Readers Write: ICD-10 Readiness – What Do Your Colleagues Think? (And What Are They Doing?)

ICD-10 Readiness: What Do Your Colleagues Think? (And What Are They Doing?)
by Jim Denny

Here’s a quick survey for all the HIStalk readers out there: Which of the following is the most common occurrence?

1. An ant in an anthill
2. A mullet (hairstyle, not fish) at an Eagles concert
3. An ICD-10 article on a healthcare technology website

I should probably add option (d) all of the above, since each is pretty common. Just as you’d expect to see an ant or several hundred when you brush up against an anthill, I’m sure you’ve brushed up against quite a few ICD-10 how-to articles in recent months. I’m not mocking these articles – as a matter of fact, Navicure is responsible for many of them, so why would I? But, I’m sure some of you are tempted to skip over this piece simply due to its title. After all, what could I possibly say that hasn’t been said?

Keep reading — it will give you a sense of what your colleagues across the nation have accomplished (and are concerned about accomplishing) to prepare for ICD-10, and how they feel about the impending transition date. Between 2013 and 2015, Navicure conducted three surveys with physician practices as participants to obtain insight into their leaderships’ plans, attitudes, and progress related to ICD-10. Most recently, we released key findings from the 2015 survey. Here are a few of note:

• The state of ICD-10 preparedness varies widely, but practice leaders are very optimistic they’ll be ready by the transition date. In Navicure’s most recent survey, only 21 percent of respondents believed they were on track with their ICD-10 plan. Even so, 81 percent were confident they’d be ready by October 1, 2015. This level of optimism is great; a doomsday attitude can’t be conducive for learning and preparing. On the other hand, the optimism shouldn’t be at the expense of detailed orientation and thorough planning. If your organization hasn’t kept up with its original ICD-10 plan, it’s a good time to make adjustments and come up with something your team can truly accomplish in the months remaining.
• The ICD-10 delay impacted practices positively and negatively. Not surprisingly, nearly 60 percent of practices “pressed pause” on their ICD-10 implementation efforts when CMS announced the delay in 2014. Between Meaningful Use, value-based reimbursements and other strategic priorities, this extra year has been a gift. In the final stretch, though, it’s important to regain any lost momentum and keep your organization on task. A plan that builds on weekly progress across key components such as vendor updates, coding, and clinical documentation will keep your organization on track.
• Physician practice leaders don’t think ICD-10 will be delayed again. Slightly more than two-thirds of respondents believe the transition date will take place on October 1, 2015 as planned.
• Most recently, respondents believe the biggest challenge they’ll face is dealing with unprepared payers. In the January 2015 survey, 41 percent of respondents cited lack of payer readiness as the most challenging aspect of the transition. End-to-end testing with payers remains a priority, but the number of practices opting out has increased. In the two earlier surveys, respondents cited training as their greatest challenge.
• The greatest concern amongst practice leaders is how ICD-10 will impact revenue and cash flow. The overwhelming majority of respondents in all three surveys cited revenue and cash flow as their top ICD-10 concern. This isn’t surprising, since every facet of ICD-10 preparedness – from training to vendor updates – can impact cash flow. Having a contingency plan – for instance, establishing a line of credit with a bank – can give you peace of mind and ensure your practice operates smoothly during the initial weeks of the transition.

Want to learn more about what your colleagues think about ICD-10? Download the complete report. And please take advantage of those thousands of how-to resources available across the industry so you can be ready for October 1, 2015.

Jim Denny is president and CEO of Navicure in Atlanta.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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News 3/5/15

Top News

HHS Secretary Sylvia Burwell and predecessor Kathleen Sebelius attend oral arguments in the King vs. Burwell Supreme Court case, which is expected to wrap up by the end of June. At issue is the legality of the subsidies for an estimated 7.5 million subscribers in the 34 states that chose not to run their own health insurance exchanges. Critics argue that the law, as written, permits the subsidies to go only to people who use state-run exchanges. Administration officials contend the subsidies were intended to be available in all states.

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Thanks to the following sponsors, new and renewing, that recently supported HIStalk Practice. Click a logo for more information.

The HIMSS 15 media requests have started to trickle in. Note to PR and marketing professionals who may reach out to the HIStalk team with interview opportunities: There’s a good chance we won’t respond if your opening line is “Hello XX.” That tells me right off the bat that you don’t have a vested interest in our team, and that you’re not very attentive to detail and/or proofreading. Should you work at a PR firm, it also does no favors for your clients. While I have few pet peeves, laziness is definitely one of them.

I completely neglected to celebrate the birthday of Dr. Seuss on March 2, despite the fact that several school-age children in close proximity are honoring him this entire week. Fortunately, Mark Gettleman, MD penned this poem in homage. You can read my interview with him (Dr. Gettleman, not Dr. Seuss) here.

Webinars

March 5 (Thursday) 2:00 ET. “Care Team Coordination: How People, Process, and Technology Impact Patient Transitions.” Sponsored by Zynx Health. Presenters: Grant Campbell, MSN, RN, senior director of nursing strategy and informatics, Zynx Health; Siva Subramanian, PhD, senior VP of mobile products, Zynx Health. This webinar will explore the ways in which people, process, and technology influence patient care and how organizations can optimize these areas to enhance communication, increase operational efficiency, and improve care coordination across the continuum.

March 12 (Thursday) 1:00 ET.  “Turn Your Contact Center Into A Patient-Centered Access Center.” Sponsored by West Healthcare Practice. Presenter: Brian Cooper, SVP, West Interactive. A patient-centered access center can extend population health management efforts and scale up care coordination programs with the right approach, technology, and performance metrics. Implementing a patient-centered access center is a journey and this program will provide the roadmap.

Acquisitions, Funding, Business, and Stock

The local business paper profiles JobMedic LLC, a Houston-based startup that’s looking to be Monster.com for healthcare. The eight-month-old company is piloting a program that allows health organizations to import their job listings directly to the site, and plans to target HR departments across the country with a similar service.

Medic Management Group Managing Director Tom Ferkovic points out that the grass isn’t always greener on the other side, at least when it comes to hospital-employed physicians in Ohio. “The pendulum has swung,” he says, adding that physicians have started to leave hospital umbrellas in the northern part of the state to form 30-plus doctor groups. “Some are doing really creative things with quality measures and contracting for risk and bundled payments,” he adds. “They’re faster, they’re more nimble when they have an issue on fixing those, because its their money."

Announcements and Implementations

Cornerstone Health Enablement Strategic Solutions (NC) chooses Lightbeam Health Solutions for population health management.

Chase Brexton Health Care (MD) selects i2iTracks population health management solution from i2i Systems to help care for 30,000 patients across seven clinics. It partnered with the Mid-Atlantic Association of Community Health Centers and other FQHCs in Maryland to purchase the company’s PopIQ analytics tool.

Government and Politics

The Citizens Council for Health Freedom offers Minnesotans a way to petition against a state mandate that requires all healthcare providers use an interoperable EHR without giving individuals the right to opt out. Its one-page citizen petition argues, among other points, that, “Interoperability also limits patient access to unbiased second opinions.” I’d like to hear from physicians if this is indeed the case. Does seeing another physician’s diagnosis and notes tend to sway you in the same direction?

Senators John Thune (R-SD), Lamar Alexander (R-TN), Pat Roberts (R-KS), Richard Burr (R-NC), and Mike Enzi (R-WY), authors of the 2013 REBOOT report, express their frustration with HITECH’s $35 billion investment, pointing fingers at ONC and its lack of “nitty gritty” vision for interoperability:

“The long-term sustainability of EHR systems remains one of the biggest unknowns. ONC’s roadmap is surprisingly silent on this topic, which is stunning considering that there is only $7 billion in funding left from the HITECH Act. While the President’s Budget does request a significant increase in funding for ONC, the administration seems to ignore the reality that taxpayers have already committed billions of dollars toward a goal that is still vague.”

The HIT Strategy & Innovation Workgroup attempts to provide a high-level summary of 400 public comments on ONC’s 10-year Federal Health IT Strategic Plan. Its recommendation that the plan “must hold federal partners accountable, with regular, transparent reporting on progress toward goals,” especially stood out to me, given the senatorial concerns noted above.

Telemedicine

Georgia Partnership for Telemedicine representatives install five telemedicine carts in Lusaka, Zambia as part of the Zambian Defense Force telemedicine project. The GPT team will travel back to Zambia next month to install three additional carts and provide training to Zambian clinical staff.

A bill to expand telemedicine in Colorado heads to Governor John Hickenlooper’s desk after passing muster in both the state House and Senate. The governor now has 10 days to sign or veto the legislation, which would require insurers to reimburse equally for telemedicine and in-person services in counties of all sizes. Previous legislation allowed for reimbursement in counties with 150,000 or fewer residents.

Research and Innovation

A study of diabetes patients 50 and older finds that the majority have no use for mobile apps to help manage their condition. Of the 32 study participants, half refused to use apps because they saw no added benefit. Twelve percent experienced problems with interoperability (or lack thereof), and another 12 percent decided against them because of poor user experience.

@QualcommLife’s tweet from the Mobile World Congress in Barcelona captures in a 140-character nutshell the mobile health experience of the diabetes study participants.

Physicians have just a few days left to participate in the 13-question WEDI survey on ICD-10 readiness.

People

William Kinsley (NextGen) is elected to chair the HIMSS EHR Association Privacy and Security Workgroup.

ChartSpan appoints Patrick Carter vice president of product, in addition to his existing roles as co-founder and senior medical officer.

Other

News coverage of a recent rape investigation at the University of Oregon brings to light privacy issues related to student medical records. Students are crying foul over the fact that their on-campus medical records can be used against them in court because they are covered under the Family Education Right and Privacy Act (FERPA) rather than HIPAA.

A Wall St. Journal article titled “The Next Marketing Frontier: Your Medical Records” highlights the alerts and reminders sent to patients in Practice Fusion’s EHRs, with some of those messages paid for by drug companies. Practice Fusion’s CEO defends the practice, saying that with regard to the alerts and presumably the company’s free EHR, “someone has to pay for it” and adds that new agreements have been signed to deliver sponsored alerts from Aetna and another drug company. He also states, “For every project we do that drives forth public health or gives data away, we need to make sure it’s balanced out by a monetizable exercise.”

NHS GP Samir Dawlatly writes a piece for The Guardian about what NHS England will be like in the future, given that “automatons” will be in almost total control:

“I feel around for the micro USB port behind my left ear. Even though wireless transmission rates are pretty good, I still prefer the ultrafast USB 12.2 link to download the latest medical updates. I’ve had the last three days off, so there will be a lot of new guidelines, alerts, emails, novel medicines and recommendations to stop dangerous old therapies to download onto my integrated organic digital hybrid memory hard drive inserted into my hippocampus – the centre for memory and learning in my brain. I notice that my own computer still takes several seconds to boot up. I wonder why doctors have the worst hardware and the slowest software, even though we have people’s lives in our hands. At least mistakes have decreased since the advent of the integrated hippocampal hard drive, enabling all medical knowledge to be deposited and updated weekly in the doctor’s memory.”

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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HIStalk Practice Interviews Lawrence Bentvena, DC CEO, ClickAClinic

Lawrence Bentvena, DC is founder and CEO of ClickAClinic.

Tell me about yourself and the company.
I have a significant background as a medical practice management consultant and as a healthcare entrepreneur. The impetus for founding ClickAClinic was to fill a significant need for doctors and patients; namely, to be able to communicate their health concerns within a single, fully integrated Web-based platform. Additionally, we at CAC realized that there are a significant group of Americans without health insurance coverage, and so we designed our platform to provide an extremely cost-effective video medical consultation. We believe that most physicians will eventually want to donate a portion of their time to providing free medical care to this population, provided those physicians and related healthcare entities are empowered with a simple and HIPAA-compliant platform they can utilize.

We currently have between seven and eight full-time staff, and at least that many off site helping us to launch. Since we own all of our technology, we currently support two business models – CAC as a direct medical provider model and CAC as an SaaS model. We are focusing equally on both. Enterprise customers and early adopters are seeking us out at this time. With regard to investment funding, we’ve had interest from several very large private-equity funds and individual family trusts.

Did you develop CAC’s telemedicine software in-house, or did you collaborate with a vendor?
I hired U.S.-based code developers that are employed by my company directly. The CAC platform represents over 700,000 lines of code, and required two-and-a-half years of full-time work, and direct planning/architecture and code development.

What EHR does CAC use? Why did you choose that solution?
We currently utilize OpenEMR, an open-source HER that we have licensed and added significantly to its look, feel, and functionality. We believe it was the best fit as it allowed us to remain 100-percent Web based. On a related note, we are preparing to attest for Meaningful Use.

How many physicians have signed up to provide care?
We have two full-time physicians and one full-time ARNP providing care. On our SaaS side, we are in beta currently and have signed enterprise customers. These customers have various numbers of providers. We are beginning our direct provider model as we speak.

How many patients have used your service?
At least 200 so far. That number is growing daily.

CAC made news recently for becoming Florida’s first licensed medical provider of telemedicine services and software. Are you planning to offer services outside of the Sunshine State?
Our current AHCA license provides CAC with the opportunity to be a licensed healthcare facility. This license holds no sway outside of Florida. However, we believe this will allow us to achieve licensure status in the remaining states.

How involved are you in helping to push telemedicine legislation through Florida’s legislature?
I am currently communicating through our spokespeople with various legislative entities in Florida. Some of them have asked our company to provide testimony and/or opinions on telemedicine issues.

Do you think it will finally pass this legislative session?
I do believe it will pass this legislative session, as the various stakeholders have identified and realized that without any law in place in Florida, they may well have too many unregulated telemedicine service providers. Additionally, we are the second most populated state in the U.S., and we are one of the very last to have any kind of telemedicine law at all, so the legislators have realized this is not a good situation for our citizens.

Would you like to share any final thoughts?
Though the obstacles facing our healthcare system seem insurmountable, the advent of new telemedicine applications offers us some hope that a solution is available. Telemedicine, while not a novel concept, is more and more frequently brought to the forefront of efforts to reduce costs and improve patient outcomes. Improving patient access to healthcare options and facilitating early detection of complications results in better patient outcomes and, in the long term, a reduction of cost. 

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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From the Consultant’s Corner 3/3/15

Primary Care Networks
They can be a win-win for medical centers and physician practices.

Competitive pressures, access to expanded patient populations, healthcare reform, and changing reimbursement models have required healthcare organizations to re-evaluate their growth and population health management strategies, which often includes implementing clinical alignment and integration initiatives. One such initiative becoming increasingly popular again is the formation of employed primary care networks.

The primary care model offers substantial benefits for both the academic medical center and the physician practice, including:

Health system benefits. In the past, academic medical centers and integrated delivery systems created physician networks with the intent of growing their patient population, expanding their service area and brand, and creating opportunities for primary care teaching. Although the initial goals are still valid, a more financially prudent and economically sustainable approach is to develop and manage the network not as a cost center, but as a sustainable delivery model. This improves care quality, and does so in a manner that downstream revenues — from sources such as specialty referrals, hospital-based services, and inpatient admissions — exceed the network’s operating expenses. For example, according to a 2006 Academic Medicine article, Ohio State University Medical Center (OSUMC) found that for every $1 invested in its primary care network, it received $6.30 in downstream contribution margin.

In addition to the financial benefits, primary networks can help position medical centers for future success. For instance, in the context of population health management, primary care physicians will bring significant strategic value to health systems in overseeing large populations. As the industry keeps moving toward value-based care, health systems will increasingly rely on their primary care networks to manage quality and care delivery, as well as coordinate care across a range of providers.

Physician practice benefits. As healthcare reimbursement declines and business risk increases, more physicians are considering selling their practices. A 2012 survey by the American Hospital Association showed that between 2000 and 2010, hospital employment of physicians increased by 32 percent, and that trend appears to be continuing. With shrinking margins and increasing costs, independent physicians are struggling to maintain profitability.

There are many reasons why joining a private network can be an attractive option. For instance, it can reduce overhead, while providing a better work-life balance and predictable compensation. It can also offer practices greater negotiating power with payers as well as access to more cutting-edge technology because physicians benefit from the collective resources of the larger group and health system.

In some cases, patients have greater exposure to a wider range of specialists within an academic or large-scale health network, helping practices attract more patients and ensure better care continuity. There is also benefit in aligning with the medical center brand, potentially improving credibility and driving even more patients to the practice.

It’s all in the design
In my experience, in order for a primary care network to be a strategic asset for an academic medical center or other large health system, it must be designed and managed correctly. Effective network management includes:

• Developing reasonable practice-management controls.
• Crafting appropriate, incentive-based compensation models.
• Consolidating management, administrative, and clinical staff.
• Right-sizing property, plant, and equipment.
• Achieving balance between internal and outsourced services.

Before going down this road, medical centers should create a strategic plan that addresses all of these points, including how they will accomplish these tasks. Moreover, they should engage in financial modeling to budget and manage true downstream revenues.

Just like their medical center counterparts, physician practices must also take a strategic approach when deciding whether to sign on to a primary care network. While the benefits can outweigh the negatives, physician practices need to fully understand the impact of the decision before making the commitment. In particular, practices should keep in mind that they may lose some autonomy, see a reduction in administrative staff and/or be compelled to redefine their productivity expectations.

Planning ahead
Whether an organization is looking to create a primary care physician network or join one, there are several complexities to consider, and organizations should not rush in without careful planning. As such, both parties can benefit from seeking expert resources in areas such as strategy development, contract negotiations, and network management. By taking a careful approach, medical centers and physician practices can achieve a partnership that truly supports collaborative care both now and in the future.

Brad Boyd is vice president of sales and marketing for Culbert Healthcare Solutions.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis

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News 3/3/15

Top News

Allscripts and NantHealth make a play for precision medicine, announcing they will partner to develop genome-based clinical decision support features within the Allscripts EHR that will help oncologists create personalized cancer treatment plans.

Reader Comments

From Lady XYZ: “I thought this was an interesting article. Given that Pittsburgh has deep healthcare roots but yet the article indicates there are only three physicians in the area that offer concierge service.” The article she refers to profiles Rebecca Plute, MD a hospital and family care physician that struck out on her own to launch a concierge practice. The business model seems to be slowly growing in popularity – Plute notes that 5 percent of physicians have taken the leap so far.

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I literally laughed out loud when I read of Mr. H’s disdain for comparing Uber and healthcare: “I swear I’m going to throw up the next time some inspiration-impaired ‘thought leader’ tries to draw parallels between anything healthcare-related and Uber.” I’ve shared my similar opinion in the past (though in a more delicate fashion), but wonder if I might have to concede that the two might have more in common than we thought given that the ride-sharing startup announced late last week that a May 2014 data breach has affected 50,000 drivers. No fingers have yet been pointed at China or North Korea (or Lyft, for that matter) and no misuse of the data, which included names and license numbers, has been detected thus far.

Webinars

March 4 (Wednesday) 1:00 ET. “5 Steps to Improving Patient Safety & Clinical Communications with Collaborative-Based Care.” Sponsored by Imprivata. Presenters: Robert Gumbardo, MD, chief of staff, Saint Mary’s Health System; Tom Calo, technical solutions engineer, Saint Mary’s Health System; Christopher McKay, chief nursing officer, Imprivata. For healthcare IT and clinical leadership, the ability to satisfy the clinical need for better, faster communication must be balanced with safeguarding protected health information to meet compliance and security requirements.

March 5 (Thursday) 2:00 ET. “Care Team Coordination: How People, Process, and Technology Impact Patient Transitions.” Sponsored by Zynx Health. Presenters: Grant Campbell, MSN, RN, senior director of nursing strategy and informatics, Zynx Health; Siva Subramanian, PhD, senior VP of mobile products, Zynx Health. This webinar will explore the ways in which people, process, and technology influence patient care and how organizations can optimize these areas to enhance communication, increase operational efficiency, and improve care coordination across the continuum.

March 12 (Thursday) 1:00 ET.  “Turn Your Contact Center Into A Patient-Centered Access Center.” Sponsored by West Healthcare Practice. Presenter: Brian Cooper, SVP, West Interactive. A patient-centered access center can extend population health management efforts and scale up care coordination programs with the right approach, technology, and performance metrics. Implementing a patient-centered access center is a journey and this program will provide the roadmap.

Here’s the video of the “Cloud Security Primer” webinar that was presented by Sensato CEO John Gomez last week.

Announcements and Implementations

The Palm Medical Group (FL) selects HealthFusion as its vendor of choice for EHR software. PMG, an independent provider association, will introduce HealthFusion’s MediTouch EHR to its 1,7000 physician members.

ProPublica launches an app that shows consumers if their healthcare companies have been hacked, and what federal fines were imposed as a result. Over 1,100 large-scale data breaches have been reported since 2009, with just seven resulting in fines. The investigative journalism company also seeks input from impacted consumers to further its research on medical privacy.

ManagementPlus and HydrantID partner to enhance patient portal security measures in an effort to better protect sensitive communications between optometrists and their patients.

Vericle partners with healthcare business development company MDReferralPro to offer physician practices a combined marketing and PM system.

SRSsoft launches its Essentials EHR for specialists and new EHR users, labeling it as “an alternative, non-MU EHR” that allows users to gain benefits without having to change the way they practice.

Acquisitions, Funding, Business, and Stock

Healthcare market intelligence company Definitive Healthcare receives a “significant investment” from Spectrum Equity. As a result, Spectrum Equity’s Jeff Haywood and Chris Mitchell have joined Definitive’s Board of Directors.

Microsoft’s Tom Lawry outlines how the company’s acquisition of Revolution Analytics earlier this year will help it build a foundation for future “Big Data” healthcare solutions.

Telemedicine

Foster family recruiting agency KVC Nebraska rolls out the MyLink telehealth and distance learning program to 500 children and adolescents in 300 foster families. The program, a result of new grant from the USDA’s Rural Utilities Service Distance Learning and Telemedicine program, will help connect foster kids with behavioral healthcare services and educational resources.

Research and Innovation

Intel-GE Care Innovations, a join venture between Intel and GE Healthcare, partner with Cincinnati-based Xavier University’s Center for Innovation to test and analyze “health peripherals” and apps that will help patients manage their chronic conditions from home.

The local paper profiles MB Device LLC, a Louisville, KY-based startup that is working to develop a mobile health device that will predict preterm births. The company’s prototype measures cervical impedance via sensors implanted in the cervix, and then wirelessly sends those measurements to the patient’s smartphone for further analysis by her and her physician. "It’s a device to be able to predict labor,” explains founder Divya Cantor, MD. ”That’s the broadest definition. The (idea) is to help women know what’s going on with their bodies before they feel it."

People

Justin Barnes (ATDC) joins Austin, TX-based ePatientFinder in an advisory capacity.

Joining PerfectServe are Terry Hayes, RN, MSN as VP of client experience and Michelle McCleerey, PhD, RN (TeleTracking) as VP of product marketing.

Other

Tech columnist Dan Gillmor writes a pretty compelling piece on why he has made a conscientious effort to stay away from Microsoft, Google, and Apple: “Control is moving back to the center, where powerful companies and governments are creating choke points. They are using those choke points to destroy our privacy, limit our freedom of expression, and lock down culture and commerce. Too often, we give them our permission — trading liberty for convenience — but a lot of this is being done without our knowledge, much less permission.” His sentiments seem to draw striking parallels with the plight of healthcare data: Hacks are becoming downright de rigeur; interoperability still seems like a pipe dream; and a growing group of patients, vendors, and physicians advocate for the Open Notes route.

Nokia CEO Rajeev Suri weighs in on the net neutrality debate, arguing that service providers should be able to tap into an Internet “fast lane” if consumers demand it. He cited connected healthcare and driverless cars as prime examples of services that will be negatively impacted by a one-speed-fits-all World Wide Web.

High tech attempts to meet high fashion in Apple’s 12-page advertising spread in the March issue of Vogue. There’s a fine line between haute couture and depeche mode, which means the cheap and chic version of Apple Watch will likely trickle down to High Street/Big Box retailers in the coming months. 

Sponsor Updates

• E-MDs posts a preview video for its users group conference June 18-20 in Austin.
• Medicomp Systems posts a HIMSS15 preview video featuring its Quipstar game show (watch for the Dr. Gregg cameo).
• Nordic offers the first episode in its “Making the Cut” video series on Epic conversion planning.
• The Informed Medical Decisions Foundation, a division of Healthwise, hosts Shared Decision Making Month in March.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

More news: HIStalk, HIStalk Connect.

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