Healthcare as a Startup

There’s one metric, above all others, that represents the state of the healthcare information technology industry – the number of two-story vendor booths at HIMSS.  While there are always vendors that take up an acre or two of floor space, the number of exhibitors with double-decker exhibitions fluctuates based on the industry’s outlook.

If I took a picture of a two-story booth at HIMSS10, this is what it would look like.

At HIMSS 2008, just before the recession hit hard, I counted a dozen two-story booths in the literally mile-long corridor of vendors.  Last year, when the economy was tanking and the HITECH stimulus $ was a big unknown, I only saw two double-decker booths.  This year, we’re probably in the 6-8 range, despite the economically tumultuous times.  The reason for the rebounding is undoubtedly, the ARRA/HITECH Stimulus funds.

Thanks to the adept implementation of the legislation by the Office of the National Coordinator, the support of organizations like HIMSS & HITSP, and the enthusiasm of an industry primed for a federal booster shot, vendors and providers alike are spending $ and hiring people as if we weren’t recovering from the great recession.  People on the exhibit floor, on the shuttles, and in the bars are abuzz with talk of “meaningful use” and the tone is overwhelmingly optimistic.

If the goal of the HITECH stimulus was to get this sector of the economy moving again while advancing the use of electronic medical records, the rebounding number of two-story booths means we can safely check-off one of those goals off the list.  Based on the progress I’ve seen and the discussions I’ve heard so far, the second is not far behind.

We make heavy use of Amazon Web Services (AWS) for our hosting, large scale data storage, and load balancing needs.  In fact, the latest release of Breeze leverages AWS’s Auto-Scaling functionality to automatically bring additional servers to life during times of heavy load.

For anyone interested, here’s how:

As records come in for processing, Amazon’s CloudWatch monitors the performance of our processing servers and, once a certain CPU threshold is exceeded, more servers are added to the job.  These new machines are configured to automatically jump in and start lending a hand in the processing.  When all of the charts have been processed, the additional machines are terminated and the system goes back to its normal state.

Obviously, the best part of this system is that we don’t do anything.  The system automatically resizes itself based on load which means we can processes large batches of records at any moment, without having to pay for idling high-end servers 24/7.  Ah, the power of the cloud.

After hanging out with other Seattle upstarts for a while now, here are my favorite Seattle startup networking resources:

Local Info:

• Seattle Tech Startups – The Seattle tech startup mailing list
• Seattle 2.0 – Great resource for news and startup events through-out Seattle
• Seattle Tech Calendar – Exactly what it sounds like

Local Events:

• Poker 2.0 – (Reserved for Tech Startup Execs & VCs/Angels) Terrific, relaxed low-stakes poker, food & beer.  One of my favorite events.  Contact me for an intro.
• Lunch 2.0 – Monthly lunches sponsored by a local startup
• Hops and Chops – Good people, casual conversation at Spitfire every Thursday from 6:30 – 9:00
• NWEN – Northwest Entrepreneurial Network. More structure & a bit more establishy than other events/organizations.
• Open Coffee – Tuesday mornings from 8:30 – 10:00 at Louisa’s in Eastlake.
• Startup Drinks – Monthly drinks at a bar somewhere in Seattle

1. Encrypted File System (EFS):  This option lets you encrypt some folders in your hard drive, without having to encrypt the entire drive.  That means you don’t have the (relatively) small performance hit of encrypting the entire drive, but if someone steals your hard drive, they’ll be able to see the names of all of your files/folders (although they won’t be able to see the contents of them).  This assumes you have a very strong password protecting your login – if you don’t, there’s no point in EFS because someone could simply brute force your password and get your files.
2. BitLocker:  If you have the Ultimate or Enterprise versions of Vista or Windows 7, you can turn on BitLocker and encrypt an entire hard drive.  Note, BitLocker only encrypts the drive your OS is installed on (most likely C:) and requires some special hardware, which your computer may or not have.  Pros: encrypts entire drive & doesn’t rely on your login password for security.  Cons: slight performance hit, requires Ultimate or Enterprise versions of Vista or Win7, and requires special (although fairly common) hardware.
3. TrueCrypt: An Open Source version of BitLokcer which works on any Windows OS version (e.g. Windows XP, Vista Home, etc.).  Cons: not quite as fast as BitLocker.

Now, if your laptop gets stolen, at least you won’t have to worry about notifying hundreds of patients that their data has been compromised.

We’ve finished our first webisode in our “Business Power Tools” series, highlighting useful tools for booking HIMSS travel and planning out your education sessions while you’re there.

Problems playing the video? Try here: http://blip.tv/file/3146159.

Here’s what we covered:

• New Tools for Buying Airline Tickets Online
  • Are the deals on the HIMSS website any good? (Tool: HIMSS website)
  • Price Prediction: should you buy your ticket now or wait a week? (Tool: Bing Travel)
  • Prices for arriving a day early or a day, at a glance (Tool: Kayak.com)
• Great hotels for < $100/night (no roommate required)
  • Tools: TripAdvisor.com, Google Maps
• Build an Outlook calendar of your HIMSS keynotes, SIG meetings, education sessions, etc. ahead of time
  • Tools: myHIMSS10

Too fast, too slow, too boring?  Feedback welcome!

Based on interest from within, and outside, our HIMSS Small & Independent Consulting Special Interest Group (SIC SIG), the Nimbus Health team has decided to do a trial run of some free recurring webinars to highlight online tools & resources that we’re hoping HIMSS members, and healthcare oriented organizations at-large, can benefit from.

To test the waters, we’re going to do a webinar on “Tools for a Great HIMSS.”  In it, we’ll cover:

• New Tools for Buying Airline Tickets Online
  • Are the deals on the HIMSS website any good? (Tool: HIMSS website)
  • Price Prediction: should you buy your ticket now or wait a week? (Tool: Bing Travel)
  • Prices for arriving a day early or a day, at a glance (Tool: Kayak.com)
• Great hotels for < $100/night (no roommate required)
  • Tools: TripAdvisor.com, Google Maps
• Build an Outlook calendar of your HIMSS keynotes, SIG meetings, education sessions, etc. ahead of time
  • Tools: myHIMSS10

The webinar will be at:

Website: https://www.gotowebinar.com/register/328464945
Date: Thursday, Jan. 28th (Register)
Time: 1 pm (PT)

Please “register” by accepting this Outlook meeting request so we can keep you posted if there are any last minute changes:

Subscribe to this blog using the links on the right hand side to get updates when new webinars are scheduled.

Asked thousands of times, is it “Electronic Medical Record” or “Electronic Health Record.” A colleague of mine was tired of Outlook, Word, and PowerPoint converting EHR into HER, every time he typed it up, so he went with EMR. Seemed as good a logic as any I’d heard.

For anyone else stuck in an epic battle with Microsoft Office’s auto-correct functionality, here’s how to turn it off for specific words:

Full screen version: here.

We are pleased to announce that we have completed another update to the Breeze system this evening January 19, 2010.   The enhancements included in this release are geared toward increased integration, improved system efficiency, faster chart processing and the ability to view charts while they’re being indexed.  Please take a few minutes to review the complete list of system changes included in this release, which is shown at the bottom of this post.

We appreciate the feedback we’re receiving from our users and are pleased when we are able to improve your experience using Breeze.

Please let us know if you have any questions or comments regarding the changes in this release.  As always, we would encourage you to report any problems you find in the software and any enhancements you would like to see in the future using our support contact information – support@nimbushealth.com.

Thanks for all your assistance.

Breeze Release Notes

This document identifies all enhancements and system changes that have been made to the Breeze Medical System with the January 20, 2010 release.

Breeze Console

Support for All Electronic Medical Record Systems

1. Breeze now supports all EMRs including Cerner, McKesson, Epic, Allscripts, etc.
2. To share an electronic medical record through Breeze, simply select the medical record in the EMR and print it using the automatically installed Breeze Medical System Virtual Printer
3. Patient demographic data will be automatically populated within Breeze

Support for Hybrid Records

1. Breeze makes it easy to combine paper and electronic sections of medical records
2. When any two charts are uploaded with the same demographic data, users will have the option to:
   1. Add the new pages to the beginning or the end of the existing pages
   2. Manually arrange the new pages as necessary
   3. Or overwrite the existing pages with the new pages

Support for Uploading PDF Files

1. Breeze can now support uploading full, multi-page PDF files in addition to scanned and “virtually printed” records
2. Drag and drop any PDF into a chart and its pages will automatically be added to the chart

Breeze Website

Faster Loading Charts

1. Unindexed/temporary charts are now created after initial upload, decreasing wait time during full chart processing
2. Faster processing of large charts

Additional Chart Status Values

1. Chart processing Status values in order of occurrence:
   1. Awaiting Processing
   2. Building Temporary Chart
   3. Temporary Chart Available
   4. Indexing Permanent Chart
   5. Ready

Transmitting of paper-based or hybrid medical records (part electronic and part paper) between authorized users has been a security challenge for several years.  While most traditional solutions such as faxing, shipping, emailing or hand delivering of records have their own unique security risks, many covered entities and business associates still use these methods to varying degrees.  This article reports on the multiple privacy breaches in Tennessee when medical records were faxed:  http://tinyurl.com/ycy3zsy.

Whether you’re a covered entity or a business associate, if your organization is faxing or shipping medical records we would like to help you to avoid any potential privacy breaches associated with the transmission of health records.  The Breeze Medical System (Breeze) offers a cost effective; fully HIPAA compliant electronic solution for the transmission of paper-based or hybrid medical records that significantly minimizes your security and privacy risks.

While we’re obviously in business to promote Breeze, we are also saddened to hear of these types of privacy breaches, both from the patient’s and healthcare provider’s standpoint.  We definitely want to be part of the solution when it comes to securely transmitting healthcare records.  Please contact us if you would like more information about Breeze and how we can help your organization minimize potential privacy risks.  Terry – TerryW@NimbusHealth.com

I figure, there’s no worse way to break a month-long silence than with a purely self-glorifying post…so here goes:

We got named Microsoft’s Startup of the Day today!

Big thanks to Microsoft, and to the BizSpark team for taking the time to get to know us and what we’re all about. Anyone else out there with a startup, I highly recommend the BizSpark program.

Justin

Newsletters sent via email are great because they let you reach out to specific people, provide unsolicited value, and remind them that you’re out there. The downside is that when you email newsletters, the information inside them isn’t easily discoverable by new people.

Blogs on the other hand are automatically indexed by search engines and will virtually guarantee new people find your information. Of course, those new people may or may not people the people you really want to reach out to. So…

Why not do both? The purpose of both your newsletter and your blog should be largely the same: demonstrate expertise by providing value to your readers. In fact, the content should be largely the same as well. Neither blogs nor newsletters will be successful if you’re just shilling your services. If on the other hand you’re always providing value, readers won’t care what format it comes in.

Here’s what I recommend:

• Write blog posts once or twice a week
• Figure out which blog posts are most useful/generate the most traffic
• Once/quarter send out a newsletter with summaries and links to your five most popular articles

This technique will ensure you are not only sending out the most valuable information to your newsletter recipients, it will also remind them you have a blog and should lead to more subscribers.

When you get ready to send out your newsletter, check out the following services:

• Constant Contact – The “big name” in managing email campaigns
• MailChimp – Free if you’re sending to 100 people or fewer. Also offer pay/email pricing plan.
• iContact – Strong alternative

Good luck!
Justin

I got the privilege of speaking at the annual Oregon chapter meeting of the American Health Information Management Association (OrHIMA) on leveraging the web for professional networking.  I figured I’d record the dry run so anyone else interested in the talk could take a look.

Topics covered:

• What is professional networking online (aka professional social networking)?
• Why is it worth it?
• What are some of the key tools?
  • Generic communities (FaceBook groups, LinkedIn groups, Yahoo! Groups)
  • Specific communities (Codapedia.com, AskLeslie.net, etc.)
  • Your community (blogging & twitter)
• How to get started

There’s a lot more information on this subject that I’d love an excuse to share, so if you have any questions, please don’t hesitate to ask.

Thanks,
Justin

Those of you who know me personally know that I’m a big fan of Gary Vaynerchuk and his video blog at Wine Library TV.  Sure, I like wine and learning more about it, but I’m amazed by Gary’s ability to leverage the web & social media to revolutionize a tradition industry like the one surrounding wine.

As you’ll see, Gary provided the inspiration for interviewing guests here on the Nimbus Health blog.  Thanks for that Gary; we’re changing more than just the wine world.

Big thanks to Rand Fishkin, CEO of SEOmoz for being a great sport and reviewing Two Vines Columbia Crest 2006 Merlot/Cab blend with me.

I had the terrific privilege of interviewing Rand Fishkin, an undisputed titan in the Search Engine Optimization (SEO) field.  I highly recommend taking a look at this video if you’d like to learn more about getting your site to the top of search engine results.  Here’s what we covered:

* What is SEO?
* What’s the difference between SEO & SEM?
* Why should healthcare CIOs care about SEO?
* Why should healthcare consultants care about SEO?
* Examples of good SEO’rs in healthcare
* Ways to increase your site’s SEO
* Free SEO tools you should look into
* What is SEOmoz?

SEOmoz – High quality tools & advice for Search Engine Optimization.  I highly recommend checking their site out, especially Rand’s Whiteboard Friday sessions on the SEOmoz blog.  Btw, SEOmoz will donate $1 to Ocean Conservancy for each visitor they get from the SEOmoz link by 5/9/09.

Seattle Children’s Hospital – Terrific example of a healthcare organization leveraging SEO.

Remember when I mentioned the issue of open source EMRs having trouble scraping up enough money to get certified, as would be required by the HITECH portion of the ARRA for users to get their stimulus money?  Senator John D. Rockefeller has unknowingly proposed an interesting solution: federal grants to subsidize open source development.

I’m not sure Rockefeller understands how open source projects are typically funded (blood, sweat, & tears…but usually little in the way of $), and I see no mention of utilizing this money to achieve CCHIT certification, but he could have stumbled upon an interesting solution to a problem he may not know exists.

CCHIT has to charge something for the certification process because it’s supposedly extremely time consuming.  And while open source EMR developers may be rich in passion and skillz, the vast majority of them aren’t going to be able to put up the money for certification…so why not make federal grants available to subsidize these non-profit organizations developing software that everyone can benefit from?

I’ll throw out a hybrid solution: CCHIT lowers their certification costs for open source projects by 50%, potential users/developers of the system scrape together some money to cover half the remaining  cost, and grants be made available to cover the rest.  At that rate, we’d be looking at as little as $10k from users/devs and $10k in grants to get an open source EMR certified every 3 years.  Could be a solution that keeps the open source community thriving, requires at least $10k of “buy-in” from prospective users, ensures CCHIT can cover most of its own costs, and provides a excellent alternatives for healthcare providers who find open source systems to be a better value than traditional closed source ones.

Justin

If you’re in the Seattle area (+/- 100 miles), grab a ticket to the Seattle 2.0 Awards and get a sneak peak at what we’re working on for our next release.  We were lucky enough to get selected to demonstrate our product on May 7th and we’re pushing hard to incorporate one of our most exciting new pieces of functionality before the big day.

In addition to us, you’ll also get to see 12 other up-and-coming companies demonstrate their technology, not to mention you’ll rub elbows with the big players in the Seattle start up scene.

Hope to see you there – should be a great time!

Justin

One of the best ways we’ve found for reducing overhead, next to crowdsourcing, has been to leverage online printing companies instead of the standard Kinko’s or local print-shop plays.  Two of our favorites are:

uPrinting.com – Great for business cards, flyers, rack cards, etc – anything that you print on paper.  You can upload your graphic files to their website and order in less than 10 minutes.  The quality is terrific (better than Kinkos & another local shop we tried) and I haven’t seen better prices anywhere else.

BuildASign.com – Cheesy name, but these guys knock the ball out of the park.  Again, great software, very high quality output, and almost astounding prices on banners, signs, etc.  We just got a sign printed up by them to be delivered next week.  We called a couple local shops and they quoted us 5-times the BuildASign price.  When we told them that was way too high, they dropped their price to 3x the BAS price.  Clearly the BAS guys are leveraging the economy of scale advantage they have to keep their prices extremely competitive.

Next time you need something printed, and you’ve got a week of lead time, I highly recommend trying an online printing service.

Justin

HIMSS has published their recommendations on the definition of meaningful use for both hospitals and physicians.  I recommend everyone interested in healthcare IT take a look at them.

A couple interesting pieces caught my eye:

1. Acknowledgment of open source systems.  Today, the cost of receiving CCHIT certification (approx. $35k) prohibits the vast majority of open source EMRs from getting an official stamp of approval.  Of course ARRA requires that stimulus money only be provided to users of “certified” technology (which will likely be provided by CCHIT), potentially leaving open source developers and users out in the cold.  That the FOSS community and the CCHIT board were able to meet at the HIMSS ‘09 conference and discuss ways around this problem clearly manifests itself in these documents.  HIMSS clearly recommends that HHS tackle the CCHIT & open source problem, which is the first step towards a win for everyone.
2. Progression of interoperability over time.  Overall HIMSS appears to place an importance on interop, but only after the first “phase” of widespread EMR adoption.  With that timeline, we won’t be looking at mandated interoperable systems until 2013 or so.  That’s not the end of the world and it’s certainly better than nothing, but I would have liked to see interop make a more substantive showing in “phase 1.”

Just my thoughts, what are yours?

Justin

In a terrific example of a healthcare organization leveraging the power of social media to disseminate valuable and timely information, the CDC is now tweeting updates on the Swine Flu.

You can follow them here: http://twitter.com/CDCEmergency

Justin

Our second interview with members of the healthcare community who think like startup – Mark Horoszowski from White Space Healthcare Marketing. Mark has a lot of expertise in the world of “social media” which he generously shares with us:

More information:

White Space Healthcare Marketing
Mark will donate $1 to the Tacoma Relay for Life for each visitor who clicks the link above over the next two days.

American Cancer Society

Btw, feedback on our interview format would be very much appreciated.  Shorter, longer, more shots of the product/website in use, higher quality video, etc.?  How can we make these more interesting and informative.

Justin