From The PACS Designer: “Re: Microsoft’s updated BAA. Microsoft has released an update for its Business Associate Agreement to encompass more secure communications tools for HIPAA compliance. The changes provide for healthcare organizations to leverage cloud solutions to improve clinician productivity, care team communication, and care transition coordination while maintaining compliance with the recently updated Omnibus HIPAA Final Rules.”

From Laboratorian: “Re: University of Michigan. Goes live June 1 with a massive IT rollout. This includes a new Epic (Denali) implementation and a completely new LIS, an experimental version of SCC-Soft being used at U-M for the first time. The LIS rollout, in particular, is particularly audacious in scope, being the culmination of a seven-year implementation cycle. Barcode-based tracking of both tubes and surgical pathology specimens will be on par with the level of automation seen at BML labs in Japan. The spatial location of every asset in lab space will be tracked in real time. The project benefitted from co-development of code with support from U-M’s own software engineering teams. Nearly 2.5 million lines of new code above base SCC product will drive this new version.” SCC is often forgotten as maybe the leading LIS vendor for big health systems, and writing 2.5 million lines of new code is just crazy. Obviously Beaker wasn’t going to do the job for UM, although it’s improving to the point that some larger Epic customers are cautiously committing to it.

More than two-thirds of respondents think that Meaningful Use Stage 2 should be extended for a year before starting Stage 3. New poll to your right: CMS released hospital Medicare pricing information for the top 100 DRGs. How valuable is that information to the public?

Jamie Stockton of Wells Fargo Advisors sent over his monthly summary of hospital EHR attestations by vendor. Customers of the big multi-national corporations whose business is mostly not healthcare IT (McKesson, Siemens, and GE) are the clear laggards.

Just in case you are wondering what it would be like to have HIMSS darling and cardiologist Eric Topol, MD as your doctor, ponder this quote from an NBC fluff piece from January that I just ran across: “These days I’m actually prescribing a lot more apps than I am medications.” He claims that up to 80 percent of the 20 million echocardiograms performed each year could be replaced by in-office smart phone tests, saving the healthcare system $13 billion per year. In a stunning piece of investigative journalism, the on-camera talking head (also a doctor) who has clearly performed her research convinces him to eat tortilla chips and goads him into saying positive things about his own books and devices.

EHR vendor Mitochon Systems notifies its customers that it will shut down its free cloud-based EHR service in mid-June. The company isn’t sure how doctors will retrieve the data they’ve entered on patients before the system is turned off, but says it will come up with something.

Data visualization software vendor Tableau Software, whose product is popular in healthcare, raised $254 million in its Friday IPO as shares soared 64 percent. I’ve played around with it a couple of times and it’s pretty cool – there’s a free trial download on the site.

Sheila Sanders, VP/CIO of Wake Forest Baptist Medical Center (NC), will step down effective May 31. The hospital says she’s leaving the $465K job for personal reasons that are unrelated to its struggles with Epic.

CareWire names advisors Ken Saitow and Phil Hotchkiss as president/CEO and EVP/chief product officer, respectively.

Encore Health Resources CEO Dana Sellers was recognized Friday, May 17 as a Distinguished Engineering Alumna by the Cockrell School of Engineering at The University of Texas at Austin. She was also named Friday as a finalist for the Ernst & Young Entrepreneur of the Year for the second consecutive year.

James Holtzman is promoted from CFO to CEO of Prognosis Health Information Systems.

Terry Boch (JET Health Solutions) joins Wellcentive as SVP of sales and marketing.

Susan K. Newbold PhD, RN-BC, director of Nursing Informatics Boot Camp, is selected as one of the 2013 “Women to Watch” by the Nashville Medical News.

MD Anderson, which just announced Epic as vendor of choice, will freeze wages, cut back on hiring, and postpone construction projects, hoping to offset an anticipated 2014 financial shortfall that it blames on the federal government (the Affordable Care Act, the budget sequester, and federal deficits) even though its rapidly increasing operating expenses seem to be its primary problem.

A controversial decision by Britain’s NHS allows life sciences and insurance companies to buy access NHS’s patient-identifiable data (“bespoke patient-level abstracts), even providing companies with an Excel worksheet to calculate their cost.

Partners HealthCare System (MA) made a $133 million profit in the latest quarter even after it took a $110 million accounting charge to write off computer systems slated for replacement. Most of that came from investment income, as operating income dropped from $41 million last year to $5 million.

Vince covers Part 1 of the HIS-tory of Allscripts this week (more specifically, TDS, which passed through many hands before landing in the Allscripts lap via its acquisition of Eclipsys.) Vince also scored a major coup for upcoming episodes – he e-mailed Judy Faulkner at Epic and asked if could talk with her about the company and she invited him to meet with her in Verona, which he did last week and is still gushing about. Those are going to be some great HIS-tory installments.

Sponsor Updates

• Carl Fleming of Impact Advisors raised $6,000 for St. Baldrick’s Foundation by having his head shaved at Impact Palooza 2013.
• Sunquest Laboratory v 7.0.1003 is certified as an EHR module by CCHIT.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

256 Shades of Grey(scale): The Dirty Little Secrets of Radiology and PACS
By Brad Levin

There is widespread agreement that radiology has been the epitome of success spreading PACS far and wide over the last two decades. Thousands of organizations transformed from the dark ages of film to digital operations. Early activity started in the mid-1990s and peaked in the mid-2000s. Once the 2000s were in full swing, many groups moved to PACS for the first time, but it was relatively common for PACS early adopters to have implemented their second or in rare cases, their third PACS by then.

Along came the late 2000s, when industry analysts KLAS and Frost & Sullivan called for the next wave of PACS replacements. Many systems had aged well beyond the average 5-7 year lifespan of PACS, and it seemed like a solid market forecast. However, in reality the replacements never came in earnest. 

Fast forward to present day and the institutional use of PACS has stagnated. PACS continue to be used past their useful life, problems persist, and upgrades are delayed. The other contributing factor is a majority of institutions today are using PACS born in the late 1990s or early 2000s. Their vendors purchased PACS largely through acquisition, and while these systems have been upgraded periodically, most of the core architectures remain largely unchanged.

This would be fine if time stood still, but of course it hasn’t. Over the last two decades, modalities have advanced at breakneck speed, producing computed/digital radiography, multislice CT, PET/CT, digital mammography, and the newest modality, digital breast tomosynthesis (or 3D mammography).

Modern technology has also dramatically changed consumer and physician expectations. Everyone expects instant gratification. Pay phones are extinct and we all use smartphones. The world is app-driven and tablet accessible. LPs/CDs have been replaced with MP3s. Medicine is mobile, and we’ve ditched our VCRs/DVDs for streaming media.

Today’s challenging healthcare environment, supported by yesterday’s PACS technology, has led to widespread chronic problems and missed opportunities. When I was told recently that some of the most senior leaders in imaging informatics had convened and were discussing how "Radiology Has Solved The Problems of Going Digital", I was stunned. Based on what I see at community hospitals, academic medical centers, IDNs, imaging centers, radiology groups, and teleradiology vendors, I know that statement couldn’t be farther from the truth.  

The vast majority of practices are digital, but are their problems solved? In my view, absolutely not. Just this week I spoke with a PACS administrator from a 400-bed hospital in the Southwest. I was told that when their network access peaks, performance gets crushed on PACS, taking up to a minute to launch even a small CR study. Radiologists launch the study on PACS, grab a coffee, and hope that when they come back they can start reading the study. While this may or may not be just a PACS issue, it is a persistent, unacceptable problem nonetheless.

If you are unaware of the state of your imaging operations, I encourage you to speak to your radiologists, referring physicians, PACS administrators, and your IT staff. You may also consider meeting with your affiliates, and plan on attending the upcoming SIIM 2013. If you tackle today’s Imaging problems with the same vigor you used to transform from film to digital, your problems will quickly go into the rearview mirror.

Brad Levin is general manager, North America for Visage Imaging.

Trade Shows: How to Make Sure You’re Heard When Everyone’s Screaming
By Cindy Thomas Wright

More than 1,000 companies exhibited at this year’s HIMSS. Did you go? If you did, can you name 10 companies and describe their trade show exhibits?

If you’re like most attendees, you can’t. Because with 30,000-plus people there and row after row of exhibits, you were probably on trade show overload.

Now let’s put you on the other side of the exhibit table. Your business is there, in a giant room filled with the hottest prospects in the world. How are you going to get their attention when you’re one in a thousand?

Well, you can’t just hit play on a PowerPoint and toss some business cards on a table. You need to engage, quickly and with impact. Here are a few points that will help you do so and can apply to HIMSS or any other trade show, such as HFMA coming up in June and AHIMA following in October.

Point 1

You have a brand. Bring it to the trade show. What is your brand positioning? What is your brand personality? Have you done the hard work to define who you are? Without a clear positioning, marketing is futile. You can’t tell a story that you haven’t written yet.

But if you do have your brand strategy locked down, that’s what your exhibit needs to tell the world. Throughout your trade show exhibit’s development, keep asking yourself, “Does this align with our brand?”

Point 2

Make sure the best people are manning your exhibit – and be sure they know their goals. Most people that you meet on the floor aren’t professional trade show folks. At HIMSS, for example, you might see people at the exhibits who are CIOs, program managers, or system developers by day, and they come to this one trade show a year. They are then tasked with “booth duty”, shall we say. 

What you see when you walk the floor is often folks looking down at their phones or a laptop, sitting in chairs meant for would be prospects, or perhaps taking a break to eat their lunch. Let’s face it, are you really going to approach anyone whose obviously eating lunch? Or who has their hands in their pockets or are busy texting? These are all issues that need to be addressed prior to the show. Be sure your representatives are outgoing, have their messaging perfected, know how to “triage” exhibit visitors and how to get them to the right person, and most importantly, be sure they know how to make everyone feel welcome and engaged.

Point 3

Don’t forget that you’re all about technology. We’re in the tech business. So don’t fire up your seven- year-old MacBook at the exhibit. And don’t click through a PowerPoint that looks like it was designed in 1989.

Look at the people manning the booth – do they look “modern”? Are they wearing shoes and eyeglasses from this millennium? Remember, everything you put out there has to be clean, polished, high-tech, new and smart. Because that’s what your company is, right?

Point 4

This isn’t just about you. It’s about them. So many trade show exhibitors see this as their chance to tell everybody all about them. But remember, people are looking for solutions to their own situation. Find out what people need, and show them how you can fill that gap. Trumpet your solutions in a way that’s interesting, but tangible.

Cindy Thomas Wright is the owner of Thomas Wright Partners.

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in November 2008.

If EMR Vendors Designed Cars, the Steering Wheel Could Be Anywhere: Why a Universal Physician Interface Makes Sense (and will never happen)
By Mr. HIStalk

I used to work in a two-IDN town. In fact, I had worked in the IT department of both of them (not at the same time, unfortunately, since that would have been a sweet paycheck).

Both IDNs bought big-ticket inpatient clinical systems within a few months of each other. Those who have worked in a two-hospital town or remember the Cold War understand this instinctively.

As inevitable as it was that rumors of one of us buying a system sent the other scurrying to draft an RFI, it was preordained that we would not consider the same vendor. Whichever IDN bought last would look like an unimaginative lemming, so there was no doubt that two vendors would be shuttling people into town for years.

I was shocked that the local newspaper not only cared about our respective deals, they took both IDNs to task in a rather scathing editorial for going our separate ways. In their minds, we had blown a golden opportunity to finally agree on something other than the fact that one of us was a plainly second-tier system (which one was another thing we didn’t agree on).

From a community perspective, they were probably right. Both places served mostly community-based physicians who practiced in hospitals of both IDNs. Our ruggedly individualistic decisions meant that most of the doctors in town would not only have to learn to use an EMR to keep in our smothering good graces (since ROI was dependent on massive, yet unlikely voluntary physician usage). They would have to learn TWO systems with nothing much in common except they both had a screen and a keyboard.

(That allowed us both to argue that we had chosen a better system than our cross-town loser competitors. In addition, there were only three real vendors that would have been acceptable and one of those was a little shaky at the time, so we went out of our way to avoid consensus).

Vendors would never object to this, of course. Software that looks and works alike has a name: “commodity.” In that respect, vendors had as much interest as we IDNs did in bucking the trend set by our competitor or vice versa.

Here’s an interesting idea, though. Why couldn’t CPOE and EMR systems have the same common user interface? They provide and accept the same basic information. Are screens really so highly proprietary and ingenious that they can’t be the same on all systems? Couldn’t they put their high-margin secret sauce somewhere else, like in clinical decision support, scalability, cost, or maintenance quality?

(You could almost make this happen in the old character-based days by using screen-scraping applications to redesign the front end, like Attachmate or programmable fake Windows front ends).

Everybody always says, “You can use a browser without reading a manual first.” As annoying as that statement is, everybody is right. Browsers, cars, TVs, and credit cards all look and work pretty much alike to the user. That increases adoption, yet still allows plenty of criteria on which vendors can compete and differentiate.

Physician systems operate under the most bizarre paradigm of any software application. The organization that buys them isn’t the one using them, for the most part, since doctors are self-employed (unlike pharmacists, rad techs, nurses, etc. who practice in just one place using just one system). Usage is voluntary and therefore sporadic. Those voluntary users (who are really our customers) are supposed to deal with it, show up for training, and read ongoing messages about bugs, upgrades, and downtime (times two or three, depending on the town).

If I were HIT King for a Day, my second decree (after putting a spending cap on HIMSS exhibits) would be this: every system intended for physician use will employ a common user interface whose visible appearance, terminology, and user interaction is fixed. Vendors who fail to comply will have their kneecaps broken by CCHIT.

What vendors do behind the scenes is their own business, but when you’re selling cars, no matter how clever your designers are, the steering wheels and pedals need to be in the same place if you want to move iron.

HHS Secretary Sebelius announces Senate confirmation of Marilyn Tavenner

The US Senate today confirmed Marilyn Tavenner as the new CMS administrator, making her the first to be confirmed to the position in over nine years.

Hospital can’t afford EMR contract, Assembly rejects funding request

City assemblymen from Juneau, AK rejects an $8.5 million budget request to pay for an already-signed Cerner contract for Bartlett Regional Hospital, saying that they were never consulted on the contract prior to its signing and that the $1.15 million in annual maintenance fees is more than they are willing to pay.

Health Care Innovation Awards Round Two

CMS announces Round Two of the Health Care Innovation Awards which authorizes up to $1 billion in awards to help fund innovative projects that will help deliver better care at a lower cost.

Marin General Hospital nurses warn that new computer system is causing errors, call for time out

Unionized nurses at Marin General Hospital are asking administrators to put its Paragon CPOE implementation on hold until glitches can be ironed out, claiming, "Orders are being inadvertently passed to the wrong patients. People have gotten meds when they’ve been allergic to them. This is dangerous.”