to come out from the federal government — almost like a Joint Commission certification or the NCQA designation for Patient-Centered Medical Home — that includes a real set of criteria that says, “OK, we’ve told you from a structure standpoint what’s necessary and what we’re going to allow.” But there’s got to be certain benchmarks that you have to hit so that when you apply to one of our ACO demonstration projects, we can say, “Yes, you meet our certification designation or whatever they’re going to call it to be an ACO and to participate in our ACO demonstration project.”

The thing is, none of that’s really been finalized. In the mean time, we’re keeping our ear to the ground saying, “What is that going to look like down the road?” But in the mean time, we know that we’ve got a very large hospital system in Houston, Texas with a very nice geographic footprint. We have acute care, post-acute care, emergency care, trauma care. We’ve got so much of the aspects of care covered. We have relationships for long-term acute care, and skilled nursing home help — all that stuff covered.

We have a relationship with our academic partner, the University of Texas, which has a large clinical practice group. We have our own employed physician organization. We have a very large IPA with over 3,000 physicians that is part of the Memorial Hermann system. We think we have all of the pieces of the puzzle, if ACO was a puzzle and you had to have all the pieces. We think we have it all to be able to connect it together.

I think we’re still waiting for the federal government to come out and say, “Here’s how you connect it. Here’s how you fill out the application so that you can get in the game.” I think we have minimal stuff we’ve got to go build or buy, so to speak. I think we’ve got just about all the pieces that are going to be necessary to put it together. That’s not to say that in some ways we’re not already engaged in or doing things that fit within the model of an Accountable Care Organization.

Like our family practice residency program. The Memorial Hermann Family Practice Residency Program was the first family practice residency program in the country to receive NCQA designation for Patient-Centered Medical Home. The things like that that we’ve done have been fortuitous. Things we’ve been working on over the last few years that we think, “Wow, OK, this positions us very well for this.”

Another good example is our independent physician organization, which is called the Memorial Hermann Physician Network. We’ve been, for the last four years, developing and engaged in our clinical integration model. So, much like the Advocate Physician Group in Chicago that’s probably been at it for over 10 years now, we’ve been at it for about four years. But, we’ve consistently followed all of the FTC guidelines and recommendations on developing our program.

We do have one clinical integration contract now and we’re looking at developing others. Our independent physician organization — the whole basis of clinical integration — is about high-quality, cost-effective healthcare where you get otherwise independent physicians to come together and agree to develop a quality platform amongst the physicians that’s both specialty-specific and for the organization as a whole. It buys a higher-quality care that we think creates a real differentiation in the marketplace.

In the ACO model that Memorial Hermann is considering, what would the governance structure be?

Right now, the law is not very specific, other than that they say that it has to be a shared governance model. Our intent would be to create a shared governance model so that you have — I don’t want to say ‘equal’ — but the correct representation of physicians and hospitals, and maybe the academic medical center and all of the right components.

We like the concept of the shared governance model. We strongly believe that it’s going to need strong physician leadership in that governance model.

As you’ve looked at what’s being proposed and the goals of the ACO model, what would you say are some of the bigger implications for both hospitals and individual physicians?

For years, hospitals and physicians have wanted to figure out ways to better align incentives around patient care, managing costs, and driving good revenues and things like that. I think physicians and hospitals have looked for some kind of a model that really pulls it all together. I think the ACO can potentially do that because the ACO, at the end of the day, is very much focused on the patient, where it’s really about how do you give the most highly coordinated, highest quality care you can give. Quality from the standpoint of process and outcomes.

How do you really give that high-quality care in a model that’s most cost-effective that can be efficient? I think it’s a way for hospitals and physicians to be fully aligned in that regard, because I wholeheartedly believe if you focus on the patient, you do the right thing by patients, then you shouldn’t have to worry about the money.

If you’re doing the right thing for patients, you’re giving them high-quality care. You’re not over-utilizing. You’re not wasting. You’re not ordering tests that they don’t need. You’re not leaving them in a hospital longer than they need to be where they can get an injury or an infection or something of that nature. You’re truly doing the right things for the patients. If you do that, I think the finances will follow suit.

But I think there are some issues here. I think there’s some upside and downside for patients. The upside for patients is the fact that patients will be able to get a sense that their providers are better connected, a better flow of information. That the continuum of care should be more seamless and patients should feel comforted by the fact that the federal government is not going to relax its quality standards. As a matter of fact, it will only enhance their quality standards over the years, so the ACOs will still have to give high-quality care.

I think the issue, though, is that there may be some impact on provider choice for patients. Because what may end up happening down the road — whether it’s through CMS or private insurance plans that decide to follow the same model — is that you’re going to see, in order to achieve the level of connectivity, information flow, quality, and cost savings, these networks are going to have to be rather exclusive to some degree. I think patients are going to have to be willing to accept the fact that, whereas there will be choice within the network, going outside of the ACO, outside of the network, is going to be detrimental to the whole purpose. I think there will be some impact on provider choice to patients.

I think some of the issues that the federal government needs to work through is this whole concept of continuing to pay fee-for-service for some kind of a bonus for cost savings because I don’t think that’s going to work. I see the government having to migrate quickly to fixed payment for certain procedures, like a bundled payment, and some other type of a fixed, bundled payment for populations of patients — almost like a capitation model — in order to really control costs.

I still think within both of those, there can be rewards for achieving certain quality benchmarks and cost savings as well. But the fee-for-service model, I don’t think it’s going to lend itself to the level of cost saving that the federal government is looking for.

Could the fee-for-service model, in time, go away?

I don’t know if it will go away or become significantly modified. Look, if doctors and hospitals continue to get paid on a per-click basis, then what’s going to prevent them from adding up clicks?

So that’s my concern about rolling this out and continuing to have it in a fee-for-service model. I don’t know that it’s going to drive the level of efficiency and cost savings that could be achieved without suffering the quality.

As healthcare moves more to the ACO or Medical Home models of care, what will hospitals and health systems need to do in terms of physician alignment?

I think what you’ll see are increasing models of integration. In other words, you may see more physician employment. You may see more PHO development — Physician Hospital Organization development — where physicians are still independent, but either through a PHO or an IPA model, they declare their loyalty to a hospital or hospital system. I don’t think that ACOs will necessitate employment of physicians, but I think it is going to necessitate a unique level of loyalty or exclusivity for private, practicing physicians who want to engage with a specific ACO.

What are some things that Memorial has done, or things you think need to be done, to effect change in physician behavior when implementing new models of care or even new technology?

Two completely different kinds of questions there. The technology issue really has to do with how disruptive the technology is. At the end of the day, you’ve got a certain generation of physicians who maybe aren’t as IT adept. Therefore, sometimes they have a hard time adjusting to new technologies. I think a lot of the physicians coming out of residency and fellowship today, because they grew up in the Internet age, are much more accepting of new technologies. Therefore, I don’t think that’s as big of an issue, but technology’s one thing.

Models of care .. I think what you have to do there is really work on the alignment of incentives. I think that when you start talking about creating a new model of care, it can’t be a zero-sum game, obviously, to the physician or to the hospitals. There’s got to be a consensus that drives a win-win so that both the hospitals and the doctors can benefit from a new model of care and the incentives can be aligned.

That means just as what’s been described in the ACO. Developing ways that cost savings can be shared back with the providers, both the physicians and the hospitals, is important. Or, rewards for reaching levels of excellence and quality. I think that’s important, too, where you can reward and align incentives around reaching certain quality benchmarks.

What are your thoughts on incorporating decision support tools into the care process?

Let me just say this. I’m a big proponent of always learning how to work smarter and not harder. In other words, why does a physician, every time they admit a patient to the hospital, have to sit down with pen and paper and go through the ADCVAANDIML of writing admission orders?

If you believe a patient has pneumonia, then why don’t you use a common pneumonia order set to admit the patient, or a pneumonia pathway that has flexibility within it to adjust it for the uniqueness of the patient? All of the basic things that happen every time are there. They get covered. You know they’re going to happen, therefore they don’t get forgotten.

I’m a big believer in using admission order sets or care pathways, these kinds of things. I think they’re smart. I think they work. There’s evidence in the literature that patients do very well when they’re placed on these things.

Regarding clinical decision support, I think their only issue there is that you have to worry about alert fatigue. I think you can overdo clinical decision support where physicians will be able to ignore the suggestions. I think that there’s a fine balance there as to how you offer that in the electronic medical record setting without creating alert fatigue, but I think it’s smart stuff.

I think any time you’re about to prescribe a medication that’s going to interact with the patient’s blood thinner and you hadn’t thought about it, you get a nice alert that says, “Whoa, didn’t you know they were on Coumadin?” or whatever. I think that’s perfectly fine. You’ve just got to be careful how often those things trigger and at what levels.

Does Memorial have much in place in terms of clinical pathways?

Yes. Not all of our hospitals are on computerized physician order entry. We have a few that are, and they use order sets and there’s clinical decision support tools and things like that that are being rolled out.

Shifting gears a bit, how will recent healthcare reform affect Memorial? Are there changes being considered or that are being put in place to control cost and improve efficiencies?

I would say Memorial Hermann is always engaged in continuous improvement around being more efficient, controlling costs better, etc. I don’t necessarily know that the healthcare reform law has changed what we’ve always done around here. We’re a not-for-profit, community-owned healthcare system. We always practice good stewardship of our resources, so there’s always that opportunity to look at how we’re doing things.

I think it’s going to impact us, though, just like it’s going to impact everyone else. You’ve got up to the 26-year-olds that you have to be able to offer insurance for under a family plan. The issues of the no-lifetime max, when that kicks in; issues of the no pre-existings, all these kinds of things.

Our health plan is self-funded and I don’t think we’ve ever, for employees or dependents, turned anyone down for pre-existing illness, but we’re going to have the same kind of pressures. We are a healthcare provider and healthcare system, so I think we will always do our best to provide a benefit for our employees.

But unlike us, I think there are going to be, maybe not so much in healthcare, but certainly other industries, where large employers and even small employers are going to have to weigh the option of — do I provide a benefit or do I pay the fine? Which is less expensive for me? Then let the employees get out there and get insurance on their own.

The other thing we worry about is really how strong will the individual mandates be? What are the chances that instead of more people having insurance, actually less people have insurance? You know, there’s always that chance that actually, individuals, if they’re not being provided insurance through their employer, may say, “Well then, I’m not going to go buy it on the open market until I absolutely need it.” So what are the chances that actually the uninsured will go up?

There’s just so much uncertainty and potential unintended consequences that the best I can say is we’ll just kind of hunker down and try to do our best to be prepared.

How is the health system positioned for qualifying for Meaningful Use?

I’m not the expert on that, but I can tell you according to our chief informatics officer, we are extremely well-positioned for Meaningful Use. I think we’ve hit all but one of the last remaining checkmarks. We’ve been named one of the most wired companies in America and all that kind of stuff.

Trust me, we’ve got an ISD team that’s second to none. We’ve got a leader there who is really, just a rock star, and he’s been with us for several years. Very well respected. We’ve done a lot of work in that area and I can assure you, we’re there. We’ve done a lot of work on that one.

What are your priorities for the next five years?

I can tell you that my boss, the president and CEO, Dan Wolterman, said that my number one priority is learning everything I can about Accountable Care Organizations and preparing all aspects of our physician organization to be prepared to move in that direction. That really is the number one thing.

A lot of it is working with our IPA and our clinical integration model to use that as a tactical platform to get us toward an ACO strategy. Also, to integrate with our employed physician enterprise to basically do the same. It’s about helping the physician organization develop all of those aspects of high-quality, cost-effective care in partnership with the healthcare system.

Healthcare IT from the Investor’s Chair 9/28/10

Capitalizing a New Venture: So Many Choices…

I appreciate everyone who reads, especially those who leave comments. A comment on my previous post asked, “Isn’t it ALL about the patient?” 

As I pointed out in my response, for better or worse, healthcare in America is all about entrepreneurship — from medical spas to physician-owned hospitals and imaging centers to million-dollar salaries for hospital execs (I agree wholeheartedly with Mr. H on that topic, btw) to software entrepreneurs like Neal Patterson (Cerner), Judy Faulkner (Epic), or Randy Lipps (who realized that supply storage could be improved while his child was in the hospital and so founded Omnicell).

Anyone in the healthcare system, from physicians to business people to lab managers, who realizes that the current system they are using or experiencing just isn’t working as well as it could or should can decide to take the risk and form a company, develop a product, and go to market. Even before ARRA, HCIT attracted more than its fair share of entrepreneurs. That’s what makes this sector my favorite playground.

That said, I think it’s more like the playground of my youth. Before safety was the law and springy floors and safety teeter-totters came into being, it has historically been an area where start-ups thrive, but a disproportionate amount of investment dollars have been lost. Never a dull moment.

Hopefully someone reading this has started or is thinking of starting a new venture. Let’s explore their options along the continuum to finance it.

Friends and Family

Just what it sounds like. It’s going to Mom and Dad, Rich Aunt Joan, Crazy Cousin Bill, your stoner college roommate who was employee #55 at Google, and all the other friends you ask to put money into your new venture.

This is clearly a mixed bag. While their terms will likely be the most generous and they’ll likely value your new venture at the level you think is fair, these shareholders can be demanding in a psychic way. Family gatherings could turn into business updates. You’ll get calls on nights and weekends.

There’s the risk of that feeling in the pit of your stomach that if it goes wrong, you’ll have to face these people for the rest of your life. Hmm, sounds like a more expensive form of capital then I originally thought.

Angels

“Angel” typically refers to high net worth individuals who invest in private companies for themselves, as opposed to within a fund.

Angel investing has been on an upswing over the past few years for several reasons. First, with the stock market’s mixed performance over the past five years, this class of investor is looking to enhance their returns with some non-traditional investments. More importantly, angels are filling a gap that has resulted from the decreased popularity of traditional venture capital (discussed below).

Angels are typically much closer to the friends and family investor. They also have some of the same pros and cons.

On the positive side, they’re typically easier on valuation and they’ve often been entrepreneurs themselves. On the other hand, they’re not professional investors and so might lack some of the dispassionate views that a VC can bring. While they might have run companies, they might not know healthcare or software at all and might insist that their great success running a plumbing supply business obviously translates to your venture.

Their lack of a traditional venture fund (and its limited partners) cuts both ways as well. Where a VC might care only about an ultimate sale (or IPO), an angel might care more about receiving cash distributions. If you want to invest for growth, that could be a source of conflict.

If you have a choice of angel investors, as the knight in Indiana Jones and the Last Crusade said, “Choose wisely”. Do they bring experience and industry knowledge and contacts, or are they just a source of funds? Whichever it is, would they answer that question the same way that you would? How active do they want or plan to be? Will they want a board seat? Even if not, what will they require for ongoing communication as well as general care and feeding?

The importance of clarity and alignment of goals, vision, and timing here simply can’t be overstated. More than ever before, angels are starting to organize around their activities. Many top-tier business schools and tech associations have formed quasi-official angel groups.

Venture Capitalists

Traditional venture capitalists (VCs) are professionals at investing in private companies. Typically structured as a partnership, the investors (limited partners) tend to be foundations, pension funds, endowments and often high net worth individuals.

Research (and my observation) shows that VCs can bring much more than capital to their portfolio companies. They typically have strong networks in the sector and a great ability for pattern recognition, often having seen similar companies grapple with similar issues.

One of the most successful HCIT entrepreneurs I know once told me that, after herself, she attributed her company’s success most to the VC involved. This clearly suggests that valuation (and even terms) shouldn’t necessarily be the key factor in selecting one’s financial partner.

Beyond that, however, I’ve observed a huge continuum of both personalities and skills. I’ve seen VCs add tremendous value and insight. I’ve also seen VCs where I’d suggest the entrepreneur sell a kidney on eBay before taking their money.

Another factor to consider is that different funds tend to invest at different stages of a company’s life cycle. Loosely defined, these stages range from: (a) a good idea and founder (Seed Stage); (b) great team and product (Series A); (c) proven product and critical mass of customers (Series B); and business seems to be working, but needs growth capital (Series C and beyond).

While topnotch venture capital funds are continuing to fund early stage companies (and HCIT is no exception), for multiple reasons (to be discussed in a future post), fundraising has become more of a challenge to earlier stage companies than ever before. Hence the significant growth in angel investors to fill the gap.

None of the Above

What other options might exist for funding early stage ventures? I’ve seen companies of all stages think creatively to help bridge funding gaps. Government grants (especially lately) are a source of capital. Sourcing expertise from academia can help reduce the burn (many business schools and engineering schools have programs for students to consult).

One of my favorites is customer or partner financing. Perhaps a distribution partner or a few customers will pre-purchase software licenses, allowing you to combine a revenue and capital event. This win-win scenario serves to both build a customer reference and development partner and help your balance sheet.

Many hospital systems now have internal venture funds as well. These range in terms of stage of company they invest in (some are more risk-averse than others), but can also provide an appealing imprimatur to the marketplace of both customers and ultimate investors.

As I said, even though I don’t guard the Grail, my best advice here is to choose wisely. From my research days to now, when I’m looking at a company, one of the first things I do is see how they’re capitalized and who their investors are. Whether it’s shallowness or just a lesson learned, I find that it can tell me a great deal about a company. Is this a fund with a reputation for thoughtful investing and management, or an investor that typically throws companies to the public before they’re ready to maximize their own returns? Are there angels involved with experience and reputations for success?

While perhaps not the best way, assessing the backers is sometimes an efficient way of coming up with preliminary judgments about companies and their management teams.

Thanks for reading, but I’m afraid I’ve run out of space before even getting to Private and Growth Equity investors (who are sometimes also known as leveraged buy-out investors). While I touched on this in my Take Private post, it probably warrants its own, so let me know if there’s interest.

In the mean time, I’ll be attending the Health 2.0 Conference in San Francisco. That will be the topic of next month’s Investing Chair post. If you’ll be there and would like to chat, drop me a note.

Ben Rooks spent ten years as a sell-side equity analyst covering HCIT and related sectors before spending six years as an investment banker where he closed transactions ranging from $40 to 365 million. Seeking to make an honest living, he then founded ST Advisors, LLC where he works with healthcare companies and their sponsors, most often on issues around strategy, financing, and outcomes/exit planning. After all this time, he still can’t wait for HIMSS!