The following appeared a few days ago. Bipartisan bill would slash iEHR funding May 16, 2013 | Erin McCann, Contributing Editor Members of Congress are lauding a bipartisan bill that limits funding for an integrated electronic health record system between VA and DoD and requires aggressive progress updates from both agencies, which have, in recent months, come under fire for the dilatory pace at which they're moving forward with the iEHR.  At a subcommittee mark-up hearing Wednesday, John Culberson, R-Texas, chairman of the House Subcommittee on Military Construction, Veterans Affairs and Related Agencies, called the bill a bipartisan success. "Our bill this year has dealt with the failure of DoD and VA to develop a single unified medical record in a very straightforward, commonsense way," he said.    The bill, Culberson explained, will limit the funding toward the iEHR to 25 percent — of the $344 million requested. The agency will not receive the remaining dollars...

This is the initial part of the post - read more by clicking on the title of the article. David.

The question was: Are You Confident Placing Advanced Care Directives On The PCEHR Directly Will Not Lead To Unanticipated Problems? I Am Sure 13% (4) Just A Remote Chance 19% (6) Could Just Be Risky 13% (4) Seems Pretty Risky To Me 48% (15) I Have No Idea 6% (2) Total votes: 31 Looks like a little more than half of readers have some concerns . Again, many thanks to those that voted! David.

This is the initial part of the post - read more by clicking on the title of the article. David.

Local Health IT Firm Healthland Acquires Software Co.

Healthland acquires Jackson, MS-based post-acute care EHR vendor American HealthTech for an undisclosed sum.

Change in Directors or Principal Officers, Financial Statements and Exhibits

NextGen Healthcare board member Ahmed Hussein resigns after multiple failed attempts to take control of the company through proxy fights. He currently holds more than $100 million in company stock, which means that he can reinstate himself to the board in the future through cumulative voting rules.

Healthcare Innovation Council Calls Out CMS’ EHR Program as "Emperor Has No Clothes"

The Healthcare Innovation Council, an independent group of healthcare experts, has called upon Congress to reconsider CMS’ Meaningful Use program since it is not furthering Congress’ goal of improving patient care. The group calls for a reboot of Meaningful Use before all of the money is spent. They are asking for a shift in focus away from hospital adoption of technology and toward improving the design and implementation of the EHR systems.

VMC’s electronic medical records system will increase efficiency, reduce medical errors

A Silicon Valley editorial praises Santa Clara Valley Medical Center’s $220 million Epic implementation, calling it a robust system that should lead to more efficient billing and significantly improve quality of care.

Two North Carolina physicians have decided to have a little musical fun with their EHR-related frustrations. Pediatrician Ken Roberts , M.D., and hematologist-oncologist Jim Granfortuna, M.D., at Moses Cone Health System in Greensboro, N.C., have produced this little ditty entitled, “Ode to Electronic Medical Records, or Our Song of Epic Proportions.” Cone Health just happens to have an Epic Systems EHR.

Roberts and Granfortuna don’t seem like they’re anti-EHR, just anti-EHR that makes their work more difficult. From the song: “Now we ain’t saying the EHR is bad/When all the bugs are fixed I know we’ll all be glad/It’s just by then us pioneers will all be dead.”

Top News

Healthland acquires post-acute care software vendor American HealthTech of Jackson, MS.

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Reader Comments

From Dortlund: “Re: GE Healthcare. Charging a premium on top of annual maintenance for MU Stage 2 and ICD-10.” Not to mention spelling “after hours” as “afterhours” for some reason.

From CMIO: “Re: clinical informatics exam. I applied, paid, and took a board prep course and plan to take the practice test this summer. I did not do a fellowship, but I want to be on the inaugural class of the new board based on three years as CMIO. It is worth it for me, as this is my career and this is my credential.”

From NoLongerPhamis: “I LOVED the last Slideshare about GEHC/IDX. Almost fell out of my chair laughing. The part about seamless integration of marketing materials was spot on. I was there.” This was in a recent episode of Vince Ciotti’s HIS-tory.

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Acquisitions, Funding, Business, and Stock

Healthcare consulting firm Information Resources Associates, Inc. merges with ESD.

Virtual visit technology vendor ConsultingMD raises $10 million in funding from Venrock.

Pittsburgh-based wound care EHR vendor Net Health acquires Integritas, which offers EMR/PM solutions for urgent care, occupational health, and hospital employee health. 

Quality Systems, Inc. investor and board member Ahmed Hussein, mostly known for criticizing his fellow board members and launching proxy fights in an attempt to take control of the company, resigns. He owns more than $100 million in QSII shares.

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Sales

Orange Accountable Care, a subsidiary of Orange Health Solutions, will deploy Sandlot Care Manager, Sandlot Dimensions, and Sandlot Metrix.

Wellmont Health System (TN) expands its relationship with MModal to include MModal Fluency Direct and Fluency for Imaging as its clinical documentation platforms.

St. Joseph’s Imaging (NY) selects Merge Healthcare’s Outpatient Radiology Suite.

The ERx Group, a staffing provider for rural acute care and critical access facilities, will use T-System’s clinical, financial, and operational technology and services.

Southeast Alabama Medical Center selects Besler Consulting to assist in the identification of Medicare Transfer DRG underpayments.

Western Maryland Health System (MD) will use Dimensional Insight’s business intelligence solution, The Diver Solution.

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People

Long-term care EHR provider MatrixCare names Denise Wassenaar (Alliance Pharmacy Services) chief clinical officer.

 

Imprivata, expecting to go public within two years according to its CEO, names John Halamka, MD (Beth Israel Deaconess Medical Center) and former Phase Forward CFO Rodger Weismann to its board.

Stoltenberg Consulting appoints Douglas Herr (maxIT Healthcare) VP of Epic practice and client relations.

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Announcements and Implementations

Peak Health Solutions partners with ChartWise to offer a solution that includes Peak’s clinical document improvement consulting and education program and ChartWise’s CDI software.

Stillwater Medical Center (OK) integrates its Philips IntelliVue patient monitors and Meditech ED management solution using the Accelero Connect healthcare integration platform from Accent on Integration.

North Shore-LIJ Health System adds cameras in operating rooms at its Forest Hills Hospital (NY) to remotely audit surgical teams for performing timeouts prior to procedures and to alert hospital cleaning crews when a surgery is nearing completion.

Fox Business News is running a week-long series called “How Private are Your Medical Records?” on “The Willis Report.” Monday’s episode featured Deborah Peel, MD of Patient Privacy Rights and Mark Rotenberg of the Electronic Privacy Information Center.

Covenant Health (TX) and MemorialCare Health System (CA) are named winners of the 2013 Crimson Physician Partnership Awards presented by The Advisory Board Company, saving a combined $20 million by presenting comparative performance information to their physicians.

CampDoc.com releases an electronic medication administration record module for its summer camp EHR.

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Government and Politics

The Consumer Partnership for eHealth and the Campaign for Better Care submit a letter to the six Republican senators who last month questioned whether the implementation of the HITECH Act was money well spent. The consumer groups argue that MU is working and that delaying Stage 2 implementation and Stage 3 rulemaking will be detrimental to patients, will stifle innovation, and will delay progress towards interoperability.

CMS posts the 2014 ICD-10-PCS files, including code tables, index, and coding guidelines. CMS notes that the FY 2014 ICD-9-CM diagnosis codes will not be updated.

ONC posts positions (1, 2) for medical officer reporting to the Office of the Chief Medical Officer.

Twila Brase, RN, president and co-founder of Citizen’s Council for Health Freedom, says EHRs are burdensome and inaccurate, adding that they are turning doctors into data clerks. She adds, “Documenting a full clinical encounter in an EHR from scratch can be pure torment. The full chart doesn’t fit on the computer screen. Each element is selected by a series of clicks, double-clicks, or even triple-clicks of a mouse button. Hunting, clicking, and scrolling just to complete a simple history and physical exam is a tedious and time-wasting experience."

A Health Innovation Council commentary article says HITECH is causing, “A massive disruption of providers’ patient care focus as they chase Meaningful Use dollars; increased burdens on physicians, nurses and clinicians since EHRs as currently designed require more, not less, of their time and effort; and an unprecedentedly huge expenditure by providers on EHR hardware and software at a time when providers are under severe financial pressures.” The group recommends that the HITECH program either be redesigned to emphasize patient care, safety, and efficiency or be shut down completely and spend what’s left of the money on rewarding provider care improvement by whatever means they choose.  What is minimally noted in the press release is that the Health Innovation Council was formed and is run by Anthelio Healthcare, the former PHNS, a healthcare IT consulting services vendor.

In the UK, Health Secretary Jeremy Hunt announces creation of a $400 million fund to help hospitals with the cost of replacing paper-based clinical documentation and prescribing with electronic systems.

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Other

MyMedicalRecords.com files another patent lawsuit, this time against the recent Allscripts acquisition Jardogs. The complaint states that the FollowMyHealth Universal Health Record infringes on MMR’s personal health record patents.

LSU Health Shreveport (LA) and Siemens Healthcare inform 8,330 patients of an unintentional disclosure of PHI  stemming from an error in a computer data entry field. LSU and Siemens, which prints and mails bills on behalf of LSU Health physicians, have now identified and corrected the error that caused the names and treatment information for one patient to incorrectly align with another patient’s mailing address.

Palomar Pomerado Health CMIO Ben Kanter, MD presented A Darwinian View of the Electronic Medical Record at a HIMSS SoCal meeting.

UPMC will outsource its transcription services to its development partner Nuance at the end of June, laying off 100 transcriptionists who have been offered jobs by Nuance.

Moore Medical Center (OK) is destroyed by a 200 mph tornado, but the 30 patients housed in the 46-bed hospital all survived, as did all of the hospital’s employees.

A Silicon Valley newspaper editorial lauds the $220 million Epic implementation at Santa Clara Valley Medical Center (CA), saying it will improve billing efficiency and quality of care, also avoiding the 1 percent Medicare penalty and instead reaping $11 million in HITECH funds.  

Weird News Andy says he’ll take one today if it can help find his car keys. A New York Times article says helper robots will be used to help care for the elderly.

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Sponsor Updates

• ISirona employees participate in the Emerald Coast Mud Run benefiting Heart of the Bride, which supports orphans around the world.
• Valence Health offers a May 29 Webinar in its monthly series called Care Coordination and Patient Outcomes: Utilize Innovative Automated Population Health Solutions.
• DocuTrac, a provider of EMR technology for behavioral health, will add DrFirst’s e-prescribing technology into its QuicDoc EMR Professional and Enterprise edition software.
• An Imprivata-commissioned survey of Canadian HIT executives reveals key barriers for clinicians when accessing patient data, including a lack of systems integration, privacy and security concerns, and slow access.
• McKesson’s Horizon Lab 13.5 becomes for the first LIS to receive EHR Module certification for MU Stage 2.
• Ingenious Med updates its impowermobile charge capture software to include the ability to create a virtual superbill at the point of care.
• Greenway Medical adds ClientTell’s ReminderManager patient communications solution to its Online Marketplace as a certified API solution for the PrimeSUITE platform.
• DirectTrust.org and EHNAC extend accreditation to ICA under its Direct Trusted Agent Accreditation Program.
• IHT2 hosts Health IT Summit Denver July 24-25.
• In a GetWellNetwork-sponsored Webinar May 29, administrators from Hasbro Children’s Hospital (RI) share details of how it improved patient satisfaction and workflow by joining patient-centered care technology with a meal ordering system at the bedside.
• Kareo posts a Webinar that answers the top six Stage 2 MU questions and offers three reasons to check out CMS eHealth.
• Several HIStalk sponsors earn a spot on the Informatics 2013 Top HCI 100 list, including 3M, ADP AdvancedMD, Allscripts, API Healthcare, Beacon Partners, Capario, CareTech Solutions, Covisint, Craneware, CTG, Cumberland Consulting Group, eClinicalWorks, Elsevier, Emdeon, ESD, GE Healthcare, Greenway, Iatric Systems, Impact Advisors, Infor, Intellect Resources, MModal, McKesson, MedAssets, Medseek, Merge, NextGen, NTT DATA, Nuance, Optum, Orion, Passport Health, Philips Healthcare, Siemens Healthcare, Sunquest Information Systems, Surgical Information Systems, T-System, TeleTracking Technologies, TELUS Health Solutions, The Advisory Board Company, The SSI Group, Vitera Healthcare Solutions, Vocera Communications, Wolters Kluwer Health, and ZirMed. Porter Research submitted, compiled, and reviewed sales figures to create the list.
• The Philadelphia Alliance for Capital and Technologies recognizes InstaMed  as its Technology Growth Company winner and Halfpenny Technologies a Life Science Growth Company finalist at the Alliance’s 2013 Enterprise Awards.
• Imprivata launches a migration program that enables customers using the Citrix SSO feature to migrate to Imprivata OneSign SSO. Also, Imprivata participates in a breakout session on desktop virtualization and SSO at this week’s Citrix Synergy conference in California.
• Emdat profiles Illinois Bone and Joint Institute, which realized a 50 percent year-over-year cost savings in documentation and correspondence costs using Emdat alongside its EMR.
• Beacon Partners hosts a May 31 Webinar integrating business intelligence and analytics through the healthcare enterprise and offers a white paper on why risk assessments help reduce an organization’s risk of a data breach.
• Awarepoint’s RTLS platform will be featured in an industry-wide interoperability demonstration at the Association for the Advancement of Medical Instrumentation 2013 Conference and Expo June 1-3 in Long Beach, CA.

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Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

IMS MAXIMS, a leading provider of clinical information systems, is implementing software into NHS trusts that will ensure risk assessments take place that will help to significantly reduce the number of preventable deaths caused by VTE in UK hospitals every year.

I read with interest this morning an article by Erin McCann, Associate Editor at Healthcare IT News . Ms. McCann shines a bright light on the sad fact that under today’s reimbursement system, better care doesn’t always yield better business results. That...(read more)

For those who don’t know, I’ve started a series of EMR, EHR and Healthcare IT video interviews with some of the leaders of our industry. You can attend the video interviews live and can ask questions on Twitter. If you want to receive email notifications of upcoming interviews, just subscribe on this page. Tomorrow I’ll be doing another video hangout on Hospital EHR and Healthcare Analytics with Dana Sellers and James Kouba.

The following video embed is from an interview I did with Sean Benson and Andre L’Heureux from Wolters Kluwer Health. We had a great discussion about the gap or white space between EMR software and what clinicians want them to do. We also talked about the challenge of integrating EMR with CDS systems. Plus, I asked them what EMR vendors could do to make the Smart EMR of the future possible. Their answer was quite interesting. We also discussed the challenge hospitals face of clinical knowledge management in their organization. Then, we wrapped up the conversation with a look at the WKH Innovation Lab’s sepsis project.

I think there’s a lot to be excited for when it comes to creating smart EHR and getting the most from clinical decision support systems. Enjoy the Smart EMR and CDS video interview embedded below.

Part 2 in a series. Read Part 1: Brick Walls Are No Match For Regina Holliday’s Medical Advocacy “Courage does not always roar. Sometimes courage is the quiet voice at the end of the day saying, ‘I will try again tomorrow.’” ― Mary Anne Radmacher Think about the last time you saw, heard or experienced something [...]

Royal Philips (NYSE: PHG, AEX: PHIA), the Radboud University Nijmegen Medical Centre (Nijmegen, the Netherlands) and Main-Taunus Cardiac Center (Bad Soden, Germany) today announced the results of a clinical study that demonstrate that the safety for patients and clinicians can be significantly enhanced during cardiac interventions.

The following papers were published a few days ago. J Am Med Inform Assoc 2013;20:e9-e13 doi:10.1136/amiajnl-2013-001684 Perspectives Ten key considerations for the successful implementation and adoption of large-scale health information technology Kathrin M Cresswell, David W Bates, Aziz Sheikh Abstract The implementation of health information technology interventions is at the forefront of most policy agendas internationally. However, such undertakings are often far from straightforward as they require complex strategic planning accompanying the systemic organizational changes associated with such programs. Building on our experiences of designing and evaluating the implementation of large-scale health information technology interventions in the USA and the UK, we highlight key lessons learned in the hope of informing the on-going international efforts of policymakers, health directorates, healthcare management, and senior clinicians. The full article -...

This is the initial part of the post - read more by clicking on the title of the article. David.

Several readers shared this link about a smartphone app that tracks patient activity and reports it to physicians. Called Ginger.io, the app is being studied at several hospitals in the US. The goal is to mine data on phone use and movement to show changes in patterns that could indicate illness or worsening of chronic conditions.

The app has to be activated by a hospital or health care company and obtains a baseline on personal activities once it’s activated. Caregivers are notified when there are changes in patterns of travel, phone calls, texting, etc. According to the Ginger.io website, it uses both passive data collected from the phone and active data reported by patients to create context-sensitive interventions.

The behavioral analytics platform is based on research from the MIT Media Lab. Several interesting papers are referenced on the website. With the level of data that can be gathered, privacy is a concern. The site claims to “only collect data we need to paint a rough texture of your behavior.” Patients are able to control whether data is shared with clinicians and researchers and can opt out at any time.

As a primary care physician I find the idea intriguing. The key is in the predictive ability of the algorithms to identify when a patient would benefit from an intervention. For this to really take off with hospitals and health systems, however, outcomes are not enough. It’s going to have to demonstrate cost savings as well. It will also take some patient education to make some of the “insights” valuable. Just looking at the screenshot, they’re pretty vague. “On Wednesday, you spoke with 2 fewer people than average.” “You interacted with 22% more people than average on Thursday.”

It reminds me of a virtual parent of high school students. You need to get out more. Stop talking on the phone and go to bed. You’re spending longer on your homework than usual. Get some exercise. You’re texting too much. Your music is too loud. There are twice as many miles on the car as there should be for where you said you were going.

Thinking back to what my phone has been up to the last several days, I wonder what the app and related algorithms would think of me. My boss is out of town, so I used Monday and Tuesday as rare opportunities to work remotely. I love working from home – I’m at least 40 percent more productive than in the office and feel a greater sense of accomplishment. I was able to use my land line and wasn’t running around so I made virtually no calls. Would it think I was withdrawn? Or would it interpret the flurry of text messages as I tried to reschedule a girls’ night out as evidence that my behavior was still within the range of normal?

Have you tried Ginger.io or do you know anyone who has? I’d love to hear what they have to say about it. E=mail me.

E-mail Dr. Jayne.

MyMedicalRecords Files Patent Infringement Complaint Against Jardogs, a Subsidiary of Allscripts

MMR Global files a patent infringement suit against Jardogs, recently acquired by Allscripts. The suit references Jardog’s FollowMyHealth patient portal as infringing on an MMR Global patent. Prior to this suit, MMR Global had been predominantly targeting hospitals and health systems in its string of lawsuits, but it appears that patient portal vendors will now be targeted as well.

WEDI announces ICD-10 best-practices initiative

Organizations from California, Massachusetts, Minnesota, and Wisconsin announce the formation of a new collaborative initiative with the goal of documenting and sharing best practices guidance to help hospitals prepare for ICD-10 conversion.

Computer error releases 8,330 LSU Health patients’ personal info

Louisiana State University and Siemens Healthcare have informed 8,000 patients that their personal health information was exposed after a bug in a Siemens system associated visit information with incorrect billing addresses. Siemens had been contracted to print and mail patient bills on behalf of LSU. The issue was discovered when patients began calling the hospital reporting incorrect names and treatments on their bills. No Social Security numbers, birthdays, or account numbers were exposed in the breach.

ONC’s Mostashari to Open HIMSS ICD-10 Forum with Insights on Interoperability, Testing & Big Data

National Coordinator for Health Information Technology Farzad Mostashari, MD, will deliver the opening keynote speech during the ICD-10 Forum on June 17-18.

Business Strategy: Accountable Care Maturity Model

IDC Health Insights has published a guide to ACO formation, detailing five stages of what it calls ACO maturity. The report emphasizes the importance of introducing new technologies, like data analytics and mHealth apps, to support post-acute care, but only after key maturity levels are reached.

The news just came out the Mitochon is shutting down their Free EHR service. They aren’t closing as a company (more details below), but they will no longer be offering EHR software. Here’s the full shutdown message:

Effective mid June 2013, Mitochon intends to exit the EHR market and cease our physician service.

We are sensitive that our providers’ medical practices will be affected by this. However this difficult decision has been driven by the need to focus on other lines of business, and the increasing liabilities we are incurring while supporting our free EHR service.

We will keep our active subscribers updated in the coming days as to how we will address the important issue of clinical data retrieval as well as possible alternate systems and solutions we are in discussion with.

It is with a heavy heart that we are existing the EHR market. The Mitochon team appreciates the support all of our clients have shown to us over the past few years and will work diligently to ensure this transition will be as smooth as possible for their practices.

Best Regards,
Dr. Andre Vovan & Mr. Chris Riley

Mitochon has been a great supporter of EMR and HIPAA over the years, and so I’m sorry that Dr. Vovan won’t be able to see his vision come to fruition with the Mitochon EHR. He was one of the first people I met who was talking about a community based approach to caring for patients. It’s interesting to see many of the topics he told me years ago are being talked about so much now in the world of ACOs.

As for the Mitochon EHR software, I won’t be surprised if some other players in the EHR space decide to take over the code and EHR business from Mitochon. There are actually a number of companies that have been white labeling the Mitochon EHR and it won’t surprise me if one of those companies takes over the codebase and users.

What’s likely more interesting is where Mitochon plans to take the company. Ever since I first met Mitochon years ago, their goal had been to build their own ad network and supply other third party networks. Now their focus will be exclusively on their content delivery and advertising network business. As Chris Riley, CEO, mentioned to me in an email, being in the EMR business and trying to partner with EMR vendors can often be a big issue.

Mitochon has some patents around CPT and ICD level targeting of ads. So, it will be interesting to see if Mitochon can become the pharma ad network for EMR companies. Although, there are a lot of non EMR opportunities for Pharma advertising as well. It will be interesting to see where Mitochon takes the company going forward.

There is a correlation between having a pet such as a dog or cat and an improved health status. Exactly how this works was the subject of a recent article (See: American Heart Association: Pets, especially dogs, are good for the heart). Below is an excerpt from it:

An animal companion may not just warm your heart, but also help you maintain a healthy heart....Pet ownership, particularly dog ownership, is probably associated with a decreased risk of heart disease," [said the] director of the cardiac care unit at Baylor College of Medicine....[T]here are 78.2 million owned dogs and 86.4 million owned cats in the United States. Thirty-nine percent of U.S. households have at least one dog, while 33 percent have at least one a cat. The AHA's committee reviewed previous research on how pets affect human health, and they found studies that showed owning a pet was associated with fewer heart disease risk factors and increased survival among patients. In particular, owning a dog was shown to reduce cardiovascular risk, perhaps because dog owners are more likely to engage in physical activities just by walking them. One study of over 5,200 adults showed that dog owners were more active than non-dog owners, and were 54 percent more likely to reach recommended levels of physical activity....[A cardiologist said that] "there are plausible psychological, sociological and physiological reasons to believe that pet ownership might actually have a causal role in decreasing cardiovascular risk." [He also] pointed out though if people buy a pet but sit around all day, smoke, eat whatever they want and don't monitor their blood pressure, heart benefits aren't likely."

So walking your dog improves one's health by providing an incentive to walk him around the block a few times a day. This probably won't help if the owner engages in other unhealthy habits. You all know what they are. I also believe that caring for a pet has unique psychological benefits such as relieving stress. These benefits have been shown to be more effective than ACE inhibitors in lowering blood pressure (see: Pet Dog or Cat Controls Blood Pressure Better than ACE Inhibitor):

[A professor of medicine] assessed the effect of social support on heart rate, blood pressure and renin reactivity in response to mental stress in a group of 48 stockbrokers, all of whom were being treated with lisinopril, an angiotensin converting enzyme (ACE) inhibitor used to treat hypertension. She found that in 24 participants selected at random to add a dog or cat to their treatment regimen, these cardiovascular measures remained significantly more stable during stressful situations than in 24 participants in the non-pet-owner group, who served as controls.

The bottom line is that rather than spending money on drugs and surgery for yourself, redirect it to the veterinary bills for your dog and cat. It's a better investment.

Here are a few I have come across the last week or so. Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment. General Comment The Budget came this week and we saw the funds committed to e-Health last year continue and then an apparent drop of in 2014/15 and deeper drops following . Other than that we learn that we have just over 150,000 people registered to the PCEHR, some trials of secure messaging between differing providers and Tasmania looking for some new systems. Hopefully a quiet week. ----- http://ehealthspace.org/news/budget-2013-ehealth-round Budget 2013: eHealth round-up Posted Wed, 15/05/2013 - 13:51 by Fran Molloy The 2013 Federal Budget, delivered by Treasurer Wayne Swan last night, will deliver new spending of around $13 billion and make savings of an estimated $44 billion over the next four...

This is the initial part of the post - read more by clicking on the title of the article. David.

On June 7th, 2013 the Texas Children’s Hospital and Smith Seckman Reid are producing an educational workshop on medical device connectivity. Nursing is the predominate perspective explored in this event. (One of my pet peeves is all the focus physicians get from vendor’s marketing departments. Yet, when it comes to systems in hospitals, the predominate user – by far – is nursing.)

TCH, an early adopter of clinical documentation into EMRs and alarm notification, has some of the most extensive experience with medical device connectivity in the US. They’re hosting and presenting at this one day seminar. Here’s the blurb on the event, with links to where you can register. Besides the great content, the next best thing is the cost – free. The only downside is there’s room for just 150 attendees.

The context for this even is the planning, implementation and opening of a new building at TCH. This was a maj0r new building with both ambulatory and inpatient facilities, and lots of new technology and systems. Besides expanding the physical plant, TCH was looking to improve patient care and outcomes.

The day opens with a focus on workflow and assessing needs. TCH delves into their vision of technology in the service of improved workflow and past experience about the system’s they’ve implemented. Next, myself, Debbie Gregory and Joyce Sensmeier will be on a panel discussing the issues from an industry perspective. In the afternoon, TCH presents “executing the vision,” and their experience with the opportunities and challenges of the new systems and how they impacted operations in their new building.

Should be a terrific event.

Cisco Systems is running this commercial about the “Internet of everything,” with a focus on connected healthcare.

 

It all sounds great, but how much of this is grounded in the real world today and how much is wishful thinking? I mean, connected medical records? It sounds so idealistic.

More Time Spent Selecting the Right EMR Vendor is a Prudent Investment ow.ly/kRPvC

— Billy Cline (@RecruiterBillyC) May 20, 2013

A prudent investment is an understatement. The very best use of your time in an EMR implementation is in the selection process. Although, I’ve also seen some clinics go too far and run into the issue called “paradox of choice.”

EMR – Electronic Medical Records Going Mobile getreferralmd.com/2012/04/emr-el… #mhealth #digitalhealth #HIMSS

— Jonathan Govette (@ReferralMD) May 19, 2013

Mobile EMR has always been a wonderful idea, but how many are really using their EMR on a mobile device. Let’s also not confuse mobile EMR with remote EMR. Certainly many doctors are using the same EMR from multiple clinics. That’s common and beautiful. However, far fewer are using their EMR on a mobile device. The most common response I get from doctors about a mobile EMR is “I can access my EMR on a mobile device, but the experience is terrible.” I expect this will dramatically change over the next 3-5 years, but won’t likely be the full EMR. Instead, I think it will be a really focused set of EMR functions on the mobile device. I’m not sure anyone has nailed that experience yet. Although, a lot of EMR vendors are working on it.

Choosing an an EHR is about as much fun a root canal and as straightforward as buying a vehicle. #EHR #EMR#Electronic

— Dr. Vicki Roberts (@fmsemo) May 19, 2013

Everyone that’s read this site for a while knows how much I love analogies. Both of these are pretty spot on. The root canal is necessary and can relieve a lot of long term pain, but it’s no fun going through the process. Buying a car is hard because there are so many choices and so many details that it’s hard to know what really differentiates the complex item you want to buy.

Mitochon Intends to Exit the EHR Market and Cease Physician Services

Free web-based ambulatory EHR vendor Mitochon Systems has announced that it will close its health IT business unit. Mitochon was a Meaningful Use Stage I certified vendor with 12 attestations according to the most recently released CMS data.

Tableau Software soars in trading debut

Seattle-based Tableau, a data visualization vendor popular in the healthcare space, raises $254 million on its IPO Friday and shares closed up 64 percent at the close of its first day of trading.

Wake Forest Baptist IT director stepping down

Wake Forest Baptist CIO Sheila Sanders will step down from her position effective May 31st. She leaves her position for personal reasons, unrelated to recent difficulties with Baptist’s Epic implementation.

DePinho: M.D. Anderson to freeze wages, curb construction

MD Anderson announces a wage freeze, a reduction in hiring, and the postponement of construction projects due to lower than anticipated operating income for FY13. President Robert DePinho reports that an increase in donations and investment income is the only reason the institution will finish the year with positive net income.

As mentioned a week or so ago there has been an update to the viewable NEHRS / PCEHR. See here for the blog. http://aushealthit.blogspot.com.au/2013/05/it-seems-nehrs-pcehr-has-had-bit-of.html A few days ago the professional FAQ for the PCEHR was updated. This is found here: http://www.ehealth.gov.au/internet/ehealth/publishing.nsf/Content/faqs-hcp-managing This section I found interesting among others. It explains what the intent of the new Medication View of the PCEHR is and it now becomes clear it is a broader implementation of the MedView Wave Site program conducted by the Pharmacy Computing Company FRED IT I believe. MedView has been renamed the NPDR. Here is what we learn. What is the National Prescription and Dispense Repository (NPDR)? New functionality has been added to Australia’s eHealth record system to make, over time, the prescribing and dispensing of medication a safer, more effective part of health care. The National Prescription and Dispense Repository...

This is the initial part of the post - read more by clicking on the title of the article. David.

Agfa HealthCare will highlight its comprehensive IMPAX Cardiovascular suite of products at the EuroPCR congress, the official congress of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), from May 21-24, in Paris, France. The focus will be on demonstrating how IMPAX Cardiovascular delivers the benefits of digital cardiology to the cardiologist's fingertips.

When CMS recently released hospital chargemaster and payment data for the 100 hospital codes most frequently billed to Medicare, there was much written and said about the significance of the data release. Some found this to be significant; others (including...

David Harlow

Have you considered what an EMR would look and feel like if it integrated telemedicine? Rashid Bashshur, director of telemedicine at the University of Michigan Health System, has given the idea a lot of thought.

In an interview with InformationWeek Healthcare, Bashshur tells IW’s Ken Terry that it’s critical to integrate HIEs, ACOs, Meaningful Use and electronic health records.

Makes sense in theory. How would it work?

To begin with, Bashshur said, healthcare providers who have virtual encounters with patients via a telehealth set-up should create an electronic health record for that patient.  The record could then be ported over to the patient’s PHR.  The physician can also share the health record via an HIE with other providers.

When providers attempt mobile and home monitoring, it steps the complexity up a notch, as such activities generate a large flow of data. The key, in this situation, is to use the EMR to sensitively filter incoming data.

Unfortunately, few EMRs today can easily pinpoint the information providers need to process, so most organizations have nurse care managers sift through incoming monitoring data. That’s the case at University of Michigan Health System, where care managers sift data manually to determine whether patients seem to be seeing changes in their conditions.

Unfortunately, even attentive care managers can’t catch everything a properly-designed system can, Bashshur notes.  To integrate EMRs and telemedicine/remote monitoring, it will be important for EMRs to have sophisticated filters in place which can pinpoint trouble spots in a patient’s condition, using a standard protocol which is applied uniformly.

According to InformationWeek, vendor eClinicalWorks has promised a new feature which can pick out relevant data from a large data stream. But until eCW or another EMR vendor produces such a feature, it seems that remote monitoring will be labor-intensive and expensive.

Judith Faulkner, founder and CEO of Epic, is warming up to the media according to an interview in Forbes by Zina Moukheiber (see: An Interview With The Most Powerful Woman In Health Care). Here's the reason that she offers in the interview:

I’m recognizing that when we were small, we could stay under the radar, but now it’s harder. I get so many requests for interviews. If I talk to everyone, we can’t do our job with our customers and work on our software. It would be hard to stay focused.

Here's one of the many reactions to the piece by David Shaywitz, also of Forbes (see: Two Quick Reactions To Epic Faulkner Interview: SV Should Show Judy More Love; We Should Shouldn't Let Hospitals Off Hook)

Interoperability issues associated with Epic may reflect tacit preferences of hospital systems.  Tory Wolff and I have discussed the interoperability challenges associated with Epic, and it’s potentially negative impact on the innovation ecosystem (see here and here).  Faukner’s comments don’t particular assuage my concerns, but certainly highlight Epic’s laser-focus on delivering what customers want – and make no mistake, the customer isn’t the patient but the hospital.  This is critical to appreciate.  Thus, while it’s easy (and appropriate) to critique Epic for impeding data sharing, it’s probably also important to remember that if hospitals were all that keen to share data better, I suspect Epic would rapidly find a way to accomplish this. It’s almost as if Epic provides hospitals with plausible deniability.  While it may be convenient to blame EMRs in general, and Epic in particular, for data access challenges, I suspect we also need to dig deeper, and hold hospital systems themselves far more – what’s the word? – accountable.

I couldn't agree with Shaywitz more. In fact, here's a quote from my note of September 14, 2011 (see: Judith Faulkner, EMR Interoperability, and Washington IT Politics)

Now comes a little secret that is not discussed much. Hospital CEOs and CIOs have little interest or enthusiasm for multivendor interoperability, either within their hospitals or hospital systems or across the outside hospital systems that they compete with. Customized interfaces between heterogeneous systems are a pain in the rear-end for the CIOs. They would thus rather have shrink-wrapped integration delivered by a vendor like Epic, the so-called "enterprise solution." Moreover, CEOs don't want to encourage broad patient and clinical data portability because it gives the payers (insurance companies and the federal government) a strategic advantage during negotiations about reimbursement.

So, when the feds raise the topic of interoperable EMR software, most hospital CEOs and CIOs will stand up and cheer. However, when they go out to purchase EMR software, they largely select Epic, particularly the larger ones that can afford it. Faulkner provides the non-interoperable product that they really want. She can also runs political interference for them. She donates generously to the Democratic party, she is tight with the Wisconsin congressional delegation, and takes no prisoners in her political feuds (see: Epic Flexes Its Political Muscle in Wisconsin with Boycott). And she can now try to block any inconvenient initiatives in the arise in the Health Information Technology Policy Committee.

Epic will provide some measure of interoperability to her hospital clients but slowly and most efficiently among Epic client hospitals. This is what her hospital clients want and this is what she will give to them. Here are the (slightly garbled) Epic "rules of the road" in terms of working with other HIT vendors, quoted from the Forbes interview:

We don’t let anyone write on top of our platform, come read our code and study our software. I worry about intellectual property at that point. With our customers, we make sure we have signed agreements. They know they have to respect our software. Customers can do it in a controlled environment, but not the whole world. You’ll see us do more and more of that.

I now present the latest health IT-related podcast from Sivad Business Solutions, an interview with Suzanne Leveille, research director of OpenNotes, a project to give patients online access to the entirety of their own medical records, including the visit notes from clinicians. Leveille describes a trial at Beth Israel Deaconess Medical Center, Geisinger Health System in Pennsylvania and Harborview Medical Center in Seattle. She reported that not one of the 105 participating physicians asked for the access to be shut off after a year. In some cases, patients even discovered errors and prevented adverse events.

Here is the description from Sivad:

A pleasure to welcome Suzanne Leveille to the program today. Suzanne is a professor of nursing at The University of Massachusetts-Boston, and the research director for OpenNotes.

OpenNotes is an initiative that invites patients to review their visit notes written by their doctors, nurses, or other clinicians.

As a patient, you have the right to read the notes your doctor or clinician writes about you during or after your appointment. Having the chance to read and discuss them with your doctor or family member can help you take better control of your health and health care.

As a healthcare professional, you may build better relationships with your patients and take better care of them when you share your visit notes. Our evidence suggests that opening up visit notes to patients may make care more efficient, improve communication, and most importantly may help patients become more actively involved with their health and health care.

Some highlights from the conversation include: the dramatic improvement between patient and doctor communications; how they overcome potential push back and resistance from physicians; patients became more engaged in their personal health care; OpenNotes has been pleasantly surprised at the patient engagement; how advanced technologies and mobile technology are going to impact the future of this idea; and how they are planning to spread the word and get more patients and doctors improving communications and care with OpenNotes!

 

I recently learned about the concept of a lab formulary, an analogue of the pharmacy formulary. The latter is a list of the stock drugs carried by the pharmacy in a hospital. Prescriptions for hospital patients can only be written by physicicans for the drugs listed in the formulary. The comparable notion on the lab side is that only tests contained in the lab formulary can be ordered by physicians. Here is an article that describes the concept in greater detail (see: Constructing A Lab Formulary). Below is an excerpt from it:

Given healthcare's increasing emphasis on cost control and quality measurement, laboratorians need to reconsider their roles within healthcare organizations. A lab that provides what appears to be a commodity service may be at risk of being marginalized at best or outsourced at worst. But a laboratory that plays a highly visible role in promoting high-quality clinical care can strengthen its status within a hospital or healthcare system. One approach worth considering is to think of the laboratory test menu as a "laboratory formulary" analogous to the drug formulary maintained by a hospital pharmacy. Despite what outsiders might think, the role of the hospital pharmacy goes far beyond simply stocking drugs and fulfilling orders. For one thing, it is not feasible to stock every drug in every formulation that a physician might order. For another, it would not be in patients' best interests for pharmacists to fulfill blindly all orders they receive. 

...[T]he appropriate role of the laboratory professional goes far beyond simply maintaining analytic quality and fulfilling laboratory orders. It includes determining what test methodologies will be offered and in what forms, specifically point of care, in-house laboratory and referral laboratory. It also includes redirecting physicians when they order tests that the laboratory knows to be suboptimal....The stereotype of a lab professional, whether technologist, clinical lab scientist or pathologist, is one of an introvert who likes to hide away in the lab... But the stereotype still risks being self-fulfilling....As lab professionals find creative ways...to share diagnostic testing expertise with medical staffs, we, too, will see an increase in professional status. And more importantly, patients will benefit through more efficient and accurate diagnostic testing.

I have not heard any strident calls for the use of a lab formulary so perhaps I am stirring up controversy where none exists. One of the major drivers for the development of pharmacy formularies has been the need to switch physicians to the less expensive generic drugs to contain drug costs. If a particular generic drug is the only option available in a hospital, this goal can be more rapidly achieved. The ire prompted by such a shift from the clinicians is transferred from the pharmacist to the hospital pharmacy committee that maintains the formulary. Since there is no "generic equivalent" to lab tests, such a goal can't be used as an incentive for the development of a lab formulary.

I can envision that one major rationale for the development of a lab formulary: the desire to place some limits on the inappropriate ordering of expensive molecular and genomic tests. However, even the most expensive of these tests may be appropriate under the right circumstances. Rather than a blanket ban on such tests, it would seem more appropriate to publish the clinical criteria for the ordering of such tests and then require the approval of a pathologist when these clinical criteria are not met. In other words, publishing criteria for ordering expensive lab tests, and then enforcing them, would be a suitable substitute for a lab formulary.

EU Health Ministers, meeting in Dublin at the Ministerial eHealth High Level Conference organised jointly by the Irish Presidency of the Council of the European Union and the European Commission, today agreed a Declaration on eHealth presented by the Irish Presidency. The Declaration is aimed at prioritising the use of ICT in health among Member States to contribute to better, safer, sustainable and innovative healthcare systems for all European citizens.

Going public with her story of a prophylactic double mastectomy after testing positive for BRCA1 (a gene linked to breast cancer) via an op-ed piece in the New York Times, Angelina Jolie is clearly trying to get the message out...

David Harlow