Arizona Sports Hub Is A Joke To Journalism

30 07 2015

Lewis Ling

‘Professional’ journalism isn’t slating a team.

A fellow on Twitter that runs on the name “Arizona Sports Hub” is, by no means, a professional.

How come?

For someone that claims they provide ‘professional, independent and truly local coverage of AZ’s pro & collegiate sports teams”, he really doesn’t play that off well. A journalist shouldn’t mislead their readers, and (I shall refer to Arizona Sports Hub as AZSH) AZSH has done just this.

After being destroyed by the Arizona Coyotes with this tweet:

AZSH just hasn’t stopped being mad at the organization, all because he made up a few lies (or retrieved them from his sources) and clearly wasn’t aware of what the consequences are.

Interestingly, AZSH now uses the Coyotes burn as an excuse…

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Big Fat Liars, CCHIT and the ARRA EMR Incentives

25 10 2009

We had the pleasure of attending a trade show recently, our ZipChart EMR booth was in a room with other vendors, including four other EMR vendors. Of those four EMR/EHR products, three had a CCHIT certification of some kind. ZipChart is not CCHIT certified for a good number of reasons, the major one being that the certification had little real world relevance to our specialty oriented software.

We listened to potential clients ask us why the other vendors were stating that ZipChart is not a “Certified” EMR and that a medical practice selecting us as their EMR would not be able to collect any of the ARRA HITECH funds that are being made available from CMS (Centers for Medicare & Medicaid Services) for providers that are demonstrating meaningful use of a certified EMR. That statement is patently false, and we assume was being made by people who know it’s false. Besides being rude it’s an extremely distasteful business practice to compare one’s software product with another on anything besides the merits of the application and the support thereof.

It should be noted that currently there is NO CCHIT certification that qualifies any EMR / EHR to collect ARRA HITECH funds. If, as a potential buyer of an electronic medical records product, you have been informed that a CCHIT certification qualifies software for ARRA funding, you have been misinformed either deliberately or simply by a vendor undereducated in the regulations affecting their industry.

How is that possible? The US Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) is responsible for the standards that need to be meet for ARRA certification. CMS has not yet issued those standards and the current timeline is December 31, 2009.

So why are there so many EMR companies stating that they are CCHIT certified and already certified to enable practices to collect ARRA funds using their EMR? Part of it is marketing hype and outright lying of course, but the balance is possibly a lack of understanding regarding the certification process.

The CCHIT organization has recently (October 7, 2009) opened the process for EMR vendors to become certified for CCHIT 2011 and Preliminary ARRA 2011 Certification even though the final standards have yet to be published by CMS. The CCHIT organization feels confident that, upon reading the recommendations that were presented to CMS by HHS and ONC (The Office of the National Coordinator for Health Information Technology), they have all the required items in their Preliminary ARRA 2011 certification program, and as such have begun offering EMR companies the opportunity to get certified. If they find the final standards CMS decides upon is different then what CCHIT anticipated, they will retest EMR software at no additional cost to the vendor and that vendor will be placed first in the queue to get the ARRA 2011 certification. There has been significant resistance to the CCHIT organization within the EMR industry and within the Federal government sanctioning bodies, so their certifications may be rendered moot. Even if the CCHIT certification stands, the price remains (in our opinion) exhorbitant.

If the EMR vendor opts to certify for the CCHIT 2011 Certification, which is more costly than the Preliminary ARRA 2011 certification, CCHIT is confident that those EMRs will meet all the standards required for ARRA incentives.

Well what does all of that mean? Well for ZipChart, it means at least two rounds of certification.

Why not opt to become a CCHIT 2011 Certified product and only go through one round of certification? While that may seem like the path that would be prudent, one only has to look at the numerous EMRs that have been CCHIT certified over the years and have been found by providers to be unusable, unintuitive and costly. EMRs that have proven to be inefficient and unproductive actually cost physicians more then the incentive money that is being offered by CMS for HIT adoption. The CCHIT standards are designed to shift clinical decision making from the hands of the physician to the hands of the software developer and, in the process, present software that is cumbersome and considerably more ‘click heavy’ than a clinician should have to deal with. One of the problems with these software packages is that, when being demonstrated by an expert, the actual effort required to complete a patient encounter is NOT obvious. So, the medical practice will invest a great deal of money and effort in a system that is guaranteed to slow down the most expensive person in the office, the physician. 

One other thing to consider for EMR companies that has not had much discussion, but is addressed in a letter in the welcome section of the CCHIT’s Preliminary ARRA 2011 Certification Handbook published on October 5, 2009 is that CCHIT may not continue to be the certifying body. Mark Leavitt, MD, PhD Chair of CCHIT and co-signed by Alisa Ray, Executive Director of CCHIT, state:
“CCHIT is currently an HHS recognized certification body, and expects to continue that status under the accreditation process yet to be developed by HHS/ONC; however we are unable to guarantee that outcome.”.

If you are even more confused now, just know this; HHS and the ONC have sent a list of recommendations to CMS for the ARRA certification. Any EMR company that intends to remain in business is paying a great deal of attention to the details of these recommendations. ZipChart has been closely following the recommendations, and as such has already implemented many of the items that have been recommended for ARRA certification. If you would like to read what CMS has stated about the HITECH ARRA act, including their timelines, click here. When the final standards have been published and certifying body (or bodies) have been decided upon, ZipChart will move toward becoming certified in a way that does NOT hinder a physicians productivity and have an negative impact on a practices’ bottom line.

Remember the incentive money is nice to get, provided it doesn’t cost you more by having an inefficient, unusable system.

Who owns EHR/EMR Patient Record Accuracy Liability?

23 08 2009

Nearly everybody agrees that interconnected electronic medical record (EMR) or electronic health record (EHR) systems will eventually bring new efficiencies and, hopefully, reduced costs to the health care system worldwide. The privacy concerns of the public are a legitimate roadblock that needs to be addressed completely before action plans are put into effect.

A confusing stab at resolving health record privacy was made in the mid 90’s (amended in 2003) with the Health Information Portability Accountability Act (HIPAA). The act was intended to codify how anything related to the privacy and security of patient information was supposed to be handled. It also addresses the remedies available to patients whose records were not shared correctly or contained errors.

Implementation of HIPAA laws has been spotty and unwieldy. Health care facilities, insurers and individual providers have wildly varying interpretions of what ‘HIPAA compliant’ means. The end result has been nearly universal non-compliance with the spirit of the law and sporadic compliance with the letter of the law. Electronic medical records systems are, by their very nature, generally MORE compliant that traditional paper charting systems. Ask youself is it easier to grab a paper chart from the front desk of a typical doctor’s office or to hack into a computer system? Any four year old could grab a folder.

The above digression is only introduction to liability concerns. Other than thorny economic issues, much of the current sturm and drang associated with proposed health care reform revolves around, essentially, the same privacy concerns that were supposedly resolved years ago with HIPAA. Being in the electronic medical records business, it’s part of my job description to monitor at least major moves and talks affecting our business. The one discussion I haven’t seen raised, and it’s possible I have simply missed it, is resolution of liability for medical record accuracy.

It’s no secret that the average United States citizen is a litigious beast, nor is it a secret that there is a surfeit of litigators champing at the bit for a big payoff. The malpractice business is a huge one, with (depending on where you get facts) the cost of medical malpractice litigation increasing at nearly 12 percent per annum since 1975. Without tort reform, there is no reason to believe that these costs will not continue to increase at a similar rate into the future.

Criticism of the current malpractice debacle isn’t the purpose of this rant, however. My concern is that part of the foundation of nearly every proposal for nationally ‘electronifying’ medical records includes patients personally modifying and, in some cases, maintaining their own medical records through web based systems. Google (Google Health) and Microsoft (HealthVault) are two of the big players with this philosophy. Now, since my company markets a web based electronic medical records system, it isn’t the ‘web based’ component that concerns me. I am quite certain that any privacy and security issues can be resolved using existing technology and techniques in everyday use. The thing that I have never seen addressed is, who will ‘own’ the liability for any potential medical ‘breach of duty’ and/or injury caused by said breach if medical decisions were made based on inaccurate data NOT under the control of the provider being accused of malpractice.

The incentives proposed under ARRA (American Recovery and Reinvestment Act of 2009) for providers moving to electronic medical records are chump change compared to their potential increased malpractice exposure UNLESS they verify every bit of data within the composite electronic chart. How will they do this without ordering yet more tests and spending even more diagnostic time with the patient? My contention is that they will not be able to, and thus will continue to resist the move to EMR/EHR regardless of the financial incentives available to them.

If, however, at least some of the responsibility for the accuracy of personal electronic medical records could be more squarely placed upon the patient, we could make great strides towards the goal of eliminating paper charts. Until that issue is resolved, and until the usability of electronic medical records systems (so using them daily consumes LESS time than paper) becomes part of any federal certification process; health care providers will rightly refuse to give up their paper charts.

Coyotes belong in Phoenix, period

8 05 2009

There’s big buzz in the Phoenix area this week about the Phoenix Coyotes (the local NHL team for the uninformed) moving north to Ontario under the auspices of Blackberry bigwig and perennial hockey team shopper Jim Balsillie. Jerry Moyes, the current majority stakeholder in the Coyotes, has been facing financial challenges with both his Swift Trucking outfit and the Coyotes. It should come as no surprise to anybody that the cell phone biz is outpacing the trucking biz these days.

Mr. Moyes this week filed for Chapter 11 bankruptcy and listened to a spectacular hubris driven $212 million plus bid from Mr. Balsillie, maybe enough to bail Moyes out of his financial predicament with the ‘Yotes. The City of Glendale, landlords for arena, would probably also be paid off for back rent and parking fees. That’s good, especially since Glendale has recently had to furlough some city employees. So what’s the problem?

The first problem is that a condition of the sale is that the Coyotes would be relocated to southern Ontario. The second problem is that Mr. Moyes may not even have the right to declare the hockey club bankrupt, at least that’s the argument the NHL is making. The third problem is that the City of Glendale has a fresh contract with the Coyotes that would potentially result in a $750 million penalty. The fourth problem is that the NHL was in town to discuss with Mr. Moyes another potential sale to Jerry Reinsdorf (owner of the Chicago Bulls and White Sox and sometime Paradise Valley resident) at the very moment Moyes was filing his petition.

It isn’t rocket surgery to put some guesses together about whether Moyes and Balsillie had discussed the bankruptcy filing beforehand. If the $750 million penalty was negated by a bankruptcy, and then the bankruptcy judge decided that accepting the highest bid was in the best interest of the team debtors, then a logical conclusion is that the Coyotes would be packing for the Great White North pretty quickly. Slick move, if ethically questionable, and one that was really in the face of the NHL.

The Pittsburgh Penguins (currently in the hunt for the Stanley Cup) went through the same sort of big buck offer from Balsillie back in 2006, with very similar machinations revolving around a new arena and a move to Ontario. The Nashville Predators had a similar experience in 2007. Now, it’s our turn.

NHL Commish Gary Bettman, rightly or wrongly, doesn’t seem to like Balsillie very much. We imagine that being recently end-arounded (with the bankruptcy filing) once again won’t add much amicability to the relationship. Bettman has stated on more that one occasion that the Coyotes will be staying in Phoenix, and has represented that position at the bankruptcy hearing yesterday. Glendale has basically promised that they will sue for $750 million if the Coyotes leave, although there is precedent that the maximum penalty for a broken lease could be more in the $500k range.

So now we wait for the next hearing for the next installment.

Filling seats and making money with hockey in the desert has always been a challenge. The minor league Phoenix Roadrunners just closed up shop this year. The last game we went to was pretty sparsely attended. It’s not much different at many Coyotes games, there are usually plenty of empty seats. If a popular team from out of town is playing, particularly the ever-annoying Red Wings, it’s not uncommon to have Coyotes fans out-cheered by the other fans. The ‘Yotes have the third worst attendance record in the NHL, despite having an excellent venue for hockey and the best arena staff I’ve ever had the privilege to encounter.

Despite flashes of competency and energy from the Coyotes, as a team they seem doomed to disappoint. A bunch of promising young additions to the team have so far failed to bear the fruit of a playoff bid. The refrain of “There’s always next year” begins to wear on the psyche of dedicated fans, especially considering ticket prices and the current state of the economy. That said, our family will be there next year hoping for the best and having a great time. We went to a Diamondbacks game a couple weeks ago, we wanted our French exchange student to have the experience, and there is NO comparison to watching a hockey game and a baseball game.

I don’t want to speculate on what it would take to make the Coyotes a consistently winning team. I do know that the fan base would grow significantly if they managed to get into the playoffs. Even the vaunted Boston Bruins weren’t sold out THIS YEAR (something like 80% attendance) until they showed some strength. Some say the attendance problem is because Glendale is too far out. Tell that to the Cardinals DIRECTLY ACROSS THE STREET. Besides, the Phoenix sprawl is rapidly engulfing arena.

So, let’s see Moyes and the NHL reach some kind of agreement that fulfills the contracts signed. Hey, a deal is a deal even in the hockey business, isn’t it?

Go to for updated information and hit the Coyotes Forever Facebook page.

CCHIT lobbying for Federal HITECH nod

17 03 2009

We’ll be attending a CCHIT town hall conference call later today, we’re pretty sure it will include another push in an agressive attempt to be ‘the’ certification process for federal stimulus funds. Why is this a bad idea?

  • There is a great deal of perception in the EMR/EHR marketplace that it’s already a done deal and CCHIT is the de-facto standard for any stimulus funds. From whence did this perception arise? There is actually a statement on their web site that would lead you to believe they were selected in 2006.
  • CCHIT is a ‘nonprofit’ organization, which does NOT mean they make no profit. They are free to give bonuses and other profit sharing incentives to their 23 employees. I’m sure that information will be available in their annual report, but since they just incorporated as a not-for-profit in January it won’t be published for awhile.
  • The pricing is ridiculous. We won’t go through the entire list, but the initial fee for their ambulatory certification is $35,000, broken down as $29,000 for the ‘Application’ and $6,000 for ‘Certification Maintenance’. Ouch. Additional certifications for specialties range from $8,000 (Child Health) to $16,000 (Cardio). They are now proposing a Dermatology add-on, but there’s no mention yet of price.
  • The fee structure includes, in effect, a penalty for software enhancements. A new version with ‘Significant Changes’ (we haven’t had time to root through the documentation to find their definition of ‘Significant’) carries a recertification fee of 15% of the Application Fee. So, if a company decided to roll out a new version with significant enhancements (one would assume to IMPROVE their product) before the normal two year certification period expired, they’d have to pony up at least $4350. Not a ton of money, but lots of people would just save the enhancements for the next certification process.
  • If federal funds are being used for this EMR/EHR spiff, having ANY private organization involved beyond an advisory capacity is a golden ticket for influencing market pressure on any target of choice.
  • Even with the CCHIT newfound enthusiasm for providing a realistic set of rules for specialties, it’s still necessary to meet 100% of their initial ambulatory requirements and THEN meet the additional requirements for the specialty of choice.

There are any number of other reasons to develop a better standard and a more efficient way of implementing them. We’ve been around the EMR/EHR block long enough to have already heard the opposing arguments, but few of them ring true.

Probably more on target for standards to be adopted is the open source community. I am too mercenary to fully embrace the open source standard for electronic medical records, but their arguments have merit. OEMR is a decent place to start following that trail if you have interest. CCHIT is perceived as anti open source.

We agree there should be some standards regarding security and other safety and ineroperability requirements to receive federal funding. What is definitely NOT required are the additional rules that expect EMR/EHR software to replace the individual physicians medical education, forcing the doctors to go through a tedious procedure for each patient encounter. Nearly every (I would say EVERY but that’s a big blanket statement) software application that implements the CCHIT standard includes way too much templating and clicking with the responsibility for completion lying directly with the physician. The end result is a noticeable reduction in the efficiency of the most expensive person in the medical practice. Is that going to REDUCE healthcare costs?

We, as a small specialty-specific EMR company, are hoping for a more rational choice. We release ‘significant’ updates to our software nearly monthly, almost always as a result of listening to feedback from our clients about what would help them run their practice more efficiently. We focus on providing a complete, secure, easily accessed patient record that’s maintained in concert with the patient, the office staff and the physician. We have confidence in the scrupulousness of our health care providers to provide the best patient care possible, we just provide a tool to reduce their costs and (usually) either see more patients per day or go home earlier.

Doctors shopping at Wal-Mart!

12 03 2009

So it looks like Wal-Mart is jumping into the electronic medical records business in concert with Dell and eClinicalWorks. From reading what I could find around the ‘net, it doesn’t look like Wal-Mart is adding any value to the resultant product other than their prodigious marketing footprint. The proposed pricing structure is very un-Wal-Martlike as well.

Being in the EMR/EHR business myself, it’s encouraging to see the retailer everyone loves to hate jumping into the business. If Sams Club is getting in, there must be tons of money involved. One has to wonder if having the Wal-Mart name attached to an expensive product is an advantage considering the clientele. We have a superstore nearby, and I rarely see too many AMG Benzes parked out front.

We’ll see more and more partnership deals like this popping out of the woodwork over the next weeks and months as the details of the HITECH initiative surface and congeal. Having just returned from the American Academy of Dermatology conference (in chilly San Francisco), I am aware of the confusion and the anticipation surrounding the plan. Nearly every doctor that approached us about our electronic medical records system asked about two things; the e-prescribing ‘spiff’ from Medicare and how much money would be available to them under the HITECH thing.

Much of the misinformation revolves around who is eligible for additional e-prescribing related payments (NOT everybody) and who is responsible for certifying EMRs for consideration (NOT CCHIT yet). A lot of it was being dispensed, naturally enough, by EMR vendors touting their CCHIT certification. Ironically, considering the venue, CCHIT does not have a certification that is dermatology specific, although one is in the planning stages.

It will be an exciting year for EMR vendors like ourselves, although we’re hoping that small firms like ours that ‘specialize in specialties’ won’t be squeezed out of the mix or priced out of the certification process by a federal mandate.

Witness what’s happening to the hospice business as an example of a federal misstep in this regard. Medicare has essentially been working to eliminate hospice payments after a certain period of time, which will effectively knock smaller hospice agencies out of business if they keep their dying clientele on their rolls too long. Certainly this is more Draconian than anything in the HITECH proposition (so far at least), but once the politicians and lobbyists are involved it seems like it always goes in that direction. There’s too much money on (and under) the table for this initiative to not attract the attention of the usual suspects.