News 7/14/10

From CernerDoesItToAnutherExec: “Re: Trace Devanny. He’s leaving Friday. He was shipped by Neal to France early this year, which is like getting dead fish in the Sopranos. Unlike the last 5-7 execs, it looks like Trace left on his own.” Too bad I don’t usually post news on Monday since that’s when this came and I’d have had a scoop. As I said on February 12 when Cerner announced his transoceanic relocation, “It seems curious that Cerner would allow its president to live and work overseas when only a tiny bit of its business comes from there, so I’m guessing there is more to that story.” It was nice timing to release not-so-positive company news on the day of Meaningful Use’s rowdy debutante ball (and not only just ahead of the earnings announcement, but “to pursue other opportunities” that apparently start just three days from now – hmmm). They’ve already removed him from the Web site. Neal will now hold all the Cerner titles – president, CEO, and chairman of the board. His Pie is secure.

From Jacob Black: “Re: Daniel Barchi interview. I guess Epic has a very closed system like Apple, but the similarities stop there. I think one of the problems with HIT today is that there are too many Microsofts raking in the implementation fees and we desperately need an Apple to shake things up. I think we’ll see one arrive in the next 24 months, and when it does, it will be a game-changer.”

From Dr. Boogie: “Re: Gibson General Hospital, Indiana. Medicare fraud.” The fired hospital CFO goes whistleblower.

From Ms. MarCom: “Re: Meaningful Use. All I can say is WOW. You have totally blown away any publishing competition this morning, both from a posting standpoint and from a speed of analysis standpoint. WOW! Great job!” I replied back to Ms. M that I would treasure her nice words, especially if I got fired for spending a couple of hours digging through the MU rule instead of working for the hospital whose clock I was on at the time. I don’t know if my employer would buy the industry service argument that I had rationalized. Our only plan for the day was that Inga would sit in on the Webinar, so it was impromptu.

From Ivo Nelson: “Re: consulting company life cycle. I’m going to take offense to your comments regarding your life cycle for consulting firm buy-outs. What you failed to mention was that some of us build our businesses on delivering for clients. That delivery creates trust that leads to more business. It takes years, if not decades to build the level of trust needed to be in the ‘inner circle’ of the CIOs. Most of them aren’t stupid and don’t just buy the current consulting fad; rather, they hire firms they trust and respect knowing these decisions can be career-limiting if it leads to a bad implementation. The reality of our business goes well beyond the spin. In my world, there’s an intermediate step that few of the hundreds of consulting firms that start up in this space ever achieve — that is widespread respect and trust that only happens through the grind of delivering on projects year end and year out. Trust doesn’t happen through spin.” Ivo knows I was being tongue-in-cheek. He’s right that a consulting company doesn’t grow enough to be an acquisition target unless they do things very, very well, like he did with Healthlink and is doing again with Encore Health Resources. My ribbing was aimed more at the companies (usually hardware vendors) that buy them thinking it looks like easy, high-margin money compared to moving iron.

And now, the obligatory Meaningful Use news and reaction.

Notice that during the press release (video above) that Kathleen Sebelius started off by botching the name of CMS, calling it the Centers for Medicaid and Medicare Services (backwards). That makes about as much sense as making its acronym CMS instead of CMMS, but I can’t swear I’d say it right either if facing a ton of cameras.

Inga has collected some thoughts and comparisons about the proposed vs. final Meaningful Use rule. She’s Meaningfully Used up, so help her out by adding a comment to that post with anything she missed.

Everybody with skin in the Meaningful Use game will be cranking out press releases extolling their love or hatred for what’s been passed. Thos who love it so far: Allscripts, AARP, UnitedHealth Group, Medsphere, AHIP. Those who hate it: American Hospital Association. I’m sure PR people are proofing a lot more press releases yet to come. In fact, CHIME issued a press release that said they are “actively reviewing the changes” and will publish its summary “once CHIME has thoroughly reviewed the 864-page rule.” I shall alert the media. Oh, wait, they already did.

Don Berwick’s first day on the job involved participating in the Meaningful Use press briefing. He reminded everybody about President Obama’s goal to for every American to have electronic medical records by 2014, which was probably a mistake since, like a lot of other ambitious administration goals, it’s clearly not going to happen just because of some stirring oratory. Inga speculates that the President rushed Berwick’s confirmation through so DB could look authoritative on his first day and use the opportunity to meet and greet. To me, he comes across as likeable and sincere.

Announced: the House Ways and Means Subcommittee will review the guidelines next Tuesday.

Check out Page 34: “We expect to update the meaningful use criteria on a biennial basis, with the Stage 2 criteria by the end of 2011 and the Stage 3 criteria by the end of 2013.”

My reaction to the rule: it’s a nicely done compromise. The really contentious areas were scaled back, and even in areas that weren’t, thoughtful rationale was provided. Breaking out the requirements into the mandatory vs. elective requirements was a great idea. CMS was smart to start tough in the proposed rules and then ease up after taking public comments into account. Some folks will still think the bar is set too high, but nobody’s putting a gun to anyone’s head to take the thousands to millions of otherwise free taxpayer dollars. If you don’t like the gift horse, don’t ride it.

What’s the biggest surprise in the final Meaningful Use guidelines? That doctors don’t have to actually enter any orders to meet the CPOE requirement. Anybody allowed to write orders can do it for them. That should goose the medical scribe job market. I think CMS got a little too user-friendly with that change since the next most important number other than overall percentage of orders entered via CPOE is the number that are entered directly by the physician instead of entered on their behalf as verbal or written orders by nurses (which opens the door right back up to transcription errors – the whole “readback” thing is lame). Also, anybody who implements clinical decision support thinking that the nurse will sift through the on-screen warnings and pass the important ones to the doctor knows how poorly that works.

I loaded the government’s PDF to Scribd as soon as a reader sent me the link this morning (thanks!) I see that file has received 2,177 reads so far. I don’t think HIStalk will set a one-day reader record, but it’s had 6,000 visitors so far (early Tuesday evening Eastern time). Needless to say, MU interest was high.

I e-mailed John Glaser to get his thoughts since he was instrumental in putting MU together. He thinks the best part was that they listened to industry concerns about flexibility and setting the bar too high. I told him he should get a completion bonus of the billions, of which he humbly suggested 1%. He also offered this piece:

The Big Day

On Tuesday (7/13/10) the final Meaningful Use regulation was released as was the final Standards and Certification Criteria regulation.

Arriving at the release of these regulations took time and an impressive amount of work. The regulations appeared 17 months after the passage of ARRA and 14 months after the first meetings of the Policy Committee and Standards Committee. Hundreds of hours were spent by volunteers of the Policy and Standards committees and their workgroups. Thousands of comments were written by organizations and individuals and read by dozens of federal staff. Some very large number of blog comments, articles and white papers were prepared by consultants, academics, vendors, practitioners and others. And an incalculable number of hours were devoted by staff at ONC, CMS, OMB and other federal agencies and departments.

All of this resulted in over 1,000 pages of regulations. Regulations that will bring tens of billions of dollars into healthcare and promise to significantly improve the care of patients. Healthcare in this country was forever changed on Tuesday. Those of us who work in the industry have not seen a day as momentous as this and may not see one again.

There are many individuals whose efforts brought us to this point. David Blumenthal. Farzad Mostashari. Tony Trenkle. Paul Tang. Jon Perlin. John Halamka. But I wanted to single out one person – Janet Marchibroda.

Janet was the founding CEO of the eHealth Initiative (eHI). For many years the eHealth Initiative has brought together a diverse group of stakeholders to develop strategies, author example policies, compile lessons learned and provide education to further a vision – significant improvements in care through the adoption and effective use of interoperable electronic health records. Years before there was an ARRA, eHI and Janet were relentless in their pursuit of this vision and they were remarkably effective in bringing their ideas to Congress, the Executive Branch, state governments and the industry. While not the only voice in the early days of this undertaking they were an exceptionally effective voice. You could clearly argue that Janet and eHI are one of the primary reasons that HITECH was included in the ARRA legislation in the first place.

Congratulations Janet. This day must be very sweet.

I hear that Eric Rose, medical director of McKesson Physician Practice Solutions, has signed on with Microsoft’s Health Solutions Group to work on global health technology offerings. 

A reader tells me that a Vermont hospital’s practice EMR has been down for two days so far after its vendor tried to apply an upgrade, apparently mistakenly loading the 64-bit version instead of the 32-bit. They had to go to backup, and everybody could have predicted what happened next: the backup was no good. I guess downtime doesn’t get you Meaningful Use credit.

St. Joseph Health System (CA) chooses periop and anesthesia systems from Picis for its 13 facilities. A couple of readers have sent over positive rumor reports about Picis lately, so without my speculating about the details, I expect to hear news shortly.

Listening: The Doors, because I was watching the mediocre, Johnny Depp-narrated When You’re Strange on Netflix and got stoked about them all over again (actually, it was pretty good other than Johnny). May favorite Doors tunes: Crystal Ship; Yes, the River Knows; Not to Touch the Earth; The Unknown Soldier; and When the Music’s Over. Mr. Mojo Risin’ has been dead for nearly 40 years, but his digital detritus remains vibrant and essential. We should all be so lucky.

Consumer Reports says it can’t recommend the iPhone 4 because of its notorious antenna problems, saying Apple should fix its own phone instead of telling owners to buy themselves a case (or use duct tape like CR recommends) to prevent touching the antenna and thereby drop signal strength. The iPhone scored at the top of its ratings otherwise.

If you clicked the e-mail link to read this post, you’ll notice a single sponsor ad at the very bottom, right before the comments. That was the brainchild of a couple of readers who felt guilty that they don’t always look over the ads in the left column, but who said they’d pay significant to attention to a single strategically placed one. All sponsor ads get an equal chance – it’s a random display for each page view. Thanks for the idea and for supporting HIStalk’s sponsors.

Speaking of sponsors, thanks to new HIStalk Gold Sponsor My Health Direct. You’ll recall that I interviewed CEO and Chairman Jay Mason a few weeks back. The best way to describe the company’s offering is as “OpenTable for Healthcare”, a SaaS application that connects patients (usually ED ones) with provider appointments in the community. The system searches open provider appointments and manages the mix of low-paying reimbursement those providers are willing to accept. It also increases compliance with follow-up visits since patients leave the ED with a firm appointment. Thanks to My Health Direct for supporting HIStalk and its readers. And in case it looks suspicious, I promise there was no discussion about sponsorship when we did the interview. I often interview somebody who is then overwhelmed by the “hey, I saw your picture on HIStalk” feedback they get afterward from the very cool HIStalk readership, so they send the marketing people my way.

Weird News Andy loves his UK stories, of which this one is big: NHS will restructure and take hospitals out of the system, eliminating all 10 strategic health authorities and the 152 primary care trusts in favor of local control answering to an independent NHS board. Their private income was previously capped. From the video: “Our guiding principle will be no decision about me, without me.” Sounds like the opposite of what we’re doing here. I wonder if Don Berwick admires them more or less now?

Interoperability vendor Holon announces GA of its Medication Management Solution, which accepts electronic or scanned orders and routes them via a workflow scheduler.

Healthcare claims processor and cost management vendor MultiPlan will be acquired by private equity investors in a deal valued at $3.1 billion. You just know you’ll see more of this as investors lick their chops at the profitable administrative overhead sure to be introduced by healthcare reform (irony intentional). Surely nobody thinks insurance companies and their lobbyists will voluntarily find another line of work.

Iowa HITREC chooses Greenway’s PrimeSuite EHR.

Dentrix Enterprise Dental Practice Management earns certification as an electronic dental record solution for the Indian Health Service.

Kronos introduces its new Rich Internet Applications. I had to look that up – it means Web apps that work like desktop apps by using browser plug-ins or virtual machines. Gmail is an example.

It’s not exactly poverty-vowing nuns running hospitals: Wayne Smith, CEO of publicly traded hospital operator Community Health Systems, took home $17.8 million in compensation last year.

E-mail me.

Inga Compares the Preliminary Meaningful Use Rule to the Final

This is a first pass at trying to catalog the changes in the final rule. Your comments and observations are welcome!

CPOE

Preliminary rule

• Practices: use CPOE for orders involving medications, laboratory, radiology, and referrals.
  Hospitals: medications, laboratory, radiology, blood bank, PT, OT, RT, rehab, dialysis, consults, and discharge and transfer.
  Orders do not have to be sent electronically to the fulfilling department (lab, pharmacy, etc.)
  Practices must enter 80% of their total orders directly by the clinician into the CPOE system. Hospitals must have 10% of all orders entered by CPOE.

Final rule

• For practices and hospitals: more than 30% of unique patients with at least one medication in the medication list have at least one medication ordered through CPOE. The denominator is no longer total orders generated. Lab and diagnostic orders eliminated from the CPOE requirement. Any licensed professional can enter the order. ED orders count toward the inpatient total for CPOE.

Clinical Checking of Orders

Preliminary rule

• Real-time screening (drug-drug interactions and drug-allergy contraindications), formulary check, user ability to maintain screening rules, track user responses to alerts.

Final rule

• The EP/eligible hospital/CAH has enabled the drug-drug, drug-allergy, and drug-formulary check functionality for the entire reporting period. Any EP who writes fewer than 100 prescriptions during the EHR reporting period is exempt.

Problem List

Preliminary rule

• Longitudinal current and active diagnoses coded in ICD-9-CM or SNOMED CT.
  80% of unique patients must have at least one coded problem/diagnosis, with “none” being an allowed entry (hospitals and practices).

Final rule

• At least 80% of patients have at least one entry or an indication that no problems are known. Data must be recorded as structured data . Coding doesn’t have to be done concurrently – the codes can be added later by anyone.

E-Prescribing

Preliminary rule

• Practices only.
  Must send 75% of non-controlled substance prescriptions electronically.

Final rule

• Threshold dropped from 75% to 40%

Active Medication List

Preliminary rule

• 80% of unique patients must have at least one coded entry, with “none” being an allowed entry (hospitals and practices).

Final rule

• Unchanged.

Medication Allergy List

Preliminary rule

• Longitudinal with allergy history.
  80% of unique patients must have at least one coded entry, with “none” being an allowed entry (hospitals and practices).

Final rule

• Unchanged.

Demographics

Preliminary rule

• Practices: preferred language, insurance type, gender, race, ethnicity, and data of birth.
  Hospitals: all of the above plus date and cause of death if applicable.
  80% of patients must have demographics recorded as structured data.

Final rule

• Threshold dropped from 80% to 50% .

Vital Signs

Preliminary rule

• Height, weight, BP, BMI, growth charts for patients 2-20 years old, temperature, pulse.
  80% of patients aged 2 and over must have blood pressure and BMI entered.
  Children 2-20 must have a growth chart.

Final rule

• More than 50% of patients 2 years and older must have height, weight, and blood pressure recorded as structure data. EPs who believe that measuring and recording height, weight and blood pressure of their patients has no relevance to their scope of practice can be excluded. For MU purposes, providers do not have to maintain BMI and growth charts, although certified EMRs are required to do the BMI calculation and display growth charts with structured data.

Smoking Status

Preliminary rule

• Record if current smoker, former smoker, or never smoked.
  Must be recorded for 80% of patients.

Final rule

• Must record at least 50% of patients 13 and older for smoking status.

Clinical Decision Support Rule

Preliminary rule

• Included five measures beyond drug screening, based on demographics: diagnoses, lab results, or medication list. Real-time alerts and suggestions based on evidence. Track response to alerts.

Final Rule

• Implement one clinical decision support rule relevant to specialty or high clinical priority for EPs, or one clinical decision support rule related to a high priority hospital condition for hospitals. Also must track compliance with that rule.

Record Advanced Directives

• This is a new one not included in the preliminary rules to prove meaningful use. Hospitals must record at least 50% of inpatients 65 years old or older an indication of an advance directive status.

Structured lab results

Preliminary rule

• Display results, translate LOINC codes, allow maintenance based on new results.
  Must record as structured EHR data 50% of all results that are delivered in positive/negative or numeric format.

Final rule

• Threshold reduced to 40% of clinical lab test results.

Patient Lists

Preliminary rule

• Allow user to select, sort, retrieve, and output patient lists based on demographics, medications, and conditions.

Final rule

• Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.

Report Quality Measures to CMS and States

Preliminary rule

• Calculate, display, and submit quality measure results.

Final rule

• Clarification: this is for hospital quality measurements. For 2011, provide aggregate numerator, denominator, and exclusions through attestation. For 2012, measures must be electronically submitted.

Patient Reminders

Preliminary rule

• Practices only: issue based on patient preferences, demographics, conditions, and medication list.

Final rule

• Reminders must be sent to at least 50% of patients age 50 or over that are seen by the EP.

Insurance Eligibility

Preliminary rule

• Allow user to record and display based on eligibility response from insurer.
  Must cover 80% of unique patients.

Final rule

• Requirement withdrawn for Stage 1 but look for it in Stage 2.

Submit Claims

Preliminary rule

• Must submit 80% of all claims filed electronically.

Final rule

• Requirement withdrawn for Stage 1 but look for it in Stage 2.

Electronic Copy of Health Information to Patients

Preliminary rule

• Allow user to create an electronic copy of test results, problem list, medication list, medication allergy list, immunizations, and procedures. Hospitals must also provide a discharge summary, but not procedures. Must provide an electronic copy of health information to requesting patients within 48 hours.

Final rule

• Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies,
  discharge summary, procedures), upon request. Discharge summary and procedures are for hospitals only.  Must provide to at least 50% of requesting patients within three business days.

Electronic Copy of Discharge Instructions 

Preliminary rule

• Hospitals only.  Must provide electronically to 80% of discharged patients who request them.

Final rule

• Threshold reduced to 50%.

Timely Patient Access to Health Information

Preliminary rule

• Practices only: diagnostic results, problem list, medication list, medication allergy list, immunizations, and procedures. Within 96 hours of availability.
  Must provide to 10% of unique patients.

Final rule

• Practices must to 10% of its patients within four business days of being updated in the EHR, subject to the EP’s discretion to withhold certain information.

Clinical Summary of Each Office Visit

Preliminary rule

• Practices only: diagnostic results, medication list, procedures, problem list, immunizations. Must provide for 80% of office visits.

Final rule

• Provide clinical summaries provided to patients for more than 50% of all office visits within three business days.

Access to patient-specific education resources

• Another new item that was not in the preliminary rules. Use EHRs to identify patient-specific education resources and provide those resources to the patient if appropriate. Both EPs and hospitals must provide patient-specific education resources to at least 10% of patients.

Information Exchange

Preliminary rule

• Enable electronic sending and receiving of diagnostic test results, problem list, medication list, medication allergy list, immunizations, and procedures. Hospital requirements also include a discharge summary. Must conduct at least one test of information exchange.

Final rule

• Exchange key clinical information among providers of care and patient authorized entities electronically. Both practices and hospitals should exchange problem list, medication list, medication allergies, and diagnostic test results; hospitals should also exchange discharge summary and procedures.

Preliminary Rule

• Compare and merge two or more medication lists into a single list that can be displayed in real time. Must be performed in 80% of encounters and care transitions.

Final Rule:

• Threshold is reduced to 50%.

Submit Data to Immunization Registries

Preliminary rule

• Must conduct at least one test of submitting information.

Final rule

• Perform at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the EP, hospital, or CAH submits such information have the capacity to receive the information electronically).

Submit Lab Results to Public Health Agencies

Preliminary rule

• Hospitals only. Must conduct at least one test of submitting information.

Final rule

• Perform at least one test and follow up submission.

Submit Syndrome Surveillance Data to Public Health Agencies

Preliminary rule

• Must conduct at least one test of submitting information.

Final rule

• Perform at least one test and follow up submission.

Protect Electronic Patient Information

Preliminary rule

• Unique identifier, emergency access for authorized users, session timeout, encryption where preferred, encryption when exchanging information, maintain audit logs, provide integrity check for recipient of electronically transmitted information, verify user identities and access privileges, record PHI disclosures.
  Must conduct a security risk analysis and implement security updates.

Final rule

• Conduct or review a security risk analysis, implement security updates as necessary, and correct identified security deficiencies.

Meaningful Use – Final Version Full Text

Meaningful Use – final

Click the Fullscreen link at the top to read more easily.

We will be adding comments to this post as we find important facts in the long document. Feel free to add your own findings or thoughts.

CIO Unplugged 7/13/10

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

Strategic Plans — Getting to 2.0

I recently met up with a friend I hadn’t seen in a decade. After breaking the ice, we shared deeper life stuff. As I tried to understand the aura of weariness and apathy hanging on my friend, I realized with sadness that he had no focus for his future. No vision.

He was going nowhere and getting there too quickly. Opportunities crossed his path, but he didn’t take them or he had taken notice of them too late. I dreaded to think how many regrets he’ll face on his deathbed.

As you know, this bankruptcy of success doesn’t just occur with individuals. I listened to a guest speaker ask a leadership team to cite the enterprise vision. The audience fell silent! A departmental vision? she said. More silence. Personal vision? Silence. The group was wandering, but you’d never guess that by reading their strategic plan. A plan written but not lived out is an epidemic tragedy.

In a 2007 post, I shared my thoughts on “Taking Control of your Destiny,” encouraging readers to have a carefully crafted plan for business and for life. The number of businesses and individuals who wander through time without connecting to their purpose is frightening.

Try this test to see if your organization has an effective plan. Ask staff members to cite from memory your mission and vision. Could they explain how strategies are aligned to clinical and business imperatives? Ask them to tell you the one thing that provides focus. A failure to pass this test reveals a failure of future success. It’s time to act.

Moving on …

For those who have past the above test and have a functioning plan in place, what’s the next level? As you would imagine, I’m a deliberate planner, forever exploring creative and innovative approaches. Here is one.

This spring, the IT leadership teams of Texas Health Resources and Pier1 met for an all-day strategic planning session. In the morning, my team and I presented the Texas Health strategy and dived into the IT components. In the afternoon, we reversed roles.

Together we rolled up our sleeves and challenged one another throughout the presentations. We shared experiences and best practices, offering unique perspectives as consumers and patients. We poked holes and pressed buttons and then commiserated. What we learned from one another added value not only to our corporations, but to each individual.

The big takeaway for us affected our approach to (clinical) business intelligence. Recognizing that we were headed in a direction sub-optimal to our potential, we heeded their experienced-based counsel and immediately changed direction to avoid significant future pain. In fact, Pier1 CIO Andrew “Andy” Laudato now serves on our business intelligence committee.

Another takeaway tactic I intend to employ: if Pier1finds an IT-related expense in the organization that’s not currently part of IT, they move it to the IT budget immediately. Even though this causes a negative budget variance, it allows the organization to understand the complete cost of IT and provides them control in the future. Simple, but profound.

This fall, we’ll have another exchange, this time with Radio Shack. I had lunch with their CIO Sharon Stufflebeme this week to hammer out details. Our teams are psyched. I’m hoping to celebrate a Le Tour victory when we visit their headquarters.

How do you make this happen? Look for innovative CIOs outside of healthcare. I serve on the Texas Christian University advisory board, and when I first joined, Andy (Pier1) presided over the board. Fascinated by his leadership and accomplishments, I made an appointment. While visiting in his office, it became clear to me that Pier1 would be a good match for my team.

At another time, I was speaking on a panel with Sharon from Radio Shack. Her leadership style differed from mine, and she was very successful. On the panel, we worked as contrarians, and I benefitted from that diversity. I have great expectations for the impact she and her team will have on our planning and thinking. We need people to rock our world, business and private. Iron sharpens iron.

You might be asking, Why doesn’t he have these exchanges with healthcare providers?

Good question. In specific areas, we tap into peer organizations on topics ranging from cost allocation methodologies to enterprise PMO. For example, we belong to excellent think tanks like Scottsdale Institute that enable exchange of ideas. Although these are helpful, they carry limited value, for if we restrict ourselves to healthcare peers only, IT will continue to lag. So we reach out beyond our protective covering to break free of the chains binding us to lack of foresight and preventing the fulfillment of our purpose.

Avoid the epidemic tragedy that plagues present day IT. Encourage your subordinate units to develop plans that support the organization so you have complete line of sight from top to bottom. As a bonus, encourage them to create personal plans. They’ll thank you for it. Remember: living without purpose is the greatest invisible tragedy that’s never perceived until the end. And then, it’s too late.

Update 7/16/10

Thank you for the feedback to my recent post on strategic plans — Getting to 2.0. I am pleased that some are finding the ideas and concepts helpful. One of the first questions I ask when I see a floundering person, division, or company is for a copy of their plan. I have never met a person or company with a well thought out plan who is floundering, but the inverse is true 100% of the time. Those who flounder have no plan.

I am sorry for Hamon Tower Patient experience. As articulated by HHS in the MU announcement, transforming healthcare delivery with technologies such as EHRs and RTLS is a journey and that we are continuously working with our caregivers to improve their experience and that of our patients. In the spirit of continuous improvement and openness to collaboration, we would welcome the opportunity to connect with you offline to learn more about your  experience. Please send me an e-mail directly and I will set something up.

Ed Marx is senior vice president and CIO at Texas Health Resources in Dallas-Fort Worth, TX. 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.”

Monday Morning Update 7/12/10

From Holy Smoke: “Re: Cerner. Misidentification incidents have been reported with Cerner PowerChart and Millenium in hospitals in Indiana, Michigan, and others after a Cerner upgrade. Entries are placed in the wrong electronic chart and reviewed data is for the wrong patient.” Unverified. I saw nothing in the FDA’s Maude database, so if it’s happening, customers should file an experience report.

Former Cerner COO Paul Black, now working with a private equity firm, is named board chair of Truman Medical Centers (MO).

Lots of us may benefit from the redistribution of taxpayer money into our healthcare IT pockets, but our taxpayer side apparently wins, as almost 2/3 of readers say they wouldn’t have voted for HITECH had they been given that chance. New (similar) poll to your right: if you’d had the chance to vote on Don Berwick’s nomination to CMS administrator, would you have voted for him?

Health officials in Canada’s Northwest Territories say they’ll start enforcing medical faxing policies requiring cover sheets and pre-programmed telephone numbers after patient information was faxed to the CBC in at least four separate incidents. A recent embarrassing incident had led to a temporary ban on medical faxing except in emergencies. This caused big problems for pharmacies, who were given no advance notice that the 30-40% of their business that involves faxing would be shut down.

Doctors in Taiwan are taking iPads to the bedside, using them to show patients their diagnostic images right in their beds.

Bruce Greenstein, a Seattle-based Microsoft managing director of worldwide health, will become secretary of Louisiana’s financially struggling Department of Health and Hospitals after incumbent Alan Levine quits to go back to the private sector. Levine was previously CEO of Broward Health (FL).

Senator Richard G. Lugar of Indiana pitches HIT during a stop at Union Hospital East and at the remarkably coincidentally named Richard G. Lugar Center for Rural Health, which does some small telemedicine projects. The article mentions some of the hospital’s technologies: smart beds, patient tracking systems, bar code scanning, electronic inventory, and and Vocera communicators.

Inga and I are thinking that we need to get our ears a little closer to the ground with all the healthcare IT news that’s breaking this summer (mergers, Meaningful Use, etc.) We’re thinking of anonymously crashing the Allscripts user group meeting in Las Vegas the first week of August since that’s a pretty big one that should give us lots of insight beyond just Allscripts news. Inga always does MGMA. I usually only go to HIMSS, but I’ve got a lot of time off at work and figure I might as well do something useful with it. We will report the rumors and trends from wherever we end up.

Struggling Grady Memorial Hospital (GA) is criticized for giving its CEO a $291K bonus on top of his $615K salary. The board says he put the hospital into the black and met his performance targets, but it’s still getting $80 million per year from taxpayers. And in Calgary, the CEO of Alberta Health Services earns $744K in 2009 while the organization failed to meet many of its goals and ran a $885 million deficit.

More on Don Berwick’s Institute for Healthcare Improvement. Tax records indicate that it took in $43 million last fiscal year, of which Berwick was paid almost $2.5 million, although $1.4 million of that looks like vested benefits from the previous seven years and his base salary plus bonuses was $621K. Nothing unusual or extravagant that I can see.

As a comparison, HIMSS reported $41.4 million in revenue, about the same as IHI, according to its most recent tax documents filed in May. Only $5.3 million of that came from member dues, while the annual conference raked in $18.9 million. Steve Lieber received compensation of $731K (CEO). Other salaries are above: Dave Garets (former CEO of HIMSS Analytics), Carla Smith (EVP), Norris Orms (EVP/COO), Jeff Kenjar (EVP Sales, HIMSS Analytics), Mike Davis (former EVP, HIMSS Analytics), Kelly Laidler (senior director, sales), and Jessica Daley (sales director, HIMSS Analytics). The Advisory Board must be paying Garets and Davis really well since they walked away from some pretty big salaries. HIMSS isn’t big on technology, apparently, having spent $675K on IT, a paltry 1.6% of expenses.

Former Columbia HCA president and Florida gubernatorial candidate Rick Scott challenges the state’s “millionaire” campaign finance law, saying it restricts his free speech by giving his opponent matching state funds once Scott spends $24.9 million. Scott has spent $20 million so far. His opponent’s campaign manager said, “It should come as no surprise to anyone that Rick Scott, a man who oversaw the most massive Medicare fraud scheme in history, just can’t seem to play by the rules.”

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News 7/9/10

From Sturges: “Re: The Berwick saga is a great view into just how political healthcare is right now (and will be through 2012). It obviously will be a big topic in November, a key part of the Berwick opposition in the first place. It also will command big attention next year as Congress takes on the deficit. The upshot is cuts for hospitals on the spending side in ’11 and a much more political environment for the rule-making process on the regulatory side in ’11-13. Mr HIStalk for Congress? Your slogan can be, ‘I think it’s crap, too’ or, if we need something more positive, ‘Yes we can — anonymously!’” Don Berwick was the right person for the job, I’m convinced (though why he’d want it is beyond me) and even though people don’t want to hear it, some kind of financial allocation (“rationing”) is unavoidable given the way the current and previous administrations have put the country deeply into debt to preserve the illusion of prosperity. It’s political poison to cut healthcare and entitlements, but Berwick is right — we don’t have a choice, especially now that the government controls so much of healthcare delivery and payment.

Speaking of Don Berwick, this article says he makes almost $900K running IHI and listed more than a dozen current jobs on his ethics filings, but most of them are voluntary or honorary, including compensation-free positions at Children’s Boston, Harvard, and Brigham and Women’s that the White House describes as “essentially honorary professorships.” The article suggests that the White House inflated his credentials with those positions, but I don’t see it that way — it looks like they just wanted to include everything whether they were required to or not. It does mention, however, that in taking the CMS job, Berwick’s annual salary will drop to $165K for running a $800 billion organization. That sounds like public service to me.

From TooLate: “Re: iSoft. To make cuts to UK staff — sales and marketing, product strategy, and implementations.” The company looks to be an acquisition target, which means slashing expenses to make short-term numbers attractive. It announces a $30 million credit facility from an obscure US investment fund, which the company will use to replenish the cash it spent on 2010 acquisitions (which didn’t help much given that shares are still at or under 20 cents).

From Lemmy: “Re: E&Y. From this job posting, it does appear that your rumor that they are trying to rebuild their healthcare consulting business is correct.”

From HITInsider: “Re: Eclipsys. It joins Epic as the only vendors with CCHIT Certified 2011 Enterprise certification.”  

From Wildcat Well: “Re: Tim, ol’ boy. ARRA, HITECH, and now $1B for broadband initiatives including health centers. Comcast. Microsoft. All talking. Time for the adults to take over. Most EMR vendors could be an afterthought. Buy stock.” I keep getting rumor reports about EMR executives talking shop with the cable operators, but I don’t have details. Not that I wouldn’t enjoy having some, mind you.

From Frank Poggio: “Re: A Meaningful Ruse. As a follow up to by February Readers Write piece, note today’s announcement: The Centers for Medicare & Medicaid Services has issued a proposed rule imposing a 0.25 percentage point reduction to the fee schedule increase factor for outpatient hospital services. If you do not met meaningful use criteria, which most providers won’t per the recent Glaser interview, you get a reduction in this adjustment. Let’s see, that’ll be 0.33 times -0.0025 = +0.000825 increase! Or is it 0.66 times -0.0025 = -0.000166 decrease? Seems to me either way you come out better.”

From HCDude: “Re: KLAS report on professional services firms. New players are entering the market. It doesn’t look like all the acquisitions done by IBM, CSC, and ACS worked. One of these days, the big boys will realize this is a cottage business where big companies just don’t ever seem to get it.” KLAS says all those acquisitions drove the principals to leave and start new companies, bringing people with them. They specifically mentioned Encore and Santa Rosa, started by former executives from Healthlink and Superior, respectively, saying that while Encore didn’t make its list because it wasn’t consider by prospects often enough, it still earned as much attention as CTG. This life cyle is obvious to old timers who have seen it time and again:

1. Sales-savvy former consulting company executives start their own consulting company.
2. They cherry-pick the good consultants who want a change, offering clients the same people and services at half the price the big boys charge since they have low overhead and no shareholders.
3. They build up the business, finding some niche for which providers are willing to pay.
4. They dress up the offerings by claiming to be in “life sciences” (i.e., make it sound like rich drug companies and foreign genomics rock stars are beating their doors down).
5. They wait for some industry development that makes consulting look like a hot industry that will never fade (data warehousing, CPOE, Meaningful Use, ERP, etc.)
6. They sell out to a cash-rich, often plodding big company that’s tired of low-margin hardware sales which thinks consulting looks easy and profitable and which is too lazy and impatient to start their own consulting organization, preferring instead to pay a ridiculous premium for a company that basically does little beyond reselling the bodies it employs at multiples of what it pays them.
7. The former consulting company executives, flush with cash and quickly fatigued by corporate BS, leave the stifling bureaucracy claiming they will retire or pursue non-competitive interests.
8. Go to #1.

From The PACS Designer: “Re: Scribus. TPD has been testing open source desktop publishing software called Scribus. It’s kind of like Visio, which has been around for a long time, but has more robust features.”

Listening: The Smiths, influential early 80s Brit indie pop featuring Morrissey on vocals. Still sounds good.

McKenzie Medical Imaging (OR) wins NueSoft’s Make Software Sexy video and photo contest, featuring user submissions with employees wearing free company tee shirts. I may steal that idea.

Proposed HITECH-related HHS modifications to HIPAA (warning: PDF) would expand the right of patients to access their own information, restrict some types of disclosure, and expand rules to cover business associates. AHIMA releases a statement supporting the change (one paragraph) and pitching itself and its members as being essential to further discussions (three paragraphs). We asked privacy advocate Deborah Peel, MD of Patient Privacy Rights for her reaction:

What we heard in the remarks of Secretary Sebelius, OCR Director Verdugo, and the National Coordinator for HIT Dr. Blumenthal is a very significant and welcome major change of direction at HHS and ONC. Several VERY strong, positive comments were made today in the press conference announcing the NPRM today by Sec. Sebelius, OCR Director Verdugo, and Dr. Blumenthal which support the patient’s right to privacy and consent. Sec. Sebelius said. “It’s important to understand this announcement [of NPRM, a new Web site, and other new initiatives] are part of an Administration-wide commitment to make sure no one has access to your personal information unless you want them to.” Then during her remarks, OCR Director Verdugo said, “The benefits of health IT will only be fully realized if health information is kept private and secure at all times.” And finally during his comments, Dr. Blumenthal stated, “We want to make sure it is possible for patients to have maximal control over PHI.” And he referred to the Consumer Choices Technology Hearing last week, which demonstrated consent tools enabling patients to make choices about how their information is used and disclosed from EHRs and for HIE.

The great news from the press conference announcing the NPRM was the very CLEAR language, from the Secretary of HHS, to the Director of OCR, to the National Coordinator for HIT, that supports building Americans’ rights to consent and control over PHI into electronic health systems and data exchange. We hope the details in the NPRM actually do give Americans the kind of control over sensitive personal health information that will enable them to trust health IT systems and data exchanges. We will share our analysis of/comments on the NPRM as soon as we have it.

Royal Philips Electronics announces that President and CEO Gerard Kleisterlee will step down in April, announcing that it will nominate former Philips board member Frans van Houten to replace him.

HealthcareMegaMall is running a text ad here announcing a September 1 go-live, but I know nothing about the company. A Google search finds this press release, which describes it as an online marketplace for sharing information, comparing products, and viewing demos (including HIT products, apparently). They’ll also communicate with providers and advertise both in print and electronically (so I guess that explains the ad).

On HIStalk Mobile, we review ReachMD, which offers medical CME via the iPhone.

Jobs: Cerner SurgiNet and PowerOrders PMs, Manager, Clinical Informatics, Senior Software Engineer, Cerner Clinical Analyst.

Weird News Andy finds this story of an enterprising London hospital that “generated substantial income” by renting out an empty patient unit to a film company that used it as a location in a big-budget porn movie.

Gwinnett Hospital System (GA) expects to save $300K per year and speed up its revenue cycle as a result of its medical records digitization project involving EDCO Group’s Solarity technology.

Baltimore’s mayor will announce as the city’s new health commissioner Dr. Oxiris Barbot, a pediatrician whose credentials include creating an EMR for New York City’s school health system and developing disease management and public health programs. The search committee was led by Michael Klag, MD, MPH, dean of the Baltimore-based Johns Hopkins Bloomberg School of Public Health and a member of HHS’s HIT Policy Committee.

Two Australian hospitals will implement an ICU EMR system from Vision Software Solutions of Queensland. I can’t say for sure, but I’m guessing it’s actually the iMDsoft MetaVision system since Vision is (or was at one time, anyway) a distributor for it in Australia.

I don’t recall if I already knew this, but apparently Resurrection Health System (IL) is going Epic, based on this job listing.

Cal eConnect, the group created to oversee California’s HIE projects and to spend $39 million in federal money, hires Carladenise Edwards as CEO. She was formerly HIT coordinator for the state of Georgia, an HIT advisor to former Florida Governor Jeb Bush, executive director of South Florida Health Information Initiative, and owner of a consulting company that sold services to Florida’s state government.

Strange: hospitals in China, reacting to a rash of patient deaths due to suspected medical negligence, hire local police officers to “improve relations” between doctors and patients. Critics say hospitals are cozying up to police to get them to arrest people who complain about their medical services. State-run media coined the phrase “hospital troublemaker” to describe unhappy family members who display banners, set up altars, or abandon the corpses of their deceased family members, any of which could get them locked up.

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HERtalk by Inga

The 120-provider Physicians Alliance (PA) plans to implement Allscripts EHR, which will connect directly to its existing Allscripts Vision PM system. Allscripts execs, by the way, are meeting with bankers to secure up to $720 million to finance the buyout of Misys Plc’s ownership stake and the purchase of Eclipsys.

Physicians running Advanced Data Systems PM/EHR will soon be able to connect to the Jersey Health Connect HIE using RelayHealth’s HIE tools.

Ochsner Health System (LA) says it is now connecting thousands of community physicians to Ochsner’s patient medical records using Orion Health’s HIE technology.

Speaking of HIEs, KLAS says only five vendors are considered in more than 10% of purchasing decisions: Medicity, Axolotl, RelayHealth, ICA, and Epic (the latter in Epic-to-Epic exchanges). Cerner, dbMotion, GE, InterSystems, and Orion rounded out the top 10.

The Santa Cruz HIE implements Anakam Identity Suite into its Axolotl Elysium Exchange to provide secure access to health information.

Dr. Bill Tierney is named CEO of the Regenstrief Institute, taking over for Dr. Tom Inui on October 1.

Christ Hospital (NJ) selects Allscripts reseller ITelagen to provide EHR and PM for the hospital’s affiliated medical practice.

Health Net agrees to pay $250,000 to the state of Connecticut to settle a HIPAA violation case. The suit stems from the theft of a disk drive that contained financial and medical data on 1.5 million consumers, 500,000 of them from Connecticut. The deal also includes two years of credit monitoring, $1 million of identity theft insurance, and reimbursement for the costs of security freezes.

Industry veteran Mark Trigsted is named EVP of healthcare for Diversinet. Trigsted must have friends all over HIT, having worked previously at 1-800-Doctors, Sysware, HEALTHvision, Sunquest, Oacis, McKesson, and GE Medical.

EDI testing service QualEDIx names Larry Watkins EVP of healthcare strategy and business development.

Six orthopedic surgeons from Rush University Medical Center (IL) are under fire for violating Medicare rules. The US District Court says the physicians routinely overbooked their schedules and relied on residents to perform surgeries. A fellow surgeon and a former hospital executive filed the suit.

E-mail messaging between patients and providers improves the quality of care provided, according to a Kaiser Permanente study. Patients with diabetes and/or hypertension were found to have statistically significant improvements in HEDIS scores when patients and physicians communicated via e-mail and were 7-10% less likely to schedule an office visit.

Elsevier launches Top Doc, an iPhone app designed to help medical students and residents improve with visual diagnosis skills. The $15 app includes quizzes with more than 600 questions and allows user to determine the correct diagnosis by viewing actual photographs. You can even have your grade posted to Facebook. Kind of cool, but I’ll stick with Scrabble.

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HIStalk Interviews Daniel Barchi

Daniel Barchi is SVP/CIO of Carilion Clinic of Roanoke, VA.

You just finished your massive Epic project, with eight hospitals and 100 practices brought live over a couple of years. Tell me about that project.

When we decided that we wanted to integrate from 11 different medical records — 10 electronic and one paper — down to one integrated system, it was 2006. At the time, we were also merging from being a confederated health system into a single Carilion Clinic, so the two projects converged nicely.

We knew if we wanted to operate like an integrated system and have a continuum of care for our patients, we needed one tool to do so. It was an easy choice to select the one integrated EMR.

We ended up choosing Epic because they had a reputation at that time, and I think still do, for implementing well. We knew we had the focus of the entire organization, so we took advantage of it and used it as a tool to integrate all of our hospitals and our practices onto one platform as rapidly as we could, while still protecting the use of clinical data and the health and safety of our patients.

Carilion was a high-profile Siemens client and an early Soarian adopter. What led to the change from Soarian?

Soarian had a great reputation and was doing a lot of innovative things. But when we traveled to Malvern in the summer of 2006 and saw where they were in the development cycle, they were making progress, but they weren’t going to be ready to do everything that we wanted to do as rapidly as wanted to do it.

We knew that we wanted to implement our integrated EMR in every clinical area and work financials in at the same time — front office, back office, hospitals, physician practices — and so it really forced us to find another vendor, which we did relatively quickly.

Soarian has been on the drawing board in some phase of rollout for forever and it still seems like it’s always going to be a year or two more. Do you think it will be a tough job for John Glaser to make Siemens a little more competitive with the window of opportunity that’s out there?

You know, that’s the reputation Siemens has had, and yet it’s a great company. We’re still a big Siemens customer for its many imaging products. If there’s anybody who can make this happen, well, it’s John Glaser. I was alternately surprised and thrilled that he was the one going to take the helm, so I’m happy for him.

I do think, with the right leadership, they’ve got all the right tools and financial backing. There’s certainly a need for more integrated systems. Two or three big companies should not have a monopoly on everything that is out there. The more systems that meet all of the needs of our health systems, the better.

When you looked at systems, what were your overall thoughts?

At the time, in late 2006 to early 2007, we were looking for one that flowed seamlessly. At the same time, I didn’t want our technology team to make the decision. We were adamant that it had to be our clinicians and our financial teams that chose a product that was going to work well, both face-to-face with the patient and in the back office as well.

When we did the selection, we got literally 300-400 doctors, nurses, therapists, and financial folks in the room with some of our IT folks as well and scored them. We went from eight, through a quick cut down to four. We had four vendors on site in front of 200-300 people in a large auditorium. We narrowed that down through the choices of my colleagues in Carilion Health System down to two.

That’s when we had 300-400 people in a room looking at day-long shows from the final two, which were Cerner and Epic. We put a team of about 10 doctors, nurses, therapists, financial folks, and IT folks on the road to do a couple of site visits to see Cerner and Epic in action. Like I mentioned, we chose Epic in the end because they had seemed like a great partner and we were eager to select a vendor that was going to work with us for a rapid implementation.

When you look back at what you chose and where you are today, was Epic something that you were truly excited about compared to your experience with Soarian or was just the best of what your choices were?

We were truly excited. This was not that many years ago — three, three and a half years ago — and certainly, they’ve made a lot of progress even since then, but it was state-of-the-art at that time. In fact, we are still operating all eight systems and about 110 physician practices on the original version that we installed, the Epic 2007 version.

We have plans to upgrade for Meaningful Use purposes next year, but we are very, very happy with the way that the system is operating in all aspects of our health system. At the time, we were very excited about consolidating our many different systems onto one platform. It has certainly met our needs.

Tell me about the structure. You did it all internally — who led the teams? How did you actually set about doing this to get it done on time?

The first thing I’ll say is that you’ve got to have cooperation from all facets of the health system to make it successful. We had great executive leadership and good cooperation with physicians and nurses. While our IT team staffed and managed the project, I made sure that our governing structure was led by our chief medical officer and chief nursing officer.

We were led at an executive steering level by a small team — a CMO, CNO, chief financial officer, the head of our physician practice group, and me. That small executive team ended up making the hard decisions.

Below that, we had our IT team, led by a vice president of clinical information systems who was essentially our vice president of the Epic project team. Her name is Kay Hix. She did a fantastic job organizing the structure and allowing us to use our existing infrastructure to get it done.

Instead of going out and hiring a third party to do it, we decided that we would make our IT team work in tandem with a new Epic team that we set up, and largely within the confines of our existing organization, built a team to develop, train, and build and implement the system.

Underneath Kay, she had two directors, one primarily focused on ambulatory physician practices and one primarily focused on the hospitals. Beneath them was a large team of talented people, including about 35 trainers. We ran training from about 7 a.m. to 11 p.m., six days a week, to train more than 7,500 users.

People say, “Well, Epic just sends out a lot of inexperienced kids who follow the cookbook.” How would you describe how they got involved and contributed to your project?

I’d say the team that we worked with from Epic was top notch in every way. They are very focused on the area that they know well, and almost skill-typed. If you ask an expert in one area about another area, they are quick to get their colleague involved and won’t go out on a limb to guess at what they might not know.

In that way, it seems like Epic does a very nice job of training its people to be subject matter experts. They can have people very deep in knowledge without having to worry about being too wide.

It also works out well with the health system team because we’ve certainly had subject matter experts, whether it’s our OR team or our ED team, who was going from a legacy application that they knew well. They had been trained on Epic, but wanted to interact with an Epic person who was a subject matter expert in that area.

In that way, it seems like Epic has been able to replicate — and continues to replicate — its success with a slightly changing but relatively stable workforce.

Everybody wants to be Epic these days. Can other vendors copy what they’ve done?

I hope so. People ask me, “What’s Epic’s secret sauce?” I often say, if you look at the two biggest players — Cerner and Epic — Epic is Apple and Cerner is Microsoft. Both very talented companies, but each has a unique feel and flavor about them. Even when we were making our selection, Epic felt more university campus-like, while Cerner felt more business-like.

I think that other health information systems can do as good a job as Epic without trying to replicate all of its collegiality. But at the end of the day, I hope that other health systems continue to grow in the way that they are and that we have more systems out there that meet the needs of hospitals and physician practices.

Do you see that happening?

One of the challenges — and I’m amazed every time I go to HIMSS and walk the halls — is all of the small start-ups who think that there is an opportunity to break in at this point. I think if you’re a relatively established big player — one of the big ones already, an Allscripts, a GE, McKesson, Cerner, Epic — there is opportunity to grow and gain market share. I’m happy with John Glaser and his role with Siemens because I think he will make it happen there as well.

Growing from a smaller, unknown vendor at this point into one of the larger players? No, I don’t think so. I think this is a game of musical chairs. Within five years, every large and medium hospital and health system will be seated in the place where they’re going to be for the next 20 or 25 years  without much opportunity for anybody smaller to work their way in.

You’re talking about for the major, core systems – correct?

Exactly.

CIOs could be fairly accurately characterized as risk-averse and finance people obviously are. How would you approach the market? People say they want innovation, but nobody seems to want to be the first to buy it in hospitals.

The funny thing is the tools that we have out there at our fingertips have been adopted in such a limited way. I think I saw the fact recently that fewer than 14% of US health systems or hospitals have achieved 10% or greater CPOE to this point. It’s almost funny to be out there demanding more innovative products when we’re not even using the products that are out there well.

I think there is a lot of runway for hospitals and health systems to use the systems that they have, tweak them, and make them more meaningful for their physicians and patients before we go out and try and demand something else. I think that the products that the big players have put out in front of us today should more than satisfy our needs for the next five or 10 years, even without a whole lot of smaller innovation.

What’s held everybody back? Why aren’t they using what they paid for?

It is very difficult. I’m surprised at even the way that some large health systems have achieved what they have. You know, and all of our colleagues do, that these are tough and challenging projects made challenging not only by the fact that they’re very complex, but they involve human lives, so there’s a premium on risk. They involve physicians who are well trained and want to be very efficient and good in what they do and see these tools occasionally as a threat to the way that they operate, and a threat to the way that they care for their patients.

Balancing all those factors is very difficult. Even a well-run project, which on paper has good governance and structure, if it doesn’t balance those needs, and especially if it doesn’t meet the needs of the physicians and the nurses using the system, it’s a recipe for failure.

What are some things that you learned that most people would not pick up on or that you wouldn’t have expected that really made a difference in how your project was completed?

I’d say the factor that made our project a success more than anything else was a buy-in to the schedule. We knew that this was something we needed to accomplish across all of our hospitals and practices. We knew that if we went very slowly it could take many, many years, and that if we were going to achieve the benefits for our doctors, nurses, and patients in a reasonable timeframe, that meant we had to implement in a reasonable timeframe.

That meant we had to make our hard decisions upfront and then stick to them and operate in a system fashion. When we focused on our order sets, for instance, we went from more than 3,500 order sets down to 500 common order sets. It was not 120 order sets for Hospital A and 50 different order sets for Hospital B. It was 500 order sets which you could use, and were the same at every one of the Carilion Clinic hospitals. We did all of the hard work upfront, set a schedule that we said that unless we were going to put patient safety at risk, we were not going to deviate from.

Then, once we had that focus that we knew what we needed to achieve and when we needed to achieve it, we looked for any outliers that would get in the way. As long as everybody was on board — our executive leadership, our clinical leadership, and our project team — we didn’t deviate from the schedule. It was more like riding a train than it was stopping and approaching every new hospital and physician practice and making decisions about it.

For a lot of hospitals, their problem is that their milestones are all wrong. They have to pay more money when they get the code loaded and then pay more money again when they get implemented and go live. It’s almost like an anti-sense of urgency.

That’s a great point. One thing we did was we bought an enterprise license upfront so that we had laid out the capital dollars initially. It was just a question of when we were going to use it, not if we were going to pay more when we got around to using it.

We also front-loaded the project. We did our largest hospital first. We have our largest, 880-bed hospital going to down a smaller 120-bed and even smaller hospitals than that. We decided to start with the 880-bed medical center first because we knew that we would run into the biggest, hardest issues there. Once we solved them there, we would just replicate the same process at our other hospitals.

By getting all of the right people on board, knowing that they had to make the right decisions upfront, and that there was not room for error at a smaller hospital that we could go back and fix later on, we really did have focus and cooperation in a way that I think we would have not had had we started at the other end and worked our way up.

You mentioned Meaningful Use. Are you comfortable with what you think Meaningful Use will be and where you are?

We are comfortable. I’m very interested to see what rules come out. It’s been a fascinating process to watch it all along. I do hope that the standards are held relatively high, but I agree with many of my colleagues who worry that they’re high, almost to the point of a lot of people not being able to participate. It almost seems like it begs for a common ground — that that bar is set high enough that it causes us to achieve more, but not enough that it decapitates anyone.

At this point, I expect that it’s going to be challenging for many hospitals across the United States to achieve it. We’re comfortable with almost all of the elements as they’re laid out today. There are four or five that don’t come easily that we have planned reporting for. We’re prepared, but we’re counting on achieving both certification and Meaningful Use in fiscal 2011.

You mentioned Carilion’s move to the practice-type model, the Mayo model, in 2006. What kind of IT changes did you have to implement to support that?

It was all about integration. We had 11 different systems, more than 512 different interfaces, and we had the challenges of trying to get down to a common way of operating because we really wanted the physician in Roanoke to be able to refer to his or her colleague in Blacksburg, and for both of them to see the same information on a discharged patient from our medical center. We thought we were only going to be able to do that, not by brushing up on our 500-plus interfaces, but by having it all operate on the same system.

One thing that we had done was that we had a whole lot of experience with the GE Centricity product. In the previous eight years, we had rolled out GE Centricity to every one of our 140 physician practices. When we implemented Epic, we knew that we had a responsibility — not only to our patients, but to the doctors that had put all the work of entering and maintaining that information — of having it available at their fingertips the first time they logged in to Epic.

One of the biggest early challenges we had in this project was converting literally eight years’ and about 800,000 patients’ worth of data from GE into Epic. We had a small team led by two of our physicians and about five of our IT people who did nothing for about four months than plan the migration of the data and test it over and over again.

Then, when we actually did push the button and convert the data, our data center literally chugged for about 11 days converting all of that information from the GE system into the Epic system, so when our first practice went live, it was all there. That was a commitment we needed to make so that our physicians had, in their new tool, all of the data that they had in their old tool.

There’s a new Virginia Tech Carilion School of Medicine. How are you involved with that?

We do have a new school of medicine that we’re very proud of. It’s been a challenge. In the past four years, we have implemented Epic. We’ve build 200,000-square-foot new medical center. We’ve acquired two major practices. We’ve acquired one hospital. We’ve built a research institute. We just started the Virginia Tech Carilion School of Medicine. All of which made for a very busy past four or five years.

My team and I are responsible for the technology for the school of medicine. It’s been a fascinating experience helping them stand up their practices, implement IT for them, and put the systems at their fingertips so that they’re ready to go when their first students show up 23 days from now.

One of the most fascinating things was participating in the selection of medical students. The Virginia Tech Carilion School of Medicine used an innovative interview approach where they had many people, lay people and clinicians alike, participate in the student interview process. Getting to do that was a highlight in addition to being the CIO for that school of medicine itself.

In terms of the curriculum for the medical students, are you involved in any IT or informatics training components?

Yes. In fact, we’ve made use of the medical record one of the components of the school of medicine. It’s not something that the students will have Year One, but by the time they get to their clinical rounds, we will have them trained on the Epic electronic medical record and built templates for them to use on their own, in ways that they can step slowly from viewing patient data initially to full CPOE over a period of about six weeks.

The other hat you wear is that you’re involved with the Virginia Information Technologies Agency. What kind of work is being done at the state level?

I’m proud of the way that throughout the Commonwealth of Virginia, we’re cooperating to make sure that the data that we have in each one of our health systems is available to others. Part of the HITECH Act was $2 billion set aside for HIEs. Five of the CIOs of the other large health systems in the state of Virginia and I serve on a Governor’s Commission to help define the standards for the HIE.

We’re also on the advisory board for implementing it. We’ve been meeting in our state capitol  at Richmond  for the past 12 months focused on how we’re developing HIE, who we will have implement it for us, and how we will begin to exchange data and interchange with the NHIN as well.

What are your IT priorities for the next several years?

One of the things that has been nice about getting to the point where we’re close to wrapping up this implementation is that we know that for the next five years, we’re going to be all about optimization. We don’t want to go into the next big project. We don’t want to go buy the next new piece of cool technology. We want to take what we’ve built and implement it and make it work as well as we can for our physicians.

We have an optimization team, which is getting larger all the time, and that we hope through our upgrade to the 2010 version of Epic next spring that we will bring even more useful technology to our clinicians. Our priority, instead of being very forward-thinking and cutting edge, is all about using this tool that we’ve built to its maximum advantage.

Any concluding thoughts?

It is a heady time to be part of healthcare IT. For the first time in my career, my mother understands what I’m doing because it’s front page in The New York Times. I’ve really enjoyed being part of it. Doing it in a large health system and trying to make it integrated is very rewarding.

Obama Names Berwick as CMS Head, Using “Recess Appointment” Authority

President Obama today named Donald Berwick to head the Centers for Medicare and Medicaid Services while Congress is recessed, allowing Berwick to bypass nomination hearings and Congressional voting. The move also avoids public debate of the administration’s healthcare reform law before the midterm congressional elections.

Berwick, a Harvard Medical School professor and president of the Institute for Health Care Improvement, would have faced questions about previous comments in which he praised Britain’s government-run National Health Service and stated that healthcare rationing is inevitable.

Sen. John Kerry (D-MA) said, “Republican lockstep stalling of Don’s nomination was a case study in cynicism and one awful example of how not to govern. When these federal programs were in trouble, they denied the administration the capable guy the president had chosen to oversee them. The president did the right thing making this a recess appointment”

A statement from Sen. Mitch McConnell (R-KY) said, “As if shoving a trillion dollar government takeover of health care down the throat of a disapproving American public wasn’t enough, apparently the Obama Administration intends to arrogantly circumvent the American people yet again by recess appointing one of the most prominent advocates of rationed health care to implement their national plan. Democrats haven’t scheduled so much as a committee hearing for Donald Berwick but the mere possibility of allowing the American people the opportunity to hear what he intends to do with their health care is evidently reason enough for this Administration to sneak him through without public scrutiny."

Sen. Max Baucus (D-MT) who chairs the Finance Committee that would have overseen Berwick’s nomination hearings, was was quoted as saying, “Senate confirmation of presidential appointees is an essential process prescribed by the Constitution that serves as a check on executive power and protects Montanans and all Americans by ensuring that crucial questions are asked of the nominee – and answered. Despite the recess appointment, I look forward to working with CMS as they implement health reform to deliver the better health care outcomes and lower costs for patients we fought to pass in the landmark health reform law.”

News 7/7/10

From GladToBeLongGone: “Re: Sentillion. You should check with your sources at Sentillion or now the marketing leadership of HSG of Microsoft in Andover about some recent changes in personnel with one of the key players leaving, which they are keeping hush hush.” I did check. Microsoft confirms that it will announce today that former Sentillion president Paul Roscoe has resigned as GM of worldwide sales. Steve Shihadeh will take over as GM of North American sales, reporting to Peter Neupert.

From Boboloo: “Re: Stryker Imaging Division. It’s being sold to Merge Healthcare.” Unverified. Stryker focuses on orthopedic PACS, including CR, HDDR, OrthoPad EMR, and NetPractice PM.

From Sabrina: “Re: Ernst & Young. They are trying to restart their healthcare consulting business. VP/MD Bill Fera of UPMC is moving there. Guess the Capgemini non-compete ran out.” Unverified. E&Y sold their consulting business to Cap in 2000, which then sold everything but life sciences consulting to Accenture in 2005.

Reminders of stuff you can do: (a) the search box to your right covers HIStalk, HIStalk Practice, and HIStalk Mobile, so it will dig through millions of words at your command; (b) sign up on each site to get updates when we run something new; (c) Friend or Like us on Facebook; (d) send us your guest article, interview idea, or rumor; and (e) support our sponsors so they will keep supporting us. Oh, and (f) give yourself a little wink in the mirror like Inga would do if she were with you, just because we’re crazy about our readers.

CCHIT responded to a reader’s question about its commissioners, trustees, employees, and consultants. Its Web site is current with regard to commissioners and trustees, it says. It does not publish the names of employees. Specifically, Linda Kloss of AHIMA is a trustee, while Steve Lieber of HIMSS is not. Update: I should have noted that while the site lists Linda Kloss as AHIMA CEO, she stepped down from that role last November.

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HERtalk by Inga

Access acquires the intellectual property and contracts of Formetta. Access is the developer of the Access Enterprise Forms Management suite and Formatta is a provider of on-line forms and workflow solutions.

The University of Texas MD Anderson Cancer Center says that 28,000 patients have accessed their medical records on its year-old portal, with 40% of referring community physicians tracking the progress of their patients online.

Kansas City’s Swope Health Services selects eClinicalWorks EMR/PM for its 200-provider FQHC.

University HealthSystem Consortium partners with AcuStream to offer a co-branded version of AcuStream’s RevBuilder service to UHC members.

Last week I was on a field trip of sorts, hanging out in a hospital. The level of automation at this community hospital was pretty typical: clinicians still rely heavily on paper charts despite having a clinical system (CPSI) in place. Providers enter orders into the system (though not at the point of care), which are then available to the pharmacy, lab, etc. The hospital uses a Pyxis CUBIE system for medication administration with individual stations at each nursing pod. (I actually asked the nurses to give me a demo of the Pyxis system, but they looked at me like I was some sort of drug seeker.) I was reassured to learn that the hospital and community physicians were able to see one another’s record. All and all, their IT usage at this stage won’t qualify them for Meaningful Use money, but it seems to be serving their needs.

Here’s something I’m all for: software that simplifies medical terminology so that clinical information is better understood by the masses, suggesting plain-English replacements for jargon. That topic reminds me of the time a male doctor once suggested I had cellulitis. I almost slapped him.

Capital Health Systems (NJ) contracts with Aprima for EHR, PM, and RCM solutions. The health system manages 13 practices with 49 physicians.

A HealthPartners Research Foundation team wins a five-year, $3.7 million NIH research grant to develop and implement an EHR-based clinical decision support system to help reduce patients’ risk of heart attack or stroke.

HIMSS names CynergisTek CEO Mac McMillan as chair of its Privacy and Security Steering Committee.

A former VP from Beverly Hospital (MA) faces charges of commercial bribery and felony larceny. Paul Galzerano is accused of accepting kickbacks in the form of cash and services in exchange for awarding contractors lucrative hospital contracts. In addition, Galzerano allegedly placed valuable hospital-owned antiques in his own home. Prosecutors believe the schemes netted him almost $500,000.

The CDC awards the Association of Public Health Laboratories $2 million to provide technical assistance in advancing the electronic exchange of laboratory data. That’s chicken feed compared to the $800 million in loans and grants the government will spend to bring broadband to underserved Americans, including $17.7 million to the Iowa Health System.

Patient Safety Technologies (PST) closes on $6 million in private placement financing to be used to fund working capital and continued growth. The company also names a new president and CEO plus four new directors. PST has quite a complicated history, so if you care to read the tale of a suffering company, here’s a recap.

A class action lawsuit is filed in connection with a patient privacy scandal at University Medical Center (UMC) in Las Vegas. A former UMC employee was paid $8,000 to fax information on over 55 patients involved in traffic accidents. The lawsuit claims UMC “recklessly” distributed news releases that indicated when credit monitoring would end for affected patients, thus alerting would-be privacy thieves.

The 24-bed Lower Umpqua Hospital (OR) agrees to spend $560,00 for an EMR, which includes $332,000 for software from Healthland.

Nebraska Orthopaedic Hospital makes plans to implement Wellsoft’s EDIS.

Dell’s strategy to increase its healthcare presence seems to be making an impact. Its service division, which includes the former Perot Systems, accounted for 13% of Dell’s first quarter revenue and helped sustain the company’s 17.6% margin. In addition, the services unit is fueling sales for hardware, including a recent $3.5 million order from Methodist Hospital (TX), which has a services agreement with Dell.

E-mail Inga.

An HIT Moment with … Dennis L’Heureux

An HIT Moment with ... is a quick interview with someone we find interesting. Dennis L’Heureux is SVP/CIO of Rockford Health System of Rockford, IL.

What are your most important IT projects at Rockford Health System? Which ones represent a change in strategy from just 2-3 years ago?

The most significant IT undertaking at RHS is the introduction of an integrated electronic medical record. This said, it seems that we can tag almost every project we do as “important”.  Among other important projects are C-PACS, Bed Management / Patient Flow, Utilization Management, and Patient Dietary Service.

Many of these projects were defined as needed during the past three years but are just getting underway. Strategically, however, we are now exploring the feasibility of a more tightly integrated approach.

You’ve said that the hospital’s transcription program is cost-competitive with offshoring because of speech recognition. What benefits have you seen, and how does dictation and transcription fit into your electronic medical records strategy?

Before leveraging speech recognition technology, we could not seem to compete with offshore transcription options. As we analyzed costs, we found that typical employee benefit costs measured in cost per line seemed to be the component that made us uncompetitive.

However, speech recognition — we use Enterprise Turbo Speech from Nuance — has provided us the ability to drive transcription productivity high enough to offset this disadvantage. Additionally, it is important to note that in-sourcing our transcription workload also increased the qualitative satisfaction that our physicians demanded.

As we transition to an EMR, we believe that we will use voice recognition to allow physicians to add narrative to their patient’s records. We are in the process of taking a look at the benefits of Dragon Medical, which would allows our physicians to dictate directly into our EMR for real-time documentation.

What changes do you anticipate from healthcare reform, specifically with regard to reimbursement?

I believe that healthcare reform will increase volume and reduce reimbursement. Overall, providers will not fare well if they do not align their cost per unit of volume to the corresponding reimbursement per unit of volume. As bundled payments are offered, this will create a need for more cost accounting detail.

Are you considering any innovative technologies or vendors that the average hospital CIO would not have heard of?

There are many innovative technologies being introduced. For example, natural language processing and script digitization. However, many CIOs are not well positioned to take risks since budgets are razor sharp and it is difficult to prove ROI beyond a paper exercise.

That is why I believe it will be difficult for new products to find any kind of market penetration unless they are built into existing, well-known products. 

What are some ways that the IT department interacts with the clinical front lines to improve patient care?

Technology is hard, but process change is harder. IT is learning that much of what it does relates to facilitating change, and this cannot be done without direct involvement with care givers at the point of care.

Integrated implementation teams are the norm these days, whereby IT analysts must work in tandem with those that are to optimize the utilization of the expensive information systems we invest in.

Monday Morning Update 7/5/10

From Cherry Capri: “Re: MMRGlobal. Docs are required to inform patients when they refer them to a facility in which the doctor has a financial interest. Do physicians also have to disclose to patients that they get a kickback if the patient upgrades to MyMedicalRecordsPro?” I’d guess they aren’t doing that since they also don’t disclose financially beneficial drug company ties, but maybe they’re supposed to.

From Jerry: “Re: how to add an HIStalk icon to the iPhone desktop. Click the icon at the bottom left of any Web site and click the Add to Home Screen button.”

From Barry Zuckerkorn: “Re: EMR patents. There are several. How can HIT vendors sell EMR systems without infringing? Or are they paying royalties to all these guys?” Good question. I’m surprised that patent trolls like Acacia Research Corporation, which routinely shakes down HIT vendors, haven’t jumped on this. I notice that Acacia just lost a case against Red Hat and Novell, which it ridiculously sued for infringing its patent for network-based desktop icons. The only surprise there is that Acacia actually took it to court since they specialize in “license fees” that costs less than a legal defense, making it teeth-grittingly easier to just write them a check to make them go away.

We talk a lot about CPOE applications, but the survey shows what we all really know: when it comes to CPOE success or lack therefore, the customer should get the credit or blame, not the company that wrote the software they use. Hospital culture and leadership are the most important, 79% of you say, with just 7% of readers saying it’s all about the application. New poll to your right: if you as a citizen were allowed to cast a ballot for or against $20 billion in federal spending for HITECH EMR incentives, how would you vote?

TPD has updated his iPhone healthcare apps list, which now numbers more than 200.

Jobs: Senior Software Engineer, Manager Clinical Informatics, Epic Ambulatory Trainers, Cerner Orders Consultant.

CPSI fires suspended CFO Darrell West, saying it has confirmed that he charged $55,000 to a company credit card to pay a personal tax bill. You’d think a CFO should have (a) known that he would get caught, and (b) calculated the net present value of years of lost income vs. $55K now and realized what a bad deal that is. Former CEO David Dye is brought back as interim CFO.

Weird News Andy deviates from his core competency in finding this article, which he says isn’t weird, just cool. A laid-off software engineer whose three-year-old son has cerebral palsy is shocked by the “stone age” devices that therapists were using to train him. Being a MS in software engineering from the best school in the country for that field (in my mind, anyway — Carnegie Mellon) he buys a Mac Mini, signs up for Apple’s iPhone developer program, and creates TapSpeak Button. It allows pictures to be uploaded and then pressed to play recorded messages. He’s selling quite a few at $10 per copy.

HHS CTO Todd Park on the now-open HealthCare.gov that helps people find medical insurance:

You know, I think everyone, I would presume, is in favor of better informed consumers. Everyone’s in favor of healthy Americans, everyone’s in favor of more functional marketplaces. I mean it’s not a political thing, it’s an American thing.

Britain’s NHS spent $2.4 billion on IT in the most recent fiscal year, most of it on NPfIT. The NHS spending that’s making headlines, however, is $10,500 in grants to teach unemployed women how to be stand-up comics.

Here’s another case, this one in Ireland, where critical patient lab results were recorded in the computer but were not seen by the physician in time to prevent a serious mistake.

Private equity firms are checking out iSoft, rumor has it, now that its share price has been beaten down. Among those supposedly interested is General Atlantic, whose other healthcare holdings include Emdeon and CompuGROUP.

The new president at University of Illinois announces his intention to run the organization, including its hospital, as a single university. He describes the Chicago hospital as “dilapidated”.

The ACLU sues Rhode Island’s state health department, claiming its not-yet-live Currentcare HIE will not adequately protect patient privacy. And in Alaska, ACLU sues the state’s Department of Law for failing to ensure the privacy of medical records that were seized in a raid on a midwife’s office, brought to light when an officer with the Ketchikan Police Department taunted a patient’s daughter by saying her mother had been treated for a sexually transmitted infection.

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News 7/2/10

From Jack Ripert: “Re: Cisco Pad. Apparently it will run Android. This may have killer healthcare application if done right.” Cisco will launch its Google Android-powered Cius tablet PC next year: smaller and lighter than the iPad and with two cameras, USB connections for external devices, and an easy tie-in to Cisco’s Telepresence videoconferencing system. They’re shooting for an under-$1,000 price. IT shops aren’t crazy about supporting Android, but they probably like it better than Apple and Cisco carries a lot of CIO clout, so this could be a big deal in hospitals, at least those prepared to wait for it. Those with long memories will recall that Cisco sued Apple over the use of the iPhone name (Cisco was selling a $12 iPhone), then settled with Apple and gave them the name (reported here in January 2007).

From I Have Friends in Military: “Re: AHLTA. To be declared a failure and replaced.” Unverified. That would be huge (and expensive) news if true, but I’m a doubter. Confirmation, anyone?

From Big Dave Brewster: “Re: [HIT publication name omitted]. Looks like it’s going toes-up.” Another HIT rag that I won’t name apparently goes on death watch. They’ve laid off the editor and no ads are displaying on the site (no loss from what I can tell from online stats – it looks like it’s only drawing a handful of visitors each day). Someone said management had already decided to run only advertiser-friendly stories to try to keep the money coming in. Something’s wrong with the cost structure if you can’t make a living charging high five figures for a yearly full-page ad and nearly that for an online ad that nobody will see.

From Denise: “Re: most overused press release buzzwords. You’re gonna love this one.” Right you are, Denise! It’s a press release word frequency list, with the most common being (1) leader; (2) leading; (3) best; (4) top; (5) unique; (6) great; (7) solution; (8) largest; (9) innovative; (10) innovator. Now if some would just write a Word add-in that would count these in a document, I could run a Buzzword Bingo game using real-life press releases and make it part of the HISsies awards.

From Texass Longhorn: “Re: Dell. I didn’t know that we at UTex could come up with a math problem so difficult as to bring down a Dell computer.” It was probably trying to calculate Texas football coach Mack Brown’s $5 million salary. Dell, stung by complaints and lawsuits about widespread failure of its OptiPlex PCs three years ago because it used cheap (and leaky) Asian capacitors in 11.8 million of them, is surely embarrassed by this New York Times story. When UT’s math department complained about failing Dell PCs, the company blamed the university for overworking them with tough math problems. An interest fact: the legal firm defending Dell from huge lawsuits over the problem had 1,000 of the bad PCs itself; Dell stiffed them too. Who would have guessed that 90s darlings like Dell and Microsoft would be struggling?

From Del Taco: “Re: CCHIT. Can you please shed some light on who the actual commissioners, trustees, and staff are at CCHIT since Mark Leavitt’s departure? Its Web site is out of date. How many HIMSS employees are still considered as staff of CCHIT? There should be more transparency if CCHIT intends to apply for more government grants.” I e-mailed your questions to both Sue Reber and the press contact at CCHIT Thursday morning. No response yet, but I’ll let you know one way or the other.

Welcome to new HIStalk Platinum Sponsor Capsule Tech, a leading provider of medical device connectivity. The company, operating in 27 countries and 600 hospitals, offers the vendor-neutral, 510(k)-cleared Capsule Enterprise Device Connectivity Solution, which allows connecting any medical device to hospital information systems. Part of that system is Capsule Neuron, a touch-enabled bedside platform for managing device connectivity that adapts to the environment it’s operating in. Our long-time HIStalk friend Ann Farrell of Farrell Associates will be co-presenting Capsule’s July 21 Webinar on medical device integration and its impact on patient safety, care outcomes, and meaningful use, so I know it will be good. Thanks to Capsule Tech for choosing to support HIStalk.

CynergisTek announces three new products for small healthcare organizations: IT support services, e-mail, and HIPAA/HITECH security compliance review.

A reader e-mailed me about the cool Mass General ED finder for smart phones. I agreed it’s cool, but opined that they’ll be sued in no time since any obsolete information is going to make someone needing an ED unhappy about being led to a closed one. Another reader noticed that problem when he tried the app: it highlighted EDs in his area that have closed. Its database is from 2007, he believes. They’d better have a lawyer review the disclaimer extra carefully.

MedAptus is awarded a patent for its automated process for capturing professional and facility charges in outpatient settings.

Showing the new HIStalk mobile display is as pointless as showing a fancy TV’s picture in a TV commercial, but just in case you don’t have a smart phone and wonder what it looks like, here you go (thanks to Inga for the early morning screen shots). Several readers e-mailed to say they love it, so thanks for that. One reader suggested creating a downloadable launcher for BlackBerry, iPhone, and Droid to avoid having to go to browser bookmarks, so if anyone knows how to do that, let me know because I don’t.

Speaking of smart phones, strong rumors say Verizon will start selling iPhones right after Christmas.

BJC HealthCare (MO) signs a $49 million, 12-year agreement to migrate 11 of its hospitals to Soarian Financials. Also, Platte Valley (CO) and Kingman Regional Medical Center (AZ) each signed multi-year deals for Soarian Clinicals.

The healthcare industry spent $8.2 billion globally on handheld devices last year. Kalorama Information predicts sales will grow 7% per year for the next five years and physicians and hospitals purchase new IT systems.

Results of the investigation into $11 million worth of delayed charges at University of Iowa Hospitals and Clinics: budget cuts left them with only one person to perform the required manual record review to document the appropriateness of cardiac cath charges, so it didn’t get done. Doh!

API Healthcare issues a set of best practices to help hospitals deal with nurse shortages.

AMIA names Jonathan Grau as VP of corporate relations.

Family doctors in the UK say they will not allow the medical records of themselves or their families to be stored on the troubled Summary Care Record, citing privacy concerns.

An interesting All Things Considered story on athenahealth, which processes 30,000 pounds of paper per month. A fun Jonathan Bush quote: “Because what healthcare really is is this awkward word slapped on top of a million little tiny markets.” An interesting factoid: New York Medicaid, among the worst claims payers, requires claims to be filed on special forms that must be ordered from Albany, then hand signed by the doctor.

Encore Health Resources announces two new hires: Julie Morrison (CSC, FCG) as client services executive and Paul Murphy (KSA) as services area leader for IT strategy.

HIStalk readership easily set a new record in the normally slow month of June. The tally, for those scoring at home: 101,652 visits and 139,766 page views (up 50% over a year ago). Most of that wasn’t because of the Allscripts or John Glaser news since those days were up only a few thousand visits. The e-mail list has 5,746 verified subscribers. Thanks to everybody who made that possible: readers, sponsors, authors, interviewees, commenters, and of course my trusty companion and kindred spirit Inga. It was fun writing HIStalk back in 2003 when nobody was reading, but I admit it’s more fun now.

Weird News Andy notes this story: in preparing for the rollout of its Healthcare.gov portal, HHS gets all cool and takes over a dormant @healthcaregov Twitter account, but forgets to clear the favorites list. As a result, HHS’s list of favorite tweets include several about P. Diddy and the vodka he was pitching a year ago.

Cash-bleeding West Penn Allegheny Health System will lay off 1,500 employees and cut back operations at West Penn Bloomfield. Considering the big money UPMC makes, that looks like an area ripe for consolidation if you don’t mind the idea of UPMC having no competition (like it really does anyway).

FormFast will offer a July 13 Webinar on avoiding HIT contracting pitfalls.

Rockford Health System (IL) chooses Epic, the same system used by its potential acquisition partner, OSF HealthCare.

If anyone still cares about The Leapfrog Group, it expresses concerns about those CPOE systems it’s been bugging everyone to buy for years. Leapfrog’s tests find that CPOE (actually its decision support component, which isn’t distinguished separately) misses a lot of really dangerous orders. CEO Leah Binder says, “The belief that simply buying and installing health information technology will automatically lead to safer and better care is a myth.” I agree, but wasn’t Leapfrog perpetuating that myth by making CPOE adoption one of its Leaps without really getting into the nuts and bolts? Above is a snip from a 2000 press release, which shows unconditional CPOE love.

A Florida county’s EMS department pays $500K for 911 software that claims to predict where the next emergency call will come from based on historical data. Paramedics say it wastes their time sending them to areas waiting for calls that never come.

ProHealth Care (WI) plans to replace multiple modality-based software applications with McKesson’s Horizon Imaging PACS, Cardiology CVIS, and Study Share case collaboration tool.

Adventist Health System signs up with Lexi-Comp for drug data. I guess they didn’t like Cerner’s Multum product even though they’re running Millennium.

Software Testing Solutions will demo two new products at the upcoming SUG 2010 meeting for Sunquest users: Application Monitor and Calculation Extractor. Product data sheets are here.

The ever-optimistic MMRGlobal predicts massive MyMedicalRecords and MyMedicalRecordsPro sales increases, with the business model being the 35% skim that doctors get for convincing their patients to upgrade. The company says that “can result in substantially more income to doctors than the $44,000 in government stimulus programs.”

Norton Brownsboro Hospital (KY) connects its GetWellNetwork system to Cisco Unified Communications, allowing patients to send messages to their nurses.

WellPoint notifies 470,000 of its insurance customers that their medical records and credit card numbers may have been exposed in a March breach cause by a problem with its online insurance application system. A customer noticed that she could see other people’s information by tweaking the browser address of her own. She let WellPoint know — by filing a lawsuit against them.

Another breach: Siemens Medical Solutions USA FedExes several CDs full of unencrypted patient information to its billing client, a New York hospital. The CDs fall out of the envelope during transit, apparently, and FedEx assumes they were trashed. The breach affects 130,000 patients.

I’m skipping town for the holiday and haven’t decided if/when to do the Monday Morning Update, so for those who start e-mailing me when the withdrawal symptoms hit late Saturday afternoon (yes, I’m pleased to say those people exist – maybe they’re the same ones who keep track of the readership stats), be prepared for these eventualities: (a) I don’t publish the update until late Monday afternoon; or (b) I bag it entirely. The only HIStalk that will get my undivided attention this weekend is Mrs. HIStalk, but I’ll probably sneak back sometime Monday for some PC intimacy. I hope everyone has a happy Independence Day.

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HIStalk Interviews Howard Messing

Howard Messing is president and CEO of Meditech.

How’s business?

I think we’re doing very well. The stimulus bill has certainly stimulated.

I noticed on the financials that operating income dropped last year for the first time. Was that just an accounting irregularity, or what happened there?

Operating income dropped last year… Well, we had a drop in sales last year because of the first half of last year. Nobody was buying anything because everybody was figuring out what was going on. That’s probably why you see a small drop in there.

I take it that’s totally reversed and then some.

Right, the problem being that between the time we make a sale and the time the income shows up is the better part of a year. Even though we were making a lot of sales, the second half of last year wasn’t reflected until this year.

Tell me about the challenges and the successes with 6.0. That’s a pretty big step for the company.

6.0 is, yes, a very big step for us. We’ve rewritten a bunch of our software from scratch, which we tend to do every certain number of years, certainly every 7-10 years, as we get new ideas and better ideas. It’s gone pretty well. It’s gotten a great reaction from people.

The biggest challenge for us is that we have so many customers running our older version of software that we have to not only maintain the older version, but actually continue to development in it. We’ll have to continue that for some number of years to come until the vast bulk of our customers upgrade to our newer software.

In addition, we still have the rest of our apps. We’ve only done a core set of applications so far. We’re going to have to do the rest of those over the next 2-3 years.

I take it those would co-exist? If someone wanted 6.0, they could still run everything, it’s just they would be 6.0 on some things?

Right. That’s the way we do it.

I would assume there’s quite a number out there running Magic?

Yes, there’s quite a lot.

Do you have a feel for how many that is?

Something over 1,000-1,200 sites, I believe, are still running Magic.

And your total count — I don’t know what it is now. It used to be around 2,100.

2,100 or 2,200.

So half are still on Magic. Is that the next logical step, that they would go all the way from Magic to 6.0?

Yes, we do have a plan where people go straight from Magic to 6.0. There’s no reason to go to the intermediate.

There were some good things said by the folks at the HIMSS conference — by Dave Garets, if I remember right — about the CPOE adoption with 6.0, which seems to be dramatically improved. Was that part of the reason for rewriting it in a way that was more Windows familiar?

Yes. I think the big difference there is functionally. The old stuff and the new stuff currently is pretty much the same, but the look and feel is certainly different.

People, particularly doctors and nurses, are much more desirous of a modern look and feel and they’re willing to accept things a lot easier if it’s a modern look and feel. I think, yes, that’s why you’re seeing a much greater acceptance. I don’t know about much greater, but a greater acceptance, certainly, with 6.0.

At the same time, the new interface also has allowed us, I think, to reduce things like number of clicks and all those good things. That’s also helped.

Some of the attention that’s out there now is going to companies like Eclipsys and Cerner for opening up their system to third-party customization or hooks into the application. Meditech’s always been pretty close to the vest on not letting clients screw around with the underlying stuff. Is that something that’s in the works or do you even believe in that concept?

I’m not really even sure what the competitors are doing in that area. We’ve always had some ability for our customers to define some things on their own, but overall I would say no, we don’t believe in customization as a desirous thing. It certainly is a necessary thing, on occasion, to do.

I think, moving forward with certification and the patient safety and all that, it’s probably going to be a less attractive feature for people to use than it is in the present time. We don’t have any great plans on that.

What do you think about the whole certification argument? Do you like the way it’s changing? What are your thoughts, as a vendor, on what certification means to you?

What certification means to me? I guess in many ways, I would have been the last one to say that certification was a good thing, but I have surprised myself by coming around quite a bit in thinking that it, perhaps, is a good thing for our industry. Certainly, we’ll quibble over the details of how it’s done, and quibble about the particular way of the government’s getting involved.

I’d like to say I’m a short-term pessimist and a long-term optimist, but in the long run since I worry a lot about patient safety, I think certification may very well be in everybody’s best interest. I would rather that it was cast in terms of results rather than specific ways to get there, but over time, I assume that we will get modification into the way it’s written and be able to do it in a meaningful way — not to use the word too much. We’ll see …we’ll see.

In the short-term, yes, it’s a pain in the ass because you’ve got to get it certified. We don’t know all the rules and we may have to get it certified multiple times, but so long as it’s a level playing field for everyone, and so long as the eventual outcome is to have better systems and interoperable systems, I don’t think it’s necessarily a bad thing.

How do you think the whole CCHIT will change now that Meaningful Use is off on a different direction? What do you think certification’s going to look like in a year or two?

I really don’t know. We’re certainly will have some people who continue to look at it and put their ideas in and we’ll see how it goes.

Do you think, under the CCHIT requirements, that you had to invest R&D to do stuff that customers probably didn’t really care about that was still on the checklist?

A very small amount of that, but most of what’s on there is stuff that people do care about. I’d actually have to think long and hard about something that nobody cared about.

Meditech’s one of the few systems out there that’s really appropriate for those many small hospitals that maybe aren’t very far along on their IT journey. Are you doing anything new to go after that business?

Not really. First of all, we think we’re suitable for all hospitals regardless of size, but I will agree that the small hospitals find our cost of ownership to be particularly good for them, and tend to work with us. No, we’re not doing anything specific to do that, other than we continue to watch our pricing to make sure that we remain appropriate for various sizes of hospitals.

What competitors do you face across the table most often?

I think McKesson is certainly in the medium-sized hospitals as the competitor, and I think we face them most often. In the small hospitals, probably CPSI. In the large hospitals, it’s mostly Cerner. Occasionally in the largest hospitals, Epic.

I’m assuming you displace some in-house vendors occasionally. Who are the ones that usually get displaced in favor of Meditech?

It’s a mixture of all of them.

Yes?

Yes. I’m not going to single out any particular vendor.

Have the demographics of your customer base shifted as far as size, location, or type of hospital?

Yes, I think the size is slightly larger than it used to be. If you would have asked me five years ago, I would have said our sweet spot was 200-225 beds. I would say it’s closer to 275-300 beds today.

If you took that as a percentile, that’s probably a fairly huge chunk of the hospitals that are out there. I’m sure you probably know that number by heart, but that’s, I would guess, most of them by far.

Well, we think we’re in about 25-28% of the hospitals in the country, if that’s what you’re asking me.

I was just saying, if somebody drew a line and said, “Well, your sweet spot’s 300 beds,” or whatever it is, you would still not be ruling out very many potential prospects.

That’s true, that’s right. We don’t want to rule anybody out.

What about hosting? What’s the latest buzz on people wanting hosted solutions or turnkey solutions?

Actually, that’s kind of interesting because I used to not be at all a fan of hosting. I didn’t think that made economic sense for Meditech customers again because I thought our cost of ownership was pretty low.

Having said that, I’ve seen more interest over the last year or two than I expected, and not necessarily from the places that are most cost-pressed, which is what you would expect. I think a lot of people are taking the attitude that even if they don’t save money, it reduces management time and frees them up to deal with more long-term issues.

We’re seeing more of it. We ourselves have no intentions of providing that service directly, but there are various people out there who are interested in providing that service with Meditech software and we continue to say that’s fine with us.

When I talked to you years ago, it was the ‘stick to the knitting’ philosophy; that you didn’t want to be in something that was distracting. Is that the reason that you don’t want …

Absolutely. We sell software and the services around that software. We don’t do anything else.

The proposed acquisition of Eclipsys by Allscripts moved the idea of integration between hospitals and physician practices to the forefront. What do you think about the acquisition and that trend of people suddenly short-listing only those vendors who have strong integration with outpatient?

I don’t pay too much attention to what the competitors are doing, so I don’t know that I have any particular impression on Eclipsys and Allscripts. But in general, I agree with the philosophy and something we’ve promoted –  that there has to be tighter integration with all avenues of care, both ambulatory and acute care and eventually, nursing homes and independent care and whatever.

Obviously the biggest connection is between ambulatory and acute care, and one way or another, there needs to be a seamless integration with that, both in terms of getting the doctors to appreciate better what’s going on and in terms of taking better care of the patient. So I think you’ll see, whether it’s by acquisition or strong partnerships between companies, a tighter and tighter integration between all horizontal attributes of care. We’ve done that for a long time ourselves with our partner LSS, but even with us, I think you’ll see a tightening of that integration.

At the same time, still recognizing that for a long time to come, there are going to be doctors out there who have their own systems that are not necessarily the one that the inpatient or the acute care facility might choose for them.

Are you finding that that question comes up more often when you have prospects; and are they comfortable with the answer that you can give them on your strategy for either one system for doctors, or foreign systems that you can integrate?

It does come up more often. I’m very happy with that answer. It seems to be something that most people respond well to.

What do you think about the trend of smaller hospitals that are struggling with everything from technology to financing being acquired? How do you think that will change your business?

I don’t think it will change the business that much. There may be less customers, but they will be bigger customers overall if that trend continues.

I think we’re actually a few years away from the real cost pressures hitting our hospitals. Many of my hospitals would disagree with me on that. They’d say they’re under that pressure today, but as the baby boomers age in the next four or five years, there’ll be a lot of cost pressure and there’ll probably be a lot of consolidation in the hospital industry at that time.

When we have customers of ours that are acquired by another hospital, often our system is the one that stays in place. Often they do a search to decide what they want to do and it’s just another competitive situation. I don’t think it changes the business that much.

It might hurt a vendor that specializes only in the smallest hospitals if they tend to disappear, but I actually don’t think the smallest hospitals will all disappear. There’s a need for those small hospitals out in rural areas, and many of them are fiercely independent.

It seems like nobody even blinks an eye these days when you see a deal signed for $30 or $50 or even $100 million. Does your phone ring more often when hospitals that can’t afford that suddenly think the Meditech picture looks attractive?

Well, I blink at somebody spending $100 million. I don’t really understand some of the economics behind these decisions that are being made at a time when the hospitals are claiming they’re under so much cost pressure. Then you see them making these gigantic deals for huge amounts of money for a system that I consider to be basically equivalent to what I offer for 20% of the cost. It’s very, very strange, and I think that will catch up with people in the long run.

So, I’m not sure how to answer your question, but we continue to say that we’re good value. We’re not looking to take advantage of anyone by raising our prices tremendously. We think that, in the long run and with the cost pressures now, people will more and more realize that we were a good alternative.

Assuming that it would be difficult to look at the marginal benefit compared to the marginal cost of $10 million versus $100 million, why do you think people are making those decisions?

I think there’s some element of people thinking if you’re spending that much, you must be getting a better system. I think there’s some element of … how do I want to put it? There’s some element of people wanting to … I have to be careful how I say this.

Many hospital managements are afraid of losing their doctors, and so they turn the decision over to their doctors. The doctors are not necessarily concerned with the overall finances of the acute care institution, so the cost does not become a factor in the choice. I think we see a lot of that happening. I don’t think there’s any way it can be cost justified.

As I understand it, the HITECH reimbursement isn’t based on what you spend, it’s based on volume. Bottom line, it would stand to reason that the less you spend, the more you get to keep of the difference. Are people asking you to run those numbers?

They do ask us to run those numbers. That’s the way I understand it. Like I said, I think it will come back to haunt some people who are spending gobs and gobs of money on some of these systems.

And it’s not, of course, just the capital upfront. The maintenance is going to be just excruciating on some of that.

Right, right. Total cost of ownership is huge on some of these systems.

Are you pricing 6.0 differently, or is that basically just a replacement at the same price?

It’s a replacement. We don’t charge different amounts for different systems. It’s too complicated.

Your maintenance fees are, I assume, still low?

Our maintenance fees are basically the same as they’ve always been. We charge basically, 1% a month of what people buy for maintenance and we intend to keep that. Not that there aren’t modest raises over time, but we try to keep it low. We don’t think that our systems are difficult to maintain.

With other vendors, not only do the price goes up, but so do the maintenance percentage. It seems like it shames the other vendors who get 18 or 20% on five times the cost.

They don’t seem to be shamed by it. If they were truly shamed by it, they would do something about it.

Or the customers would stop buying.

Right, right.

How do you educate someone who somehow sees that as an equivalent alternative? Are they just not price sensitive?

To be honest, we don’t actually lose many sales to the real expensive systems that are out there. Many of our customers do toy with it. Many of them do understand it’s too expensive and then back off on it.

We just do what we’ve always done, which is we want people to want our system. We don’t want them to buy from us because they don’t want somebody else’s system, so we continue to demonstrate what we do.

If they bring up specific features that they think they’re getting with somebody else’s system that we don’t have, we try to point out to them that it’s actually there in our software. Hopefully, we make our case and it’s a strong one, that it’s better to go with Meditech.

Three or four years from now is when I believe the real crisis will happen in healthcare. Again, I know people say it’s happening now, but I really believe it’ll be three or four years from now. As the baby boomers enter Medicare, hospitals are not going to be able to spend as much on healthcare information systems as they do today. I think Meditech is very well positioned for when that happens, and the companies that are charging a lot will have built cost structures that they won’t be able to maintain.

Do you think there’s a certain snob value that a hospital says, “Oh, I can’t run Meditech. I’ve got to have Epic or Cerner because that’s what all the cool hospitals like mine are running.” Do you think that there are people who never even pick up the phone to call you?

Yes, I believe that exists. I think it’s less than it used to be. I think we’ve made a lot of progress, particularly in the multi-hospital chains. Particularly among the Catholic hospitals we’ve done very well, so I think it’s less than it used to be, but yes, there is certainly the snob appeal or whatever you want to call it — the CIO of the large teaching institution who can’t do Meditech because we’re also in community hospitals.

I would assume your win percentage is a lot higher when the CFO is involved more actively.

I’ve never really looked at that, to tell you the truth. I’d imagine it’s true, but I’ve never actually thought about it.

What’s your overall thought on the proposed Meaningful Use criteria and the whole healthcare reform issue and how it’s going to affect your business?

I wish the Meaningful Use was caged in terms of results than it was caged in terms of features of software. Then, I would think you would have a much better impact on patients than it, perhaps, will caging it the way that they’ve done it. It’s certainly is driving a huge amount of sales for us today in time, as people decide they have to make a decision now.

If they are going to change systems, they won’t be able to afford to change their system 18 months from now when they’re in the thick of trying to get that money from the government. So, it’s driven a huge amount of business today, which I expect to be a blip.

I expect that 18 months to two years from now, there’ll actually be a lull in people buying systems; much as it was after Y2K, wherein 1999 was a huge year and then 2000-2001, business really fell off. I see the same thing here.

I do wish the government had spread this out over a longer timeframe. I think that our customers would be able to be better focused on the real results they can get from it if we had done that rather than chasing after the money and doing the minimum they can to get the money because it’s under such a tight time frame. But again, as I said before, I’m a long-term optimist. I think in the long run this will all be good.

How do you plan for your business knowing that that hump is going to go away after the people have locked in with whoever their partner is?

The main thing we’ve done is limit the implementations that we’re doing currently, which has been a struggle. We have done that in term of we are growing, but we’re not growing so fast that we’ll have people who won’t have what to do 18 months or two years from now.

We’ve really spaced out the implementation. As people coming to us for the first time today are getting dates for delivery that are well over a year, to sometimes, depending on what they’re buying, as much as 18 months from now, which many of them don’t like. But that’s the way we control the business and make sure that our long record of no layoffs and controlled growth remains intact.

How do you think your job will change as CEO?

I don’t think it’ll change very much at all. Neil Pappalardo, who has been our CEO for 40 years or so, has just decided that it’s time for him to give up that title, but in effect, I’ve been running the day-to-day business for quite a while now. He’s still around; he just has been gradually spending more and more time on other pursuits, and so thought it was time to pass the baton. So, I don’t really think it’s going to change much on a day-to-day basis.

Is there a movement to prepare to transfer to the next generation of leadership?

I think we’ve always done that. It’s the case that we have appointed new officers several times over the past three years. I think you’re going to see us doing that again before too long.

We have a great set of people who are what we call directors, the round of people who report to our officers. It’s a lot of good people who have been here a long time who see this as their life’s work, and they will gradually take over. Our succession planning is thought out very carefully. We try very hard to get people promoted before the person who they are going to be, so to say, replacing, is ready to retire.

For example, we had a VP of development, a fellow named Bob Gale, who about 2-3 years ago we promoted him to senior VP and brought in a woman by the name of Michelle O’Connor, and she has been gradually taking over responsibility from him. You’ll see that in all of our areas.

This is one of those boom cycles where suddenly everybody and their brother want to be in healthcare IT. Is the company going to stick to its guns about not selling, not going public, not changing?

As long as I’m around it will. Yes — the answer to that is yes. We have too much fun the way it is. Again, we think the prospects for the future are very, very good. We see no reason to change the structure of the company. It’s worked well for us and we don’t see any benefit.

If you looked out 5-10 years, what are the strengths, weaknesses, opportunities and threats for Meditech?

I think the biggest threat is if the healthcare system changes in such a way that we can’t adapt correctly, and nobody really knows where the healthcare system is going. There are certainly many competing thoughts. That’s one of the reasons that I have been pursuing international business is to give us some stability that doesn’t depend on, let’s say, one healthcare system in the world. I think that’s the biggest, biggest risk we have.

I also think in some ways that that’s our biggest strength, in that we’ve shown flexibility. We reinvented ourselves many times and shown that we can have multiple generations of software running that address the different needs of the healthcare system. Hopefully, whatever does happen, we’ll be able to deal with.

Anything else you wanted to talk about or any concluding thoughts?

You know, there’s one thing you didn’t ask me about that I think is going to become more and more important as IT systems become more and more central to the clinical care process, which is patient safety. That’s something that’s a very big personal concern to me. We’re making every effort we can to produce a safe as possible software as we can. To some extent, I wish that the ARRA requirements actually included some patient safety issues as well in them.

I’m sure that the FDA, if they ever get funding, will start to regulate our software. In Canada, our kind of software becomes a medical device in about a year. We’re going to have to be regulated if we were a medical device which has patient safety implications. I think that’s the biggest issue for the industry that we should all be cognizant of and we should all care a lot about.

The only thing that keeps me up at night is the fear that we’re doing something that’s going to hurt someone. I hope that all the other CEOs have the same kind of feeling, because if one hurts somebody, it casts a light on the entire industry.

Generally when that happens, either it wasn’t designed to be very usable or the QA wasn’t very good. What steps do you take to build that safety into the product?

We certainly have a fairly thorough QA process that we do to make sure that the software is as absolutely safe as it can possibly be. Then we also have a fairly detailed process when a customer reports a possible patient safety issue. That problem is immediately elevated in status. We make a quick determination whether it’s even possible that there’s a patient safety issue so that we can notify all customers of the possible issue. Then we throw a lot of development resources and QA resources on it to figure out what the problem is and fix it.

I agree with you that sometimes patient safety issues are bugs, but sometimes they’re just a misunderstanding of how the software needs to be used; or a question of terminology. Those are actually a lot tougher to find, so you have to be that much more careful in your design, and that much more careful in your quality review of things.

News 6/30/10

From The PACS Designer: “Re: Yoono. Yoono allows you to connect to all your social networks and instant messaging services in one place.” Guess all the good domain names were taken if Yoono was all that was left. I gave up on Twitter about five minutes after I tried it. Recruiters have run everyone off from LinkedIn. Facebook is pretty cool, but trending up on self-conscious constant users trying to impress their phony online friends with minimally clever observations. Still, Inga and I like it when someone Likes or Friends us on FB because we’re just as vain as everyone else when it comes to public displays of fake affection, the electronic version of the Hollywood air kiss.

From ExER: “Re: Betsy Hersher. It seems she’s back in the recruiting business. Her picture and references are gone from CES Partners and she’s working with former employee Bonnie Siegel on a search.”

From GladToBeLongGone: “Re: you won’t run this, but word is that Mr. Big Yahoo whose name sounds like his initials at a company being acquired is already looking for a new gig. This should be good news for all the sales people at Newco since the guy who should get the top job doesn’t have that incredible ego.” I expected that — the coattails he rode in on are long gone.

From Medsync: “Re: baby pool. Join the pool on the arrival of the Blumenthal twins, Meaningful use and Certification.” Someone set up an online “when will the baby be born” contest. Funny. The MU draft went out right before New Year’s, as I well know since I worked frantic hours summarizing it here, so maybe the final version will come out this holiday weekend and mess up another holiday for me.

I’m in solo mode again as Inga takes a bit of me-time. Here are a few quotes from her e-mails to me today to tide you over (feel free to guess the context): (a) “Seems to be a lot of interest in porn stars these days”; (b) citing readership increases since she came on board, “just saying … I’m sure your work contributed to that growth as well”; (c) with a forwarded press release of dubious value, “Hmmm …”; (d) when testing a change I had made in the HIStalk display on smart phones, “We have been re-mobilized.” She’s a bit terse from her iPhone, but always entertaining.

Listening: new from The New Pornographers, indie pop from Canada.

Back in March, I dug out a juicy nugget from an internal VA report: it was scrapping a $150 million patient scheduling system without ever bringing it live. The GAO weighs in with its official report (warning: PDF), pegging the cost at $127 million and saying “VA has not implemented any of the planned system’s capabilities and is essentially starting over.” The contractor that developed the system with “a large number of defects” walks away with $65 million. GAO finds much to criticize about the VA’s involvement: lack of competitive bidding, sloppy specs, unreliable status reports, and lack of action by project oversight groups when the project started tanking. They made the same massive mistake they made with BearingPoint in the also-failed, $472 million CoreFLS — they just gave the incumbent contractor more work orders against an existing maintenance contract instead of bidding it out. All of this started coming out a couple of years ago in various reports, which got a few VA bigwigs fired and some politicians fired up to hold VA accountable. The contractor is not conspicuously named in any of these documents, but it appears to have been Southwest Research Institute of San Antonio, a non-profit bringing in $564 million per year. It was founded, oddly enough, by an Texas oilman named whose last name was Slick.

A Compuware survey attempts to make a point about clinical system response time, but I’m not going to bother with the results because their methodology was terrible. They scrounged up 99 respondents to take their survey, all from social networking sites and with no apparent attempt to qualify the respondents by the system they use, their roles, etc. Given that the company is in the infrastructure business, you will not be shocked to learn that they conclude that clinicians taking Twitter surveys aren’t happy with response time. (note to self: develop a Twitter-based CPOE system and go public fast).

A Dr. HITECH contribution for Independence Day (please, can we avoid calling it the Fourth of July?) Ross Martin, MD, MHA re-imagines a National Anthem that’s easier to sing and allows variations (hopefully better than those godawful hack jobs done to the Star Spangled Banner by “Nashville recording artists” and diva-lites before NASCAR races). You can vote for Ross’s version.

A new KLAS report covers cardiovascular information systems. Its conclusion: they suck. Every vendor except Philips and Digisonics gets a lower client satisfaction score than last year, making the CVIS segment one of the worst. Those vendors: Agfa, Fujifilm, GE, HeartIT, Lumedx, McKesson, Merge, ScImage, Siemens, and Thinking Systems. KLAS says 30% of respondents are hoping to dump their vendors, concluding that they “fail to deliver on integration, functionality, and service expectations.”

I installed a new smartphone display format for HIStalk, HIStalk Mobile, and HIStalk Practice. If you’re a mobile user, it should be fast, sleek, and easy to read.

I liked HIT better before the politicians got involved and vice versa. Dr. Ron Kirkland, a self-styled conservative Republican running for Congress and former chair of the American Medical Group Association, bragged on AMGA’s political involvement in getting HITECH passed. Now that he’s running for office, he hates HITECH, saying the country is going bankrupt because of “the bailouts, the ridiculous stimulus plans, the outrageous farm subsidies to big corporations, and yes, even the small incentives for electronic medical records. We must end them now!” In the mean time, his 120-doctor clinic will lap up $4 million from the HITECH feed trough. A bang-up reporting job by Andis Robeznieks from Modern Healthcare. You can tell the real journalists like Andis from the posers: Google their subject and see how often (95% of the time, in my experience) they obviously just saw a press release, e-mailed a couple of people for vanilla quotes, and wrote it up cleverly like they sleuthed out real news.

Ed Marx always updates his CIO Unplugged posts with responses to reader comments, which he’s just done for his CPOE adoption one.

I’ve mentioned business analytics vendor Qlik Technologies a couple of times going back to February 2006. It’s doing an IPO valued at around $700 million.

Mass General’s Emergency Medical Network develops an ER locator app that covers the entire US.

Misys PLC CEO Mike Lawrie says that even though the company will cash in most of its Allscripts shares, it remains committed to Misys Open Source Solutions. It’s an odd press release: he made the quoted announcement at a company sales conference, not generally perceived as the best venue to deliver objective news.

IASIS Healthcare extends its plans for McKesson Horizon Clinicals, committing to physician documentation and CPOE in its 16 hospitals.

University of Tennessee Medical Center chooses GE Centricity Perioperative.

Industry longtimer Bettina Dold joins transcription vendor Acusis as director of product development. 

Australians won’t be able to review their medical records online for at least two years, the health minister says.

Sponsor news:

• IntraNexus has a shiny new Web site, which I notice includes a handy features and benefits list for each application in their SAPPHIRE lineup.
• Bayonne Medical Center (NJ) goes live with Picis ED PulseCheck two months ahead of schedule, integrated with Meditech.
• Hoag Memorial Presbyterian Hospital (CA) chooses Medicity as its HIE partner, signing up for ProAccess Community, MediTrust Cloud Services, and the Novo Grid.
• St. Cloud Medical group (MN) signs up for Greenway PrimeSuite for its 55 providers, including its patient portal and mobile version for hospital rounding.

Samsung launches its Android-powered, 4G-capable Epic smart phone on Sprint, which I’m mentioning only because I’m sick of hearing about iPhones.

Conmed (seriously) gets a $9 million, five-year contract to provide services to the City of Roanoke, VA, including implementing an EMR for its jail.

The FBI is brought in to investigate a hacker’s demands for data ransom after claiming to have penetrated the Texas Cancer Registry. Seems suspicious: the firewalls are intact, only one message was sent, and no proof was provided. It sounds like it could be an employee trying to coax more budget money from the state with a false alarm, but I’m sure the Fibbies will figure it out.

Former McKesson VP Mikael Ohman is named COO of T-System.

Odd lawsuit: two former porn stars are suing a clinic that provides medical clearance for the adult film industry, saying its release forms allow disclosure of their health information to almost anyone. I never thought of porn stars as being particularly protective of their anatomy and physiology, but I guess they’re like the rest of us.

E-mail me.

An HIT Moment with … Sharona Hoffman

An HIT Moment with ... is a quick interview with someone we find interesting. Sharona Hoffman is professor of law and bioethics and co-director of the Law-Medicine Center at Case Western Reserve University School of Law in Cleveland, OH. She recently published an article, E-Health Hazards: Provider Liability and Electronic Health Record Systems in Berkeley Technology Law Journal with co-author Andy Podgurski, a CWRU professor of computer science who also contributed to the information below.

The article suggests that a hospital may expose itself to liability for physician acts, from which it is currently protected, by forcing doctors to follow its EHR-enforced practice guidelines. Should this be a significant concern?

This is a complicated legal question and I don’t think it should be of primary concern for hospitals. Whether a hospital is vicariously liable for the acts of physicians will depend upon the degree of control it has over them. Often, a hospital can prove that the physician is an independent contractor. In some circumstances, however, doctors are found to be employees and not independent contractors. The issuance of an EHR practice guideline alone, however, probably will not undercut the independent contractor defense.

Provider errors due to software usability issues have made headlines recently. The article suggests an option of requiring all EHRs to use a standard user interface. Given the competitive and proprietary nature of the EHR industry, is that likely or even advisable? Is there a precedent in other industries?

Major software platforms like Microsoft Windows and the Mac have user interface standards or guidelines that application vendors follow. An EHR interface standard should define an essential level of consistency between the UIs of different system. It shouldn’t require them to be identical.

How much liability do software vendors and hospitals have for programming errors and setup mistakes, respectively? Do you think those cases are coming up but being settled out of court such that the problem is understated?

Vendors would have primary responsibility in such cases. Vendors both design the software and help hospitals implement the systems and train employees. Hospitals would have liability if they tried to customize the system inappropriately on their own or did not engage experts to provide responsible training. They could also be held liable for mistakes that employees, rather than independent contractors, made with the system that caused patient harm.

The vast majority of cases that are filed in court do not produce a reported decision and many of these are settled, so you are right that it is difficult to know how many EHR cases have arisen.

In fact, regardless of litigation, a major problem is that there is no adverse event reporting requirement. If an EHR system has a problem, the vendor or user doesn’t have to report it to any regulatory agency. Nobody is keeping track of what kinds of problems are arising and how frequently. Therefore, EHR system purchasers can’t obtain information they need to make educated decisions.

The article concludes that the federal government should oversee and monitor EHRs in some way that goes beyond simple certification. Explain why that’s the case and who in the industry should advocate for government involvement.

EHR systems are much more than just record-keeping systems. They manage patient care in a lot of ways, and therefore, they are safety-critical. They provide doctors with prompts and alerts concerning patient allergies, other drugs patients are taking, and the patient’s medical history. They provide a mechanism by which doctors order diagnostic tests, medications, and other treatments. They will create the patient record and could be the way by which a physician communicates with other departments or with the patient herself. 

If anything goes wrong with any of these functions because of software bugs, computer shutdowns, or user errors due to poor system design, this could be catastrophic for medical outcomes.

The FDA regulates drugs and devices. A responsible doctor would never think of implanting a pacemaker that is not FDA-approved, because a flawed device could kill the patient. We believe that EHR systems will be just as critical for patient welfare and therefore, they require an equal degree of government oversight.

Anyone who really cares about patients and medical outcomes should be advocating for government involvement.

As you looked at the EHR industry and EHR adoption by providers, what aspects concern you the most, both as an attorney and a patient? 

EHR systems have the potential to improve patient care significantly. They can increase efficiency, provide doctors with essential information about the patient, and help doctors make optimal medical decisions. Most other industries are computerized, so it is certainly time for the medical profession to catch up. However, in implementing EHR systems, we must proceed cautiously and responsibly.

It is extremely important that the government establish appropriate approval and monitoring processes for EHR systems. These must include an adverse event reporting requirement.

We have heard from a lot of health care providers that the systems they have are difficult to navigate, reduce efficiency because they require too much time and data, and disrupt the relationship with the patient. Some doctors feel that they are overwhelmed by irrelevant or trivial electronic alerts and that they don’t have time to listen to and examine patients because they are too busy attending to the demands of the computer.

Therefore, we need regulatory standards and criteria that ensure that vendors minimize these problems. Once a practice purchases a system for millions of dollars and trains its staff, it will not be able switch to a different system that is better. It is only with appropriate oversight and quality-control that we can maximize the potential of this technology.

Monday Morning Update 6/28/10

From MaxPayneUK: “Re: iSoft. Shares hit 17c AUS – penny stock range. Directors and CEO reportedly selling off shares and rumors of massive layoffs in the UK and India have come up. ANZ MD sacked – will the UK MD be next? Too right!” Shares dropped to as low as 13.5 cents Friday when CEO Gary Cohen sold some of his, saying he had no choice due to margin calls. Denis Tebbutt, managing director in Australia and New Zealand, has been replaced. Wanna buy a train wreck cheap? Someone could pick iSoft up for a song, disengage from its money-losing UK business, and still become the non-US world’s biggest healthcare IT player.

I appreciate the support of CapSite, new to HIStalk as a Platinum Sponsor. CapSite is a healthcare technology research and advisory firm that offers an easy-to-use online database of evidence-based information to support healthcare technology capital expenditures. It provides the always-elusive pricing transparency (i.e., “Am I getting a good deal compared to hospitals like mine?”) by offering line-item details from contracts and proposals, broken out into software, hardware, and services. Its scope includes healthcare IT, imaging equipment, and medical devices. CapSite offers services to vendors as well, helping them understand pricing, competitive positioning, and industry trends. They’ll give you a live demo if you ask nicely. Thanks to the folks at CapSite for supporting HIStalk and its readers.

Orlando Health (FL) signs a deal with Health Care DataWorks for an enterprise data warehouse.

Finally, a meme (and a background buzz) even more annoying than Meaningful Use: vuvuzela.

The MyMedicalRecords people seem to be desperate to make something happen with the PHRs that nobody wants (including free ones, and theirs runs $100 per year), so their latest attempt is to run a commercial during the Daytime Emmy Awards (honoring the best of Unemployment TV). Last time I checked, the money-losing company had a dozen or so employees with microscopic revenue going down instead of up and with an odd D-list celebrity board of advisors that includes former astronaut Buzz Aldrin, former politician Dick Gephardt, and former boxer Sugar Ray Leonard. I was going to include their commercial video here, but it doesn’t work unless you manually switch to HD mode, so I’ll just link.

John Glaser e-mailed to confirm that he’s moving from Partners HealthCare to Siemens, where he’ll be CEO of its healthcare IT business, reported here first thanks to a non-John tipster (if you haven’t signed up for updates, do it now to avoid future in-your-face gloating by those who have). John will have held three big jobs in one calendar year: Partners CIO, ONC advisor, and now vendor CEO. Some are speculating that his move was due to announced Partners cost cutbacks, but he tells me he was just getting restless after 22 years at Partners and his ONC stint stimulated his desire to try something new. Congratulations to him. I always say the best times to take risks are in your 20s (no money, no kids, no clue) and your 50s (money, kids grown, ready for deferred excitement). If he wanted a tough job, I think he found it.

Singapore’s national EHR project chooses its vendors: Accenture, Oracle, and Orion Health get the $144 million USD deal to tie together Singapore’s EMRs to meet its “one patient, one record” vision.

We’re firing on all cylinders on HIStalk Mobile, double-teaming mobile health news with Travis (MD, MBA, software developer reporting news and opinion) and the enigmatic M (who’s contributing app spotlights and iPhone news). Sign up for the e-mail list over there and jump in with comments or guest articles if you are so inclined.

This is encouraging: nearly 2/3 of readers say their doctor used an EMR in the exam room during their most recent visit (mine did too, by the way). New poll to your right: which factor most directly affects a hospital’s adoption of CPOE?

MIT researchers develop a $2 cell phone add-on called PerfectSight that will let patients, particularly those in developing countries, check their own eyesight. Also using consumer technology to create diagnostic tools: Rice University, whose biomedical engineers worked with MD Anderson to rig a $400 Olympus digital camera and special dyes that can detect cancerous cells in the cheek, which could make it possible for non-pathologists to perform portable cancer screening.

The FDA and FCC will meet in July to “identify regulatory challenges” with mobile health devices and ensuring their safety and effectiveness. A UK article says the FCC is interested in reports that wireless broadband could interfere with medical equipment, saying that GE Healthcare has asked for increased regulation to avoid interference to its hospital equipment.

Raj Toleti, who founded kiosk maker Galvanon and content management company Cytura in the Orlando area, joins another Orlando kiosk company, PatientPoint, as CEO.

The West Virginia Health Information Network outsources its entire six-person payroll, including its CIO, in a no-bid contract with a research institute. They say it’s cheaper because the employees don’t receive state benefits and that its structure could change anyway.

E-mail me.

HIStalk Interviews Terry Edwards

Terry Edwards is president and CEO of PerfectServe. 

Tell me what PerfectServe does.

At a high level, it’s all about making it easy for clinicians in a hospital environment — nurses and doctors — to connect with the right doctor at the right time and in the right way. It’s about enabling communication processes that are accurate and simple.

Then from the perspective of the doctor, it’s about enabling processes that gives physicians the ability to really selectively filter and control the communications that they receive throughout their work day. When I use those terms, ‘the ability to selectively filter and control,’ it’s really about enabling them to mold the flow of communication that a hospital directs at them around their own personal unique workflows.

Give me an example of two or three problems that this would solve.

Let’s say that we are three physicians, and maybe we’re cardiologists. Our workflow rules might be that we each take our own calls during the week beginning at 6:30 a.m. until 4:30 p.m. except for the days that we’re off.

John is off on Tuesdays, Bill is off on Wednesdays, and I’m off on Thursdays. On those days that we’re off, one of the other two covers for the person who’s off. Then we have our consults during that same weekday time period, handled by our PA. Our PA will route those to one of us based on the things that are unique to those consults. In the evening hours and on the weekend hours, everything is handled by one doctor on call and we change that schedule daily. One guy would cover the whole weekend, like Friday night through Monday morning.

In addition to that, maybe John likes to have everything just route to his cell phone in real time. He doesn’t mind being interrupted; he like being really accessible. Maybe Bill likes only the urgent things routed to his cell phone, and for everything else, he wants a text message to show up on his phone. Me, maybe I’m just a numeric pager kind of guy — I just want a call-back number and that’s it, but beginning at 9:00 p.m., I want you to call me at home.

Instead of all those instructions living in pieces of paper, Rolodexes, and call schedules in three-ring binders and things in and around the hospital that nurses and other doctors need to refer to and interpret every time they need to call one of us, we build all of those rules into the PerfectServe system. We give the hospital one number to dial.

This is where the ease comes in. If I’m trying to reach Bill, I just call on the system and I say, “Bill Smith.” The system will confirm that, it will interpret the rules, and then route the call either to Bill or maybe the PA or one of us according to the workflow rules, and then our individual instructions for that specific moment in time. It does it automatically.

That sounds something a little bit similar to what Vocera offers. Who would you consider to be your competitors?

Our competitor is the status quo, just in terms of all the manual processes that are in place in health systems today. Vocera is not really a competitor. They’re really a complementary technology in that Vocera is more like a device or a node on PerfectServe’s network or PerfectServe’s platform.

We can answer calls and messages that would originate on Vocera devices and we can send calls and messages to clinicians on Vocera devices. But Vocera, for the most part, is an ‘in the four walls of the hospital’ solution; whereas PerfectServe includes the communication to physicians regardless of whether they’re in the hospital or out in their practices, or mobile — wherever they are. We’re device agnostic.

Someone comes to you and they decide what end-user devices they need, whether it’s voice-over-IP or plain old telephones, or whatever. Then you’re what rides in the middle to decide, when those calls come in, how to route them?

Exactly. It’s about really intelligent workflow-based, rules-based routing according to the rules of the recipient. Physicians are the biggest users in terms of receivers of calls and messages, and then those who might be around them as part of their workflow — like a nurse practitioner, physician assistant, or some other sender.

Like in the example that I gave, the consults during the weekdays would route to a PA. If, for example, I was the nurse on the floor, I might not know that those are the rules, but when I called in and said, “Bill Smith,” I might hear prompt, “Are you calling about a consult?” Yes. Then, that would route that call to the PA, and maybe the outcome would be a voice message where I can leave all the detail, and the PA picks those up throughout the day and then determines where to forward it to.

So if I’m calling a doctor and their preferred method at that moment is to roll to a pager, do I then get prompted for their pager number or does it just say, “Your message will be delivered,” and then it logs you off and it just does what it does in the background?

Yes, it does what it does. When we configure the system in a hospital, we configure it so that we’re pulling all the appropriate Caller ID information. We map that back to departments so that we greatly reduce the need for nurses to key in numbers and make mistakes and things like that, as well as speed up the system.

Everything that happens on the platform is documented automatically. We’ve developed an analytical tool that then allows, say, a chief medical officer at a hospital to look and see how many calls and messages we are initiating to which doctors and from which departments, and drill down into that by specialty and contact method. When you have that data, then you can begin to use it as a tool to enhance process improvement for those clinical processes in which communication are really a fast, and/or efficient communication is central.

What about patients? Would physicians’ practices use this as the front-end for patient calls?

Yes. There is another module of the service that is designed to replace the conventional answering service. That provides a portal, or an access point for patient calls coming into the practice. The caller experience is different than the hospital portal, which is optimized for communication that originates from clinicians at a given hospital site.

What would be the compelling reason that they would do that? I know a lot of them are really tied to their answering services.

It’s the elimination of human error. In the current communication processes, whether they’re those that originate at the practice, or those that are being done manually in the hospital environment, the complexity of the physician workflows coupled to the manual processes — you’re basically dealing with a high volume of highly variable processes handled in manual ways, so you have a high degree of communication breakdown.

When you have a breakdown, you have situations where the wrong doctor, for example, is paged or called when he should be off. Or maybe a doctor, when he is on call in the middle of the night, his rule is that he wants his pager to go off and not his home phone to ring. The reason why is if the home phone rings, it wakes up everybody in the house. Whereas another person, when they’re on call and they’re at home, they might sleep in a different room from their spouse and they want their home phone to ring.

With doctors, those breakdowns really result in a high degree of frustration; and then the overall process inefficiencies cost them time. Time is the only thing that the doctors have, really. That’s their key asset.

Looking at it from the hospital perspective, tell me about what the advantages would be to hospitals and to patients for physicians being able to directly access physicians and nurses to make their communications with physicians.

Those benefits, at the highest level, really accrue up into the coordination of care, the reduction of risk, and tighter physician alignment. When I talk about tighter physician alignment, I mean really being able to integrate the care delivery processes of the hospital with the communication workflow of the physicians. These things are important because of the high volume of communication that takes place just in the coordination of care.

For example, a typical 300-bed hospital will probably initiate some 15,000 voice-related calls to doctors every single month, or 180,000 a year. These are interactions where it’s about: there’s been a change of status on this patient; or we’ve got these results and I need to act, but I need to know what order you’re going to write.

Those events are all related to patient care. When you improve the accuracy of those processes, then nurses aren’t wasting time making phone calls to the wrong people. You reduce the delays in communication and decisions can be made faster. That has an impact on not only reduction of risk and quality, but faster throughput; and it can make a contribution to reducing length of stay and everything related to improved efficiency.

You mentioned the measurement of length of stay. Have any users done any quality measures or satisfaction measures?

We had started a study with one of our small hospital accounts and we didn’t complete it because of some changes in their operation, but that was a study that suggested that we had been able to impact length of stay when physicians used the tool in the right way; but some of that data was inconclusive.

I was in a meeting actually yesterday with one of our clients at the St. John Health System where we were talking about value. It was a value analysis discussion with some of the executives. They had indicated that their length of stay had gone down with PerfectServe. There were many things that they had done to drive that, but they felt that PerfectServe was a major contributor.

Has anybody ever asked you to do anything with emergency communication to an entire group, where one call blasts information out in different ways to more than one person?

We have what we call a ‘team alert’ function, and it’s really designed for smaller clinical teams; although I think we have some applications of maybe 50-100 people. We’re not designed for mass emergency notification. There are other companies that do that.

Where our team alert applications work is when we have processes — such as a process around mobilizing an open-heart team or maybe a cath lab team where there are multiple people who might serve in one of the handful of roles — we need to know who’s covering which role at what time. Then we need to have fail-safe or measurable processes, where we can get a message out and know and receive confirmation that it has been retrieved or acknowledged within a certain time period, and if not, it escalates.

We have a lot of those applications that are out there and running in hospitals for not only what I mentioned in terms of cath teams and open-heart teams, but rapid response teams and other code teams as well.

I had read the case study on your site of Fairfield Medical Center and the cardiac cath lab, which I thought was pretty cool. Can you describe that and think about other ways hospitals might do something like they did?

In that particular application, they had … it was again, manual processes, and they literally had one person who would go down and manually call through a list. It just took time. They were able to basically replace multiple calls, and the time and the acknowledgements back and forth, with a single phone call.

There’s another case study on there around Henry Ford Macomb Hospital, and that’s an interesting story. They had an environment where there was a lot of dependence on paging. The call-backs and the repeat calls were creating satisfaction and quality problems between the ED physicians and a lot of the primary care doctors.

The ED physicians got together with the primary care doctors and they said, “Look, we’ve got in PerfectServe the ability to filter communications that go to you from the ED. Here’s the deal. If you guys will enable rules to route calls from the ED to your cell phones, we’ll make sure we’re on the other end of the line when we call you.”

They put that process in place and saw significant increase in real-time calls to physicians, which had a major impact on helping them improve flow, as well as physician satisfaction with both the ED and the primary care doctors.

What are the time and the requirements and the cost of implementing?

The costs depend on the size of the hospital and the medical staff, but the time requirements are … I mean, there are certain things that can change this a little bit, but typically, in about a three- to four-month time period from the project kickoff.

In fact, we just went live at Monroe Regional Medical Center just about two or three weeks ago. I guess it was about three weeks ago because it was in May. That project kicked off the end of February, and in addition to the planning, the big job of implementation is gathering the workflow rules of all the members of the medical staff and educating them on what the platform can do. That starts with some high-level awareness, workshops, one-on-one meetings with heavy admitters and other key doctors and practices; then gathering and collecting all this information and configuring it, and then we have the go-live.

In Monroe’s case, we went live on one day with the entire medical staff, 552 doctors, and they were immediately, out of the gate, processing at a rate that was equivalent to probably about 20,000 interactions a month. It will just go up from there.

On that particular thought, one of the things that has really amazed me about their organization, even to this day, is that it’s the kind of project that a hospital can do and actually succeed. I mean, it has a major impact on nursing and a major impact on physicians. They can actually drive a process change in a very short amount of time and realize and see those benefits just immediately.