Buyer-Side Secrets Revealed

Congratulations to the Wausau West Warriors Boys Hockey Team for making it to the 2010 Wisconsin State Boys Hockey Tournament championship game. Sadly, the team’s stellar play throughout the regular season did not carry forward to the championship game, resulting in a stunning loss for West and its failure to capture a first-ever state title.

And congratulations to University School, whose brillant play in the first period of the championship game created a deficit that proved to be too large for West to overcome. University School scored 4 unanswered goals in the first period. University School Coach, Cal Roadhouse, now has two state championships under his belt.

If you have suggestions for improving the integrity and sportsmanship of Wisconsin amateur athletics, including thoughts on rules governing player recruitment efforts by coaches and limitations on student transfers and transfer eligibility, you may contact Dave Anderson at the WIAA:

Dave Anderson
Executive Director
Wisconsin Interscholastic Athletic Association
5516 Vern Holmes Drive
Stevens Point, WI 54482
Phone: 715-344-8580

Long-Awaited Criteria – ONCHIT has finally issued regulations that define “meaningful use” of EMRs, the major qualifying criterion for the EMR adoption incentives provided by ARRA.

You can view the text of the regulations here.

Stage 1 criteria take effect in 2011. Stage 2 criteria will apply in 2013, and Stage 3 criteria in 2015 (both to be defined at a later date).

Major Elements of the Meaningful Use Rules:

CPOE

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.

Clinical Checking of Orders

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

Problem List

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).

E-Prescribing

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

Active Medication List

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

Medication Allergy List

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

Demographics

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

Vital Signs

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.

Smoking Status

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

Structured Lab Results

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.

Patient Lists

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

Report Quality Measures to CMS and States

Calculate, display, and submit quality measure results

Patient Reminders

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

Five Clinical Decision Support Rules

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

Eligibility

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

Submit Claims

Must submit 80% of all claims filed electronically.

Electronic Copy of Health Information to Patients

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.

Electronic Copy of Discharge Instructions

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

Timely Patient Access to Health Information

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.

Clinical Summary of Each Office Visit

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

Information Exchange

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 exchanging information.

Medication Reconciliation

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.

Submit Data to Immunization Registries

Must conduct at least one test of submitting information.

Submit Lab Results to Public Health Agencies

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

Submit Syndrome Surveillance Data to Public Health Agencies

Must conduct at least one test of submitting information.

Protect Electronic Patient Information

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.

Tennessee and Pennsylvania – The Centers for Medicare and Medicaid Services (CMS) has announced that Medicaid programs in Tennessee and Pennsylvania will receive federal matching funds for state planning activities to implement the electronic health record incentive program established by the American Recovery and Reinvestment Act of 2009.

Iowa was the first state to receive the matching funds; California, Georgia, Idaho, Montana, New York, Texas and the U.S. Virgin Islands were the next seven states and territories to receive the funds.

How Will the Dollars Be Used? – Federal matching funds will be uses by the states for planning activities that include a comprehensive analysis to determine the status of health IT activities in the states. Information will be gathered on issues such as existing barriers to the use of EHRs, provider eligibility for EHR incentive payments and the creation of state Medicaid health IT plans.

The Best EMR Software – The best EMR software is the EMR software that’s best for you. All EMR systems have the same end game in mind, but how each system accomplishes its objectives varies from system to system and vendor to vendor.

The Best EMR Software for You – If you want to find the best EMR software for you, try EMRmatch. EMRmatch allows you to state your needs and preferences across a wide range of EMR software feature and function points, including useability criteria. Using a sophisticated statistical matching engine, EMRmatch checks your needs and preferences against standardized information about a large number of EMR software offerings presently on the market. This is good stuff, but there’s more. EMRmatch is 100% objective and unbiased, with no ties to the EMR vendors (no reseller relationships, no referral fees and no commissions).

Learn More About Finding the Best EMR Software – You can learn more about EMRmatch here.

The Problem – Toyota vehicles equipped with alloy wheels are experiencing abnormal corrosion and bubbling of paint and/or clear coat finish. I noticed that the finish on my Sienna’s (2005 XLE AWD) alloy wheels had some bubbles several months ago. My wife drives this vehicle almost exclusively, so I don’t “inspect” it too often. But last week I noticed the wheels now look horrible. Looking at other Siennas with these same wheels, most (over 80%) have the exact same problem. The problem affects post-2004 Siennas and other Toyota models equipped with alloy wheels.

Toyota’s Position – At this time, not admitting any manufacturing defect, and not extending any corrosion warranty protection. Toyota has suggested that brake dust build-up and lack of prompt removal of road salt are to blame. Very interesting because my 1998 4Runner has alloy wheels, and they’re in great shape. Same geographic location, same level of care (probably above average), and 7 more years on the road.

My Suspicion – Toyota or its alloy wheel supplier switched to a “greener” manufacturing process, perhaps using a water-based finish process (as opposed to solvent based), or at the very least, a lower level of solvent. The switch-over, although well-intentioned and environmentally responsible, is often difficult to pull off. Recall the peeling paint problem (body panels) GM had in the 1990s. The problem we’re talking about here is similar, originating under the finish, as if there is a problem with the finish’s ability to adhere. The problem has nothing to do with curb rash, stone chips, etc., in which the integrity of the finish has been compromised externally.

Strength In Numbers – If you have the same problem with premature bubbling or corrosion of your Toyota alloy wheels, add your comments below. Be sure to provide the Model and Year of your vehicle. If you submit a photo of an affected wheel (150X150 px .PNG or .JPEG file preferred), I will add it to the “Toyota Quality Wall of Shame” below. Send wheel photos to: olivecg(@ symbol)charter.net. With enough feedback from angry customers, we might be able to get Toyota to accept responsibility for this widespread problem.

[View with PicLens]

Right Fit – The best EMR (EHR) system is the one that’s best for you. Although the various EMR systems on the market all do essentially the same thing, how they acheive their objective varies from one EMR system vendor to the next. Your goal is to find the system that most closely matches your specialty, existing patient base, workflows and routines. Your EMR/PM system must serve you, not the other way around.

Too Many Choices, Too Little Time – With the large number of EMR system vendors out there, and the even larger number of decision points facing any EMR system buyer, finding the right EMR system can be challenging. Pain is inevitable, but suffering is a choice! Get some help.

Why You Need a Tool – A market-specific screening tool is an efficient means of narrowing the EMR system vendor field because it gives structure to your buying process and systematically covers critical decision points. EMRmatch is a vendor screening tool designed specifically for the EMR/PM system market. It allows you to enter your particular needs and preferences across a wide range of EMR/PM system feature and function points. It then compares your needs and preferences to standardized elements of information about the various EMR/PM systems on the market, returning 4-6 vendors whose systems most closely match your stated needs and preferences. Learn can learn more about EMRmatch here.

Healthcare Reform Debate – If the ongoing healthcare reform debate has you even somewhat engaged, you have to learn more about the Bextra litigation settlement Pfizer announced today.

Pfizer Illegal Conduct – Pfizer Inc., the world’s largest drugmaker, will pay $2.3 billion in connection with its illegal promotion of the drug Bextra. Pfizer affirmatively (not close-to-the-line, grey-area behavior) marketed Bextra for off-label use in violation of the U.S. Food, Drug, and Cosmetic Act (the Act).

Criminal Conduct – This is CRIMINAL conduct, not garden-variety tort stuff. Pfizer’s Pharmacia will plead GUILTY to one criminal count of violating the Act.

More – To read more in the category of “We Don’t Need Healthcare Reform?”, check out this MSNBC news piece on UnitedHealth.

Healthcare Reform Debate – If the ongoing healthcare reform debate has you even somewhat engaged, you have to watch this MSNBC news piece.

UnitedHealth Is The Next Enron – UnitedHealth is definitely a dirty pony (as evidenced by, among other things, the numerous enforcement actions brought against it over the past three years). And Helmsley himself (who earned a disclosed $48 million in 2008) is a shameless, selfish, duplicitous and arrogant human being who epitomizes corporate greed and excess. For him to even suggest that UnitedHealth is entirely “neutral” on the issue of a public health insurer is disingenuous. I know many executives at UnitedHealth personally (two of whom are my neighbors), and I can tell you that UnitedHealth is anything but neutral on the issue. The prospect of a public health insurer is very frightening to UnitedHealth, as well it should be.

The Difficult Reality – I am a hardcore free-market advocate, and I never thought I would hear myself say this, but I actually think the public insurer idea is a good one. IMO, there’s a very good chance that it will shake things up a bit, and for the better. At present (and it’s only recently that we’ve been able to admit this to ourselves), we are locked in a fatal convergence of uncontrollably escalating healthcare costs (provider side) and corporate greed (payor side, a la Hemsley and UnitedHealth and other for-profit payors). Providers keep passing along costs, and private sector payors keep passing along costs (in order to remain unconscionably profitable). Well, game over! Enough is enough. It’s time for a change.

More Unflattering News About UnitedHealth and Helmsley:

The Health Insurance Gangsters and Their Enablers

UnitedHealth Derivative Settlement “Largest Ever”

Stephen Helmsley = Former Arthur Andersen Partner

UnitedHealth Group’s Stephen Hemsley – CEO Compensation

The Surprise – Like lots of others, I was totally surprised to learn this week that the Vikings had signed Brett Favre for the ‘09 season. My suspicion was that the Vikings had lost interest in Favre after his tryout and minor surgery, but because of his stature, they allowed Favre the courtesy of saying he had chosen to stay in retirement. But I have to say the news sparked my interest. Before this news, I was looking at an NFL season focused on the mediocre Packers, who will no doubt have a mediocre season. But now I will be watching the Vikings, too. I’m not a Vikings fan, but I’m definitely a Favre fan!

The Interest – All part of the plan, I’m sure–including the Hollywood-style “he’s out” and “he’s back and we have a deal” element–has drawn lots of interest. Packers’ fans and NFL fans at large are watching this drama unfold, and I’m in this group. There’s speculation about Ted Thompson losing his job if the Vikings win the Division, Favre running for Governor of Minnesota, and more. It’s crazy, but I’m liking every bit of it. On the Thompson thing, I would prefer that we not wait until the Packers lose the Division to the Vikings. Let’s whack him now! He’s a terrible manager, and frankly, no one likes him (the manager or the person).

The Mayhem in Green Bay – I sure hope the City of Green Bay and the Packers are planning on beefing up security when the Vikings come to town on November 1. There’s going to be a RIOT–if not before the game, certainly in the stands and after the game.

After Favre-Gate ended, Packers’ fans were split about 50-50. Half blamed the Packers’ management for not bringing him back, and half sided with management and, sadly, against Favre. Like me, the Thompson haters still harbor resentment these many months later, and I have a feeling emotions on both sides are going to peak during the November 1 home game. I hope I’m wrong, but all concerned must consider the possibility that I’m right about this. This is one game I’ll certainly watch on TV, but for personal safety reasons, I will not even consider going to this game in person.

Product Warranties in General – When we think of product warranties, we tend to think of things like an automobile warranty. You buy a new car, and the manufacturer warrants that it will fix manufacturing defects for four years or 48,000 miles, whichever comes first, at no charge to you. We all know what the warranty means, what the typical limitations are (e.g., normal wear and tear), and most of us have personal experience with making an auto warranty claim.

Standard Software Warranty – When it comes to software, however, the notion of a warranty is less clear to most. If you have ever read a software license, you know its warranty provision is long and wordy, many paragraphs appear in all cap’s (presumably to call attention to their special importance), and there is actually very little the vendor warrants. Normally a vendor will warrant only that its software “will perform substantially in accordance with its Documentation.” The remainder of the long warranty provision is devoted to establishing numerous exceptions and disclaimers to the already stingy grant of warranty.

Origin of the Standard Software Warranty – This type of software warranty provision was born at the beginning of our “software era,” when it was common for vendors to sell software that was truly “still in development.” Also, the platforms running software at the time were unstable. Under these circumstances, software vendors found it necessary to limit their exposure to warranty claims and consequential damages (“our software is not perfect, it may or may not do what you want it to do, and in all events, we’re not liable if our software causes your system to crash and you lose data, productivity and profits”).

Things Have Changed – Obviously, things are much different now. Within any software market segment today there are lots of competent vendors, and the increased competition (some call it “commoditization” of the software industry) has pretty much eliminated poor state of development at time of sale (Microsoft Vista aside). Technology platforms are also more robust and stable. All of these positive developments would suggest that software vendors could loosen up a bit and start offering more and better warranties for their products. Yet, the standard software warranty has not changed a bit.

Software Vendors Have Not Changed – Although software vendors could (comfortably) offer better warranties these days, they have no real incentive to do so. As long as the industry sticks with the same archaic and vacuous warranty provision, there is really no incentive for a given software vendor to offer anything more. The fact is, if you want more, you have to ask for it. And when you ask for more, be prepared to negotiate for it.

Change is Up to You – I have two bits of advice for you. First, stop thinking of software warranty provisions as being off-limits and non-negotiable. Just like every other contract provision, software warranty provisions are negotiable.

Second, start thinking of software warranties in broader terms. There are many aspects of your software purchases that are appropriate for your vendors to warrant, but they are usually overlooked by most buyers.

For example, consider integration issues. If you have been led to believe a software package is “fully integrated” with the ubiquitous SoftCo Communicator application—whether from reading a sales brochure, listening to sales pitches, or whatever—and this integration is important to you, then ask your software vendor to warrant its integration with this other product. More specifically, ask the vendor to warrant integration with your particular version and configuration of SoftCo Communicator.

As another example, consider sales materials in general. Do you want your software vendor to acknowledge that you relied upon its sales materials in making your buying decision, and to warrant that the sales materials are accurate and do not contain any misrepresentations? Should the sales materials be incorporated into your License Agreement?

What about use cases and demos? Are there aspects of either that stood out to your project team? Could and should these aspects be converted to warranties?

These are but a few examples. There are literally dozens of buyer-favorable warranty elements that should attach to any software purchase. You simply have to think about what is important to you—what will lower your risk, give you more and stronger rights, and in general, give you greater comfort.

Remedies – Remember, too, that for every special warranty element you seek, think about an appropriate remedy for its breach. Software vendors will often attempt to limit their liability to buy-back of their software (which is often enough), but think about going for more in special cases. For example, if your software vendor will be extending or customizing its software for you to some degree, you should think about recovery of service fees incurred up to the point where you hit the brick wall (breach of warranty is discovered).

Expected Outcomes – Whether and to what extent you get your enhanced warranty requests reduced to writing will be largely up to you and your negotiating ability. When a particular request is met with strong resistance from your vendor, there is usually a good reason. You did not get your SoftCo Communicator integration warranty, but you know why. The state of integration was overstated, and worse still, overstated in ways that are especially important to you. You did not get the warranty, but you now have better information about an important aspect of your buying decision—information that might not have come to light had you not taken an expansive approach to software warranties.