New information technologies are pitched as focused on patient-centric opportunities but most often are indirect amid host of solutions touting improved efficiency

By ARTHUR GASCH
Biomedical Business & Technology Contributing Writer
And BB&Ts

CHICAGO — After a series of years in which the annual conference of the Healthcare Information Management Systems Society (HIMSS; Chicago) focused on the emerging systems in health information technology (HIT) and the drive toward improved HIT efficiency — in other words, mostly the “information” and “technology” of HIT — the organization’s yearly survey for 2007 turned more toward “health,” which ought to be the foremost goal of HIT.

The organization’s most recent surveys have focused primarily on marketing trends: the adoption of e-mail and Internet/Intranet systems and the benefits and barriers surrounding these systems. But in unveiling the results of this year’s survey — developed over a period of three months shortly before the conference — George Hickman, chair of the organization’s board, said that the results emphasized respondents’ views “that health information technology is foundational to achievement of such quality, patient safety and necessary clinical process improvements,” and calling these the industry’s “primary” goals.

Improving healthcare delivery

According to HIMSS, the survey said that the foremost priority, both current and over the next two years, is implementing technology to reduce medical errors and promote patient safety using HIT. “HIMSS continues to track and respond to the pertinent issues related to the adoption of health IT,” said Stephen Lieber, CAE, president/CEO of HIMSS. “It is not surprising, but still encouraging, that the survey results reinforce quality in patient care and a reduction in medical errors as vital to the improvement of healthcare delivery.”

Nine clinical of ‘top 10’

The need for increased adoption of advanced clinical systems was emphasized in the new survey via respondents’ listing of nine clinical systems in the top 10 applications as most important for the future of HIT. Topping these nine were electronic medical records (EMRs), computerized practitioner order entry (CPOE) and clinical information systems. The top technologies that respondents said they intend to implement in the next two years are bar coding technology, high-speed networks and Intranets.

Previous HIMSS surveys had highlighted the economics barriers to HIT implementation, and this year’s results continued that focus. Twenty percent of respondents cited lack of adequate financial support as the most significant barrier to successfully implementing IT at their organizations. Nearly three-quarters of respondents reported that their IT operating budget will increase in the next year, with many noting this as driven by overall growth in the number of systems and technologies

Growth means more people to deal with these emerging technologies. Nearly two-thirds of respondents indicated that the number of IT full-time employees (FTEs) in their organization will increase in the next 12 months. The change however, will be modest since about one-third of respondents indicated increases of less than 10%. The greatest demand for staffing is predicted to be in the area of clinical informatics.

Of rather large concern, the survey showed HIT professionals as identifying an internal breach of security as their primary concern regarding the security of data at their organization; 18% of respondents said their organizations had experienced a security breach in the past six months.

Integration for improved patient care

Against the proliferation of new HIT systems and applications, a key path to efficiency is the integration of systems siloed and disparate, and so unable to “talk” to each other. Thus, many companies at the conference were emphasizing integration as a basic element necesssary for improving patient safety.

• Cardinal Health (Dublin, Ohio) launched a new point-of-care (POC) offering designed to help hospitals reduce medication errors. The company said the system is an integration of its Care Fusion bedside verification application, MedStation units from Pyxis (San Diego) and system IV pumps from Alaris (Hampshire, UK). For the first time, the company said, nurses and other clinicians will be able to use one application to monitor orders for their patients, determine the location of medications, pre-program pumps for IV infusions, verify the accuracy of medications administered and document to the hospital’s existing IT systems.

From the convention center floor, Jim Nuckles, VP of marketing for Cardinal, told Biomedical Business & Technology that the beauty of the new system is its ability to interface with technology from all the major IT vendors.

“Not only do you have to integrate information systems, you have to integrate devices. You could have an information system product, but it’s not going to help you that much if doesn’t connect to all the devices. What we’re providing is the actual devices . . . and linking them all together because that’s what the nurse is using.”

The new POC technology also allows clinical data to flow from the hospital pharmacy information system through a single Cardinal interface. The system will also support reporting to other information technology systems in the hospital.

Nuckles said that the company is in the process of setting up testing sites for the interface system. Initially, the company’s solutions will be targeted to Integrated Delivery Networks and large hospitals, it said.

• Allscripts (Chicago) reported agreements to connect more than 60 medical devices using its new Universal Application Integrator (UAI), an application that enables third-party vendors to quickly and easily connect their best-of-breed medical devices and software applications to EHR solutions from Allscripts. Using the UAI, Allscripts is certifying integrations from device and software application vendors, initially with its TouchWorks and HealthMatics EHR solutions, and ultimately across the entire Allscripts product line.

The first set of UAI agreements announced at HIMSS featured devices for cardiology and pulmonary specialty practices including more than 30 devices provided by Welch Allyn (Skaneateles Falls, New York); 14 from Midmark Diagnostics Group (Torrance, California); nine from Cardiac Science (Bothell, Washington); and several devices each from Microlife USA (Dunedin, Florida) and QRS Diagnostic (Plymouth, Minnesota).

Additional vendors participating in UAI certification to Allscripts include Pelstar/Health o meter Professional Scales, Smart ID Works oncology application, and a patient messaging platform from Medical Messaging.net.

Allscripts said it expects to continue to add UAI partners in response to client requests.

• Clinicomp (San Diego) reported the general availability of Essentris 1.4., including numerous enhancements to all six of Clinicomp’s core modules, with a common underlying goal of providing a multi-disciplinary solution that enhances workflow across care providers and departments, a foundation for a longitudinal patient record. The release also provides functional enhancements targeting critical care and perinatal areas.

The six specific areas are One Chart, a multi-disciplinary charting solution that provides a single view of a patient’s total clinical experience, across all departments, services and care providers; OnWatch, an evidence-based surveillance and alerting solution that provides real-time dashboards for monitoring patient status and trends; InView, which delivers integrated clinical analytics; OpenOrder, an online order entry for treatment and medication orders; InterOp, a standards-based environment for managing open interfaces to back-end ancillary and HIT systems; DeviceConnect, a framework for integrating bedside devices, such as physiologic monitors, ventilators and infusion pumps.

• Purkinje (St. Louis, Missouri) introduced its redesigned-from-scratch, integrated EHR and CPM solution, including: registration, patient scheduling, orders and results tracking, an Rx prescriber, a clinical note writer (that also works with voice input), a document scanning module, and a billing/payments module. Purkinje is intended for physicians’ offices, multi-specialty clinics and hospitals. The Registration module tracks patients by ID, last name, first name, insurance card number, telephone number or birth date. The quick -search feature fills in criteria as data is entered, further speeding up the process. The Scheduler module manages appointments and scheduling clinicians, exam rooms, equipment and other resources.

The application is used in doctor’s offices and medical clinics but also can work as a departmental system in hospitals. The Orders/Results module streamlines interactions with in-house and outside lab and imaging facilities. Results can be presented in tabular or graphical format with longitudinal trending. Ordering can be individually customized and stored as user-designed order profiles.

The Rx Prescriber module creates true electronic prescriptions and creates a medication record and profile for each patient. It contains an integrated drug guide and decision support tools to reduce complications related to drug allergies and interactions. The Prescriber will “talk” to any existing pharmacy system. Clinical charting is handled by the Notes Writer module that accepts information entered via text, voice, drawings or structured data.

The Purkinje clinical knowledgebase contains more than 150,000 coded and cross-linked terms, so templates can anticipate your next entry. This is supplemented by the e-Documents module that integrates, views and organizes scanned documents or electronic documents from any source and allows them to be annotated with drawings, text, or audio as they become part of the electronic record. All in all, one of the best new EHRs we saw.

• Axolotl (Mountain View, California) reported release of version 2.1 of its Elysium EdgeServer which can be deployed separately from the company’s related Elysium infrastructure. The EdgeServer is a non-intrusive, integrated application that links hospital and lab information systems to the ambulatory care community. Axolotl also reported that two of its Elysium RHIO customers recently participated in the demonstration of a proposed architecture for a nationwide healthcare information network.

As a participant in the Northrop Grumman consortium, Axolotl enhanced its Elysium application suite to interoperate with the prototype architecture to exchange data with other applications. The consortium solution focused on physician adoption, lowering the financial and technical barriers to entry, and connecting proven vendor products. One main requirement was to have no centralized registry or data repository, which was also supported in all of the architectural decisions.

• StatCom (Alpharetta, Georgia) reported launch of its patient flow logistics and tracking software that enables hospitals to anticipate demand and manage bottlenecks more efficiently. This software coordinates patients and resources from admission to discharge, including bed management, environmental services, transportation, patient length of stay management, operating room patient flow, emergency department patient flow and discharge coordination.

It also notifies families as well as staff and physicians as to the location and status of the patient throughout their care progression and real-time tools that manage flow within and between departments. The company used to be departmental-focused, but with this new software release, it focuses on hospital-wide logistics.

• Henry Schein (Melville, New York) was showing its MicroMD practice management and EHR solutions. Henry Schein said that it is emphasizing the integration of separate vendors that it has acquired. In the interim, it said that the applications will be interfaced to “play nice” until a future release of an integrated product.

• Orion (Auckland, New Zealand) reported its Rhapsody Integration Engine Version 3, the latest release of its Rhapsody Integration Engine designed to help small-to-medium-sized hospitals realize their messaging integration goals and prepare for future interoperability and health information sharing. This new version offers increased system scalability and operations support.

Partnerships for integration

Driven by the welter of offerings — and both an advantage and disadvantage — integration has to be pursued via parnerships, many of these link-ups rolled out at the HIMSS:

• Welch Allyn said it will partner with software company Wellogic (Cambridge, Massachusetts) to develop software providing enhanced clinical efficiencies by linking Welch Allyn’s digital medical devices to a hospital’s information system through a vital signs data management solution that helps clinicians monitor and analyze vital signs data at the point of care. This provides caregivers with real-time and reliable, patient-specific data captured by Welch Allyn devices.

Welch Allyn also introduced its Connex data management system, which works with a range of the company’s vital sign devices to document vital signs and a range of barcode scanning devices from its spin-off company, Hand Held Products (Skaneateles Falls).

• Misys (Raleigh, North Carolina) reported working together with MedAptus’ (also Raleigh) Electronic Charge Capture to integrate with products from its Misys EMR, Misys Vision and Misys Tiger, the Misys ambulatory solution suite. The partnership will provide physicians and their administrative teams with mobile solutions and integrated professional charge capture capabilities. The partnership also offers enhanced reimbursement, improved compliance with billing regulations and faster time-to-billing. Misys Healthcare has added a number of top level people, including Richard Atkin as President of the Hospital Systems Group, within the past year.

Tracking, tracking, tracking

While the stated emphasis of the conference was on patient safety, this vision usually was seen indirectly — via increased efficiencies which provide for more focus on patient care, a human element that may or may not occur given already heavy stresses on personnel and, in hospitals, a declining capacity in nursing care.

Hospitals don’t like to admit to difficulties in keeping track of their products but that difficulty was clearly acknowledged at the conference on the exhibit floor via the number of systems being featured for locating all the varied stuff in the hospital, as well as its people.

Among many, just two examples:

• InnerWireless (Richardson, Texas), a provider of in-building wireless systems, used the meeting to roll-out availability of its real-time location system (RTLS), called Spot, following a year of successful beta testing and integration with location-enabled applications. InnerWireless said that Spot gives “room-level” accuracy for tracking and locating critical medical devices and assets. Spot uses architecture comprised of master radios, beacons and asset tags that work together to locate equipment in real time, down to room level. Spot also is wireless, predominately battery operated and requiring virtually no cabling, so its wireless infrastructure “is as easy to install as a home’s smoke detector and does not disrupt the sterile hospital environment,” the company said.

Finally, Spot is a secure, IT-friendly solution that minimizes IT touch points and has no impact on an organization’s 802.11 networks, in contrast, InnerWireless aid, ‘to many real-time location systems that can only locate to broad zone levels, require room-level wiring and infection control, or disrupt existing 802.11 networks.” InnerWireless said it had completed integration with PanGo Networks (Framingham, Massachusetts) for location management and asset tracking; St. Croix Systems (Burlington, Massachusetts) for enterprise asset management; and SYMX Technologies (Santa Clara, California) for equipment and resource management.

InnerWireless said Spot beta tests were conducted at hospitals across the country, including Vassar Brothers Medical Center (Poughkeepsie, New York). The 365-bed hospital tracked IV pumps during its Spot beta test and said it saw an immediate return on investment and transformation in workflow. “Prior to the deployment of Spot, nurses spent on average 30 minutes per shift looking for medical equipment.

During the beta test, that number dropped to 15 minutes per shift, so when you’re talking about wage and overtime, that turns into a $6.5 million savings for the hospital over the next five years,” said Nicholas Christiano, VP/CIO of Health Quest (Poughkeepsie, New York), Vassar Brothers’ parent company.

• NEC Unified Solutions (Irving, Texas), a developer of voice-overInternet protocol (VoIP) and data communications, exhibited its Univerge Assured Mobility portfolio with the addition of a location tracking component for healthcare. The Wi-Fi-based radio frequency identification (RFID) solution operates within NEC’s Wireless Optimized Architecture (WOA) to track the location of medical devices, patients and hospital staff, “increasing workflow efficiency and reducing costs for healthcare organizations,” it said.

NEC’s Location Tracking is designed to enable hospital staff to track and quickly locate tagged equipment and patients. In addition, patients can alert doctors and nursing staff in critical situations through a remote call button at any point after admittance. The system also provides hospital staff with a record of where a patient was taken and the types of equipment used in their vicinity, allowing for improved billing efficiencies through location-based association. Location-based events (such as a patient entering an unauthorized zone or equipment requiring immediate delivery) automatically trigger alerts and notifications.

Paul Lopez, general manager, marketing and services at NEC Unified, said, “NEC’s Location Tracking provides . . . the ability to keep track of patients and medical equipment using secure voice and data communications over a wireless infrastructure to dramatically enhance employee productivity, improve the level of patient care and streamline procedures to increase profitability.”

• Hill Rom (Batesville, Indiana) said it was in the process of restructuring and going to a .net platform in order to facilitate better communication among all parts of the company. That was the direction set by new CEO, Peter Soderberg, and the effect is seems to be unifying. The long neglected Hill-Rom obstetrical patient data management system, Watchchild, is also being moved to a .net platform and will be re-introduced as a viable product.

Other HIT offerings

Perhaps the greatest value of the HIMSS conference is to get a look at the somewhat dizzying variety of offerings and applications in the HIT arena.

Some examples:

Speech recognition. Philips Speech Recognition (Vienna, Austria) and Language and Computing (Reston, Virginia) continue to combine outstanding speech recognition and natural language capabilities for a solution that extracts relevant information from the unformatted text and transforms it into structured and coded data.

Philips was demonstrating a speech recognition that took dictated text, recognized it (similar to competitors), but also automatically built a medical concept list in real-time (a novel feature), and then added the ICD-9 and SnoMed codes in real-time. While not yet included in any EHR, this was the first product we have seen able to structure notes from freeform dictated text.

A caveat, however: this is a work in progress, and we didn’t see much variety of dictation, so it was not possible to judge its accuracy — particularly via the concept and coding generations. In comparison, Philips with Dictaphone/Nuance seem to be foundations for other EHR providers to build upon. One company doing this is MedQuist, a Philips transcription company.

Organization of clinical information. RemedyMD (Salt Lake City, Utah) reported the production release of Investigate for Clinical Investigators (CI), which is improves the efficiency of clinical investigators. Investigate is engineered on a robust information platform that integrates clinical data from disparate sources — such as clinical data stored in an EMR system — into a centralized, researchable data repository. Investigate uses RemedyMD’s patent-pending SMART interfaces to gather and reconcile clinical data from customers’ various electronic health information systems. By drawing upon multiple clinical information systems as inputs, and storing them in a central repository using current medical technology standards, Investigate powers predictive outcomes tracking and retrospective data analysis.

Document scanning. SRS Software (Montvale, New Jersey) was showing its popular document scanning approach to EHR-lite. The company continues to make enhancements and to deploy systems, having the highest repeat business rates in the industry for EHR-type solutions. Pulse Systems (Wichita, Kansas) is also among the EHR developers announcing CCHIT Certification for its Pulse Patient Relationship Management V3.1.1, for 2006. Pulse Patient Relationship Management solution integrates Patient Flow, Workflow and Cash Flow and includes: Practice Management, Scheduling, Billing and Collection, Contract Administration, Electronic Health Records, e-Prescribing, Electronic Orders and Results, Document Imaging and Management, Electronic Charting, Automated E/M coding, Voice Recognition, Pocket PC Wireless Solution for physicians and nurses, Physician Web Portal and Ambulatory Surgical Center Solutions.

Mobile clinical assistance. The new, Intel-based, Motion Computing C5 was also interesting. The Motion C5 is the first product in the new mobile clinical assistant (MCA) category of PCs that integrates durable design elements with key data capture technologies to simplify workflow, increase productivity and improve quality-of-care. Designed with input clinician input, the portable C5 brings patient data management directly to the point of care, increases the accuracy of information and decreases the potential for transcription and medication administration errors.

The C5 weighs about 3 lbs. and has a semi-sealed design helpful in infection prevention. Its LCD screen is finished with a splash-proof seal, and the entire unit is easily wiped clean to disinfect. It features a biometric fingerprint reader or RFID bad reader to ensure that only authorized users access patient data.

Miscellaneous announcements

National Health Information Network (NHIN) Phase I pilot prototypes by vendor consortiums has been demonstrated and is completed. Phase II awards go to state and regional groups and will be reported within a few weeks. Those receiving contracts will need to deploy personal health record (PHR) software that will allow patients to review their health information, to control who access to information in their record and correct any errors they find.

The Certification Commission for Healthcare Information Technology (CCHIT) reported various changes to its certification process. CCHIT will now offer a “basic certification” (at $28,000 each), as well as practice and site-specific certification, costing additional fees. Given numerous practice sites (home care, physician office, hospital, etc.) and at least 39 medical specialties, CCHIT will require major dollars to become and remain certified.

The relaxed Stark regulations have the potential to impact CCHIT and vendors as well. Under the current proposal, only those EHR systems that have received CCHIT certification within the past 12 months will be eligible to donate equipment (e.g., hospitals to their physicians). Currently, CCHIT certifies an EHR for three years, so it will be interesting to see how this plays out.

Probably only the largest companies with the deepest pockets will be able to play at this level since the small EHR vendors will not be able to afford certification.

This is a problem for the entire EHR market because many of the smaller developers offer affordable, quality, specialty-specific solutions. If they are driven from the market, the larger companies may raise costs on solutions that are not as able to meet the needs of some physician users.

Henry Schein reported that MicroMD EMR 4.5 has been certified by the CCHIT and that the product meets CCHIT ambulatory EHR criteria for 2006.

Spring Medical Systems (Houston) also reported CCHIT Certification for its newly released product, SpringCharts Version 9, that includes OffSite, an easy-to-use, reliable and secure method of EHR remote access, one-click drug interaction and allergy checking, optional TWAIN/SANE interface enabling direct connection to TWAIN and SANE-compatible devices such as scanners and digital cameras, optional InterFax Interface enabling web-based faxing directly to and from SpringCharts.

CDW Healthcare (Vernon Hills, Illinois) reported the donation of mission-critical IT infrastructure solutions and services to MED-1 of Carolinas Medical Center (Charlotte, North Carolina), a one-of-a-kind mobile treatment facility that provides comprehensive on-site medical care in response to disasters and mass casualties. The newly upgraded facility, which consists of two 53-foot tractor trailers, one of which expands to more than 1,000 square feet of treatment space with 134 beds, was unveiled at the HIMSS Conference.

There were tours of the facility and testimonies of its employment in Mississippi following Katrina and at last year’s Mardi Gras celebration as a backup to the remaining New Orleans hospitals. It is staffed with physicians, nurses, EMTs and others but it is this staff that sets the entire facility up — within 20 minutes of arrival, the facility is ready for patients.

The donated solution from CDW, designed and implemented by CDW Healthcare systems engineers in partnership with the MED-1 staff, includes Voice over IP (VoIP) networking hardware and phones, a positive patient ID tracking system, picture archiving and communications systems (PACS) infrastructure technology and mobile computing devices.

The improved IT infrastructure will help MED-1 expand the scope and effectiveness of the care it delivers.