HIStalk Interviews Hamid Tabatabaie, President and CEO, lifeIMAGE

Hamid Tabatabaie is president and CEO of lifeIMAGE of Newton, MA.

Tell me about lifeIMAGE.

lifeIMAGE is a company that got started a few years ago with Amy Vreeland, my co-founder. The two of us had finished a successful career at Amicas. After we decided that the market was on its way to adopting PACS entirely, we decided there was a gap between what happens inside the facility with their PACS and what the needs are outside the facility to have access to that data.

We spent some time and came up with a product design and a marketing approach to make it practical to essentially create a network on which anyone can exchange information with anyone with relative ease. We are in the market primarily offering services that let people deal with outside images. We allow hospitals to receive outside images electronically. If they receive them on CD, we have a workflow that addresses the complexities that exist today with the CDs.

Over time, we will add services to enable people to deal with consumers when necessary, to deal with community physicians whenever possible, and generally bridge the gap that exists today, all the way to having access to anyone’s images at the right time and the right place. Specifically, having a smart network.

I hope that’s who lifeIMAGE ends up being. We’re doing everything we can to get it there.

What’s the general state of interoperability and data sharing with diagnostic imaging systems?

It’s really not good. It’s spotty at best. There is an underground world of image sharing that goes on today that no one really has the right applications for, no one is responsible for. People have CDs and thumb drives and still film, primarily, as the way they exchange imaging information.

It used to be that the useful life of an image ended when the report was done. Now that images are much more pervasive, especially among whom we call image intensivists. The real useful life of an image starts when the report ends. People receive the report to know what they need to know, and they use images for where they need to go anatomically and otherwise.

There’s a huge need, unfortunately, today that is being satisfied with various manual routines and workflow, and/or at best, a Home Depot-style of putting parts and pieces together to accomplish specific use cases.

When you look at the financial and clinical impact of that lack of access or that substandard way of accessing images, what is the impact of having these workarounds?

The financial impact, to start with, is tremendous. In that, everyone agrees. Various different research shows that somewhere between 10-20% of all exams are duplicate exams. Arguably, a larger percentage may be unnecessary exams, but physician support capabilities will hopefully affect the unnecessary exams. The duplicate exams we can stop by having a reliable network. If you believe those numbers, the financial impact starts somewhere around $10-20 billion to our healthcare system.

Then there are financial impacts outside the system. Every time Liberty Mutual is in the middle of a case for workman’s comp, they spend a lot of money getting images from the patient, and to their experts, and to their lawyers, and to the surgeons that afterwards see the lawyers. Those costs are ultimately passed on to the consumers via more expensive insurance bills. We can avoid those costs and hopefully even have an impact in that arena.

Self-insured companies that have a direct relationship with their healthcare expense assume that self-insured companies simply has a rule that says if you ever imaged one of my employees, you have to give me back the images and report somehow that I can avoid the next doctor who would want to otherwise order the duplicate exam. You can imagine that you can extend that to the Medicare and Medicaid patients, to the Blue Cross and Aetna patients.

All together, the cost really starts at $20 billion when you want to look at it from a macro point of view.

At the micro level, the duplicate exams used to be a revenue point for radiology departments, but the new financial arrangements between radiology departments and payers even erode that value.

I would assume there’s patient impact because of lack of timely treatment or over-radiation with retakes.

That’s absolutely a side effect. The financial impact of that alone is all the mistakes that can be made, all the delays it can cause, additional costs and complications. Simply avoiding the duplicate exam is a great deal of value, never mind the negative side effects of it.

You’re selling your offering as service. Who pays for the service and how is it priced?

That is, I think, a compelling point to get people to want to initiate connection to these potential exchanges. We charge the hospitals and imaging service providers, but they have a cost themselves, whether it is for the ingestion of the CD or for delivery of results to the patient or community physicians. We simply replace those costs with better services and less expensive approaches, much more effective at the same time.

Our business model is very much on a per-month basis. You effectively become a subscriber to whichever one of our services. You can almost think of us as a cable box that you choose to have various channels on, and for each channel you pay a monthly fee. Sometimes it’s dependent on the number of exams, sometimes it’s dependent on the size of facility you are. But invariably it’s always less expensive than the current costs.

You just signed Moffitt and Memorial Sloan-Kettering. How do you market to hospitals like that to get such prestigious clients?

We have them on our mind when we design products, when we design services, and when we design our pricing.

We are very mindful of the fact that specialists and sub-specialists are the ones who want to have access to these images more than anyone else, so we target those with the most intensive specialty population. Cancer centers, as you can imagine, are not only a great focus of a lot of specialists and sub-specialists, but also their patient population migrates in and out back to their local communities. That itself is a primary need for imaging exchange between the centers for specialty, like the cancer centers, and the patient and the community physicians.

Tell me a little bit about the size of the company.

We are a relatively young company. We started officially two years ago almost. Unofficially, three of us founders have been doing this for another three years designing things. Today, we are just under 40 people, full-time employees, and perhaps another 20 people in various contract positions.

A lot of the management team came from Amicas. What lessons did you learn working there that you’re using at lifeIMAGE?

I think Amicas, without question, was one of the early innovators of using Web technology for imaging access. We’ve continued the culture of innovation at lifeIMAGE. Our focus is on doing the right thing, and in the process, creating yet another disruptive technology. This time around, you learn both operationally how to run a much more efficient company and you learn how to more effectively market.

At Amicas, we learned a lot about radiology and radiologists. What we’re doing in lifeIMAGE is to focus on the specialists and the sub-specialists in their relationship with the radiologists. I can compare Amicas and PACS companies to the ‘local call’ equivalent of an imaging system, and lifeIMAGE is the ‘long-distance call’. You need to think about the outside world, and the need of the outside world, in order to design a system.

The lesson we’ve learned is how to focus on one constituent for one reason and other constituents for other reasons.

When you look at some of the other imaging companies like Amicas and Merge and Emageon, how do you hope the business evolves for lifeIMAGE?

They will continue to have their great place in the industry. PACS systems have been very much adopted universally and there’s almost nowhere that PACS doesn’t exist. These are complex systems that over time need to be revamped, rewritten, and bells and whistles added and so forth, so they have plenty of backlog to satisfy their markets.

We are an innovative company outside of the market. We start our life with the long-distance aspect instead of the local aspect. I think there’s a tendency to have a cooperative relationship between the ‘local call’ and the ‘long-distance call’ and similarly, our relationship with the PACS companies will be that way. Invariably, the lifeIMAGE environment can be used by smaller settings as the Salesforce.com model for some of the imaging functions that one can assume companies will offer in the future.

Your Web site uses common internet metaphors such as ‘inbox’ and ‘dropbox’. How important is it that your system be easy to use?

I believe after security and reliability, usability is by far the most important aspect of the system. Every time you try to change the current habits of busy people like doctors — or anyone, for that matter, who’s terribly busy — you have a challenge of introducing yet one more thing they’ve got to get used to. The easier you make that experience, the more likely it is to have adoption. Obviously, the choices of our naming conventions are not an accident. I invite you to take a look at some of our products to see that the design and the usability criteria for our systems follow that design.

I was interested in the company’s vision statement that is built around the concept that there will be health record aggregators that will be the equivalent of banks for consumers; and also, that there will be some sort of incentives offered like there is for Meaningful Use for providers to share images. Can you explain how that all fits together?

I think if we fast-forward some years — I don’t know how many years that exactly will be, but it won’t be too long and it won’t be very quick — we will be at a place where a patient walks into a facility and their medical record will be available to their new care providers just as easily as the current and local records.

In order to satisfy that, you have to envision a lot of social economics, political, regulatory functions will get a hold of something like this and bend and twist it to the satisfaction of how you can practically use environments like that. As a result, it’s very much likely that these will have regional flavors. I can see various networks have the capability of reaching across one another’s network so an AT&T subscriber can make a call to a Verizon subscriber — that sort of analogy. But yet among the Verizon users and among the AT&T users, they may enjoy a certain kind of behavior that is unique to them. That will satisfy some of the pressures that will come from various constituents I named and alluded to earlier.

Ultimately, I think the insurance companies and the payers stand to benefit from the exchange and the networks that enable these sorts of exchanges. But ultimately, I think we will have a way for them to either entirely or partially subsidize the costs of these kinds of networks.

I can see a relationship very much like the banking system between the Federal Reserve and the private banks. There will be some overwhelming and overarching missions for the new networks that will be governed by some hopefully good practices. But yet there will be some private providers like lifeIMAGE which will satisfy either regional or national requirements.

Any final thoughts?

From what I’ve read on your blog, you know the market well enough to put this in the right context. But really, somebody needs to kick-start the ultimate goal of healthcare information exchange. Those of us who’ve been around healthcare IT like you know that the concept of boiling the ocean never works. You have to have very, very clever, deliberate places and then you market the technologies in order to achieve some end goal. Imaging tends to be a very good, sticky one. 

The question that I would have wanted to answer if you had asked was, why start with imaging?

The answer may be obvious to you, and that is it already enjoys a great deal of standards. It is a very expensive component of our healthcare expense, and probably just second to pharmaceuticals. It is a growing expense even if we control the expense and utilization.

We are at the infancy of the benefits imaging bring to medicine. We better learn how to take advantage of this, while on one side, not bringing the costs up; or on the other side, choking innovation because it is an incredibly important component of diagnosis. Imaging to me: is a good place to start because there are a lot of good standards and it is very much universal — it exists in almost all sub-specialties.

Patients are already used to touching their CDs and being the courier from one point to the other. Finally, it can act as a catalyst for some of the rest. For instance, we allow attachments to be sent with images. So not only are you looking at somebody’s echocardiogram, but you’re also looking at their EKGs and their medication history.

That’s what’s really needed to have meaningful information at the other end. Hopefully there will be CCR- and CCD-type of standards that govern how to ingest those documents as well. But in the mean time, let’s satisfy the clinical needs.

Monday Morning Update 9/13/10

From Slinky Nighty: “Re: JPS in Fort Worth. They have definitely chosen Epic. They attended the Epic Texas Collaborative meeting this past quarter and are moving forward and looking for assistance.” Thanks for both the info and the name imagery.

From Old IS Person: “Re: Siemens. They’ve started a second help desk for radiology and PACS products, so those of us with multiple products are supposed to use two different systems just to report problems.” Don’t get me started on vendor help desks. Like the one from one of our key vendors who brags on how fast we’ll hear from an analyst, but it takes days to weeks to get anything other than the automated e-mail response that says “I have your case and I’ll get to it when I get to it” (I’m paraphrasing slightly). Not that it really matters since 90% of the time, the answer is, “Oh, we know about that problem and it’s on development’s list,” which paraphrases into, “It’s kind of a pain for us to fix that, so we’ll just add it to an Excel worksheet that nobody ever looks at.” Do some of the issues vendors ignore in this way endanger patients? No question. I bet if they were forced to go public with their open issues list they’d be a lot more responsive.

From Tupelo Honey: “Re: CPHIMS. I got an e-mail from HIMSS asking them to send me a glowing letter about all that having CPHIMS has done for me, which is mostly nothing. I am guessing that not so many people are signing up or renewing.”

From The PACS Designer: “Re: OpenMRS. TPD has posted about the third world medical record system called OpenMRS and how it was being used in Uganda, where Brigid O’Gorman is presently trying to educate their countrymen. Now they have improved their Web site and expect to release a new version OpenMRS 1.7 soon.” I noticed they’re having their Implementers Group Meeting in Cape Town, South Africa this weekend (group pic above).

From EHR Geek: “Re: HISsies. PLEASE do those again! The ones you posted today are still relevant and hilarious! ROTFL!” Thanks. I’ll try to crank out some cynically funny stuff again since I miss doing that, although someone always complains if I write anything that isn’t just a bullet list of facts addressing only those precise news stories that interest them personally. Meanwhile, you can check out the 2006 HISsies recap or one of my phony news items, of which here are a couple for old times’ sake.

HIMSS Announces 2008 Conference to Be Held in Baghdad
(CHICAGO, IL) HIMSS has announced that its 2008 Annual Conference & Exhibition will be held in Baghdad, Iraq, following a successful 2007 stop in New Orleans. Steve Lieber, CEO of HIMSS says that HIMSS has learned that it can benefit disaster-stricken cities by flying in planeloads of attendees with large expense accounts, a concept first tested by bringing conventioneers to New Orleans shortly after it was virtually destroyed by Hurricane Katrina. "We’ve proven that we can all have a great time at a site mostly known for death, civil disorder, and senseless violence. We’re going to have a blast in Iraq, no pun intended," said Lieber. HIMSS sources indicate that the surprise speakers for the "View from the Top" session may be Saddam Hussein, Donald Rumsfeld, and Neal Patterson.

Hospital Trainer Collapses During Class
(DAYTONA BEACH, FL) Todd Cleaver, a 41-year-old computer trainer at Halifax Hospital, was stricken this morning with an apparent heart attack while leading a computer class for nurses. He is reported in stable condition and is expected to recover. Debbie Dallas, a registered nurse attending Cleaver’s electronic clinical documentation course, said he was working with her one-on-one when he collapsed. “He was starting to tell me how to make a flowsheet entry and I just reached over and did it correctly. Then, he was going into switching between Windows tasks and minimizing windows, and I showed him I could that, too. That’s when he went down.” Cynthia Roda-Tiller, education manager for Halifax, says she believes that Cleaver suffered a strong physiologic reaction upon seeing a nurse use a computer intuitively. “Usually they just stare at the screen like it landed from Mars or they start clicking everything in sight like it was Whack-A-Mole. You’re thinking, ‘they let you use medical equipment?’ I’d like to think I could have handled it myself, but it’s making me shake even now. I’m not sure I even believe she’s really a nurse, at least not one I’d want working my bedpan.”

Somebody must have gotten to the Forbes writer who wrote a generally negative article called Bribing Doctors To Go Electronic. Its implications: North Shore-LIJ and Allscripts are struggling with their $400 million to implement EHRs for 9,000 doctors, it’s taking doctors longer to get their work done, they’re pawns of the government, EHRs are a tough sell culturally, and community docs don’t like hospital-hosted EMRs because they don’t trust hospitals. Careful readers may have noted that he talked to a grand total of two docs (both recently implemented) in writing the lengthy piece. Now he’s backing off in a mea culpa that says he wasn’t trying to write a definitive article on the value of EMRs and that those complaining early adopters recognize their value because they volunteered. I guess the two pieces cancel each other out, other than the time it took to read both.

As New York, Nashville, and Cleveland race to book tenants for their medical trade center buildings, the Nashville group says it’s not worried despite not signing anyone except HIMSS for its 1.5 million square feet of space scheduled to open in 2013. Reason: it says HIMSS will bring 85 to 125 companies to lease space in their building, with a handful taking up to 15,000 square feet.

Hey, it’s only $20 million, which is a HITECH rounding error, but ONC throws more money at RECs, this time as a little extra to help critical access and rural hospitals.

Stanford’s Lucile Packard Children’s Hospital appeals the $250K fine levied by the state’s health department when the hospital waited 11 days before reporting a stolen PHI-containing laptop. They fired the employee who took it home against policy.

Ivo Nelson, chair of Encore Health Resources, joins the board of Health Care DataWorks. That’s the Ohio State spinoff whose CEO is former OSUMC CIO Herb Smaltz.

The Bethesda Hospitals’ Emergency Preparedness Partnership (Hopkins Suburban Hospital, National Naval Medical Center, and NIH) chooses Versus Advantages RTLS for patient tracking in emergency care areas during mass casualties. The Versus product met its requirement for 95% accuracy down to the room level and also links patient information to location for emergency responders.

Not many folks think that the average EMR will give providers enough information to manage population-based risk. New poll to your right: if you were filling a position, what impact would a candidate’s CPHIMS credential have on your decision? Tupelo Honey wants to know.

Ken Rardin, former CEO of Merge Healthcare, IMNET Systems, and a couple of non-healthcare companies is named CEO of telemedicine provider REACH Call of Augusta, GA.

This could make a an interesting novel: the former CFO of Danbury Hospital pleads not guilty to scamming the hospital by approving phony invoices for contract management software from a software company he ran from his house. He adds witness tampering and harassment to his list of charges after e-mailing the hospital president begging him to make the charges go away despite a hospital-requested court order to keep him away for fear he would go postal. He closed his plea with, “I got no place else to go (quote from An Officer and a Gentleman)” The judge nearly put him back in jail for that, but the man’s attorney made a convincing argument: “He would have to be a total idiot to do this again.” Ever the CFO, he showed up in court with a sports coat over his jail coveralls.

One of two winners of IBM’s SmartCamps start-up competition: CareCloud, a Miami company offering physician practices a $499 per-doc-per-month practice management system with social networking thrown in and revenue cycle services optional. I’ve mentioned the company a few times previously when they won an award and were pitching at the Health IT Venture Fair at HIMSS. Points off for their latest blog entry extolling the virtues of Twitter, which they summarize in a grammatically incorrect manner as, “… us enlightened folk know that the conversations on Twitter are insightful and illuminating.” They must be living in an alternate Twitterverse than the one I’ve seen, which combines the worst aspects of text messaging and Facebook but at least allows only 140 characters of time-wasting, stream-of-consciousness preening (if they would ration the number of tweets like they do the number of characters, they’d be on to something). Do we really need to hang on the every un-profound word of vapid celebrities, self-appointed pundits, and a guy having a heart attack?

Here’s another example that healthcare is different when you have money: a new startup called ExpertConsensus will take your tough medical problem to a group of big-name doctors who will teleconference and make their collective recommendations. The company’s minimum charge: $20,000. I hated that concept until I thought about it: they’re offering convenience for those willing and able to pay, but patients on a non-$20K shoestring could find these docs on their own and pay just a consultation fee to get the same opinions (or pay Cleveland Clinic a few hundred dollars for an electronic second opinion, which I can’t believe isn’t more popular than it seems to be). ExpertConsensus offers other services seemingly unrelated except for their common denominator of buck-making opportunity: research reports, care management, on-site clinic setup, physician referrals, wellness, and personal health records.

Louisiana doctors will have to pay back $17 million in Medicaid overpayments because the state’s Department of Health and Hospitals just now got their computers programmed to handle budget cuts that went into effect 13 months ago. Said one doc who says the cut will put him out of businesses, “We’ll gut it out and when it’s obvious that we aren’t making ends meet, we’ll all retire.” I need to give docs some PR advice for those situations where they’re complaining about making less money: don’t say “retire,” but instead say “find another line of work.” People hearing “retire” assume that means you’ve milked your medical practice to the point of not needing to work any more, which doesn’t exactly bolster the “we’re poor” argument.

Interesting: doctors at McGill University in Montreal administer anesthesia electronically for a surgery being done in Italy, a pilot project for “teleanesthesia”. They managed the patient using video cameras and remote dosing computers that make up what they call “an anesthesia cockpit.”

I’ve written before about the UK’s hospital radio stations, charities run by volunteers and featuring patients and family requests. London’s Radio Marsden, which runs 24 hours a day for patients in two cancer hospitals, will move its service to the Internet this month to allow patients, friends, and families to listen together. I’m listening to Bowie’s China Girl on it right now, followed by the Talking Heads doing Burning Down the House and an announcers’s suggestion that patients ask for hospital pens and paper to write letters home. Hot on their playlist based on patient requests and favorites: Lady GaGa, 30 Seconds to Mars, Alicia Keys, Kinks, Billy Ocean, The Clash, and The Saturdays, among others. It’s kind of addictive.

Former Sun CEO Jonathan Schwartz, who replaced Scott McNealy for a short time before selling the company to Oracle, gets involved with a healthcare-related startup, Picture of Health. He’s not saying what the company will do. 

A hospital ED patient is arrested for assaulting another patient and then pulling a knife on an ED nurse. The man’s occupation: minister.

E-mail me.

A Mr. H Book Review
Safe Patients, Smart Hospitals
By Peter Pronovost, MD, PhD and Eric Vohr

A reader asked me to review this book, so I bought a copy. I interviewed Peter a couple of years ago, before he won the Genius Grant. It’s still one of my favorite interviews, with this as my favorite quote from it:

That’s the tension that we have. How much evidence do I need to give up my autonomy? We’re still uncertain about that. As an industry, healthcare is grossly understandarized. Compare that to pilots who have to use checklists or they won’t be flying. Healthcare is still very much like the Wild West or like Chuck Yeager in The Right Stuff, where we have this cowboy mentality and we’re just beginning to accept that standardization is a key principal to making care safe.

That frames up the book nicely.

My first thought when seeing the book (published just this year) was, “Hey, I get it, providers need to make lists … why do I need to buy the book since I already know the ending?” There’s a lot more to it than just making lists, however. The book is really about translational medicine, rigorous measurement of healthcare quality, and the patient harm caused by the toxic culture of hospitals and physicians. Here are the takeaway points.

• Doctors and hospitals harm patients because of poor communication, not following rules that are indisputably beneficial to patients, and not using proven research in their treatments.
• Culture dictates that doctors and hospitals pretend that they don’t mistakes and to avoid admitting them when they do.
• There is no wisdom of crowds in hospitals. Doctors are trained to be sole decision-makers and to lash out if anyone questions their decisions. Not to mention that Peter’s background is in academic medical centers, where the problem is tiny compared to community hospitals with their non-employed doctors who are always complaining to administration and trying to get employees fired for looking after the best interests of patients.
• In terms of communications, even on his own rounding team, only 5% of residents and nurses could articulate the care goals for a patient who had just been the topic of a 15-minute team discussion. You wonder what they would have concluded without the team discussion and armed only with a paper or electronic medical record, given that academic medical centers are a small percentage of hospitals and others don’t do that kind of rounding at all.
• Overworked doctors will break rules for a single patient if they think the greater good is served. Every doctor knows to wash their hands before and after seeing each patient, but only 30% actually do it because they’re busy or supplies aren’t available.
• Communication in the OR is especially bad, where the nurses know everybody’s name but the surgeons see just a sea of scrubs and have no interest in names and roles. The pecking order is inviolable.
• Some tasks or procedures can be summarized into a checklist of no more than 5-7 evidence-based items, no different than a pre-flight checklist. The list can be developed locally to encourage ownership.
• Even though Peter’s work has saved thousands of lives and hundreds of millions of dollars, most of that came from just one checklist (central line placement) out of thousands upon thousands of medical procedures and tasks. That’s either a wide-open field or a depressing commentary on modern medicine, depending on your perspective.
• Non-clinicians, like administrators and probably IT executives, aren’t usually comfortable getting out on the floors but can play a big role on offering a fresh perspective for problem-solving and in understanding how projects are financed, staffed, and run.
• Doctors practice as they were originally taught in school using the “see one, do one, teach one” model that tells them to ignore everybody else’s opinion and go with their own. Good teamwork means a nurse doing what the doctor says. Doctors are not taught to communicate or to manage stress. They do not have time to keep up with the literature. There is no standardization, even within one organization. Residents make mistakes because they don’t want to look stupid by asking questions.
• Checklists worked in aviation because the industry admitted that pilots make mistakes and took the attitude that every crash is preventable. That hasn’t happened in medicine, where hospitals and doctors refuse to admit that they are not infallible. Even Hopkins (arguably the best hospital in the country) defended its catheter infection rates (among the worst in the country), using the “our patients are sicker” argument. After using Peter’s methods, their infection rate dropped from 19% to near zero, saving an estimated eight lives and $2 million.
• Quality requires central analysis of data. You don’t know what’s working without data. No other industry would tolerate healthcare’s sloppy data practices.
• Making the list is easy. The hardest and most important parts, which hospitals always want to skip, are evaluating the culture, making sure every patient is treated using the list, and measuring the results.
• State-wide projects don’t always work. They took shortcuts, made data reporting voluntary, and let turf wars (infection control docs vs. intensivists) compromise the plan. But in Michigan, their infection rate dropped from 2.7% to zero when they swallowed their pride and followed the plan.
• Medical research gets all the funding, while patient safety research hasn’t. Part of healthcare reform is creation of the Office for Patient Safety Research.
• The only profit to be made in patient safety is for insurance companies.

I extrapolated his thoughts into IT:

• Peter said in my interview that errors will go up when CPOE is introduced because it’s a change, nothing is standardized, and CPOE is set up to look like the paper it’s replacing.
• Decision support is the real value of CPOE, but it’s not usually added until afterward.
• Every hospital has to develop its own clinical decision support rules, which is like each airport having to build its own air traffic control system.
• IT systems can support enforcing the lists and reminding providers about them.
• Use shared decision support rules to begin standardization and using best practices.
• Look at data collection, reporting, and transparency. Peter found that virtually no hospitals have the right information in their databases to be able to know their infection rates.
• Use these methods for IT project rollouts and maintenance to reduce mistakes and to remove vendor and IT pressure to do something harmful.
• Find ways to get research into practice. Why is research a science, but the practice of medicine is an art?
• For vendors, build support for lists and reminders into applications, where they can be cued by workflow.

It’s a bit disconcerting to see just how inconsistent healthcare delivery is. It’s based on science, but often is a long way from being delivered in a scientific way. The major point of the book is that nobody’s head is big enough to hold all the information about medicine and research findings, so practitioners often are endangering patients by what they don’t know or don’t practice.

Few would doubt that the book outlines incredible opportunity for improvement in every kind of patient care setting. We’re talking saved lives, not just saved dollars. The good news is that’s exactly what computers are good at. Giving providers access to lists, providing immediately usable reference material (how-to videos, audio instructions, etc.), linking to the evidence, and offering collaboration platforms could all be key elements in implementing the quality measures called for in the book.

This is an excellent book, although it will make providers question their core beliefs about the healthcare system they work in. It’s pretty screwed up, as we know, and getting worse. The goal isn’t perfection, it’s improvement, and that won’t be easy (if it were, everybody would already be doing it). Are there enough providers who can look beyond the knee-jerk reaction of just making a Pronovost list and claiming mission accomplished to actually improve healthcare quality? Maybe or maybe not, but if enough at least try to tackle their problems in a rigorous way, they’ll probably avoid killing a few patients.

News 9/10/10

From A. Nonnie Mouse: “Re: Kadlec Regional Medical Center (WA). Turfing McKesson inpatient and GE Centricity and moving to – surprise! – Epic. The number of Epic customers in Washington and Oregon make Epic CareEveryWhere something of a de facto HIE.” Unverified, but the hospital is running Epic recruitment ads, so your information may well be correct.

From FortWorthFan: “Re: JPS Health in Fort Worth, TX. I noticed they are hiring Epic Revenue Cycle analysts, but I don’t recall ever reading that they selected Epic as their replacement clinical system.” I’ll guess they’re going Epic since this position listing seeks Epic clinical analysts. From this job opening, it appears they are seeking a CIO as well.

From Tina LaBoeuf: “Re: HISsies. I miss your hilarious write-ups of the awards announcements that went away when you started the awards party :(” Tina’s comment sent me to the search function to find and relive those moments. I did find them amusing, especially since I mixed in actual winner quotes with my phony recap. You can read it here if you enjoy these snips from 2007, featuring as host my alter-ego, former HIT sales jock Billy “Biff” Jutjaw:

Imagination at Work? Must be talking about their Carecast guys porn-surfing at their desks! Zow! Rimshot! BA-DUM-PAH. GE guys … hey Jeff … we need one of your lightbulbs over here … yeah, a replacement for that faulty one that went off over your head when you bought IDX! Owwww! But I kid. What a great evening! What a constellation of industry stars! What a rack on that broad at Table 3! … Say, Chuck, let’s see who’s here. Hey, are we in the Ying or the Yang side of the house? Judy must have been having a Woodstock flashback when she laid this place out. Where did she get compost-powered PCs, anyway? That Kool-Aid they drink here must have been from Ken Kesey’s original recipe! … Yeah, it’s like a CHIME meeting – you can’t swing a golf club without hitting two CIOs and four sales VPs clinging to their underbellies like remoras on a shark. … Come on up here, Howard Messing. Nice suit! Must be nice to keep getting awards for doing nothing! But I kid, old friend. MEDITECH was an established company when some CEOs were still backdating options in Monopoly! Booyah! Boston community swimming pools always hate it when MEDITECH starts hiring because they take all their lifeguards! Kapow! You know the first thing a MEDITECH employee says after getting home from work? "Mom, is dinner ready?" BAD-DUM-PAH. I’m like butter, baby, I’m on a roll!

Listening: new from singer-songwriter Sara Bareilles, thoughtful pop-tinged heartbreak music if you’re in the mood for that sort of thing. Watching on Netflix streaming: Studio 60 on the Sunset Strip, a stupendous 2006 dramedy series about a Saturday Night Live-type program (think 30 Rock played mostly straight with an amazing cast).

An expert tells South Shore Hospital (MA) that 800,000 patient records that were on lost backup tapes of their Meditech system can’t be easily accessed, so they decide against sending out breach notices to individual patients. They’re just going to run newspaper ads, which given the state of American intellect and newspaper circulation these days, means about a hundred people will see them, especially if they ads don’t appear in the sports or entertainment sections. This is the incident where the hospital paid Iron Mountain to destroy the tapes, only to find out afterward that the company subbed the work out to another company and lost the tapes in shipping.

In England, the dismantling of NPfIT appears to be underway, as the government cuts its total cost by $2 billion to $17.5 billion and decentralizing the project. Said the co-director of the Royal College of Physicians Health Informatics Unit, “One of the dirty secrets of the NHS is the regrettable state of medical record keeping. Earlier reports have shown that this compromises patient safety and clinical care. If IT in the health service is going to regain the confidence of the medical profession, then more emphasis has to be placed by the Department of Health on making sure that the new systems accurately capture the dialogue between doctor and patient. Everything else flows from getting that right.”

Speaking of NPfIT, an NHS Foundation Trust invites bids for a new patient care and e-prescribing system, opting out of NPfIT’s iSoft Lorenzo option because of concerns it’s not ready for prime time.

The latest ISMP Medication Safety Alert (from Institute for Safe Medication Practices) has a fascinating article about why the CMS rule requiring hospitals to administer drugs within 30 minutes of their scheduled times endangers patients. ISMP only posts excerpts online, but it was truly revealing as real-life nurses (thousands of them, in fact) describe why it’s unreasonable to meet that goal. The IT-related gist: we’ve put in eMAR and bar-coding systems and written cool “overdue” functions for clinical documentation systems, but hospitals have done nothing to address the challenges of nurses trying to meet a staggering variety of patient needs without turning into medication-pushing robots. This is one of those areas where non-clinical IT people would struggle with the idea that it’s not just calculating a “med overdue” time and dinging the nurse on a report. Everybody in involved in any capacity with clinical systems should read the full text of this article – it is a tremendous eye-opener for folks who’ve never trodden the uncarpeted areas of the hospital where the real work gets done.

Athenahealth CEO Jonathan Bush tends to be a “love him or hate him” kind of guy, but he’s still eminently quotable either way. He was definitely wound up for The New York Times. On why the company was in the birthing center business in the early days: “You know, Bush family noblesse oblige. I wanted to take advantage of all this education and support I’ve had and do well by doing good, and health care seemed like a place that no one else in my family had been much. A new approach to health care seemed to me to be the oil fields of 1997.” On the company’s competitors: “We are the only cloud-based service in an industry segment full of sclerotic, enormous, personality-free corporations that have been in business making 90 percent margins doing nothing for decades and decades.” On the cost of healthcare reform: “Oh, it’s going to go through the roof! It’s widely accepted that this is not a cost-reform bill — it’s an access bill … Eventually, consumers will need to eat a big part of their health care cost, because health care will fundamentally consume the entire G.D.P. in the not-too-distant future.”

It’s interesting that WellStar Health (GA) apparently fired its CEO after it was fined for excessive Medicaid billing, but it named the CFO as the interim president. Wouldn’t the CFO be the person most accountable for billing mistakes? Mostly unnoticed: they fired their general counsel as well. And from an IT standpoint, the CEO blamed their billing system (McKesson Star, I think). Does it get the axe, too?

We like Encore Health Resources a lot since they threw one heck of an HIStalk bash in Atlanta this year (as many of you told Inga and me afterward and we saw first-hand ourselves – that’s Ross Martin in the pic). Dana and Ivo are fun at work too, apparently — the company is named as one of Modern Healthcare’s Best Places to work in Healthcare 2010. That’s pretty cool for a new, small consulting firm.

Jobs on the sponsor job page: Project Manager – Healthcare Implementation, Eclipsys Activation Consultants, Technology Account Executive. On Healthcare IT Jobs: Metadata Administrator, McKesson Horizon Consultants, IT Applications – VP. That reminds me to mention that I made a Google Gadget that you’ll see to your right that has tabs for the Events Calendar, Healthcare IT Jobs, news headlines, and posts from HIStalk Mobile. I did that for two reasons: first because the WordPress events widget wasn’t displaying the calendar entries correctly, and second because I was looking for an excuse to build something.

I always like to highlight badly written press releases, so it’s imperative that I recognize this gem from a home monitoring technology company, which leads off with: “Cytta Corp’s CEO Stephen Spalding is pleased to announce that, after a series of well received presentations and demonstrations, Cytta has been invited to provide its first major proposal to a major healthcare payor/provider to develop an individualized monitoring system.” It’s a penny stock, but the price would need to go up fivefold to actually reach a penny, closing today at $0.0018 for a market cap of $1.83 million, doubling in price since April.

The North Carolina sheriff’s association proposes that the state give its members access to its doctor shopper database of known drug seekers, saying they “can better go after those who are abusing the system.” Privacy advocates are less enthused by the idea.

iMedicor launches its National Healthcare Communications Network, which offers practices secure messaging, peer collaboration, referrals, and CME. The company changed its name from Vemics last year, which seems like a good idea since that sounds like worm medicine. According to the site, it costs $24.95 per provider per month. It looks pretty cool to me. I can think of several business models that would work if they get enough subscribers.

Jim Bradley, former CEO of RXHub and Abaton.com, is named chairman of the board of e-health connectivity vendor VisionShare.

Let’s hope they aren’t big cloud computing or ASP users. Local hospitals (along with everybody else in four Tennessee counties) lose their Internet, cable TV, and telephone access for two days when some goober takes a shot at a bird sitting on the only cable line connecting that area to the rest of the world.

E-mail me.

HERtalk by Inga

Streamline Health Solutions releases its Q2 numbers: revenue of $4.7 million (15% better than last year) and a net loss of $76,000 (versus an $18,000 loss last year). The company attributes the higher loss to increased investments in marketing and hosting operations and the reinstatement of bonuses. Streamline also announced the promotion of Gary Winzenread from SVP of product development to COO.

CIO C. Martin Harris, MD of the Cleveland Clinic and former FTC commissioner Deborah Taylor Tate join HealthStream’s board of directors.

Hard to believe, but registration for HIMSS11 is now open. If you are a HIMSS member and pay before December 7th, registration is only $695. Mr. H and I are already strategizing about all the fun HIStalk-related things we’ll be doing. If you have ideas, let us know.

HHS unveils CuidadodeSalud.gov, a Spanish-language website to provide consumers with public and private health coverage options.

Mediware doubles its fiscal year profits to $3.24 million. Revenue for the year grew 17% to $47.6 million.

KLAS adds five new members to its advisory board, including HIStalk’s own Edward Marx, CIO at Texas Health Resources. Other new members include Alastair MacGregor, MD from Methodist Le Bonheur Healthcare, Kara Marx of Methodist Hospital of Southern California, Dan Morgan from Bay Medical Center, and HCA’s Noel Williams.

Forbes magazine profiles North Shore-Long Island Jewish Health System and its $400 million effort to help 9,000 employed and affiliated physicians move to Allscripts EHR. Though North Shore is taking advantage of relaxed Stark laws to subsidize up to 85% of system costs, so far only 175 of the system’s 7,500 community physicians have signed up. The health system’s chief executive admits there’s been resistance around “cultural stuff,” including concerns about North Shore’s hosting of the EMR data and discomfort with having to make work flow changes.

Wayne State University Physician Group (MI) chooses Orion Health Rhapsody Integration Engine to help create patient data exchange between their offices and other providers and facilities.

McLeod Health (SC) contracts with Merge Healthcare to integrate Merge’s cardiology workflow solutions with McLeod’s existing radiology product.

Perioperative employees at Southwestern Vermont Medical Center explain to the local press how their Picis system works, noting it “soothes some of that anxiety” felt by family members while loved ones are in the operating room.

Stamford Health System (NY) says its MedAssets Charge Capture Audit tool helped recapture $1.9 million in lost charges last year. It will also use group purchasing contracts, consulting services, and BI tools from MedAssets.

St. John’s Hospital (IL) selects Amelior Tracker from Patient Care Technology Systems for automated medical equipment tracking.

HHS awards a $980,000 grant to the University of Kansas Medical Center, University of Missouri, and University of Oklahoma to create the Heartland Telehealth Resource Center. The center will help physicians treat rural patients using telehealth technology. Almost 90% of the counties in those three states are considered rural with limited access to healthcare.

Sponsor Update:

• The Massachusetts eHealth Institute (MeHI) REC releases a list of certified EHR vendors and Implementation and Optimization Organizations. EHR vendors include Allscripts, eClinicalWorks, eMDs, Greenway, MedPlus, NextGen, and Sage. Implementation organizations include Culbert Healthcare Solutions, eClinicalWorks, eMDs, and MedPlus.
• San Juan Regional Medical Center (NM) will use the Universal Document Portal from Access to share information between its MetaVision ICU system and Meditech CIS. San Juan also uses the Access Portal to interface perinatal documents from its GE Centricity system into Meditech’s scanning and archiving product.
• Bridgehead Software and Dell introduce an enterprise medical archiving solution that combines Dell hardware with Bridgehead’s healthcare data management software.
• Nuance Communications introduces Dragon Medical Enterprise Network Edition for  large practices and hospitals. The new release includes a centralized management console and enhanced support for Citrix-based EHRs.

Medical office employees in Colorado smell a strong odor and discover the source is a dead animal stuffed into a filing cabinet. The clinic owner believes the incident was the result of a break-in, likely by a former employee. He does not indicate whether or not he suspects the prank was some sort of statement about the clinic’s need to move to an electronic filing system.

E-mail Inga.

CIO Unplugged 9/8/10

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

Does IT Matter: Six Years Later

In a 2003 opinion piece for the Harvard Business Review, Nicholas Carr threw a grenade on the IT dinner table. Carr argued vehemently that IT no longer mattered. He leveraged this high-profile editorial into a best-selling, thought-provoking book in 2004, Does IT Matter?

Carr’s central argument states that the strategic importance of IT has diminished over time; that IT has become nothing more than a commodity providing little competitive advantage. Consequently, according to Carr, companies should rethink their investment in IT. He also laid out his agenda for IT management, examining implications for business strategy and organization. Carr’s thesis was both embraced and vilified.

Written in the IT boom years, post-Internet “bubble,” does the economic downturn change the game? What about healthcare reform implications? Are we any different?

As I observe and research, I see fatalists and opportunists at odds.

The fatalist has accepted Carr’s pronouncement as fact and has become complacent, allowing the administration to marginalize IT. Opportunists, on the other hand, see the circumstances as the tipping point to reinforce, or for the first time, to position IT as strategic.

I interpret Carr’s compelling arguments as a call to action.

During these dour economic times and the uncertainty of healthcare reform, IT has a heroic opportunity to be a catalyst for prosperity, a key differentiator. This means I cannot sit back and accept current fate, allowing IT to dissolve into a simplistic commodity or back-office function.

To advance my organization, I hunt for and seize strategic opportunities. The economy will not determine my destiny if I choose to leverage it as a clarion call and make every effort to expand our services while lowering costs.

Our department reaches out to select vendors, changing our value proposition from transactional to transformational relationships. I shared this in-depth in Maximizing Vendor Relationships. It’s not about broad generalizations. Success is about the individual organization; its circumstances; and ultimately you, the IT leader.

As organizations look to cut spending, IT is not immune. Continual across-the-board expense reductions will underscore IT as a commodity and a cost center to be managed — Exhibit #1 for Carr.

Call me competitive, but I believe that companies that lay low and marginalize their IT will have a much lengthier recovery period. Especially when it comes to seizing the initiative on healthcare reform dynamics that are fundamentally changing the value equation of cost, quality, and revenue.

In contrast, those companies that seize the opportunity and invest in IT strategically will not only perform better, but will do so at the expense of their competitors. Some of our current work is going to change the competitive dynamic.

Think. Brainstorm. Mashup. Research and develop strategies that will propel your organization forward. Even if your company is panicking and relying solely on expense reduction tactics, present ideas that demonstrate bottom-line reduction, improve clinical outcomes, and support top-line growth. Innovation that will set your organization apart in dealing with the nuances of future payment and care delivery models. Insist on having your voice heard. Demonstrate ROI through IT’s transformative and innovative power.

For competitive reasons, I cannot share details, but we are doing these things. A risk-free example from my past happened at a community hospital. Our historic 45% market share in this two-hospital town was starting to plunge. Our cross-town rival was replete with cash, given their enviable position as part of a regional health system. Our board decided that the best antidote was not to reduce expenses, but rather to make strategic investments in IT.

One year after the implementation of affiliated practice-based EMRs, clinical inquiry application, and software to link referring physicians, our market position flipped. We saw a 20% swing, especially in our target areas of hearts, births, orthopedics, and neurosurgery. We were featured nationally.

I have additional career examples, but I believe the point is made. Yes, the economy is tough. Healthcare reform is a bit fuzzy still. Fatalists seek to marginalize IT. But the time is right to forcefully lay hold of this opportunity and (re)establish IT as strategic and foundational for your organization’s long-term success. IT is not back office!

Demonstrate the strategic power of IT.

It matters.

Update 9/14/10

Good debate on IT value. My leadership team just started on our next book, also by Carr, entitled The Big Switch…Rewiring the world from Edison to Google. Whether you agree or not with Carr, it is healthy to debate his ideas and come to grips with his messages. Is IT strategic? Will cheap utility-supplied computing change the game? Does the Internet take away our ability to think deeply? Are we losing our capability for concentration and reflection?

I still maintain that we can leverage even the most common of tools in a strategic fashion. It comes down to culture, risk, vision, innovation and leadership. Give me two organizations that each implement the identical EHR and I can show you two radically different approaches…and executed well, one can be a strategic differentiator over the other.

I do not agree that IT is purely a support function. Sounds good on the surface but, short sells the innovation and passion we have been endowed with. I have been fortunate to work with incredibly talented individuals who have taken common tools and developed these to improve patient safety and increase the quality of care. I have also witnessed similar gains on the business side. As a by-product, these have helped grow IT and proven to help us differentiate ourselves from competitors.

Not everyone will adopt or deploy it as strategic, nor should they. But it can be done.

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

News 9/8/10

From HIT and Hockey Fan: “Re: Bobby Orr will enjoy this. Use meaningful useful EHRs (Epic in the office) to win a night at the UPMC Health Plan’s luxury box at the new Pittsburgh Penguins Arena. If successful in enticing the doctors to provide care as defined in the letter, UPMC Health Plan and UPMC will be paid a bonus from your tax dollars by CMS, which will more than cover the cost of the luxury box for the entire season.” I think I’ve mentioned before that I was UPMC’s box suite guest once at a Steelers opener at Heinz Field, which was somewhat wasted on me since I don’t get the point of watching someone else play sports (especially millionaires), but the atmosphere was interesting. There was lots of food, drinks, and nattily attired male UPMC executives talking shop and watching the game on the TV monitor while their carefully coiffed wives chatted harmlessly in the living room area. Just outside our hermetically sealed and climate controlled luxury digs were people (their patients, most likely) cheering, waving Terrible Towels, and actually paying attention to what was happening on the field. It was pretty enjoyable once I got over the irony of a non-profit hospital system spending money to support a billionaire’s sports team. 

From Ricardo: “Re: Napochi. I’m curious about your impressions. Someone sent me a link and they are new to me.” Never heard of them. They sell PM/EMR, but they don’t call them that exactly. The company has offices in Alabama and China (there’s an odd pairing). Their Web site isn’t ready for prime time if the number of placeholder pages is any indication. They claim 300 hospital and practice customers, but I bet most of them are in China (just guessing).

It defeats the purpose of a survey asking about compassion and spiritual beliefs when an atheist blog urges its readers to barge in and vote predictably, so take the above results with a truckload of salt. Before the ballot box stuffing commenced and real HIStalk readers were voting, it was running about 50-50. New poll to your right: is the typical practice-based EMR capable of collecting and presenting the information needed for practices to assume and manage population-based risk?

University of Mississippi Medical Center chooses Epic for a $36 million project. They expect Uncle Sam to pay $20 million of that in HITECH money.

A University of Rochester Medical Center doctor loses a flash drive containing the PHI of several hundred patients. In typical horse-left-barn fashion, the medical center vows to start using encryption. Maybe losing a drive is the best thing that ever happened when it comes to information security — embarrassing publicity apparently launches more encryption projects than any kind of thoughtful planning and it only takes one episode per hospital.

Healthcare Innovative Solutions (HIS) is supporting HIStalk as a Platinum Sponsor, I’m happy to announce. The Seville, OH company provides clinical systems implementation, process optimization, CPOE and EHR consulting, medication safety, order set, and clinical decision support services. They also do HIPAA security, strategic planning, selections, and HIE work. Here’s a white paper (warning: PDF) describing their CPOE work at Mercy Health Partners (OH). I ran across this profile and video about founder Daniela Mahoney, RN whose story is quite interesting and worth watching. Inga and I thank Healthcare Innovative Solutions for supporting HIStalk.

AMIA is offering prospective corporate members free attendance at its Industry Day, held during its annual conference in Washington, DC on November 15. They have a few spots left.

Misys shareholders won’t get their $1.2 billion in Allscripts stock proceeds immediately, as the IRS evaluates whether Misys is on the hook to pay $170 million for what may be interpreted as a material reorganization of its corporate structure.

Scotland-based charge master vendor Craneware, flush with cash after a good year, is on the hunt for acquisitions valued at up to $30 million. Nearly all of its business is in the US and the company is looking for a bigger piece of the healthcare reform pie.

mdHub launches the mobile version of The Little Blue Book, the physician directory formerly distributed on paper by WebMD. It also includes pharmacies, hospitals, and health plans. I don’t exactly understand the pricing model, which is based on regions, but I’m sure you can figure it out if you’re interested.

Everybody’s getting into the physician recommendation business, apparently. A reader says Angie’s List (of which she’s not a member) has sent several solicitations about doctor ratings, some of which seemed curiously timed to her Google search activity. I can’t imagine paying for reviews, but apparently some do (and some complain about the result, Google tells me).

In Canada, Northeastern Ontario Network (NEON) adds six new hospitals to its Meditech hosting service, bringing the total to 19.

WellStar Health System (GA) fires its CEO following settled charges of Medicaid overbilling, which he had blamed on its billing systems.

New CMS head Don Berwick plans to start using his agency’s $10 billion innovation money to fund 100 to 300 sites testing new models of patient care, which I assume means accountable care organizations.

Google is looking for volunteers to translate chosen healthcare articles into Hindi, Arabic, and Swahili on local language versions of Wikipedia.

Big German healthcare software vendor CompuGROUP will purchase Visionary Healthcare Group, which includes Visionary Medical Systems, a Tampa, FL PM/EMR vendor. The company’s first US investment was majority ownership of Noteworthy Medical Systems 18 months ago. I think it’s safe to assume that more acquisitions will follow.

HP’s board fired CEO Mark Hurd even after finding that he violated no company policies, triggering a severance payout worth up to $40 million. Oracle hired him on Labor Day as co-president. Now HP is suing him, claiming he violated his confidentiality agreement by going to work for a competitor. HP doesn’t like Oracle now that it sells its own servers, courtesy of its acquisition of Sun last year.

A British study finds that pharmacists could reduce nursing home medication errors by over 90% if put in charge of the process. The study found that 70% of patients had at least one medication error on any given day.

New Zealand will pilot e-prescribing next year.

Thinix releases a touch-friendly, iPad-like user interface for Windows-based virtual desktops, providing as a press release example a nurse working both remotely and on the desktop.

The former president and CEO of Perceptive Software, acquired by Lexmark in May, explains why the $280 million, all-cash deal makes sense using a healthcare example. That’s not surprising since Perceptive always had a fairly strong healthcare presence with its ImageNow scanning and barcoding products. 

England-based Avia Health Informatics PLC announces executive changes to support its plan to enter the US market with its odd lot of products sold under the Plain Healthcare and Odyssey brands: ship telemedicine, patient symptom self-assessment, paramedic fall evaluation,  prison healthcare, and nurse triage.

Exciting, to me anyway: the sequel to Wall Street hits theaters September 24. No Bud Fox, but GG’s back 23 years after the original.

E-mail me.

HERtalk by Inga

Mount Kisco Medical Group executes an agreement to deploy NextGen’s EHR, PM, and Patient Portal for its 230-physician practice. Looks like they are replacing Misys Vision and EMR.

Nassau University Medical Center (NY) adds Streamline Health’s Enterprise Health Information Management suite to integrate with its existing Eclipsys Sunrise Clinical Manager. Nassau already utilizes Streamline’s accessANYware product.

ASC software vendor AmkaiSolutions completes a $3 million round of Class E equity financing. The company plans to pursue “a broader sales and marketing program.”

Central Texas Medical Center (CTMC) goes live on CPOE. CTMC is part of Adventist Health System, so I assume it’s a Cerner install.

Data point: more than half of the 354 million doctor visits each year for acute medical care are not with a patient’s primary physician and more than a quarter are in hospital ERs.

Emdeon announces plans to acquire Chamberlin Edmonds, a provider of government program eligibility and enrollment services. The $260 million purchase expands Emdeon’s offerings for hospitals.

Medical scribe is one of the hot, up-and-coming healthcare jobs that has become especially popular with young medical and nursing students. The pay isn’t exceptional — $8 to $10/hour — but the job gives scribes the opportunity for up-close exposure to physicians providing patient care, particularly in the ER. Several enterprising companies are establishing offices close to major universities in order to attract ambitious pre-med and nursing students. The scribes receive basic training on medical terminology and coding before hitting the front lines.

University of Utah Medical Group selects Practical Data Solutions to migrate its data warehouse and analytical reporting to Epic. The academic health system goes live on Epic November 1st.

Carestream Health acquires Quantum Medical Imaging, an x-ray imaging provider with a strong base of community hospitals and smaller clinics.

Catholic Health Initiatives (CO) hires Sheryl Rose for the newly created position of Chief Information Security Officer.

A George Washington University ER physician initiates a study to see how accurately ER docs and PAs diagnose wounds from patient-generated cell phone images. Five months into the study, the data indicates a 90% accuracy rate. And, accuracy increases with better quality images.

Sponsor Updates

• Carolinas HealthCare System selects Medicity to help build a multi-state HIE that encompasses the health system’s 32 facilities, plus community physicians and other caregivers.

• Mayo Regional Hospital (ME) chooses Sage Intergy EHR of its eight physician practices.
• Across the pond, King’s College Hospital goes live with iMDsoft’s MetaVision in its critical care unit.

E-mail Inga.

HIStalk Interviews Ramsey Evans, President and CEO, Prognosis

Robert Ramsey Evans III, MBA is president and CEO of Prognosis Health Information Systems of Houston, TX.

Tell me about Prognosis.

Prognosis is an EHR software company. We deliver a comprehensive software solution to our hospital clients. The ChartAccess EMR/EHR is a Web-based software application that provides clinicians with a complete view of the patients and their data and to support the optimal safe patient care.

I know of only a couple of handfuls of vendors that offer inpatient EHRs and I’ve heard the least about Prognosis. Why is that?

We were founded in 2006 with the development of the certification criteria. The genesis of our company was a medical records service company, a clinical informatics specialist — mainly out of the Houston Medical Center — along with a software group came together and developed a software application called ChartAccess in 2006, with the advent of that certification criteria. We looked at it as an opportunity of leveling the playing field with there being so many established vendors in the inpatient side.

Most vendors started as technologists building custom hospital applications and then taking it from there. Your approach sounds more like you started with the traditional paper medical records or some form of electronic medical records and built the application around that. How was your approach different?

You nailed it. We married what the medical record looked like in yesterday and today’s environment with a clinical perspective and brought the Web 2.0 web services technologies to marry our application. We started with CPOE and eMAR. That was the first certification criteria focus in 2007. Then we built out from that clinical base CPOE.

What advantages did that give you, having not gone through those generations of rebuilds where the technology changes? You are, I assume, still on your original technology. Has that been an advantage from a maintenance standpoint?

Absolutely. From a support standpoint, our infrastructure requirements are very limited. We can do traditional on-premise. A lot of our hospitals aren’t ready to get rid of their servers yet, but we also can do the SaaS model but it has reduced our maintaining of hardware. Also, with the updates that go to our clients, it’s seamless. There’s no PC to update, it’s just through the Web.

Are your sales primarily hospitals implementing their first EHR system, or is it a replacement market?

Almost all of ours are first-time. They’re in a paper environment. They may have some ancillaries — you know, lab information system or a RIS or PACS system in terms of clinical — but in most cases, they have nothing in terms of a CPOE, the core medical record.

Does that make it easier or make it harder for you to implement, where you’re not replacing someone else’s system?

I would say we have clients that are net new hospitals that are just opened. That’s like a whiteboard. Those clients actually are the easiest. They don’t have a system and they don’t have a paper process. But then when you go into the implementation phase for a hospital that’s doing a paper process, the biggest piece is change management.

You can deliver a great product in the newest technology, but we spend a lot of time on that workflow migration from the paper to the pure electronic. That part of it is, I guess, a little more difficult up front, but that carries big-time dividends when you go live, as long you’re able to take care of the people.

Small and rural hospitals are pretty underrepresented in the land of HIT, so you don’t hear a lot about them. A lot of folks think a 300-bed hospital is tiny. How would you explain what it’s like in the hospitals of the size that you implement that might not be what people would expect?

Most all of those folks are wearing two and three hats. They don’t really have a whole lot of time to spend learning new things. Your IT directors, a lot of times, are also doing something else like running an ambulance team, etc.

You have to be able to come in and work around their schedules. In most cases, it’s like a small business. They’re having to do a lot of other things, so you have to make the implementation process and the training and go- live process as flexible and easy as possible.

The other perception might be that because they’re small, they’re expectations are lower as far as the systems that they purchase. Do you find that to be true?

Absolutely not. They have the same needs as a large hospital. They still have the same emergency departments. They have Level 4 trauma. Their needs are just as great as a big hospital. It’s just they have fewer folks to take care of.

A lot of the HITECH money is probably going to go to these small hospitals that are finally encouraged enough to really be interested in automation. What advantages do think that Prognosis offers them over your bigger and more established competitors in that small and rural hospital market?

We can get them to Meaningful Use from start to finish and in a rapid fashion. We have clients that have made it in 4-6 months and less. Then, with Meaningful Use Level 1 attestation starting October 1, there’s a squeeze here. We’re seeing that in the marketplace and able to help them on keeping those implementation cycles down so that they can achieve their stated goals.

Do those customers perceive that a fairly new, privately-held company holds more risk to them than a vendor that is larger and publicly traded?

Yes, we had to deal with that on a very regular basis earlier in our life cycle. As we have gotten a bigger reputation in terms of delivery, that has gone away at some levels. But in our target market, most of those hospitals require the same type of due diligence of a small, private company versus a big company in terms of their ability to deliver, like checking references. That’s where we have focused in making sure that all of our sites are reference sites.

Can you give me some idea of the size of the company in terms of number of installed sites or employees? Whatever you’re comfortable sharing.

I can. We’re working with about 60 or so hospitals right now in various stages, either all the way fully implemented all the way through to early stages of contracts.

You just had an announcement not very long ago about a relationship with Order Optimizer. What value does that bring to your customers?

That really enhances our CPOE since, as we mentioned earlier, CPOE is where we were born. Those clinicians that elect that option — that upgrade, if you will — are able to merge order sets and code morbidity, and it really cuts down on their amount of time they have to be in the system and they can get back to their patient.

We have found that most of the clinicians that are using our system, as they get very acquainted with the electronic process, that is a natural step in achieving evidence-based medicine.

If you look at your technology advantages in areas where you’ve innovated, what would you say are the benefits that you offer there?

We’re Web-native. One of the biggest pieces in this puzzle, from our perspective, is mobility — being able to access the system from anywhere, wherever the clinician is in the hospital or outside the hospital.

We’ve already developed our platform on the iPhone. The iPad will be next month. In terms of being able to give the clinicians the access to the system from wherever they are, and being able to have that user interface where they can stay off of the keyboard and can be taking care of the patient.

Sounds like you’re pretty comfortable with the status of certification and Meaningful Use and that your customers will have time to ramp up and get going in time. Is there anything that concerns you, or that you were disappointed, at what came out of Meaningful Use?

We made a calculated step. We built in almost all the recommended Meaningful Use pieces into our product, before April, after they were announced in January. So when the announcement came, almost all of our clients were absolutely happy because we were already on our way. The reduced list makes them feel even more comfortable with achieving it if they’re not already there. But we all know they’re coming and we’re planning ahead and staying ahead of that curve instead of reactive.

There is at least anecdotal evidence that hospitals are driving some of the physician practice decisions for EHRs through some type of support. What do you say to a customer who comes to you and wants to integrate their physician practices that are either owned or affiliated with their inpatient practice?

We think the open architecture approach … we offer the whole solution, but we don’t force hospitals and their clinics to replace anything if they’re happy with it. So, we take both ways. If they want that to happen, then it’s not a big hurdle for us because of our architecture. Then if they want to replace, or if they don’t have something, we know that you have to come with a total solution.

Tell me the modules that you have and those that you generally have to advise the customer to seek elsewhere.

We have everything from billing/financial from the front end registration: general financials, general ledger all the way through everything in the clinical world: CPOE, eMAR, radiology, lab, pharmacy, and HIM. We do not have PACs. We recommend PACS solutions.

And you have clinical decision support, I assume?

Absolutely. That’s one of our strengths when we’re talking to our users. It provides plenty of clinical decision support as well as care plans so that they can meet their measures.

When you look at your reference sites, what results have they seen from their implementation?

In all of our reference sites, they’ve been able to access the information at the point of care. That’s the biggest pat on our back we get is that they are able to see everything in real time and be able to make better decisions at the point of care. That’s the biggest we’ve seen.

Then, access to data. They’re all looking at the same thing. Maybe if a doc is on the phone with a nurse from wherever he or she is, they’re able to view the same information in the same system, whether they’re in lab or radiology, and be able to make real-time decisions.

One of the difficult parts of why vendors typically failed at selling to small hospitals is they’re a hard group to market and sell to and they’re also a tough group to implement in a cost-effective way. How do you do it differently than a big vendor who just tries to take the same product and stick it in a 50-bed hospital?

We take the approach that every hospital is an individual and is different. But in our product, you’re able to, instead of customize, we configure. Our architecture allows everyone to have their own workspaces. We take their desk setting, if you will — a nurse’s desk setting — and we convert that, somewhat, into their landing screen. Their landing screen allows them to match their workflow.

It’s not hard coded, it’s just a configuration at the client level, the individual level, and that remains throughout. It recognizes their permissions, etc. so they don’t have to come back. On the cost side, that is one of the things that the intuitiveness of our system allows folks to … if a clinician is able to use normal applications like Outlook, in a relatively short time they can figure out about 80% of what they want with support and training from us.

Where do you take the company from here?

We’re very excited about Meaningful Use being defined on July 13th. We’ve already seen a big increase in requests for demonstrations, so we’re going to continue to execute our plan to deliver our solution to the hospitals and stay at the front on the development side of Meaningful Use and the newest and best practices using the newest tools that we continue to embed into our product.

Any concluding thoughts?

We are very excited to be a part of this transformational time in healthcare and look forward to participating. As we look back, although challenging for the hospitals in terms of change management, we’ll surely help on the cost and patient care side.

News 9/3/10

From Bobby Orr: “Re: the new Allscripts. They rang the Nasdaq bell. Hopefully it’s not too late to have a real challenger to the mighty Epic.” Glen has rung that bell a few times, I found by Googling. Since I couldn’t find a picture from this week and their Web site seems to be down, the one above is from one of the several previous “new Allscripts”, this one from 2008. I’d like to think it’s not too late to compete with Epic either, but I think it is, at least if the goal is to match up head to head. The Eclipsys clinical apps are better in some ways, but prospects are eating up Epic’s “one record” pitch and looking that the avalanche of new Epic business compared to long, slow decline of the Eclipsys Sunrise customer base. On the other hand, those Eclipsys apps have never been in better management hands than they are today now that the acquisition is finished, so maybe Glen can turn it around. When I asked him about that, he was pretty confident that Epic is vulnerable, but then again, former Eclipsys SVP (now Allscripts president) John Gomez said the same thing right before a stunning string of Eclipsys showcase accounts announced plans to displace Sunrise with Epic.

Speaking of Allscripts, here’s an insightful comment from quadwatch on the Yahoo stock board: “We are seeing what drove this merger — Eclipsys’ inability to compete with a weak ambulatory product and Allscripts’ lack of a hospital system. Given MU requirements for hospitals (in particular, CPOE adoption) the reality is you have only three products with proven adoption rates that don’t make a new purchase a crap shoot for the CIO: Epic, Cerner, and Eclipsys. It becomes a Epic-Cerner race if the facility has employed MDs or is looking to establish a community model. This one of the most logical mergers that I have seen in this segment.”

And while I’m quoting from stock boards, here’s another excellent one from my favorite industry analyst, sonomaca, on Glen’s bell-ringing: “Not surprised he decided to go and ring the bell. This is his triumphant return to control of MDRX. He’s proven himself to be a master of the game, starting with the secondary offering back in 2000 which ultimately saved the company. You’ve got to marvel at how he took a near-bankrupt MDRX in 2002/2003 to the top of the heap in 2010. Amazing. My guess is that, in the end, ECLP will be integrated without too much trouble. In the next couple of years, US market share will be pretty well divvied up between Epic, Cerner, Allscripts, and some of the lumbering giants like McKesson. No doubt, GT is already thinking ahead. And, what’s ahead are myriad tuck-in acquisitions and, most importantly, overseas.” Above is the ten-year share price, peaking at something like $80 in 2000 and bottoming out at less than $2 just three years later, now back to $17. Glen was CEO that whole time and before. He’s got $19 million worth.

From Price Checker: “Re: UPMC. I love this creative, airline-like a la carte approach to paying for the EHR at this paperless hospital.” UPMC, like other hospitals, is charging patients a “facility fee” for being seen in a physician practice it owns, even though patients may not even know that UPMC is involved. The patient profiled in the article noted that the reception area bears a plaque thanking the donor who paid for it, making her wonder why she has to pay again. She had no choice since UPMC threatened to turn her account over to a collection agency, but she vows to steer clear of that doctor and building for her future medical needs.

From The PACS Designer: “Re: Apple TV. Apple has announced their latest Apple TV configuration containing a faster custom built processor called the ARM A4. With a hookup to an HDTV, could medical image viewing find a place in the home viewing schedule? Only time will tell if it catches on with practitioners! This iTV device also has an Ethernet port and 802.11B/G/N Wi-Fi for streaming.” I’ll say that my Roku box was a game-changer for me. I haven’t watched a minute of DirecTV or even DVRed stuff since I got it – everything else seems so primitive compared to free, on-demand Netflix streaming. I’ve discovered great TV shows and movies I would never have found otherwise. I think I saw there’s some kind of medical channel on there.

From Mya: “Re: weird medical news stories. Did you hear about this one?” Sad: a female doctor, apparently drunk, tries to break into her former boyfriend’s house while he is there. He leaves out the back door to avoid a big fight, but in the meantime, she climbs on his roof and tries to slide down his chimney. Three days later, someone checking on the man’s fish notices a smell coming from the fireplace and finds her dead a couple of feet up the chimney, where she had died of asphyxia.

From Irving R. Levine: “Re: EHR vendor. We’re converting from [vendor name omitted]. They don’t understand why an IT shop needs access to clinical data in the SQL tables, so we can’t access our clinical data on our servers on our network without using their UI. They also don’t understand why we want to do our own backups instead of using their service.” This kind of issue is going to pick up steam as people starting switching out EMRs. Small practice vendors don’t usually understand clients with real IT people on board, so they distrust their intentions in a rather parochial manner. Like Bill O’Toole said in his HITlaw, if it’s important to you, get it into the contract.

The proposed Healthcare IT site on Area 51 (geeks know what that means) needs reader commitment to move ahead, being 15% of the way there so far. If you’d like to see an place to have HIT-related questions answered by experts (or to answer questions if you’re the expert), then sign up.

Marty Larson is named executive director of the Greater Dayton (OH) HIE.

GetWellNetwork will announce that it has developed the first digital care plan for reducing admissions for pediatric asthma, including multimedia patient and family education covering triggers, medications, and equipment.

Jobs on the sponsor job page: Technology Account Executive, Epic Certified Consultants, Account Manager, Eclipsys Orders/Results Analyst. On Healthcare IT Jobs: Cerner SurgiNet and Power Orders PMs, McKesson HEO I-forms Consultants, Development Manager, Epic Report Writer/Programmer Analyst.

Listening: reader-recommended The Sensational Alex Harvey Band, 70s glam rockers from Scotland. The namesake died 28 years ago, but even though he hasn’t been reincarnated, the band has. He was quite a showman.

HIStalk stats for August: 102,047 visits, 145,694 page views, and 6,114 verified subscribers. All are new highs. Thank you for reading.

Metropolitan Health Networks and Senior Bridge start a year-long pilot project to evaluate the use of telephone-based telemedicine and specially trained staff to manage 100 Medicare Advantage patients who require frequent hospitalization. Each individual is assigned a nurse and a social worker to work with the patient’s physician to develop a care plan and to conduct in-home assessments for safety and patient evaluation.

This is ingenious: Kerry from Network Management Solutions of Garner, NC e-mailed to tell me he’s figured out a cool way to use his iPad. He downloaded the free Remote Desktop Lite app (which also works with the iPhone) and remotes into his home PC, meaning he can run all of his Windows apps on an iPad from anywhere. That sounds like it might have some possibilities for small-scale hospital or practice apps, as long as each iPad user has a dedicated PC to remote into (it’s like a poor man’s Citrix farm, although the non-poor man might run Citrix Receiver to run apps directly from a Citrix server). I bet the wheels are spinning in the heads of some readers even as we speak.

Why haven’t EHR vendors done this? A chiropractic software vendor partners with the creator of the Facebook Fan Page Generator to get its customers into social networking and promotion, or as the press release says, to create “an automatic new patient referral generating machine.”

The Community College of Allegheny County (PA) will offer free, non-credit HIT classes to qualified applicants, courtesy of $16 million of federal taxpayer money.

The presentation was from an Australian HIT executive, but the message is familiar when it comes to IT challenges in hospitals: IT gets heat to finish projects even with insufficient resources, they patch old systems together instead of buying new ones, and the IT people don’t have the clinical knowledge to run the systems used by clinicians. But it was an audience member who got big applause for describing health department IT procurement practices: “[It’s like] taking a 17-year-old and letting them buy any car they want, with any sized engine. We get clinicians to dream up what they want, then they go and buy it without even thinking about whether it will or won’t work. We have people who don’t know what should and shouldn’t be used, who have the power to make the decisions on buying".”

Odd lawsuit: a surfer hospitalized in Hawaii after a shark bite claims the hospital posted his picture of his leg wound on the Internet. He’s filed a suit alleging HIPAA violations and several more potentially lucrative charges.

More iSoft struggles: the company’s major shareholder says it will decide in April 2011 whether to unload its shares.

I haven’t quite decided whether to do a Monday Morning Update. If I don’t, or if you won’t be around to read it even if I do, have a wonderful end-of-summer holiday (just my US readers, I keep having to remind myself since that’s not all of them). I will be laboring on Labor Day in any case since I am extremely behind, so as Inga suggests below, you can always send us a Facebook or e-mail message if you are feeling lonely, unappreciated, or unfulfilled. 

E-mail me.

HERtalk by Inga

From KP Duty: “Re: Sutter’s iTriage app. Looks like a great tool for consumers, except for one thing (disclosure: I’m with Kaiser Permanente). When I clicked on the Find Emergency Department link to see the EDs closest to my house, is it a coincidence that the largest Kaiser Medical Center in Northern California is absent? I would have to drive by this large and well-established facility with its gigantic emergency department to get to the one listed. To be fair, I put in the address of one of the other Kaiser hospitals and it came up in the right order.” Is it a conspiracy or a bug? I’ll go with bug since I did a spot check on a couple addresses and KP sites definitely popped up prominently.

In what may be the first of similar announcements, ChartLogic reports it has applied for EMR certification with Drummond Group. I reached out to ChartLogic and asked them why Drummond was selected over CCHIT. Here’s the reply from Eric Sorenson, ChartLogic’s VP of marketing:

Our choice for Drummond over CCHIT came down to timing. We believe we are ready to be certified today. CCHIT has indicated that they will launch their program on September 20, and begin receiving applications then. Additionally, they’ve previously indicated that they will give certification priority to their CCHIT 2011 and their “Preliminary ARRA” certified products. We believe this would push our testing date and certification to a date much later than desired. Conversely, Drummond has indicated that they are taking applications immediately, and can begin testing within a few weeks. They have no backlog. We believe this will give us the best opportunity to be certified immediately. CCHIT has a 5 year head start on marketing their products and services, so we weighed the value of a certification with CCHIT vs. Drummond and felt we could overcome any of possible difference in marketing value by being one of the first companies certified, if not THE FIRST. Additionally, Drummond has been certifying other software for a longer time than CCHIT, so we agree with ONC and don’t believe their lack of EHR certification experience is likely to cause us problems in the certification process.

Southwestern Vermont Medical Center says it spent $1 million on its Picis periop system.

Valley View Hospital (CO) goes live on Meditech 6.0.

Actor Michael J. Fox will provide a keynote at HIMSS11, sharing his experiences as a patient and telling healthcare IT experts how IT impacts healthcare. Sadly, he’s got the dreaded Thursday a.m. slot, which means only 200 people will be in the audience. What I want to know is whether Jonathan Bush will try to schedule a meet-and-greet with his look-alike.

Memorial Hermann (TX) selects FairWarning to monitor patient privacy.

Former Streamline Health and Misys VP Scott Boyden takes over as VP of new client sales at TSI Healthcare. Kermit Copley also joins the company as CFO.

Hoag Hospital (CA) opens its new $84 million, 154-bed facility in Irvine. That’s $545,000 a bed if you are the calculating type.

HHS names its final two Beacon Communities: Greater Cincinnati HealthBridge and Southeastern Michigan Health Association. HealthBridge will focus on pediatric asthma and adult diabetic care, while Southeastern Michigan will concentrate on diabetes care and prevention.

UnitedHealth Group is loaning $10 million and donating another $1 million to help rural hospitals improve their HIT and add EHRs. Between this program and the recent Ingenix acquisitions, it sounds like UnitedHealth is trying to unload some cash.

This week on HIStalk Practice: Dr. Gregg Alexander shares the EHR-laced lyrics of some of his soon-to-be-hit tunes; Jonathan Bush tames an octopus; and an Iowa REC shares the cost of their consulting services (between $300 and $2,000 for two years’ worth.)

Stanford Hospital and Clinics commits to a seven-year agreement with Accenture to take over some  of Stanford’s IT functions. Accenture will manage applications and infrastructure and provide data centers, network, help desk, and device support. We said this was happening a couple of weeks ago, courtesy of a reader rumor from Scatman Crothers.

Memorial Hospital at Gulfport (MS) lays off 47 workers, including 10 nurses. The staff reductions are part of cost-cutting measures to offset an $11 million budget shortfall.

The Massachusetts attorney general recommends that the board of Beth Israel Deaconess Medical Center do “some soul-searching” about CEO Paul Levy’s ability to lead the hospital.This follows her office’s conclusion that his long-time personal relationship with a female employee “clearly endangered the reputation of the institution and its management.” Board chair Stephen Kay responded by saying, “We are having a great year. We have more patients than we’ve ever had before. He’s made some wonderful alliances with some quality places. He has great credibility. He’s a national leader.” I’ll bite my tongue as it relates to this toxic topic.

Sponsor News

• Enterprise Software Deployment (ESD) ranks #561 on Inc.’s list of the 5,000 fastest-growing companies. ESD, by the way, just hired former maxIT director David Tucker as its national VP of sales.
• MetroSouth Medical Center (IL) goes live with iSirona’s medical device integration solution, transmitting data from over 100 GE Unity Network devices.

If you have a three-day weekend, I hope you are not in Earl’s way and are able to enjoy the fruits of your labor.  And if you are laboring, remember you can always sneak into Facebook and drop us a note.

E-mail Inga.

HITlaw 9/1/10

Software Contracting with Meaningful Use in Mind

The final rule has been published, the incentive structure is in place, and hospitals and physician groups are investing in EHR technology. Here are some straightforward thoughts on contracting for the successful implementation of your chosen EHR.

Care must be taken by the provider customers. Some will be investing capital based solely on the prospects for reimbursement. Protection of their interests is important. This is by no means a complete list.

Certification

The best situation would be for the vendor to warrant that its EHR technology has been certified by the appropriate authority and is installed and live at more than XX (vendor to fill in the number) sites. The fallback position today would be a warranty that the product will be certified in the appropriate timeframe for full reimbursement eligibility.

Further, they must warrant that certification will be maintained throughout the reimbursement periods (note that the timelines for provider reimbursement differ for Medicare and Medicaid participants). It is technically possible for a provider to lose a year or more of reimbursement if the vendor’s EHR product was initially certified, but then misses certification during the reimbursement period. The year of ineligibility still “counts” for the provider, but they will not receive associated funding.

Be wary of “best efforts” clauses. Some vendors will take care and be uncomfortable warranting that a product will be certified, and for that they should be applauded. Others will take the “we have no choice” approach and provide the warranty. Their gamble is weighing a potential breach of warranty against lost business today when the customer selects an EHR vendor that provides the warranty. The customer has little practical choice. The warranty is essential.

Delivery and Live Status

The delivery date for certified EHR product, together with the implementation timeframe for the product, must result in the EHR in use in live environment so as to enable customer to achieve Meaningful Use. Keep in mind, though, that for long projects with work to be done on both sides, a vendor should not be expected to warrant that something will be live when considerable work must be done by the customer. That work which is completely out of the vendor’s control.

This one factor is greatly reduced as a consideration when dealing with an EHR provided in the SaaS model since time from delivery to live is in some cases negligible.

What you should look for is guaranteed timelines that, if all is accomplished on time by both vendor and customer, will allow for live use by a certain date. This is very reasonable.

Payment Terms

Assuming a certified product is delivered on time, payment should flow accordingly over the implementation timeline. That is fair.

However, some implementations will be quick and some will not. Delaying payments until reimbursement occurs would be outstanding for the small providers, if you can find a vendor that will take those terms.

Undoubtedly the primary concern for some providers is laying out capital on a project and counting on reimbursement when the possibility exists that reimbursement may not occur. If the circumstances are solely the fault of the vendor (failing to maintain certification, for example) then the customer should be protected and monies should be refunded. The requirement to make payments on a product that ultimately does not qualify the provider for reimbursement is patently unfair to the provider customer.

Some accommodation must be made for the hopefully never-to-occur failure of the project. Keep in mind that some of these contracts will be executed with the full intent and purpose of obtaining reimbursement, otherwise the investment would not be made at this time. That one major factor cannot be ignored.

Finally, Meaningful Use

The items above are tailored toward protection of the customer provider, while hopefully acknowledging the fairness factor to the vendor. Meaningful Use is another situation entirely.

In my opinion vendors cannot guarantee or warrant that any customer will achieve Meaningful Use. Vendors only provide the tools needed for that process. The customers are responsible for the work on their side, using the certified EHR tool acquired from the vendor in their operations necessary to achieve Meaningful Use.

The best I could do if writing the warranty for the vendor would be to warrant that the certified product, delivered in the appropriate timeframe, will enable the provider customer, through its efforts and implementation, to achieve Meaningful Use, but that the vendor cannot ultimately warrant that the customer shall achieve that goal. Achieving that goal is the responsibility of the customer providers that will receive the reimbursement if all goes well.

William O’Toole is the founder of O’Toole Law Group of Duxbury, MA.

HIStalk Interviews Nancy Ham and Nancy Brown, MedVentive

Nancy Ham is president and CEO of MedVentive of Waltham, MA.

Nancy Brown, formerly senior vice president of business development and government affairs for athenahealth until July 1 of this year, has been named chief growth officer of MedVentive, where she will head up the company’s sales, marketing, and business development efforts.

Tell me what MedVentive does.

Nancy Ham: MedVentive provides a physician performance management solution for whoever is clinically at risk. Traditionally in our industry, health plans have been at risk, but there’s a huge trend towards providers taking risk and becoming more directly responsible and accountable for both the quality and cost of care.

One thing that we think is interesting about our company is that we support providers and health plans, and in fact are trying to bring them together into a more collaborative environment around managing populations and managing the cost on top of those populations.

Our passion around this springs from our history. In the mid-90s, here in Boston, we started as a mega at-risk provider organization affiliated with CareGroup, which is an integrated health system with eight hospitals and 3,500 physicians. At the time, it was the leading marketplace around providers assuming risk. We were bearing full global capitated risk for about half a million patients, managing about a billion dollars.

Everything that we have today, that we believe today, was really forged in that real-world environment managing our own patients, managing our own data, engaging our own physicians, and trying to learn how to do that successfully in a provider-oriented environment. The challenge was that model was really prevalent only here in Massachusetts and in California.

What’s so exciting about today for us is that we see the whole market opening up and moving away from payer-side risk, fee-for-service risk — which hasn’t served our industry well — and into these new risk models. We’re here with 15 years of experience and a very mature product to bring to that problem.

It seems like that whole assumption of risk idea has come and gone for practices. Do you think this time they’re ready, both organizationally and technologically?

Nancy Brown: No, not generally. There have been a number of organizations who have grown up in this model. The one that Nancy Ham has just described. I grew up professionally at a staff model HMO called Harvard Community Health Plan, which is very similar to Kaiser, where we were totally at risk for a population of patients and everything about our work, our DNA, was all around thinking about populations — how to keep them well and how to deal with their illnesses in the most efficient and effective way.

The vast majority of organizations are not incented that way, are not aligned that way, and don’t have that DNA naturally. This is a major shift, meaning a shift in the industry, where more and more risk is being pushed back down to providers.

I would say the answer to your question is no, they are not generally prepared for this. Just imagine doing work the way you do it every single day being more and more oriented towards seeing the patient who’s sitting in front of you, getting paid for each encounter, and then going to a model that is really completely different. That is exactly why tools and services need to be brought out to these provider organizations to ensure that they won’t hurt themselves in the process of converting over.

Nancy Brown, let’s talk about the announcement that you are joining MedVentive. What discussion did you have with Nancy Ham about her long-term plans for the company and your contribution to them?

Nancy Brown: It’s been a really exciting couple of months, to say the least. I’ll answer that question directly, but let me start by saying that what really motivated me to go back out into the market and to leave athena was this trend towards what has really been established by all the work being done through Obamacare or the Healthcare Reform Act, which is to really think about how healthcare is delivered and to really think about how to change incentives in order to get people to think about cost and quality.

Having grown up, as I said, in a staff model HMO, it was a little bit counterintuitive to me that the management of patients was being carved out and handed to payers and third-party organizations when in fact, there’s no one better than the physicians who are in front of the patients, who really know what care should be delivered, to be the ones that think about the approach to patient care and to think about quality and cost.

I am absolutely thrilled that the country is moving away from fee-for-service and moving back towards accountable care or sharing risk and putting risk and quality back into physician hands.

I was approached by a number of people who knew my background who wanted me to either join large companies who are thinking about establishing toolsets to serve this market, or venture capitalists who were thinking about starting brand new companies that would serve this market. Honestly, the entire time I was going through that process, I thought, well, there is actually an absolutely fantastic company that has been around for over a decade that not only has come up with tools, but has lived and walked in the shoes of at-risk providers, and who has been through many, many cycles of the product. We all know, those of us in healthcare IT, that products all need to go through at least three or four life cycles before you get it right.

The conversation I had with Nancy and with Dr. Jonathan Niloff, the founder, was perfectly aligned with what I thought the market needed. I thought, here’s a company that has existed, that has had terrific tools. The market has not been huge, quite honestly. They’ve taken care of probably a lot of West Coast and East Coast clients, and now they’re perfectly positioned to fully take advantage and really educate clients as to what the needs are to take on risk.

What lessons would you say you learned from your time at athena that will be useful to you at MedVentive?

Nancy Brown: I was at athena for six years and it was a wonderful experience. I consider them to be the closest of friends. I learned about a service model. I think a lot of what we talked about in my conversations with Nancy Ham and others is that you cannot just hand a toolset to an organization — in this case, an analytics toolset — and expect them to do everything that they need to do perfectly.

What I hope to bring to MedVentive that I’ve learned — and actually, it’s really part of my DNA now, based on my time at athena — is two things. One is that we’re going to have to get even more involved with our clients to really help them through these significant transitions.

A specific example of what I mean is when you give them dashboards and toolsets, which MedVentive does now, and you point them in the direction of where they are in terms of a red zone around a particular business problem, I think we hope in the future to be able to actually be in there with them, almost as a virtual chief medical officer, to be able to get them through the ongoing change or the overall change; and then the day-to-day work that they need to get done.

Nancy Ham: Nancy’s experience — her whole career — is of incredible relevance and resonance, as you’ve been hearing. We’re very excited about the service model coming into greater use among our customers because we are very focused about real results in the real world.

We don’t build software for theoretical purposes. We’re not an IT company who’s just building something because we want to sell it for revenue. We’re a healthcare company that forged everything we do in the crucible of the real world. That meant moving the needle on cost and quality. Whether it’s pretty dashboards or beautiful analytics was really irrelevant unless we accomplished the business goals.

We have a very strong ROI story for our customers today. Along the way, for example, we were profiled by the US Department of Health and Human Services as one of the five best national practices in pharmacy cost control. Last year, we were honored to win the Microsoft Healthcare User Group Award with a lovely customer of ours, Northeast PHO, for driving breakthrough levels of quality while reducing costs.

So to Nancy’s point, we have customers today who are independently very capable-mature in their ability to take risk and to execute on risk. But as that model broadens across the country, marrying that proven experience in that ability to drive an ROI with more supportive service capabilities, I think, is going to be key.

Nancy Brown mentioned that venture capital wants to get into this and other companies want to start something up. Who would you say is the competition now and what are the barriers to entry going to be for someone who wants to be in the position you’re in?

Nancy Ham: The barrier to entry is the relevant domain expertise. Not from reading about it, not from going to conferences about it, but from living it. There is no substitute for the fact that for ten years, we were the customer. We were in the real world bearing risk for almost half a million patients and driving positive changes against our budget and our risk and our quality and our population.

There is just no substitute for that. So in one sense, unless you’ve come from that environment, it’s really hard to say you have the same relevant experience and DNA that we bring to the opportunity.

That’s what differentiates us with our customers. They come and they see and they listen to it and say, “You guys really get it. You understand what we need to do, and we take comfort in the fact, frankly, that you’ve traveled this path ahead of us and you can share with us the lessons learned — good and bad. And you can share with us how you engaged your physicians in a way that they found appropriate and relevant and caused them to change behavior in a positive direction.”

Nancy Brown: I would just add to that what I observed is this practical-tactical way of thinking about how to deliver information to physicians. But this is all about helping physicians understand what’s going on with their population and guiding them toward the right decision. That’s not easy to do. A lot of the information that comes out of these analytic tools, generally, can create a lot of noise that they tune out.

I’ve been very impressed in the exposure I’ve had from MedVentive to see what Jonathan Niloff and the team here have done to really make sure that they’re getting the most important information to the physicians and making sure that the feedback loop is staying intact. And, that it’s a practical tool that can be used versus just one of these things that the administration has bought, but that in no way, shape, or form will ever be useful at the point of service.

When you talk about the business model as a service, is there any contemplation of selling service as a percentage as athena does?

Nancy Ham: I think it’s a great question. Historically, we have been focused on wrapping services inside of our software subscription fee. Lately, we’ve been really dialing up our capabilities around clinical consulting. We just hired a new senior director to lead our practice. In there, we are starting to go at risk for the actual results that we’re able to drive.

How that evolves towards a different model or towards the athena model, I think, is something that Nancy Brown and I will be working on and thinking about over the upcoming months and quarters.

Everybody wants to talk about Accountable Care Organizations. What technologies do organizations that want to go in that direction need?

Nancy Ham: To start on the journey of taking risk, organizations need a lot of things. They need a culture of quality. They need a transformational ability. They need to think through physician alignment and reimbursement. There’s a lot they need to think through from a services and strategy perspective.

When it comes to technology, there’s really two ways that an organization can begin to assume risk. One is if they’re already financially integrated, they can jump into becoming an Accountable Care Organization. There you need a suite of tools to manage for cost and utilization and quality from a whole new perspective because it’s not about fee-for-service now, it’s around episodes of care. This was a heart attack, not a series of disconnected claims. This is a population of diabetics and I need to be able to look at them as a population — cost utilization, quality, and engagement — because I’m going to be reimbursed on it as a bundle.

If you’re going into true global capitation, you need to be able to look across the entire spectrum of care no matter where delivered, no matter whether it’s in your network or out of your network, ambulatory or inpatient, and budget it and predict it and price it and manage it very differently than what you’re doing today.

If you’re not already financially integrated, then you actually have a step before that, which is to become clinically integrated, which gives you a safe harbor, if you will, from the Federal Trade Commission. There, you really need an intelligent, patient-centered disease registry that can be distributed across the community to promulgate your quality program and to engage physicians in an interconnected network focused on driving guideline-compliant care.

We’re fortunate at MedVentive that we offer them a spectrum of solutions no matter where you are on your journey to risk. We have a technology and a capability that matches up to where you are and what you need to do next to move forward.

Who helps organizations are assess their capabilities to enter into these agreements? Are they going to become standalone at some point, or are they always going to need some sort of support — technology or otherwise — to have ongoing success in being part of an ACO?

Nancy Brown: What I’ve observed in my journey over the last few months in looking at a lot of organizations focused on this market — there’s an equal number of consulting firms that are spitting up new practices to focus on all of the human capital issues. So if you parse apart everything Nancy Ham just said, underlying it is that technology is important. MedVentive has done fabulous things, but I’m sure if Jonathan Niloff was sitting here, he would tell you that it was the people side of it. Once you get the information in front of you, it’s really getting the teams built and the mindset in place to do the right thing.

So to answer your question, I think hand-in-hand with the technology will be folks who come in — and I already see it happening — that will work a lot on everything from organizational design to organizational behavior and the creation of probably all-new incentive plans beyond the medical incentives. I think it will be ongoing, absolutely.

I also think, as I talked a lot about during my days at athena, that there will be an ongoing evolution of these reimbursement plans over time. This is yet another set of ideas that people have, from Medical Homes to P4P to accountable care. Somewhere in all of this there will be a model that begins to effect really positive change. What I mean by that is it will incent providers to actually go in and make changes to workflows and to their approach, which is what Jonathan Niloff probably observed at CareGroup and I observed at Harvard Community Health Plan.

That it is an ongoing journey of give me the data, let me observe. Then, what’s going wrong? Let me improve my processes. Give me the data, let me observe what’s wrong … it’s an ongoing effort that never ends.

The HITECH Act has stolen everybody’s attention, so everybody’s focusing on EMRs or HIEs or whatever it is. How do you expect the vendor landscape and organizational strategic priorities to change as we get past that first total focus on just EMRs?

Nancy Brown: You couldn’t have asked me a better question. I won’t get on my soapbox for too long, but I often said in Washington and other places that I felt like the HITECH Act was a little bit of a distraction. While people were busy looking at it and going out after their $44,000 and had their backs turned, they’re going to get hit by a train and the train was going to be changes in reimbursement, as well as other major changes to how people are dealing with the administrative side, such as ICD-10.

It’s very interesting because it’s very hard right now to quantify how much business is shifting from fee-for-service to these quality contracts. What I say to anyone who will listen is don’t worry so much about the percentages because right now it’s definitely a very, very high percentage still in fee-for-service.

But let’s look at the reality. You can’t bring all of these uninsured into that coverage to have insurance coverage, and then also — simultaneous to bringing this new population of patients in that will now have insurance coverage — mandate that the insurance companies cannot increase premiums and then not expect that the costs are going to go somewhere. Those are going to be really put onto the backs of the providers. The insurance companies really don’t have any other way to get the money other than to assert change reimbursement.

The accountable care concept is owned by Medicare, but I think we’re already seeing a rapid acceleration of a risk shifting by commercial payers. As that risk shifts, people are going to have to be prepared. Compared to taking on an EMR, that’s child’s play in my opinion. This is very, very serious. Meaning you have to have a lot of information, a lot of guidance, and a lot of change in behaviors to be successful.

The other thing I’ll add about the EMR side, which was a big focus at athena, is that the EMRs need to be prepared to take the information that comes out of systems like MedVentive. These are things, to be specific, like gaps in care, for instance. When they tell you that Nancy Brown has not had a particular test or is at risk for a particular disease state, that information needs to be showing up at the point of service, ideally.

Many of the systems, most I would say, the majority of them do not have the capability to take that in and haven’t even reformed themselves in a way to think about population.

I think it’s going to be a very exciting time for those EMR vendors who really step up and think about themselves as being in a continuum that starts with taking risks, managing populations, and then intervening at the point of service.

You’re right, it’s an EMR-centric world out there, and those vendors typically don’t like to acknowledge that there may be contributions from other systems or other vendors. How do you intend to work around that, from the MedVentive standpoint, to convince them that it’s in their own best interest to collaborate?

Nancy Ham: We see, in our current client base, a very interesting spectrum of organizations. We have clients today who are 95% deployed on single EMR, so they’ve already climbed that mountain. But what they have found, to Nancy Brown’s point, is that the EMR does not provide them this horizontal capability to look across their population, to manage populations in an episodic or disease-centric way. It does not allow them to look at their cost in a capitated fashion; to look in-network and out-of-network to control all the levers they need to control to be financially successful.

We have in-the-middle organizations, those who are building broad-based networks in which their physicians are on many EMRs. So there, you have a bit of a Tower of Babel approach where there’s no source of truth, no central view, no view that goes across the continuum of care and across the community.

And then we have customers who have said that $44,000, frankly, is not compelling. We’re looking for tools that we can acquire and implement rapidly to allow us to step into risk because what we hear is forward-thinking organizations know fee-for-service is dying. So whether it dies tomorrow or dies two years from now or four years from now doesn’t matter.

They know now they need to get control of their data. They need to start measuring themselves. They need to get ready so that whatever form risk takes in their market — it could be heavy pay-for-performance, it could be episodic or population, it could be true global cap — that they can’t be ready overnight to spring into that environment.

They have an urgency about that to get started now, and that’s very exciting for us as a company because as we said, we started — Nancy and her path, and MedVentive in ours — in provider risk organizations more than a decade ago. It’s exciting to us to see that model, which we know works in improving quality and reducing costs, spread across the country. We couldn’t be more excited about the possibilities in front of us to help organizations learn how to do that and to be successful.

What are the long-term plans for the company?

Nancy Ham: With Nancy coming on board as chief growth officer, our plan is clearly to execute on our growth strategy and to leverage the fact that we think we have a very unusual capability born on the provider side, but ambidextrous, if you will, because we can serve whoever’s at risk — the self-insured employer, the health plan, the provider — and bring them together on a collaboration platform, a much-overused term that rarely exists in the real world. We think it’s the right model, which is we need to be sharing and looking at the same data with a focus on changing what is a societal ill at this point.

Our collective failure to create a universal model that reduces the healthcare costs in this country is impinging our growth as a society. Really, the ability to bring that all together, we think, is unbounded in terms of size. Our focus is just on getting the word out about what we’re able to do and to do it for more people. And with Nancy Brown on board, I’m sure that that’s what we’re going to be able to do.

News 9/1/10

From Redzenskyca: “Re: Allscripts/Eclipsys merger. New company name: Allscripts. New color: green.” The announcement is coming tomorrow, reliable sources tell us (nobody official, but people who should know). Green is my favorite color, though. Here I was criticizing the sea of orange at ACE and now it’s going to be a collector’s item or something (or sold on eBay just in time for hunting season). UPDATE: the Allscripts site has been updated with the logo above and a welcome to the merged companies.

UPDATE 2: The company’s leadership team is listed as Glen Tullman as CEO (Allscripts), Lee Shapiro as president (Allscripts), Bill Davis as CFO (Allscripts), Eileen McPartland as COO (Allscripts), John Gomez as president of product strategy and development (Eclipsys), Jeff Surges as president of sales (Allscripts), Diane Adams as EVP of culture and talent (Allscripts), Laurie McGraw as chief client officer (Allscripts), Dan Michelson as EVP and chief marketing officer (Allscripts), Kent Alexander as EVP and general counsel (Allscripts), and Joe Cary as chief of staff (Allscripts).

From Curious in Texas: “Re: MD Anderson in Houston. I’ve heard they will be installing Soarian Financials. This surprises me because I thought the UT hospitals were all converting to Epic. Can you verify this rumor?” Verified. MD Anderson hasn’t signed the contract yet, but they are planning to migrate from Invision to Soarian patient accounting, ADT, and scheduling. Their primary motivation is its service-oriented architecture.

From Boomer Later: “Re: Maine Medical Center. I heard its board will meet Wednesday on a proposal to migrate from Eclipsys to Epic on a 20-month timetable. Approval is expected. It’s a blow for Eclipsys since MMC is one of their most progressive and active customers and was customer #6 on the old TDS product.” Verified. They were already using Epic on the MaineHealth ambulatory side, so this will be the next step toward their “One Patient, One Record” philosophy. Epic Enterprise will be implemented in their six member facilities in addition to Maine Med.

From Lizard King: “Re: HITECH. AAOS average member salary: $$$$. GP in private practice: $. Meaningful use is the gateway to federal $$$ to pay for HIT that providers might not otherwise be able to justify as an ordinary practice investment. Generalizing, specialists have more profitable operations and seem to have much better ROIs on HIT than GPs, so it is no surprise that MU is headed this direction. Which seems about right to this taxpayer and consultant.”

If you’ve been following the current poll and comments on Ed Marx’s Blessing of the Hands post, you may wonder why the comments suddenly turned ugly. An atheist blogger linked to it and his followers dropped by to vote and opine. Since the point was to find out what industry people think, here’s the stat that counts: the poll was running 50-50 when it was just real readers voting.

Inga interviewed Chet Speed of AMGA about Accountable Care Organizations on HIStalk Practice. It’s a hot topic, so we’ll have more soon from the hospital point of view. Hats off to her for drawing readers to HIStalk Practice, with visits up 50% or so compared to a year ago.

A Member of Parliament in England wants to know if BT was paid hundreds of millions of pounds to persuade it to stick around with NPfIT instead of bailing out like other companies did.

In the News of the Obvious, a small study finds that Facebook is a big draw for narcissists prone to encouraging shallow relationships by carefully controlling their image, bragging on themselves in their Info section, and in the case of females, posting revealing and/or doctored photos (not that there’s anything wrong with that). The conclusion is somewhat profound: “As we abandon the fake avatars and cryptic usernames of years past and begin associating our online identities with our real-world lives, our online activities begin to have more relevance to our true personality traits.”

Mike Cannavo, the one and only PACSman, cranks up a blog: The PACSman Pontificates. He was darned funny, irreverent, abrasive, and always informative when he wrote for a rag-sponsored blog, but says he got tired of being forced to change his posts every time an advertiser complained. I can only imagine what he’ll say unmuzzled. Also in the PACS and radiology world, Mike’s occasional partner in crime Doctor Dalai celebrates 200,000 blog visits. I like those guys.

Newly named EHR certifying body Drummond Group releases testing guidelines and cost (warning: PDF): $19,500 for inpatient or ambulatory remote testing, $23,500 plus travel for on-site testing.

In Australia, iSoft CEO Gary Cohen will resign after the company posts a $383 million fiscal year loss and a 20% drop in revenue. Shares are down 83% year to date to around 12 cents. I interviewed Gary in April.

WellStar Health (GA) will pay $2.7 million to settle Medicaid fraud claims, admitting no wrongdoing and blaming its claims processing software.

Ambulatory EMR vendor iSALUS names (warning: PDF) Richard Noe as president and CEO. I don’t see any mention of previous healthcare-related employment. He says he’ll double headcount there.

Retired Army General Hugh Shelton, the former chair of the Joint Chiefs of Staff and a Special Forces veteran of the Vietnam War, is named chairman of the board of Red Hat.

Detroit Medical Center says its EMR saved it $5 million last year, $4.5 million of it coming from reduced length of stay related to pressure ulcers. That’s not a great ROI for a $50 million system, but it’s a good start.

I don’t look at LinkedIn often except to verify where someone works since it’s kind of junky looking and always trying to upsell additional features. Still, I was happy to hear from Dann that the HIStalk Fan Club he started there has 1,088 members, some of them spamming my hard-won audience with their own pitches, I notice, which seems kind of tacky but common for LinkedIn. Anyway, since I seldom mention LinkedIn, feel free to add Inga or me to your network (just search for HIStalk). I even added a spiffy new photo since they removed my old one. We’re more Facebookers these days (there’s that narcissism thing), so ditto: just search for HIStalk and you’ll see individual profiles for Inga and me plus our HIStalk page. I’m feeling loserly since I have only 89 friends (although I appreciate every one) vs. Inga’s 112.

The CEO of Naples Community Hospital (FL) writes an editorial bragging on the hospital’s use of its Cerner EMR. Actually he mostly seems to be bragging on the possibility of getting taxpayer money for using it, saying the hospital will be an “early applicant” for money and hopes to get nearly $12 million continuing to do what it was already doing. He says Cerner told him Naples is the second most MU-ready Cerner site.

Markle Foundation assembles (warning: PDF) 45 organizations who advocate that HIT vendors offer the “simple, but rarely offered” ability for people to download their own health records, the so-called Blue Button.

The SVP/CFO of Danbury Health Systems (CT) is charged with defrauding his employer of more than $140,000 by directing health systems payments to a software company he ran out of his house.

IBM and Dell chase the Chinese equivalent of HITECH money. Interesting: one hospital has more than 10,000 patient visits per day.

Bizarre: an auto accident patient says he awoke in Prince George’s Hospital (MD) and asked for food, only to be told by a nurse that he was NPO for cancer surgery, which was news to him. As he was being prepped, he noticed that another patient’s wristband had been placed on him. His wife helped him pack up with intentions of getting out fast AMA, but he claims two hospital security guards beat him and advised him that “Hell, no, he don’t come up in here and be telling us what the f*** to do.” He says a hospital manager acknowledged the incorrect wristband and invited him to have “any type of drug he wanted, just to name the painkiller.” He was diagnosed with broken ribs, a sprained shoulder, a ruptured spleen, and a concussion. He’s suing for $12 million.

E-mail me.

HERtalk by Inga

From Roger Sterling: “Re: DocSite. News has it that Covisint is buying DocSite. Covisint wants to add it to the AMA portal project being rolled out in Michigan.” Unverified. I have a message out to the Covisint folks.

HealthInfoNet, the HIE for Maine, partners with Health Language to provide clinical content integration.

EDIMS licenses First DataBank’s National Drug File Plus database to integrate into its emergency department EHR.

Quincy Valley Medical Center (WA) commits $200,000 for computer hardware in advance of selecting a an EMR application. Software finalists include Meditech 6.0 and CPSI.

Sisters of Mercy Health System launches a $60 million data center in Washington, Mo. The 42,500 square-foot center will host EHR and other applications for all of Mercy’s sites. The regional business journal also points out that the medical information is secure, as it relates to “HIPPA.”

The 16-hospital system IASIS Healthcare selects QuadraMed’s coding, compliance, and reporting tools in preparation for the transition to ICD-10 code sets.

St. Mary’s Medical Center (WV) contracts with Wolters Kluwer Health for its ProVation Order Sets.

Matt Grill, Sunquest’s former manager of technical training and publications, takes over as VP of Global Client Support for MRI Software, a developer of real estate management software.

Patient education material from Thomson Reuters and its Micromedex CareNotes system is available in 15 languages, including Arabic, Chinese, Russian, and Turkish.

On HIStalk Practice: an interview with 20-year-old Greg Waldstreicher, founder of DoseSpot. Everyone who was running a viable business at age 20 while going to school full time, please raise your hand.

Sutter Health (CA) activates iTriage, giving consumers the ability to check systems and find out detailed information about doctors, hospitals, clinics, and ERs via a free mobile application.

The average American hospital barely breaks even, but some have operating margins of 25% or more, according to a Forbes survey of the country’s most profitable hospitals. HCA owns 11 of the top 25 hospitals; two of Mayo’s main facilities make the list as well. Flowers Medical Center (AL) topped the list with its 53% operating margin. Fifteen of the 25 hospitals were for-profit.

Baptist Medical Center (MS) lays off 186 workers, including 14 in management. Laid off workers are being offered a chance to apply for the 136 current openings.

Sponsor updates

• Greenway Medical Technologies says four additional HIEs, IPAs, and regional medical centers have selected its PrimeSuite EHR/PM solution.
• Cumberland Consulting Group has been named one of the 2010 Best Small Firms to Work For by Consulting magazine, having made their list every year since it was started.
• For the second year in a row, the Central Penn Business Journal names MEDecision to its 100 Best Places to Work in Pennsylvania.
• Sierra View District Hospital (CA) hires MEDSEEK to develop and deploy its Web site and clinical portal.
• Access has a new Web site at accessefm.com.
• MaxIT Healthcare makes the Inc. 5000 list, as well as being named #56 on the HCI 2010 Top 100. The company has over 430 consultants.

A baby in Italy suffers heart problems and possible brain damage after two doctors involved in his birth get into a fist fight in the operating room over the appropriateness of doing a C-section. The mother had to have her uterus removed. The region has a 60% C-section rate.

E-mail Inga.

Readers Write 8/31/10

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!

Meaningful Use:  Specialists Still Not a Priority
By Evan Steele

The HIT Policy Committee’s creation of a new Quality Measures Workgroup last week is the most recent in a string of actions confirming that meaningful use has not been defined meaningfully for specialists — and that it is not likely to be. Despite the fact that this new workgroup is charged with prioritizing Stage 2 quality measures and analyzing gaps in Stage 1 criteria, the 18 physicians selected for the 24-member group are primary care providers* — a fact that surely raises concerns among specialists.

The appointment of this workgroup comes on the heels of a growing response to the Stage 1 definition of Meaningful Use from specialists and their professional organizations, commenting on the lack of fit with the way specialists routinely practice. Every one of the six core clinical quality measures are primary care-related, and many specialists will be hard-pressed to identify three of the 38 additional clinical quality measures that are relevant to their practices.

At last month’s HIT Policy Committee meeting, committee member Gayle Harrell commented that much of the input gathered from the specialist panels convened last October seems to have been ignored, She contended that in the final rule, CMS made it more — rather than less — difficult for many specialists to comply with Meaningful Use.

This position was echoed by Thomas C. Barber MD, EMR project team leader of the American Academy of Orthopaedic Surgeons (AAOS) in discussing the Academy’s EMR position statement in the most recent issue of AAOS Now:

Orthopaedic surgeons will have great difficulty in meeting the current 25 Meaningful Use standards. Orthopaedics would derive greater benefits from standards promulgated by our medical specialty society rather than a set of generic requirements that mostly do not apply to musculoskeletal patient care.

This is not a new issue. The primary care focus of the legislation and regulations has been intentional from the outset. President Obama appointed an internist, David Blumenthal MD, to spearhead the program. There was only one private-practicing specialist among the committee members that crafted the recommendations to CMS.

It is not surprising that the Meaningful Use criteria do not reflect the practice patterns of specialists. Federal funding to assist physicians with EMR adoption has been directed towards primary care. The $357 million allocated for Regional Extension Centers, for example, was earmarked to “provide outreach and support services to at least 100,000 primary care providers and hospitals.”

The definition of Meaningful Use is not the only obstacle for specialists. The EMR products themselves are not tailored to the needs of specialists. The AAOS EMR Position Statement correctly suggests that in developing certification standards, it is essential that “the different needs and uses of EHR by disparate medical specialties should be recognized. In particular, the differences between surgical specialties and primary care specialties should be acknowledged.“

Unfortunately, because the certification criteria are linked to the Meaningful Use requirements, they are similarly primary care-driven. The EMRs most likely to be certified for Meaningful Use are predominantly those that were created and developed for primary care physicians — those of vendors that, from 2004 until recently, have devoted their development resources to meeting CCHIT’s 467 largely primary care-focused criteria. The AAOS statement continues: “Many systems are geared toward primary care medical practice, which can limit the utility of EHRs for specialty surgical practice.”

Specialists are no different from other physicians in their desire to participate actively in the evolution of the country’s medical care delivery system. But until Meaningful Use is defined in a way that is applicable to the way they deliver that care, they will participate on their own terms — adopting specialist-focused EMR technology that increases their productivity and enables them to provide the highest quality care and service to their patients.

* Includes internists, family practitioners, pediatricians, preventive medicine, an internist/hematologist, and a psychiatrist.

Evan Steele is CEO of SRSsoft of Montvale, NJ.

Safeguarding EMRs Against System Failure or Downtime
By Arthur Young

Using time-saving information technology and automated patient records management ensures clinicians have faster access to the most up-to-date patient information, enabling timely diagnoses and treatment and maintaining a high quality of care. However, if the network goes down, the system fails, or a planned or unplanned system downtime occurs, clinicians are unable to access critical patient information.

Whether they are planned or unplanned, system downtimes can occur for any length of time — from a few minutes to a few days. Downtimes can also be very costly if there is no system for preserving and accessing up-to-date patient information and maintaining uninterrupted patient care. Healthcare organizations have implemented systems for recovering from disasters, but not for protecting data and continuing operations during downtime. Without such a system, downtime can become more than an annoyance — it can be a life-threatening event.

Distinct from disaster recovery — which helps get systems back up when they go down due to a power outage or property damage — business continuance keeps vital business operations running at or near normal capacities in the event of any network or system downtime. That includes the downtime that occurs while disaster recovery mechanisms are being executed.

There are various solutions available that can help healthcare organizations remain functional during downtimes. However, they have drawbacks. Redundant or fault-tolerant systems can keep computers running and available during a system failure or power outage, but if they are the only system being used for business continuance and the network also goes down, clinicians will not be able to access patient data. Printing patient reports periodically allows clinicians to have the current data on hand, however it is a time-consuming and cumbersome task that diminishes data security, not to mention a waste of paper, ink, and other resources.

To maintain access to patient information from the location its needed, healthcare organizations need to select a business continuance approach that will provide the most protection in the most circumstances. Ideally, a business continuance solution should enable healthcare organizations to do the following:

• Identify critical information and automatically distribute it to areas it will be needed in the event the HCIS is unreachable;
• Ensure the information is secured but available on local machines;
• Maintain seamless operation in the background, notifying administrators of any interruptions; and
• Eliminate the storage of data in paper form, saving paper, ink, and printers.

Intelligent report generation and distribution decentralizes data in the event of downtime by sending the latest reports from the HCIS to its system and creating secure databases in multiple locations. The information is indexed in the database so clinicians can search and find the data they need whenever they need it.

With access to critical data during periods of system failure or extended downtime, clinicians can provide uninterrupted care and healthcare organizations mitigate risks to patient safety. Patients can be assured their health records are up-to-date and secure and confident they are receiving the best possible care.

Arthur Young is the president of Interbit Data of Natick, MA.

Ode to the Dumbwaiter and Robo-Butt
By Frustrated Farmacist (Female)

I saw your blurb about the Aethon TUG delivery robots installed at El Camino Hospital. The old ECH had an awesome dumbwaiter delivery system in place.

It is rumored that the Aethon TUG delivery robot solution was something of an afterthought that came six agonizing months after the grand opening of the $470 million hospital. Apparently earlier plans to integrate a delivery system may have been (ahem) overlooked. You can see from ECH documents that the robot contract was drafted in January 2010, several months after the new hospital opened. Early reports said the robots didn’t work for all departments and some ended up using volunteers, auxiliary staff, temporary workers, and other solutions to get medications and lab materials delivered.

$470 million and NOBODY initially planned an integrated medication delivery and lab transport system for a brand new, ultimate-in-high-tech 400-bed hospital! It doesn’t take too much imagination to extrapolate how important timely medication delivery is in the patient care scheme of things and why it’s the top complaint and employee satisfaction issue for nurses.

ECH’s competitor down the road has been using a similar robot system from Pyxis for the PAST 22 YEARS. It’s on its third generation, fondly named Robo-Butt. He travels in elevators and down halls to six floors and 15 departments. He is guided by sensors in the walls and speaks aloud to nurses to alert them when he arrives and when he commandeers the elevator. He steers around obstacles. His compartments are locked and secure, requiring a numbered password to open. He’s powered by six car batteries that are recharged and swapped for backups 2-3 times daily.

He breaks down every now and then. The elevators break down more often, grounding him on the first floor. Pyxis no longer supports these robots, so parts were scrounged from the basements of other hospitals and from a hospital supply house in Hawaii. But Robo-Butt WORKS. Here’s a picture of this bad boy:

The average hospital pharmacy department dispenses at least 40% more meds than were ordered because of late deliveries or items that are misplaced. The overhead and amount of wasted labor and supplies is unacceptable and frustrating for everyone involved, including the patient, nurse, doctor, pharmacy, and departments like lab and surgery that are held up because of medication delays.

With pneumatic tubes, you place meds in padded bullets and shoot them to the receiving department. Fragile ampules and vials can be broken — think about Epogen, a blood booster whose fragile proteins are destroyed by a violent trip in the tube system. It used to cost $6,000/vial and is still in the $600-900 range. Can I tell you how many bullets have exploded inside the pneumatic tube tunnels? Can I tell you what I think about the ER department tubing patient urine and blood samples to the lab inside this system?

We still have bullets that wind up in the basement due to malfunctioning suction or drivers. It’s hilarious when it’s a $45,000 rattlesnake venom antidote. But the bad part is that sometimes meds lie in piled up bullets in the tube receiving bin. Worse, the staff goes to send an “empty” tube to lab or ER and accidentally send a bullet filled with meds. The worst part is there is no “track-ability” or accountability — we can never tell whether someone received a bullet. If they “say” it never arrived, we have to send it again.

Here’s why I think dumbwaiters may be the ultimate smart medication delivery system with the fastest turnaround times, the least amount of waste, and minimal lost meds and lost charges. The pharmacy staff places labeled / bagged medications into little sectioned trays (like your silverware drawer’s insert) and leave them in the little locked elevator. The nurse that needs meds comes to her department’s locked elevator door, calls up the tray, and REMOVES ONLY HER PATIENT’S MEDS. She leaves the other meds in their little slots.

Think about this. You don’t have one nurse removing meds for her entire department and then misplacing them, storing them improperly (oops, that expensive IVIG that cost $20,000 belonged in the refrigerator?) or just putting them in her POCKET and forgetting to put them in the med room altogether. Then the Pharmacy can call the dumbwaiter down later and retrieve unused meds, credit them back, and recycle them. 

You can imagine that the number of missing med phone calls drops in half. Anyone in the pharmacy can check the dumbwaiter and see if missing meds are there before re-making them. Can I tell you how much time I waste every day re-doing the same missing med that simply gets misplaced or misdelivered and there’s no way to track it? It’s cheaper to bag up another blood pressure pill with the patient’s name and send it again sometimes. And then we get to retrieve all the duplicates, sort them, and restock them in the pharmacy bins…

I have nightmares about this.

A reliable well-planned medication delivery system is worth $$$ millions and makes up 80% of the nursing / customer satisfaction basis. I swear this is true! Any healthcare organization that builds a state-of-the-art facility without planning a delivery system is completely ignorant.

Done with my rant. 😉

ONC-Authorized Testing and Certification Bodies Named

The Office of the National Coordinator for Health Information Technology has named two ONC-Authorized Testing and Certification Bodies (ATCBs). They are Certification Commission for Health Information Technology of Chicago, IL and Drummond Group, Inc. of Austin, TX.

Authorized by the National Coordinator, ONC-ATCBs are required to test and certify that certain types of EHR technology (Complete EHRs and EHR Modules) are compliant with the standards, implementation specifications, and certification criteria adopted by the HHS Secretary and meet the definition of “certified EHR technology.”

Monday Morning Update 8/30/10

From Packerbacker: “Re: Epic. Wins another one, selected VOC at Children’s Hospital of Wisconsin. The contract is not signed, but they have already started planning the implementation.” Unverified, but Epic doesn’t lose many deals in its home state.

From Winston Zeddemore: “Re: clinical data. I lost a lost of respect for Halamka with the whole ePatient Dave mess. As a doc, he should have known better than to inundate unsuspecting patients with a barrage of unchecked claims data in their PHR. Then, he has the audacity to state that the switch to ICD-10 would fix the problem, when ICD-10 has no code for metastasis of cancer to the skull, either. Recall, poor Dave was alarmed to see a diagnosis of mets to the brain, when he had really had mets to skull that had been successfully managed. Well, ICD-9-CM has no code for mets to the skull, so the coders used the closest thing, mets to the brain.”

From Telluride: “Re: HIStalk e-mail list. Since you started telling the numbers, it has grown each month. Do you allow unsubscribes?” Yes, and I get some of those. That’s why I look more at the ratio of new subscribers to unsubscribers. This month, for example, it has been 372:64. Some of those are e-mail address changes, of course. Like everybody else, I’d prefer readers who love me rather than hate me, but it’s indifference that I really hope to avoid.

From Eroica: “Re: Emdeon. I thought you’d like the highlighted reference below. You are now the source for Wall Street analysts!” A brokerage and investment firm’s update cites my Thursday posting about Emdeon and Blue Shield of California, although not by name (“a well read HCIT blog”). The announcement included the same confirmation I used from the reader’s rumor report (Blue Shield’s Web site) and listed the same three of 17 remaining clearinghouses that I did (which I did because those three are HIStalk sponsors and I figured it was nice to mention them, plus I hadn’t heard of most of the rest anyway). Emdeon responded to the firm’s inquiry by saying they may still negotiate a deal and their revenue from Blue Shield of California isn’t that important since “they can shift the cost per claim to providers or obtain rebates from other vendors.”

From Paul: “Re: tube system failure. Shameless plug by a robot vendor – I work for Aethon, a Pittsburgh-based company that makes TUGs, autonomous robots that deliver medications or supplies to any location. Think of it as a tubeless tube system with no fixed infrastructure that works 24/7. We also offer a Chain of Custody solution that uses biometrics and RFID to improve patient safety.” Since Paul made it clear it was a shameless plug, I’ll allow it. I’ve mentioned the company a few times, mostly when execs from other Pittsburgh-area HIT companies ended up there. Above is a video some guy made as he chased around one of the Aethon robots at El Camino Hospital. You’ll hear him say, “Puttin’ Americans out of work,” which may be true at El Camino since the hospital just announced a 140-employee layoff.

From C’mon Man: “Re: tube system at UPMC Shadyside. The workaround to avoid the >90 minute delay after CPOE deployment is marvelous!” CM sent a UPMC internal document describing a quality improvement project at Shadyside. Before Cerner was implemented, the ED stocked 95% of the meds they used in their automated dispensing cabinet and the other 5% were requested by tubing the paper order to pharmacy, resulting in a pretty good turnaround time of 28 minutes. With CPOE, the ED had no good way to alert pharmacy about those 5% of meds, so turnaround time shot up to over two hours. An ED nurse came up with a solution: tubing a yellow “Stat ED Med” card to pharmacy along with an index card listing the patient and med needed, dropping TAT back to six minutes. I was initially appalled at this solution since hand-transcribing an electronic order onto a tubed index card seems fraught with potential error, but pharmacy reviews the electronic order before sending the med and I assume nurses still verify the med electronically in the ED, hopefully with bar code checking. What puzzles me is why the original electronic order doesn’t go directly to pharmacy anyway — surely the pharmacy module should “know” that an order was entered for a non-Pyxis order and should send it to the pharmacist’s work queue for verification and delivery with no manual notification required. That’s what integrated systems are supposed to do.

All this tube system talk stirred up some old memories of a hospital I worked in years ago, where the information superhighway was a dumbwaiter system (“the dummy”, staff called it). It was actually darned useful since the hospital was built around it, so it connected the nursing units with the major departments they interacted with (lab, materials management, pharmacy, etc.) I once dared a small female co-worker to ride it up several floors, where she proceeded to scare the bejesus out of the nurse who opened its tiny door to see what had been sent. All of these “hospitals of the future” with their LCD TVs and room service should have reintroduced the dumbwaiter, an express elevator for stuff.

Listening: I’m still obsessed with the new Iron Maiden, but I took a break to listen to some catchy and refreshingly different alt rock-pop from The Last Goodnight.

Your mission, should you choose to accept it: (a) put your e-mail in the Subscribe to Updates box, just to make sure you don’t miss any news or juicy rumors; (b) speaking of news or juicy rumors, send me some by clicking the ugliest, greenest graphic on the page, to your right; (c) show HIStalk’s sponsors some appreciation by clicking on their ads to find out what’s new with them; (d) fritter away a slow afternoon at work by performing endless searches using the Search function to your right; and (e) Friend or Like Inga and me on Facebook so we can maintain our delusions of popularity. Thanks to readers for reading, sponsors for sponsing, and everyone who takes the time to leave a comment, send an e-mail, or submit something I can use on HIStalk, HIStalk Practice, or HIStalk Mobile.

Epic wouldn’t be a good choice to replace the DoD’s AHLTA EMR system, two-thirds of HIStalk readers say. New poll to your right, since Ed Marx’s “Blessing of the Hands” piece stirred up some heated responses: should hospital IT people be expected to have a higher level of compassion and spiritual beliefs than their counterparts in banking or manufacturing?

A sad medication error at Cincinnati Children’s: a seven-month-old baby dies after heart surgery when a technician apparently infuses an alcohol solution instead of saline.

Welch Allyn announces its Connex vital signs documentation system, a single device that collects automatic instrument readings (heart rate, blood pressure, temperature, pulse oximetry) and manual entries (height, weight, pain level) and modifiers (body position, O2 settings). It also allows alarm management and on-screen documentation right from the device. It’s wireless to the bedside. The company says that an average 200-bed hospital wastes 8,000 hours per year documenting vitals and makes 10,000 mistakes in doing so. St. Joseph’s Hospital Health Center in Syracuse, NY, the beta site, reports a 50% drop in documentation time and 75% fewer errors.

Yale-New Haven Hospital’s new CIO will be Daniel Barchi, who will also serve as CIO for the Yale School of Medicine. I interviewed him a few weeks ago while he was SVP/CIO of Carilion Clinic of Roanoke, VA. YNHH will be cranking up its $250 million Epic project, so I’m sure his experience in implementing Epic at Carilion will be valuable. He’s a good guy, as was his now-retired YNHH CIO predecessor Mark Andersen. Both are fans of HIStalk and have been cordially forthright in responding when I’ve pestered them to verify reader rumors.

Also on Inc.’s list of 5000 fastest growing private companies: Vitalize Consulting Solutions, among the fewer than 10% of companies on the lists that have four-peated since the magazine started the list four years ago. I’d consider Vitalize CEO Bruce Cerullo to be a great friend of HIStalk, having known him for years and interviewed him in 2007 when he was running VCS’s predecessor company Lucida, but even I didn’t know the company had grown this much: 264 employees, $48 million in annual revenue, and three-year growth of 179%.

HIStalk reader and clinical informaticist Lincoln Farnum sent over his exclusive article, Common Knowledge: Clinical Decision Support in the Era of Meaningful Use, a CDS Toolkit. I’ve posted it on Drop.io, hopefully free of the sneaky and unwelcome Facebook tie-ins that keep biting me in the rear when I post files for download. It’s a good overview of CDS, the ethics involved in deploying it, the problems with trying to measure its impact on patient outcomes, usability issues, and best practices in CDS deployment. Give it a look.

I was annoyed by a press release from Brainware that announced a new healthcare customer without naming them (is a sales announcement really news when it omits the customer’s name?), but the company’s Distiller product still sounds kind of interesting. It’s an intelligent data capture platform that “learns” the data fields from scanned documents such as invoices and orders.

New from Japan, which seems obsessed with high-tech toilets: a network-enabled health monitor version that checks blood sugar, BP, BMI, and urinalysis, all stored for a year for a family of four. Plans for the next version of the $5,000 marvel include communicating the measurements directly to physicians. Maybe it can do its own health check and page a network engineer to bring a plunger.

Interesting: McKesson’s only obvious operation in Ireland produces software documentation (check the title page of your Horizon manuals), but McKesson books (no pun intended) $10 billion a year through its Irish subsidiaries. The reason: it routes drug sales revenues from Canada, Israel, and Mexico through Ireland to avoid the higher corporate income tax of other countries, like the one its $35-million-a-year CEO lives in. Blame the politicians, not the company — wasn’t that one of the many populist windmills that President Obama was going to joust at?

Two radiology department employees of St. Luke’s Hospital (FL) are arrested for stealing hospital computers and selling them on Craigslist. Funny that nobody at the hospital missed them until a tipster told them.

A review of computer records leads to a $5.3 million settlement between doctors and Central DuPage Hospital (IL) over a case of untreated clotting problems that may have caused a patient’s death. The radiologist said he never saw the patient’s MRI results, but the computer showed otherwise.

E-mail me.

News 8/27/10

From Sweet Thang: “Re: Blue Shield of California. Pulling out of Emdeon on November 1. It’s been mentioned nowhere, including on Emdeon’s site, but it’s on the Blue Shield site.” Seventeen claims vendors remain, among them Allscripts Payerpath, Navicure, and RelayHealth.

From The PACS Designer: “Re: Office 2010 Web Apps. If you haven’t purchased Microsoft Office 2010 yet, you can download a free trial copy of Office 2010 Web Apps to get an idea of what’s new in Microsoft’s business software offering to all of us HIStalkers.” 

From e-R Nurse: “Re: Pittsburgh. Congrats to fellow Pittsburgher Rich Goldberg, a tireless worker. And last week, 90-minute waits for meds at the UPMC Shadyside Hospital ED when the vacuum tube system got plugged for hours. It is used to facilitate efficiency between ED and Pharmacy with the CPOE system.” Not uncommon. Tube systems are in many hospitals and serve as the lifeline from far-flung patient areas to pharmacy and lab, not just for paper orders, but for meds (at least the non-hazardous and non-fragile ones that can be tubed). I can say from experience in multiple hospitals that a CPOE or pharmacy system downtime is nothing compared to a tube system outage, which requires finding people to act as couriers to run stuff back and forth constantly. If anyone ever makes the Star Trek transporter a reality, hospitals will be an instant market. And like CPOE systems, sometimes you find a lot of missing items that got waylaid in transit from Point A to Point B (the tube system is the ultimate interface).

From Katrina: “Re: kudos. Keep up the great work. I owe a lot of other people’s perceptions of my brilliance to HIStalk. ;-).” That’s a nice comment — thanks! Inga and I don’t get to look brilliant ourselves since we’re anonymous (and might well look a lot less brilliant if we weren’t), so we’re happy when readers say they benefit from reading. Our favorite stat is from our annual reader survey earlier this year, in which 82% of readers said reading HIStalk helps them do their jobs better. We console ourselves with that when someone insults us.

From Lisolette: “Re: VA’s VistA. A good blog article.” It a book review of sorts, covering the well known Best Care Anywhere. It makes some good points (VistA doesn’t get used enough because it doesn’t generate profits like proprietary EMRs) and some questionable ones (VistA is being adopted in other countries because the VA model works so well, not mentioning that many of them grab it because it’s free). Minor quibbles aside, it’s a pretty good read, especially the nice, simple overview of how MUMPS and Cache’ work. It’s also true that the VA care model is one that would be perfect other than providers are paid for procedures instead of improving health: lifetime patient care, a data-driven approach, and having incentives to improve health and not just healthcare.

Changes to the Health Information Act in Alberta, Canada bring up a question for debate: should chiropractors, dentists, and optometrists be allowed to access the full electronic health records of patients?

I’m awaiting the official announcement before naming names, but the Yale-New Haven CIO job has been filled. Readers who sent me the rumor were correct. I’d ordinarily just blast out the name since it’s confirmed, but I’m bending my own muckraker rules since it’s a friend of HIStalk and the announcement is immediately forthcoming anyway. It’s a great job for the new person and a great hire for the hospital. More to come.

A Florida medical news site profiles Sushoo (bless you!), which claims to be the first independent HIE. It was started by a Florida entrepreneur and his physician wife as a small side project, but now has 40 employees.

Hilary Worthen, MD is promoted to CMIO of Cambridge Health Alliance (MA).

I didn’t scour the entire list of Inc. Magazine’s Top 5000 Fastest-Growing Companies, so here’s another HIStalk sponsors that made it: Culbert Healthcare Solutions, coming in at #988 in its first year of eligibility. Also: GetWellNetwork.

Keith Boone, “Standards Geek” for GE Healthcare, did some good sleuthing in noticing that the public health notification standards in Meaningful Use are incorrect. It uses standards intended for state reporting to the CDC, not for providers reporting to states. It’s also an obsolete version and describes only the message standards, not the content. Apparently his observation made its way to ONC, with John Halamka stating that ONC will issue a correction. Let’s hear it for the geeks (including both Keith and JH), the unsung heroes of HIT often deprecated among the Alpha Male sales jocks and cutthroat MBAs who climb their backs to reach the organizational pinnacle.

Inga and I pride ourselves on making all viewpoints available on HIStalk, not just ours. How that works: you are welcome to post article comments, send in a Readers Write piece, or suggest items we should cover or people we should interview. We’re always especially interested in hearing from provider-siders, who tend to be underrepresented simply because they don’t hire PR firms or have products to pitch.

Ingenix Consulting announces its Strategic Technology Solutions practice, which offers services related to IT strategy development, technology procurement, and implementation. 

Weird News Andy muses, “Does the C in C-section stand for ‘clean’?” A maternity ward in Sweden, short on help, tells a newly delivered mom being discharged to bag up her laundry and tidy up her room before leaving. Two midwives in the hospital confirm her story: “You can’t leave a mother while she’s giving birth. It’s true that we sometimes need to make use of the parents and that doesn’t feel good at all.”

BridgeHead Software releases a healthcare disaster recovery white paper.

Clay County, West Virginia pilots HealtheMountaineer, a PHR system modeled after the VA’s MyHealtheVet project and tying into the state’s open source systems (Medsphere’s OpenVista and the Resource and Patient Management System from the Indian Health Service). This is pretty impressive, especially if you’ve ever been to Clay County.

Sponsor jobs: Epic Certified Consultants, Account Manager. Jobs from Healthcare IT Jobs: Executive Director Epic Systems, Lab Systems Project Manager, Medical Information Officer Acute.

Businessweek sees competition between the deep pockets of UnitedHealth and McKesson to sell updated insurance company systems (enrollment, care management, and claims processing) and those moving to ICD-10. Here’s an interesting quote from a VC guy: “Every healthcare payer in the world needs an upgrade. You or I are talking about getting an iPad. They are still getting off mainframes.” Potential acquisitions mentioned are Click4Care and ZeOmega.

OakBend Medical Center (TX) chooses the Corepoint Integration Engine for its Paragon implementation.

I got a pop-up message in my Gmail account offering free calls for the rest of the year, which must mean that the very Skype-like Google Voice is live.

An two-year NHIN pilot project will test (warning: PDF) sharing of clinical information between the Indianapolis VA and the Indiana HIE.

Senator Max Baucus, a key player in writing the healthcare reform bill, admits that he hasn’t read all of it. He hasn’t said whether he knew about the unrelated tax change attached to it that will require businesses to send out 1099 forms to any supplier selling them more than $600 worth of goods or services.

Odd lawsuit: Marin General Hospital announces a lawsuit against Sutter Health, claiming Sutter siphoned off $120 million before turning control back over to the county this past June. Equally odd: a couple sues SeaWorld of Orlando for traumatizing their ten-year-old son by trying to resuscitate a trainer who was killed by a whale during a performance they attended.

E-mail me.

HERtalk by Inga

University HealthSystem Consortium (UHC) collaborates with Carefx to provide business intelligence dashboards and analytic tools for UHC’s Clinical Data Base (their spelling). UHC members include about 90% of the nation’s non-profit academic medical centers.

Passport Health Communications launches Payment Navigator to provide upfront financial triage when patients are admitted to hospitals.

The CNO of Covenant Hospital (TX), which is implementing Meditech, says it will advance Covenant’s “Design for Perfect Care” strategic initiative, with goals of “perfect care, sacred encounters, and healthiest communities.”

Epic takes top honors in yet another KLAS report. KLAS’s latest project looked at the EMR buying experience of 146 healthcare organizations and examined such elements as the true cost of ownership, scope, how well vendor kept promises, and getting one’s money’s worth. Epic was the only vendor with high ratings for money’s worth, contracting, and costs. Epic’s projects also had the largest scope of any vendor. Meditech fared OK, with clients saying they got what they expected in terms of contract, delivery, and post-live selling events. However, Meditech’s clients were disappointed in the company’s lack of proactive help in getting their money’s worth. GE earned lackluster ratings, with customers saying that GE has been on a downward trend since it bought IDX in terms of keeping commitments.

A new study finds that hospital EHR adoption in hospitals grew slightly from 2008 to 2009 (8.7% to 11.9%) and that only 2% of hospitals meet Meaningful Use criteria. In addition, small, public, and rural hospitals are less likely to have adopted EHRs compared to larger, private, and urban hospitals. Thirty-one hundred hospitals participated in the survey, which is more than half the country’s hospitals, and researchers claim their reporting methods were conservative. Even if these results significantly understate reality, it’s probably still safe to say that HIT adoption has a long way to go.

Cayuga Medical Center (NY) contracts with Summit Healthcare for its Summit Apex integrated product suite, which will facilitate patient data exchange between Cayuga’s Meditech system and physician office EMRs.

Quality IT Partners says it’s leading the Meaningful Use analysis efforts for one of the largest multi-facility health systems in the country.

New this week on HIStalk Practice: a pretty darn funny video that pokes fun of a clueless CEO trying to set up an ACO; highlights of an MGMA letter to CMS, including e-rx recommendations; and, news on a couple of New York practices that each earned $100,000 leveraging data from their NextGen systems. Make sure you are signed up for e-mail updates so you don’t miss the upcoming interview with ACO expert Chet Speed of AMGA. It’s a good read, especially if you are an ACO newbie.

Premier healthcare alliance says 150 hospitals and healthcare systems saved over $120 million in labor and supply costs participating in Premier’s LaborConnect program. It tracks labor productivity, performance, and costs.

The AHA spent $4.2 million lobbying the federal government during the second quarter, up 20% from the same period last year. Most of the activity centered around Medicare fraud and health care reform.

Allscripts, eClinicalWorks, e-MDs, GE, NextGen, and Sage all donate EHR systems to the University of Texas at Austin’s HIT program. I noticed that a few students in UT’s program had a chance to spend two weeks this summer working at the Gulf Coast REC. One project involved spending a day in a non-profit clinic that relied completely on paper records. By the end of the day, students had created a new database system for tracking the health of diabetic patients.

E-mail Inga.

CIO Unplugged 8/25/10

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

A Sacred Calling

“The Human contribution is the essential ingredient. It is only in giving of one’s self to others that we truly live.”

— Ethel Percy Andrus

Someone asked our chief medical information officer, Ferdinand Velasco, MD, why he would leave his skyrocketing career as a cardiac surgeon at New York-Presbyterian to become CMIO at TexasHealth. I will never forget his answer: “As a heart surgeon, I could help about 200 people per year. As CMIO, I am helping the 6.2 million people in our region.”

Whether we give direct care or support someone who does, we are fulfilling a sacred calling — touching human lives. Don’t discount information technology because it’s only computer stuff and nobody really knows where cyberspace is anyway. You could’ve practiced IT in any industry, yet you chose healthcare. Or perhaps healthcare chose you.

Sacred callings come in various forms. Although healthcare IT is nothing unique in itself, the element of sanctity is why I stay. If we want to live a life of significance, we must understand the depth of our calling and then perform as if our work matters. Grasp the privilege of serving humanity with your skills and talents. That is sacred.

In using our hands for work — answering service desk calls, pulling cables, creating order sets, managing projects, developing strategies, creating apps — we are helping care for the patients and clinicians. We’re telling them, “You are important to us and we value you.”

Stop for a moment. Re-read the above paragraph then hold your hands in front of you. While studying your hands, reflect on what they do each day that contributes to caring for the health needs in your community. Seriously. Have you not chosen to bless others through the work of your hands?

Wherever people are involved (life), challenges and frustrations exist. Healthcare is beset with issues. What can keep us focused during those difficult circumstances is remembering our purpose.

Let me share with you one recent technique we developed to maintain the heart-to-head connection.

Blessing of the Hands

It is not unusual for hospitals to conduct non-denominational “Blessing of the Hands” ceremonies. Here is video example from MetroHealth in Cleveland.

I had seen this done for clinicians at one of our hospitals and it got me thinking. What about IT? What we do is no less critical to the healing process. Our hands may not touch patients, but they do touch their lives in ways unseen. Arguably, IT is the only segment that touches the entire healthcare continuum.

I contacted our chaplains, and they were excited about the concept. For the first time this spring, we conducted a Blessing of the Hands ceremony exclusively for IT. The chaplains first shared with our team the sanctity of what we do in serving people and the impact we have on the lives of both patients and caregivers. They prayed over us. They prayed a blessing over a special vial of oil then used it to anoint our hands.

One at a time, we rose from our seats and approached the chaplains. While we held open our hands, they anointed them and gave us each a verbal blessing. I sat back down and simply soaked in the moment. I imagine many others encountered the same refreshing.

All I can say is that it was a holy moment for all who chose to participate, regardless of their religious orientation or belief system. We emerged inspired and empowered. We walked out of there knowing that we were making a difference in lives every day.

No matter what your area (supplier, payor, or provider), I highly encourage you, the leader, to make this voluntary ceremony available for your teams. You’ll witness a demonstrable impact and you’ll be reminded that what you do is significant. Your calling is sacred.

***

Here is a sample Blessing of the Hands prayer. A simple Bing search will bring up other samples.

· Blessed be these hands that have touched life.

· Blessed be these hands that have felt pain.

· Blessed be these hands that have embraced with compassion.

· Blessed be these hands that have been clinched with anger or withdrawn in fear.

· Blessed be these hands that have drawn blood and administered medicine.

· Blessed be these hands that have cleaned beds and disposed of wastes.

· Blessed be these hands that have anointed the sick and offered blessings.

· Blessed be these hands that grow stiff with age.

· Blessed be these hands that have comforted the dying and held the dead.

· Blessed be these hands that develop applications that improve quality of care.

· Blessed be these hands that answer the phone and empathize while solving issues.

· Blessed be these hands that reprogram the broken network.

· Blessed be these hands that enable life-saving technology.

· Blessed be these hands, we hold the future in these hands.

· Blessed be our hands for they are the work of Your hands, O Holy One.

Update 8/29/10

I appreciate all the comments. Thank you.

The point I do not want readers to miss is to know that what we do in healthcare IT is significant, impacting the health of our communities and nation.

You can broaden the definition of spiritual to include your overall sense of purpose and mission. For me it is birthed in my faith. For others it will take on a different look, but either way I maintain that healthcare IT is sacred work.

As long as your views are not forced on others or go against the values/culture of your employer, I see no reason not to allow for individual expression. I happen to work for a faith-based health system and enjoy the freedom this brings to everyone, regardless of religious or secular orientation.

 

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

News 8/25/10

From Teaberry: “Re: Verizon vs. Comcast. To provide the secure backbone for HIEs.” I keep hearing that Comcast will make some big healthcare moves soon, so we’ll see if that’s one of them.

From Eclipsys Observer: “Re: Allscripts and Eclipsys leaders. Under fire and intense scrutiny as the merger unfolds. The Newco has not identified a single product management leader, with John Gomez and Jon Zimmerman vying for power. Rumor is that Gomez is in the lead.” Unverified.

From DigiGuy: “Re: Roche/Ventana purchases BioImagene. You probably knew about it before it happened.” The Swiss drug maker will pay $100 million in cash to acquire the privately held California-based BioImagene, which sells a digital pathology system (slide scanner, biomarker analysis software, workflow, etc.) for tissue-based cancer diagnostics. The drug makers are struggling for some reason (prescription prices make that hard to believe) and are all over personalized medicine.

From WhatDoYa Know: “Re: Yale CIO job. [name omitted] is in line for it.” I left out the name while I wait to hear back from that person. Lack of response usually means confirmation. I’m waiting on that rumored Siemens surgery system vendor acquisition since John Glaser didn’t reply when I e-mailed.

From Toomer: “Re: Ingenix. I bet their next acquisition will be iSoft.” That wouldn’t surprise me, although I don’t know how interested they’d be in a company with minimal US presence.

From Wildcat Well: “Re: NJ’s HIE program. They held a conference call Friday for fielding questions from EMR vendors. The good Garden State showed themselves to be sometimes unyielding, under-informed, and at times down right combative with EMR vendor participants.” Unverified. I can’t decide if that’s necessarily a bad thing.

From Oregon Lab Guy: “Re: Portland weekly tabloid article about open source and HIT’s ‘gold rush.’ It suggests that we have ‘thousands’ of EHR experts roaming the streets of the Rose City – OHSU must have a big lecture hall!” The article says that Portland is the country’s open source capital even though the big companies took ideas and people from there and moved elsewhere. It bemoans the lack of follow-through with good ideas born there, mentioning that Portland’s techies have a reputation for wanting to head out at 5:00 each day (kudos to them). It’s a pretty good article, using the cynical mandatory EMR analogy that I thought I made up — requiring restaurants to use electronic order-taking and processing to improve their efficiency and reduce mistakes. Above is a July OSCON lecture on open source in HIT from Deborah Bryant of the OSU Open Source Lab.

Cumberland Consulting Group is named to Inc. magazine’s Top 5000 Fastest-Growing Private Companies for the second straight year, a nod to its 34% growth and its increase from 53 to 91 consultants in the past year.

Former Allscripts COO Ben Bulkley is named president and CEO of Fluidnet, an Amesbury, MA maker of what looks like a pretty sweet IV pump.

PerfectServe announces its Clinician iPhone application, which works with its system to allow doctors to make calls using the internal directory and manage their on-call schedules and notification preferences.

Ingenix completes its acquisition of Picis. That didn’t take long.

Industry longtimer Rich Goldberg, formerly of Misys and Confluence Medical Systems, joins TeleTracking as SVP of strategy and business development.

HITECH and MyEMRChoice.com are written up in the Philadelphia paper.

McKesson CEO John Hammergren is chairing the search committee of HP’s board that will choose a successor for ousted CEO Mark Hurd.

Dana-Farber Cancer Institute implements Informatica for data integration.

NIST’s approved testing procedures for temporary certification of EHRs are here.

Clairvia announces GA of mobile open shift alerts and scheduling for its physician scheduling system. The Durham, NC-based company, which sells resource management and scheduling systems, has executives from Atwork and Per-Se. It changed its name from AtStaff this past spring.

Northern Virginia RHIO will use GE Healthcare’s Global eHIE system to bring patient medication histories into Inova Alexandria Hospital’s Picis EDIS.

A PHI-containing and apparently encryption-free laptop is stolen from the University of Kentucky Medical Center.

E-mail me.

HERtalk by Inga

From KISS: “Re: (Company X). Is it me or do these guys have the worst elevator pitch ever?” I left out the vendor’s name, but I agree that it’s a pretty bad pitch when you can’t figure out what the company sells. It’s a shame that so many companies get caught up with using all these non-descriptive but trendy buzz words in an attempt to pitch their products. As Mr. H says, “they get too highfalutin’”. Note to marketing types: Keep It Simple Stupid for those of us who don’t want to read/hear your pitch more than once just to understand what you’re offering.

Community Hospital of the Monterey Peninsula (CA) selects RelayHealth’s HIE solution to connect and exchange clinical data with physician practices. RelayHealth, by the way, just achieved full EHNAC accreditation for its e-prescribing services.

Sage North America adds its healthcare division products to Sage’s Partner Advantage program, meaning its EHR/PM/EDI are now available through resellers.

McKesson names Eisenhower Medical Center (CA) and HealthFirst Care Systems (MN) the winners of its 2010 Distinguished Achievement Award competition for outstanding use of McKesson’s HIT products.

Intermountain Healthcare (UT) contracts with The Advisory Board Company for its OptiLink patient acuity solution.

BayCare Health System (FL) confirms news we reported over a month ago: Tim Thompson, most recently CIO at the Methodist Hospital System, is BaycCare’s new CIO.

Children’s National in Washington DC successfully implements the AuditACE compliance solution from Streamline Health Solutions.

CHRISTUS Health premiers a MEDSEEK-developed enterprise website that consolidates its 16 sites.

Mahaska County Hospital (IA) fires two employees for snooping in patient medical records for purely personal reasons. The violated patients included the ex-wife of a current boyfriend, an ex-husband, a husband, the mother of an adopted child, and a hospital volunteer. Ah…it is so tempting to ignore the law and common sense and just be nosy.

Epic moves into Heaven and the local papers have photos to prove it. The Madison and Verona papers provide updates on Epic System’s newest building (Heaven), which includes a curving, stainless steel slide that lets employees shoot from the first floor down to underground parking. With Campus 2 scheduled for completion next year, Epic is now contemplating a third campus. Judy — send me an invite because I really want to try out the slide.

Lenox Hill Radiology (NY) contracts with Professional Data Systems to manage Lenox Hill’s IT department.

The University of North Carolina Health Care System signs a contract to implement the Lawson Health Resource Management suite.

The North Texas REC selects WaveTwo, LLC as an official agent, tasked with helping physicians to implement EHRs and qualify for economic incentives.

I’m guessing that someone at Methodist Le Bonheur Healthcare (TN) has not signed the Oprah No Phone Zone pledge. The hospital says it will post updates on ER wait times every two minutes. The information can be accessed via Methodist’s Web site or by texting ERwait on a mobile phone. OK, I know they are not the only hospital offering this type service and I don’t mean to pick on them, but for some reason when I read their announcement, I envision a driver speeding down a highway while texting for wait times while looking in the rear view mirror to the back seat at a child holding his arm and screaming in agony. But really, I am sure it is a great service. So great that I see that MetroWest Medical Center (MA) is launching a similar program.

Canton-Potsdam Hospital (NY) names Jorge C. Grillo its new CIO. One of his priorities will be the implementation of a $2 million EHR system (Meditech, I believe.) He’s the former CIO of the Island of Bermuda’s Hospital System (sounds like a nice gig),

KLAS takes a look at RIS, awarding the top satisfaction rating to Epic Radiant in the 200+ bed hospital market. Avero interWorks and NovaRad tie for the number one spot in the community hospital market segment and FUJIFILM Synapse IS is the leader in the ambulatory market. The top four functionality items on providers’ wish lists include management reporting tools, flexible scheduling, rollout of mammography tools, and critical test results management functionality.

Modern Healthcare readers vote President Obama the most powerful person in healthcare. Lots of politicians and policy wonks fill out spots 2 through 100 on the magazine’s annual ranking of the 100 Most Powerful People in Healthcare. Rumor has it that Mr. H came in at #101.

E-mail Inga.

Healthcare IT from the Investor’s Chair 8/23/10

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First, let me offer my apologies to all, especially Mr. H. and Inga, for the heinous length of time between posts. It won’t happen again.

It’s been an interesting time with multiple industry-shifting M&A transactions (but not much in the way of public equity activity). The big question on everyone’s minds these days is not “Who is Salt?” but rather, “What is Ingenix?” (a) a drunken sailor? (b) a whale at the HCIT casino? (c) just too darned wealthy? (d) a genius assembling parts in a way that has yet to become clear? I would submit it’s actually (e), all of the above.

Let’s take each in turn. Ingenix, as all likely know by now, is the wholly-owned IT subsidiary of UnitedHealth Group, one of the largest publicly traded managed care companies. Mr. HIStalk himself recently posted a list of its recent buys.

The first thing that’s noteworthy to me is its dramatic movement from only managed care-focused companies — such as Symmetry, Claredi, or AIM — towards first the hospital business office (CareMedic, Executive Health Resources) and then towards the clinical side of the healthcare system (Picis and, most recently, Axolotl).

When Ingenix tried to buy managed care claims system vendor TriZetto a few years ago, it was going to make the questionable bet that its competitors would purchase their core systems from them. A stretch, but one with precedent. Now it’s betting that hospitals and physicians will not only pay real money to the Great Satan of Managed Care, but that they’ll entrust their clinical data to it as well.

(A provider-focused HIE vendor I know was recently licking their virtual chops over the prospect of selling against a managed care company. Even consumers will likely start to wonder if they want UnitedHealthcare to have the moment-by-moment deep clinical data inherent in some of the recent purchases).

Let’s talk valuation for a moment. As a buyer, Ingenix is, in many ways, ideal for a number of reasons. First, recall that by SEC regulation, public companies have to disclose any material information to their shareholders. The definition of material, however, is open to some debate.

When you’re owned by a company with a $35.5 billion market capitalization that expects to generate $5 billion of cash this year, materiality is a blessedly high bar (by way of comparison, Cerner’s total market cap is $5.7 billion). What this means is that outside shareholders can’t second guess the prices paid. It is, in effect, like a transaction between private companies.

Let’s imagine for a moment that Eclipsys was a private company. Because of their relative sizes, Allscripts still would have had to disclose the purchase price. It would also have been held, at some level, accountable to its shareholders for what it paid, imposing an additional layer of market discipline. Ingenix/United, in contrast, doesn’t view any of its acquisitions in the space as financially material, which no doubt helps loosen the purse strings.

An even better attribute in a buyer than ability to remain silent is ability to pay. At the time of its last earnings release (Q2), Ingenix’s parent United raised its guidance for cash from operations by $200-600 million (or almost as much as CPSI’s enterprise value). I’m sure Bill Gates’ kids would concur — when your parent generates that kind of money, you can pretty much buy what you want if they’ll let you! So when your business generates cash of almost $14 million per day, money is just not a problem.

Now I wonder is this a casino whale or a drunken sailor? One smart HCIT company president opined to me that this characterization was offensive to drunken sailors everywhere, but perhaps he’d just been outbid. Personally, I’m leaning towards whale. Unlike Misys in the 90s, United clearly understands healthcare and Ingenix clearly understands HCIT. Even some of the prices paid, if scuttlebutt is to be believed, aren’t totally irrational (though they are unquestionably aggressive).

Let’s consider Picis as an example. The company was widely rumored to have sold for about 3x 2009 revenue or about 12x 2010 EBITDA. By way of comparison, Eclipsys is selling to Allscripts for 2.1x trailing revenues and 10.5x forward EBITDA. Who’s getting the better deal? Eclipsys has a much broader product offering, but Picis’ products have great depth in the few areas of the hospital in which it plays. Both companies are coming off difficult years with fairly robust growth forecasts. Both have a great ARRA/Meaningful Use story to tell, which pushes their multiples upward.

Bottom line, to me, it appears to be a very aggressive, but not totally absurd price. Now, on the pricier side, Executive Health Resources was purchased for over $1 billion, and I’ve heard Axolotl went for as much as 9x trailing 12-month revenues, which seems a different story.

Finally, there’s the matter of motivation, which I expect is multi-fold. I have no doubt that there’s a grand strategy at play here that will be likely be revealed by the company once the pieces are assembled. But in addition to that, each year the operational dollars that are deployed towards these IT solutions are almost certainly to be counted towards patient care (as opposed to other business purposes). This will have the effect of making the optics of its medical loss ratio appear more attractive to government regulators. Further, I believe there will ultimately be some actual patient care improvements in many cases.

Ordinarily I’d say time will tell if the prices paid are fair, appropriate, or even reasonable; but in this case absent a total implosion, lack of materiality will likely make it difficult ever to learn. I’m aware of a few assets that Ingenix is on the hunt for. I’m sure, to their current shareholders, that the price paid will quite material indeed.

Ben Rooks is the founder of ST Advisors, LLC, a consultancy which works with HCIT companies and their sponsors typically on issues around strategy, financing and outcomes/exit planning . He earned an MBA in healthcare management from The Wharton School of the University of Pennsylvania, was a leading healthcare IT equity research analyst and then worked as an investment banker in over 25 successfully closed healthcare and medical technology transactions valued from $40 to $365 million.