Some really big news dropping yesterday that Pulse and Cegedim Healthcare Software (CHS) (a European company) were merging. As part of the merger, Pulse is getting a $13.5 million capital infusion.

I’ve been very interested in what the future of Pulse would be after meeting with them at HIMSS. This looks like a good step forward for them and a nice infusion of money to be able to really attack the US EMR market full on.

I think this also illustrates the potential market opportunity that’s available for EMR vendors. I’ll be interested to see what Pulse is able to do with all the cash. Hopefully, they’ll use a very small part of it to advertise on the EMR and HIPAA & EMR and EHR websites.

As is usually the case with mergers and acquisitions of EMR vendors, the next question is what’s going to happen with the company and the software product after the merger. Seems like this is mostly just an investment by the Cegedim Group in the US market and not about merging and sunsetting product lines. Looks like Pulse will continue to operate as it has in the past, but with a bunch more money in the bank.

Here’s the letter from Pulse President and CEO, Basil Hourani, that was sent to Pulse clients:

I am pleased to announce the strategic investment and merger of Pulse and Cegedim Healthcare Software (CHS) – a division of Cegedim Group. Through the merger, Pulse will continue to operate independently with our existing management team, personnel, locations, products and services. As part of the transaction, Pulse received a $13.5 Million capital infusion which will immediately provide capital to accelerate aggressive growth of our Electronic Health Record (EHR) and Practice Management (PM) solutions as well as development of next generation Pulse products including our web-based solutions. Pulse growth plans include the addition of more than 350 new employees in all departments by the end of 2012 and additional offices in key expansion markets.

CHS is the European leader in medical software including EHR products geared to the European markets. CHS currently serves 119,000 physicians and 16,000 pharmacies in Europe but does not have any medical software presence in the US. The Pulse existing and future products and services will serve as the platform for the US markets going forward.

We are very pleased and energized about the investment in the Pulse solution. It is recognition that our EHR and PM software is a future-ready solution and the right platform. This investment strengthens our ability to continue Pulse’s strong momentum and record setting growth that we have been experiencing, and take advantage of the expected growth in the healthcare IT market fueled by the unprecedented government incentives.

As you have always been accustomed, you will continue to enjoy the personal service and support from Pulse management and personnel. Pulse will continue to be headquartered in Wichita, KS with offices in; Boston, MA, Dallas, TX, and Kansas City, MO. We look forward to our mutually beneficial continued relationship with you and thank you for your patronage.

Best Regards,

Basil Hourani
President and Chief Executive Officer
Pulse Systems, Inc.

In MedCity News, John Halamka makes an effort to summarize as simply as possible the Quality Measures:

I’ve been asked to summarize the Quality Measures as simply as possible

a. The Core Measures for All Eligible Professionals, Medicare and Medicaid are in the Final Rule Table 7, page 287. The Measures are

• Hypertension: Blood Pressure Measurement
• Tobacco Use Assessment and Tobacco Cessation Intervention
• Adult Weight Screening and Follow-up

b. If the denominator for one or more of the Core Measures is zero, EPs will be required to report results for up to three Alternate Core Measures. The Alternate Core Measures for Eligible Professionals are in the Final Rule Table 7, page 287. The Measures are

• Weight Assessment and Counseling for Children and Adolescents
• Preventive Care and Screening: Influenza Immunization for Patients ? 50 Years Old
• Childhood Immunization Status

c. The Clinical Quality Measures for Submission by Medicare or Medicaid EPs for the 2011 and 2012 Payment Year (EPs must choose 3) are in the Final Rule Table 6, page 272 . Here’s a summary of the 44 quality measures that CMS posted last week.

d. The Clinical Quality Measures for Submission by Eligible Hospitals and Critical Access Hospitals for Payment Year 2011-2012 are in the Final Rule Table 10, page 303. The Measures are

• Emergency Department Throughput ’ admitted patients Median time from ED arrival to ED departure for admitted patients
• Emergency Department Throughput ’ admitted patients Admission decision time to ED departure time for admitted patients
• Ischemic stroke ’ Discharge on anti-thrombotics
• Ischemic stroke ’ Anticoagulation for A-fib/flutter
• Ischemic stroke ’ Thrombolytic therapy for patients arriving within 2 hours of symptom onset
• Ischemic or hemorrhagic stroke ’ Antithrombotic therapy by day 2
• Ischemic stroke ’ Discharge on statins
• Ischemic or hemorrhagic stroke ’ Stroke education
• Ischemic or hemorrhagic stroke ’ Rehabilitation assessment
• VTE prophylaxis within 24 hours of arrival
• Intensive Care Unit VTE prophylaxis
• Anticoagulation overlap therapy
• Platelet monitoring on unfractionated heparin
• VTE discharge instructions
• Incidence of potentially preventable VTE

Everything clear now?

The AMA has finally weighed in on the meaningful use final rule and it’s not a glowing recommendation for meaningful use and the changes that were made. Here’s a short summary from the Wall Street Journal healthcare blog.

Now, after “careful review,” the AMA is weighing in. In a memo [PDF] to its board of trustees, the group’s CEO, Michael Maves, says that while “the Administration did move on several points, the [AMA] believes that it will be challenging for many physicians to participate successfully in the program. This will be especially true for those physicians in solo or small group practices who have not previously utilized an EHR.” (That refers to an electronic health record — the Health Blog has traditionally used “electronic medical record.” Tomatoes, tomahtoes.)

The AMA had pressed for reducing the number of criteria physicians needed to meet in order to get the first round of incentives from the original mandated 25 to a choice of any five of those. The final requirements include a “core” group of 15 requirements; providers must choose an additional five from the remaining items. That “is still too high,” the group says.

In addition, the group says no currently available EMR does everything that docs will need to do to meet the requirement — though products should be available this fall — making it tough to ramp up before the beginning of the incentive program. Also included on the list of what the AMA calls “remaining challenges”: high threshold requirements for many of the requirements, a lack of focus on how usable the systems are and the absence of an appeals process for docs if they are declared ineligible for incentives.

An article by Government Health IT’s Mary Mosquera has some interesting data from ONC about the number of EHR certifying bodies there might be available to EHR vendors. Here’s the most relevant section:

So far, ONC has received six or seven completed applications out of the 30 it sent to organizations that have requested them since July 1, said Dr. David Blumenthal, the national health IT coordinator, at a meeting of the advisory Health IT Policy Committee.

ONC released in June its final rule for the temporary certification program, which lays out steps organizations must take to be authorized by ONC to both test and certify that EHRs can perform the functions required for meaningful use.

“We are optimistic that we will have a new landscape in the certification realm in which, instead of having a single certification body, there will be more opportunity, a broader pipeline for certification, hopefully more price competition and shorter waiting times to get certification,” Blumenthal said at the committee meeting July 21.

6-7 applications to certify EHR software and 24 more out there that could come in. That sure blows the initial projection of 5 EHR Certifying body applications out of the water. I’m not really sure the business model for these organization. The customer base is about 300 EMR companies. That’s a pretty small market for these organizations to share.

I imagine this is really bad news for those people at CCHIT too. Mostly because CCHIT’s only product is certifying EHR software. At least other organizations like the Drummond Group do a number of certifications. Who would have guessed that the ARRA EMR stimulus money that looked so promising for CCHIT could become the legislation that drives them to irrelevancy?

I was passing through my LinkedIn account and saw this message from @GrandRounds4ODs which seems to have come from his Twitter account:

Appoint a single point of contact for project/contract compliance. Keep the consultants + vendors honest!

This is some great advice. One point of contact can really help to cut through the lies…err…EMR sales mis communications.

I got an email announcing the new HP EHR initiative called EHReady. I was really interested to hear what HP was working on in the EMR industry since DELL’s has a number of EMR initiatives. In order to learn more, I did an email interview about EHReady with Chris Mertens, HP’s vice president of healthcare business.

Why would a practice want to use this HP solution?  What makes it more than just a nice marketing program?

Our new EHReady program is a comprehensive solution that helps hospitals engage with their physicians and help them transition to a complete EHR solution. We works very closely with its enterprise clients and know how tough it can be for physicians to adopt new technology. As the HITECH act was being developed, we began forming this program which they believe will make it much easier for hospitals to extend their technology solutions out to their affiliated physicians.

As the largest computer manufacturer in the world, we offer the full range of products and solutions to meet the needs of hospitals and their physicians: mobile systems, desktops, printing solutions, servers, storage, and even peripherals like mobile carts and biometric devices.

Will this program focus more on hospital EMR software or ambulatory EMR software?

The program targets hospitals, Regional Extension Centers, and other associations working closely with physicians to adopt EHR solutions. We will not be reselling the EHR solution, but rather enabling each hospital to work closely with their affiliated physicians to determine the best solution.

Which EMR software will you be making available to consumers?

This service program supports a wide range of EHR software from our healthcare partners. We are also collaborating with key independent software vendors to provide customers with a choice of EHR applications. We are currently engaged in an extensive ISV qualification and selection process.

How did you decide between the 300+ EMR vendors and how do you know the EMR software you support will work well across all the unique clinical practices?

With this announcement, we are not officially naming partners for the EHReady program, although we do have existing relationships with many software providers and continue to build more. We will also be working with a number of HP resellers including one quoted in the press release – Open Systems Technologies.

We are opening up the program now to make sure that hospitals are aware of this offering. Many hospitals are already established with certain EHR vendors, and it’s our goal to work with a variety of software partners to better meet the needs of more hospitals. The EHReady program is designed to do just that – allow for a simple, turnkey solution that will fit with what hospitals may already have in place in terms of EHR software.

What will you be doing specifically to ensure that organizations understand and qualify for ARRA EMR stimulus money?

We offer a full suite of leasing and other financial options, which offer practitioners the ability to bundle HP and non-HP EHR solution components into a single, low payment.

When practitioners choose an HP Financial Services ownership program, they can choose to acquire their EHR solution now, without a large cash outlay. The practitioners can make small payments and have the choice to either pay the program off quickly or continue to make small payments after the ARRA subsidy is received.

In addition, all HP solutions meet the criteria of “Meaningful Use” that is required to obtain the funds to help physicians move towards a “digital office” environment.

Will HP be providing the software and technical support needed or partnering with other organizations?

We will work closely with our extensive network of value-added resellers to support EHReady with site assessments, training, implementation and support services for hospitals and their affiliated physicians.

Since every EHR software has its own unique features, the installation of EHR software through this program will be done in partnership with HP through our network of HP partners.

EHReady’s IT services can be structured to support a seamless EHR install or upgrade with minimal interruption to hospitals and affiliated physicians. An “IT checkup” onsite assessment service kicks off the EHR system consultation, leading to planning and setup services to fully implement the EHR solution.

Today, I thought it would be interesting to list the meaningful use final rule comments that I know of and to invite my readers to tell me about other meaningful use final rule commentary that they know about. Just reply in the comments of this post or on the EMR and EHR contact us page and I’ll update this post with all the meaningful use final rule resources we can find.

Full Meaningful Use Final Rule, Press Conference Video and EMR and HIPAA MU Thoughts
Comparing the Preliminary Meaningful Use Rule to the Final Meaningful Use Rule Done by Inga from HISTalk and a great resource.
List of Meaningful Use Webinars – Done by EMR and HIPAA
Everything HITECH Analysis of Meaningful Use
Advice on Addressing Meaningful Use – Good advice from the Healthcare IT guy on not being in a hurry to address meaningful use.
Interview with David Blumenthal About Meaningful Use
Mr. HISTalk and John Glaser Reactions to MU (have to scroll down a bit to see the obligatory meaningful use section)
Meaningful Use and It’s Impact on Physician Productivity
HISTalk Initial Comments and Reactions to MU – Just read the comments on this one.
Summary of Meaningful Use Announcement and Rule
CMS Page on Meaningful Use
Meaningful Use Final Rules Are a Big Deal – Wm. T. Oravecz Take on Meaningful Use Final Rule on HITECH Answers
David Blumenthal’s Thoughts on Meaningful Use
John Halamka’s Summary of Meaningful Use Final Rule Changes
Halamka’s Presentation on the Meaningful Use Final Rule
Summary and Other Meaningful Use Documents – The Summary Chart that’s embedded on this is an interesting one. Too bad it’s partially cut off on my screen.
Summary of the 2 Reginas and Meaningful Use – Matthew Holt talks about the 2 Reginas that spoke about Meaningful Use of an EHR
Chilmark Research Quick Meaningful Use Analysis – An always insightful look at healthcare IT
The Fox Group’s Thoughts on Where to Go from Here

I’m sure that there are plenty more. If you know of some good ones, let me know and I’ll add them to the list.

This just came in. The wait is finally over. I guess I know what I’m doing tomorrow.

CMS AND ONC TO ISSUE FINAL RULES ON MEANINGFUL USE AND STANDARDS AND CERTIFICATION FOR ELECTRONIC HEALTH RECORDS INCENTIVE PROGRAM

WHAT: CMS and ONC will host a press briefing to announce the final rules on Meaningful Use and Standards and Certification under the HITECH Act’s Electronic Health Records (EHR) incentive program.

WHO: Kathleen Sebelius, Secretary, U.S. Department of Health and Human Services
Donald Berwick, M.D, Center for Medicare & Medicaid Services, Administrator
David Blumenthal, M.D., M.P.P., National Coordinator for Health Information Technology
Regina Benjamin, M.D., M.B.A, Surgeon General

Dial In: Call in: 800-857-6748
Verbal Passcode: HHS

To watch the webcast live visit www.hhs.gov/live

A favorite topic of this blog has been Meaningful Use and it will likely continue to be a popular topic well into the future. As such, we’re all sitting around waiting to hear the word from CMS on the final rule for Meaningful Use. Doctors are waiting for it so they can select an EMR or modify their current EMR to meet the guidelines. EMR vendors are waiting for it so they can say that their EMR software can meet the meaningful use guidelines. RECs are waiting for it so that they can help doctors reach meaningful use. We’re all just waiting to see what’s going to come out.

Fierce EMR reported that the Meaningful Use final rule will be published by July 14th. Here’s a couple quotes from that report:

FierceEMR spoke with a CMS official directly involved in writing and publishing the final regulation, and she assures us that although there’s no “official” publication date (CMS missed its own self-imposed June 30 deadline), “I would be very surprised if it’s published any later than July 14.”

Not a very firm commitment to July 14th, but it should be around that date I imagine.

“We hoped to have it out by the end of June, but it’s looking more like mid-July,” the official told us this week. “There are so many moving parts and so many people are involved. This is a long regulation.” No doubt! The proposed rule was thicker than many novels. We expect nothing less from the final reg.

That wasn’t quite the novel I was hoping to read this summer, but it will be nice to have something final.

All of this said, we may be waiting for nothing. First, because I don’t think that we’ll see any real meaningful changes to the regulation. Plus, I think the regulation will still be missing much of the meat and potatoes that will be involved in managing that regulation. There will still be a lot of practical details needed and interpretation of the regulation to be done. At least if it’s the government process that I know.

Yes, you should be wincing a little bit if you clicked on this post because you just had to see what it was talking about. Thankfully, it’s not actually my post. It’s a post on the CareCloud blog titled “9 Things Electronic Health Records Can Learn From Star Trek”. Here’s the list of 9 things (you can read the full descriptions on the link above):

• Multiple Channels for Data Entry
• Interactive Patient Education
• Holographic Doctors
• Detailed PHR on demand
• Integration with vital signs monitoring systems
• Adaptive, Intuitive Touch Screen Interfaces
• Real time Practice-wide Synchronization
• Remote Access for Patients
• Support for Mobile Devices

Pretty creative if I do say so myself.