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October 18, 2007 News 7 Comments

From Rogue: “Re: HIMSS. The ‘HIMSS alliance with some kind of emergency response group’ grew out of COMCARE’s participation in a HIMSS work Group on health IT for emergency responders. The Work Group published a white paper a few months back (available on the HIMSS website) outlining the patient data issues confronting emergency responders in emergency and disaster situations.”

From Laurie Strode: “Re: Insight. The McKesson Insight user group conference is underway in Atlanta. I’ve attended this conference several times, but not this year (due to scheduling conflicts). It has usually been a good use of time, excellent educational sessions put on by a wide rage of users ranging from nurses and physicians to analysts and consultants.” Link. Somebody ask a question of the keynote and loudly and clearly reference HIStalk, please. Free PR, you know. Is Charlie McCall there?

From The PACS Designer: “Re: Oracle. As a final post on the Oracle Database 11g software, TPD wanted to leave HIStalk readers the web link that lists the features previously mentioned plus some other nice features of this new software offering.” Link.

From Annie Brackett: “Re: Inga. Someone asked me at a cocktail party recently, out of nowhere, ‘Are you Inga’? EVERYONE knew what they meant. I said not hardly, but was flattered. I thought that Inga would be pleased. She’s now like one of those stars that goes by one name, but everyone knows them … Cher, Madonna , Britney, etc.” Well, now you’ve gone and swelled her head with her newfound anonymous fame. Note her news items below – she’s noticeably saucier than usual. Isn’t she fun? Now she’ll want an entourage.

From Lindsey Wallace: “Re: Sunquest. What happened to their other products?” You must be an old-timer. The new Sunquest has deconstructed itself back to its very early roots, selling only lab-related applications. Pharmacy, radiology, Clinical Events Manager, etc. have all been history for some time. I remember a great writeup in Investor’s Business Daily about CEM — right before they pulled the plug on it. Flexirad used to be pretty good, pharmacy not so much. All on the ash heap of IT history. Just laboratorian stuff now.

John has some good stuff on Google Health (“the vision is gone”), HealthVault (“the cupboards were bare”), and Dossia (“… there is a ton of cynicism regarding what the true motivations are of the employers that are sponsoring Dossia.”) I see that, like me, John’s working the cynicism space. Good reading, although I must point out that, despite John’s indifference to Google’s message, VP Marissa Mayer (who was doing the talking) is not only a Stanford MSCS, but an awarded Stanford programming instructor, and not terribly hard to look at besides. She joined in 1999 as one of the first 20 employees, so I’m sure she’s loaded, too. A pretty, rich, 32-year-old geek … well, life’s just unfair.

Speaking of Google, Q3 numbers just came in: revenue up 57% to $4.23 billion, EPS $3.38 vs. $2.36. Yep, that’s over a billion dollars’ profit in one quarter. The company added over 2,100 employees in the quarter, pushing them up to 16,000.

WebMD wasn’t so lucky. Its shares toileted, down 14%, after the company missed Q3 estimates. More importantly, though, was an announcement that the company had signed a multi-year agreement with Yahoo for seach and advertising. That means no Google takeover, which means no one wants wildly overpriced WBMD stock (PE of 236).

Cerner’s Q3 numbers, also just announced: revenue up 8%, EPS $0.43 vs. $0.33. The value of Neal’s shares: $371 million. Makes me remember that it will be HISsies time soon (The Pie).

And speaking of Cerner, this looks like it might be a video made at Cerner’s bash at HIMSS. Despite entertainment featuring two soul groups missing all but one original member each (who sound good anyway, I noticed), the chick on the right is obviously getting down with her bad self and the one gesticulating at her beer looks a little bit like Marcia Brady.

Ben Williams is named CIO for Catholic Healthcare West, coming over from St. Joseph Health System in Orange, CA. Must have been some good money – he was making $644K at St. Joseph in 2005, according to federal forms. No vows of poverty at the new place, either – the president was paid $4.5 million and almost all the VPs were over $1 million, according to the most recent forms. Actually, I was more eloquent back in February: “Humble servant CEO Lloyd Dean made $5.8 million in compensation and benefits in 2005. Read that again slowly … the guy running a nonprofit hospital group out-earned most publicly traded company CEOs. So much for a vow of poverty. Even their HR VP made $1.9 million. What the hell is that all about? You’re telling me that a Catholic-run hospital group has to pay $1.9 million a year to get someone to run HR? And they’re supposed to be a non-profit? Ridiculous. Excessive. Embarrassing. I’m not out of adjectives, but I’ll stop.”

Listening: new VAST.

My thought while driving to work today: widespread lack of IT success in hospitals may be due to the never-ending threat of healthcare personnel shortages (despite the skills of multi-million dollar HR VPs slaving away). Hospitals have a lot of licensed employees who could work in any number of places, most of whom are expected to use IT systems as part of their jobs. What are the odds that hospitals will strong-arm them into changing their work processes as part of a software implementation? Nobody tells nurses, pharmacists, rad techs, etc. what to do because they’ll just jump ship for a competitor or better job. High-paid executives (see above) aren’t about to lift a bedpan, so it’s better to tread lightly when it comes to imposing order. And without that, IT will surely fail. IT is the only industry I can think of where the most highly educated, mission critical, short supply professionals are the ones expected to tickle the computer ivories. I’m not sure I disagree with Reid Conant’s ‘scribe’ model of letting somebody else do the typing. At least with expendable staff you’d have a shot at repeatable processes.

If you want to play around with a mashup tool for non-geeks, Microsoft just release Popfly to beta. Do something interesting with it and let me know.

I haven’t done a poll for a long time, so I figured it was time. To your right: do you keep a PHR?

I’m hearing that Kaiser Permanente has laid off some IT folks at Pleasanton. Feel free to let me know using the anonymous Rumor Report to your right (I’m fanatical about keeping sources anonymous). Layoffs are their business, but the interest, of course, is whether they’re clearing the decks for outsourcing.

William Osler Health Centre in Toronto will implement SolComHealth e-HIM software from SolCom, integrating it with the hospital’s MedSeek portal and Meditech clinical system. I noticed a new SolCom web design while I was cruising, too.

Patient flow system vendor Premise held its three-day user group meeting last week in Mystic, Connecticut.

Even CNET weighs in on Medsphere’s lawsuit against its founders. “Still, customer wins like these would be all the sweeter if the company’s board could come to a peaceful resolution with its founders, Scott and Steve Shreeve. There is blame on both sides, but nothing that justifies a $50 million lawsuit against two entrepreneurs who created what the board manages today. It’s time to resolve the past.” I have never seen a company blacken its own eye so stubbornly and intently, just as it was trying to bootstrap up out of obscurity. That and its “we’re open source, but only if you don’t look too closely” waffling aren’t winning it any friends (or customers, most likely). Soothe the egos, fire the lawyers, make a decision whether you really want to be open source or not, and sell some damn software. We all want to like you, so don’t make it so hard for us. That’s Mr. HIStalk’s free management consultation.

British hospitals, stung by poor financial reviews by NHS, blame software that lengthened patient wait times and prevented cancer patients from being seen promptly. The software was not named, but I believe it may have contributed not only to their delays, but to someone’s $371 million fortoona.

E-mail me.

Inga’s Update

Some of my postings have not made the last couple of HIStalk issues. I am prone to paranoia attacks and initially thought Mr. H was censoring me. Turns out my email was not working (somehow I felt better knowing that it was Yahoo censoring me.) I am happily back online, freeing my energy to be paranoid about other things.

Speaking of paranoia, I think the Greenway folks may have some issues thinking folks don’t take them seriously enough. Greenway releases an announcement that it has “further established itself as a leader in the healthcare information technology (HIT) industry with its latest testimony before the U.S. House of Representatives Committee on Science and Technology.” Greenway’s vice president of marketing and governmental affairs, Justin Barnes, testified last month, along with execs from HCA, AIHMA, and GE, plus a Yale School of Medicine physician/professor.

dbMotion executive Ilan Freedman makes some interesting comparisons between the French HIE initiatives compared to what is going on in the US. I told Mr. H I would be willing to visit France to assess the situation and report back to HIStalk readers. Hmm … that must have been one of the many lost emails because he never responded back.

Re: Epic photos. Someone tell me what the big chicken is all about. I found it a bit creepy.

Only a blessing from the Vatican stands in the way of a merger between UPMC and Catholic-run Mercy Hospital of Pittsburgh. The FTC just approved the deal, as did the PA Attorney General.

Medseek announces new software agreements and consulting projects with 13 hospital systems.

Nuance makes yet another acquisition – the 10th this year, by my count. Guess that is one way to grow your business. Vocada, a provider of critical test result management solutions, is the Nuance’s latest purchase.

Medsphere contracts with another community hospital for its open source-based EHR systems and services. Century City Doctors Hospital in Los Angeles will implement OpenVista EHR at its 120-bed acute care facility.

e-MDs announces a new president, Dr. Michael Stearns. Founder Dr. David Winn will stay on as CEO and chairman of the board. One thing I admire about e-MDs is its commitment to having numerous clinicians on staff. That is not to say that Dr. Stearns, a neurologist, will necessarily make a great president, but I am sure he understands the needs of physicians.

Finally, at least one person acknowledges they agree with me, at least in part, that Microsoft’s HealthVault has some merit. Dr. Douglas Krell sent this note: “I’d like to agree in part, with your appraisal of Microsoft’s HealthVault PHR. I also agree with Dr. Singh that in the beginning, many of the PHR users may be likely to be the worried well, those with real chronic illness, and the Quicken users. But from the physicians’ point of view, I believe that it will be our job to educate and encourage people to make use of these systems to track and interpret their own health data.  We’ve always found that people who actively participate in their own care will be healthier. We need to support those efforts.  It will help us to practice and advise patients more efficiently.  We ARE paid for using these systems to the degree that the more patients we see, the more data we can review and process, the greater our productivity.  Ultimately the better patient care we’ll be able to provide.  Some people will ignore our advice but nevertheless, we should be advocating the adoption of this bit of information technology.”

Is it me, or are all the harshest PHR critics those in the HIT space? Is it because deep down we still want to be the ones to hold the keys to the patients’ records? Do we consider the products too immature to be useful? Do we not trust patients with this information? I remember in the early 80’s when ATMs first became available, you could only use your own bank’s ATM since they weren’t connected. Now you can access your money from any ATM in the world. The point is we have to start somewhere and I think we need more leadership from healthcare providers and HIT to move PRH adoption forward. Otherwise, then years from now, healthcare will be the only industry that still uses fax machines.

I suppose if you use a name like hatchet_guy one shouldn’t expect a lot of feel-good postings. Earlier this week HG commented on the vendor conference mentioned last week and suggested the vendor had a number of problems. I talked to one of the customers mentioned and was told the report was “definitely not accurate” and any issues they had were “temporary” (the individual suggested the posting was so off that it wasn’t worth discussing).

The Hughston Clinic selects athenaClinicals for its nine orthopedic locations throughout Georgia and Alabama. The clinic was already utilizing athenahealth’s billing and PM services. I could be wrong, but I think this is the first EMR client that athenahealth has announced this year.

E-mail Inga (new address because Yahoo Mail eats my messages).

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Currently there are "7 comments" on this Article:

  1. Inga is right about providers spearheading PHR adoption. The only places where patients are actually using PHRs in any kind of real numbers is at the integrated delivery systems like Group Health, Cleveland Clinic, and several others. Even at these institutions, PHR adoption has been a more gradual climb than the typical S-adoption curve of other technologies. If I could sum up why these organizations have succeeded it would be the following:

    1. Real strategic commitment to the PHR tool by the organization and not treating it as a marketing tool
    2. Repeated and continuous efforts to educate patients on PHRs
    3. MOST IMPORTANTLY – Tying the PHR tool to other useful features and functions. The savvy IDNs have tied it around other functions such as online appointment scheduling, referrals, etc.

    Inga’s analogy to comparing PHRs to ATMs is one I hear all the time. It does and doesn’t hold up. The obvious part is that consumers didn’t adopt ATMs in large numbers until they saw the utility in using ATMs due to two things: ease factor/ubiquitous nature of withdrawing money from any ATM machine. It also wasn’t hurt by the fact that gradually every commerical vendor accepted debit cards for commerical transactions. The two same principles (ease factor/ubiquitous nature) generally apply to PHRs.

    Where is the analogy is not apt is that customers of all ages/sex will potentially utilize their ATM card several times a day, many patients will have no reason to access their PHR on any kind of regular basis. Just look at the health care utilization data and drill down. If I recall correctly, the average patient is only hospitalized once every 3 years (obviously huge variations here depending upon several factors) and considerable numbers of the population doesn’t access the health care system on an annual basis .

    Until PHRs become easier to use by becoming more integrated to a person’s life and bringing some kind of increased utility to consumers, adoption rates will be abysmal. I have seen some positive developments on these fronts include mobile-based solutions to PHRs. My bet is that adoption is going to continue to crawl along and I wonder what vendors will give up trying to chase this market in the interim.

    Still, unless there is some real progress on unifying clinical data though PHRs are going to remain a relative novelty item. Nice to have – Sure but they won’t be an essential item to patients/consumers.

    Worse-case scenario – No real progress is made by the end of the decade to unify clinical data and consumers are offered PHR-type solutions from multiple entities including their health plan, employer (if they work for a large company), provider, and potentially even other players in the health care system. Will result in a bunch of confused, frustrated, and angry patients who are not sure what they should/shouldn’t use for their health care history.

    Then again that might be what is needed to finally change things.

  2. As for the Microsoft Healthvault – the best analogy I can think of is as viewing it as a granite slab waiting for Microsoft’s application partners to create something out of it. You could either get a David or a motley chiseled piece of stone but it will probably be something in between though for the foreseeable future.

  3. I’ve been hearing some concerning news re: NextGen that has lead to lost business and trouble with existing customers. Is it true that when a user updates his or her software to a new version all customization is erased? I was told this recently happened to physicians running NextGen in the Lehigh Valley Hospital and Doylestown Hospital communities. Can anyone help confirm/deny?

  4. RE: NextGen

    I would try to get in touch with Barnes-Jewish (BJC) out in St. Louis, MO. They are using NextGen there…seem to like it.

  5. Great comment by Lazlo and I as well concur with Dr. Krell and Inga.

    My 2 cents:
    No one has figured out the secret sauce recipe i.e., what will work for the consumer and the provider. Adding to this challenge is the potential need to have a PHR structured to address specific diseases, something that Project HealthDesign is looking into. Maybe the ecosystem approach of Microsoft’s HealthVault is the solution, maybe something else, I just don’t know at this point, but seeing some majors get into this space is encouraging – if they stick with it.

    There are so many variations of the PHR theme in the market today, how is a consumer even suppose to decide what is in THEIR best interests in making such a choice. This also extends into such issues as portability, privacy and security as a lot of the PHR vendors today have weak to non-existent policies.

    This is going to take hard work and significant investment. Standards and common data models for clinicals and claims data are still evolving which will hinder some of the grander plans for PHRs. In my conversation with the folks at CHIP (creators of Indivo), they told me that this was their biggest challenge going forward.

    Educating the public/consumer on the value to them to take greater control and responsibility for their health records. This is where the Doctor/Provider – Patient relationship will play such a critical role. This last point may ultimately prove the most important of all for the vast majority of Americans and thus the burgeoning market.

  6. re: NextGen updates vs. previous customizations

    It is possible to update NextGen in a way that overwrites on-site customization. The technical term for that is “screwing up the update,” and it has happened in the wild at places outside Lehigh Valley/Doylestown.

    It is also possible to customize NextGen in a way that prevents that risk, including protecting previous customizations.

    Details available upon request.

  7. The vast majority of the art at Epic is purchased during Madison’s annual Art Fair On/Off the Square [http://en.wikipedia.org/wiki/Art_Fair_on_the_Square], by Judy and a handful of employee/volunteers. Judy’s only criterion: Uniqueness. First, everyone splits up and blankets the booths, taking notes on and snapping pix of the pieces they feel would best typify Epic’s culture and that quality (that chicken definitely qualifies!). Then they lunch on the lawn and make their cases to Judy. Regulars — both those who own the booths and those making the rounds themselves — can spot the Epic group a good block away. A modern-day Pavlov at the UW should study the artists’ responses to seeing that group of twenty-somethings being led toward them by Judy and The Checkbook.







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