From Bignurse: “Re: EMR/EHR. Assuming that a completed implementation is characterized by some level of utilization, what would that level be? How would you experts define ‘implemented’? Should it be based on percentage of functionality used, attainment of predefined success metrics, etc.? And if so, what would you suggest?” Good question. Is “implemented” a word to use any time you’re live, or only if you’re getting usage and/or value you expected? Answers welcome, although if anyone from HHS is reading, please don’t engage one of those trough-lapping consulting firms to define it and then invoice me $500,000 like I was Uncle Sam or something.

From Phil R: “Re: RemedyMD. Not sure how much Kool-Aid that former staffer has been drinking, but the number of ex-Remedy employees sending resumes our way would suggest that they’re leaving en masse these days.”

From The PACS Designer: “Re: hospital labs. Hospital & Health Networks online magazine has an interesting article about hospital labs and how they can be outsourced to bring in much needed capital to alleviate the cash crunch hospitals are facing because of DRA cuts. Also another benefit would be to speed the transition to populating PHRs with lab results since most lab services have digital repositories of patient tests. Another revenue increasing option is for hospitals to offer their lab services to local physicians similar to what is being done by many hospitals in Michigan.” Link.

Confirmed: CEO Bob Cullen has left Thomson Healthcare “to pursue other opportunities,” according to a marketing contact Inga reached there. Mike Boswood is the new president and CEO, coming over from the company’s legal business side. A reader noticed the tip we ran from Curious George this week and asked to have it confirmed. We are responsive, yes?

Listening: Airbourne, Aussies that sound like AC/DC circa 1976 with some Spinal Tap cliches mixed in.

Interesting seminar: The Unsummit, three days on bedside barcoding with some really good-looking sessions (including a discussion with Julie Thao, the nurse whose admitted medication error led to her legal prosecution). April 30-May 2 in Austin, TX. I know some of the folks speaking and it should be good, plus I like barbeque and I’m sure there will be some.

January will set the record for most monthly visits to HIStalk, around 54,000 or so. Man, that’s a lot of readers, every one of whom I appreciate (along with the great sponsors who get what Inga and I are doing and want to support us). I don’t get all swell-headed about it since, from this chair, it’s more like a videogame than something real, just pecking on keyboards in a quiet room and never talking about it to anyone. Sometimes I’m tired after a long day at work, but this never gets old.

Jobs: MPI Project Manager, Account Executive Sales, VP Research Services, Online/Internet Marketing Manager.

Misys put its name on iMedica’s EMR, so it’s only natural that they won’t host it, either. If there’s innovation in there somewhere, it must be in marketing.

Southeastern Regional Medical Center (NC) signs up for the RadarFind RFID-based asset tracking system.

AMICAS signed more than 60 radiology and imaging contracts last year.

HHS Secretary Mike Leavitt’s editorial on healthcare information technology runs in the Memphis newspaper. Nothing new, but aimed at the lay public: EMRs, P4P, and the FCC’s rural broadband telemedicine grant program.

UPMC South Side’s department of medicine chair is sentenced to three years in prison after pleading guilty to possession of child pornography. UPMC says he won’t be coming back, naturally. And in Louisiana, a 72-year-old retired anesthesiolgist gets 16 1/2 years for trying to get what he thought was a 14-year-old girl online to send him dirty pictures. It’s just my perception, but after many years of working with doctors, there sure seem to be a disproportionate number of horndogs among them.

Speaking of doctors in trouble, a physician peer reviewer for NEJM is caught tipping off Avandia maker Glaxo that an article he was reviewing was about to blow the lid off the drug’s heart attack risk. He was a paid shill for Glaxo, racking up the usual doctor consulting and speaking fees to push their products on his peers. His excuse: “Why I sent it is a mystery. I don’t really understand it. I wasn’t feeling well. It was a bad judgment.” Is that a multiple choice excuse?

Four hospitals that previously employed nurse Charles Cullen, who admits to having killed at least 29 patients by injecting medication into random IV bags, argue that the victims’ families shouldn’t be allowed to sue them, even though they didn’t report his previous errors and investigation for tampering.

A University of Minnesota doctor is in trouble for losing a flash drive that contained his fertility patient data backup. It was supposed to be encrypted, but wasn’t.

University of Alberta researchers have developed a $1,000, shoebox-sized microchip system (i.e., “lab on a chip”) for performing lab and genetic tests.

Sumter Regional, the feel-good recipient of a lot of good press after its tornado damage and its grace under pressure afterward, has not-so-good news this time: 31 of its employees will be laid off Friday.

UnitedHealth Group’s PacifiCare insurance subsidiary faces fines of up to $1.33 billion for not paying claims, which caused some providers to stop accepting their patients. UnitedHealth, which bought the company for $9.2 billion two years ago, said they’re sorry. California’s insurance commissioner is obviously not in a forgiving mood: “After years of broken promises to California regulators, it became crystal clear that PacifiCare simply could not or would not fix the meltdown in its claims-paying process. We’re going to put an end to that. If PacifiCare can’t understand the ABCs of basic claims payment, maybe it will understand the dollars and cents of regulatory action.”

CAP puts the lab at Yakima Valley Memorial Hospital (WA) on probation after an unannounced inspector found a patient who was transfused with another patient’s blood because a lab tech misread a computer screen listing single-spaced lines of tests. Some of the changes involved software.

Great idea: a hospital installs wall-mounted “Yacker Trackers” that look like stop lights, turning yellow and then red when noise levels get too high in patient care areas.

Physician EMR vendor MedcomSoft closes a $500,000 private placement. Its shares trade on the Toronto Stock Exchange.

E-mail me.

Inga’s Update

Re: Rogue and his PHR/EMR concerns. I have had the opportunity to hear privacy advocate Dr. Deborah Peel speak on this very topic. Dr. Peel can be a bit extreme at times, but her overall position is that patient medical records belong to the patient and not the doctor and not the facility. Her belief is the government is capable of creating a national health record bank with “Fort Knox” type security and the patient regulates who gets to see what information.

I guess it was destiny that for Hopes and Deams to come together. HopeHealth, a SC FQHC and member of the Community Integrated Management Solutions IPA will be implementing DREAM EHR and CARE Disease Management solution from Visionary Medical Systems.

Cerner announces 2007 bookings were up 14% over 2006 and revenue up 10%. Fourth quarter bookings were up 5% over 2006 and revenue up 4%.

Healthgrades says (warning: PDF) that if you go to one of the top 5% of hospitals, you are nearly 1/3rd less likely to die. Their study claims 171,424 lives could have been saved and 9,671 major complications avoided between 2004 and 2006 if the quality of care at all hospitals matched the level of those in the top five percent. Will people consider this before their next hospitalization?

Trizetto wins a $100 million contract with Blue Shield of California for a system-wide technology upgrade.

The LA County DHS contracts with Sunqest to expand and transfer its existing Sunquest LIS to a new facility and implement and integrate new enterprise applications.

E-mail Inga.

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Inside Healthcare Computing has graciously agreed to make previous Mr. HIStalk editorials available from its newsletter as a weekly “Best Of” series for HIStalk. This editorial originally appeared in the newsletter in October 2006. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.

I doubt most Misys Healthcare customers are following the company’s corporate drama as it plays out in England. They want to go private. Wait – no, they just want to sell it to someone! The CEO will lead a takeover group. Hold on, he just resigned! Their board chair is optimistic about their prospects. Shhh … did I just hear him say the company’s software was old and non-competitive?

Healthcare makes up about a third of the Misys portfolio. Within that, the lineup is a salad bar of old, mixed-heritage applications from Per-Se, Medic, Amicore, Payerpath, and Sunquest. Sometimes the blended family gets along, but often they don’t (and I’m speaking both technically and culturally.) If you know of any healthcare IT conglomerates where any of the above isn’t true, that makes one of us.

Why did a British financial software company get into the US healthcare IT market in the first place? Well, let’s just say it wasn’t a noble desire to better humankind. From their website, “The main objectives were to reduce the Group’s exposure to a single market (insurance) and to increase its size in an already consolidating software sector.” That’s about as passionless as an accountant’s nimble calculator fingers determining the net present value of three dinners with Myra the secretary vs. the potential payout.

With just two software sectors, Misys is focused, at least compared to bigger conglomerates that dip 1% of their corporate body (a toe) into the healthcare waters. Since Misys is the only company actively considering deconstructing healthcare IT out of the soup, what can we learn?

• The best way to make money as a conglomerate is to break it up into parts that are usually worth more than the whole and are more affordable to prospective bidders.
• Conglomerates often reduce corporate value unless they can harness some elusive benefit in supply chain management, reproducible management excellence, or marketing.
• Conglomerates are fine until you want to sell to someone else who doesn’t share your love for some of the corporate children.
• Product investment matters more than that impressive brand name. You may be getting free milk every day, but at some point, you better start saving up for a new cow.
• In most cases, button-down corporate management saps out the innovation that made formerly independent companies interesting and successful in the first place.
• Healthcare IT divisions of big companies live and die by the quarterly (or twice-yearly) numbers. Ambitious division executives will sell their souls to avoid being called out as company laggards among their peers.
• Healthcare IT customers carry little weight with toe-dippers. Are GE brass more worried about the flat-lining former CareCast or sagging toaster sales at Wal-Mart? Does patient safety come up in Siemens corporate meetings as often as power generators?

Just about every outcome suggests that Misys Healthcare will be carved off and sold. If you’re a foot soldier, hang in there at least long enough to see if the change benefits you. If you’re a suit, well, Misys publicly labeled its healthcare unit as underperforming, which isn’t a highly valued resume bullet for the new owners. If you’re a customer, anything or nothing could happen, but you’re stuck either way. If you’re a prospect, there’s a lot of uncertainty ahead, so act accordingly. And if you’re a vendor focused only on healthcare IT, especially if you’ve resisted the urge to cash out by going public, I say thank you.

This editorial is copyright-protected by Algonquin Professional Publishing, LLC., publishers of Inside Healthcare Computing. Please do not copy, forward, or reproduce this material without prior permission. To obtain permission or for more information about Inside Healthcare Computing’s reprint policy, please contact the Customer Service Department at 877-690-1871 or go to http://insidehealth.com/ihcwebsite/reprints.html.

Mr. HIStalk’s editorials appear each Thursday morning in the subscribers-only version of Inside Healthcare Computing’s E-News Update. To subscribe, please go to: https://insidehealth.com/ihcwebsite/subscribe.html or call 877-690-1871.

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From Curious George: “Re: Thomson. I’m surprised no one has mentioned that the CEO and VP of sales at Thomson Healthcare were both fired a couple of weeks ago.”

From The Alchemist: “Re: Middle East. On an engagement for a few months in the Middle East — you know, where all the money is. Let me propose a scenario to all you HIStalkers out there. If you had the funding, approximately 100 times the average U.S. hospital construction, what would want in your hospital? All fantasies will be accepted, but try to keep them earth-bound.”

From Scott Shreeve: “Re: athenahealth. My normally calm demeanor got a little rankled after reading Cady Heron’s comment that athena is just a billing operation.” Scott’s riposte is here.

From Tex Arcana: “Re: Christine Stanfield and QuadraMed. Yes, Christine was terminated on Thursday after receiving an unsolicited contact by another company about potential opportunities. In her research, she asked her line manager what her future role was with QM. Based on a brief discussion, QM considers these inquires as acts of resignation and promptly terminated her! The sad part is there are less than a handful of people left who know the CPR product. It’s apparent QM doesn’t get it after all.”

From Dave DiVida: “I can confirm the ‘departure’ of Christine Stanfield. I was just informed by current QuadraMed employees that QuadraMed showed her to the door. These people now report that since this development, morale there in San Bernardino is now lower than it has ever been … which is a real accomplishment, considering how low Misys could keep it. I’m dumbfounded. This is one of THE most knowledgeable CPR employee on the planet in my humble opinion. Potential employers should watch for the name to come across your desk if she’s seeking, or even proactively find a way to get in touch with her. If you have the opportunity, SNATCH HER UP.”

From Slim Whitman: “Re: Sumter. I remember reading in the rules (they’re now gone from the website) something along the lines that the MRI had to be installed in a permanent location and wondered how Sumter would qualify given that it would have to be located initially in a temporary structure. That may be the ‘gotcha’ here as on December 28th, Sumter was way ahead of Lockport in votes. Regardless, I am thrilled that Siemens chose to donate one to them as well. That’s TWO patient populations that will benefit!” I bet you’re right. Sumter did say that it would work out much better for them to take delivery later, when a permanent location will be ready. I rarely say anything nice about Siemens, but they did the right thing here and deserve kudos.

From Steve Lamo: “Re: Revolution Health. Revolution Health may have a PHR, but as a company which seems to have a strategy de jour approach, it is not very compelling and is not getting any traction in the market. The B2C model for PHRs which Revolution Health is pursuing  is not working. Also, with the impending release of Google Health, my bet is CEO Schmidt will introduce during HIMSS keynote, Revolution Health’s PHR prospects will be increasingly bleak.”

From Rogue: “Re: musings on data sharing. Hypothetical case: When I was 19 and in college, I was treated for an STD at the hospital connected to the university. Three years later in grad school, at a community hospital down the road, I saw a psychiatrist for a bout of depression associated with flunking two courses and changing my major. On meds for two months. Fast forward 10 years. Married now. One kid. All those electronic records are, of course, just archived on terabytes of EMC storage media. Why bother to electronically shred old EMRs? With storage so cheap, it’s easier to just file them. The new RHIO links those two hospitals with everyone else in the area/state. My new medical record, in Employee Health at hospital #3 where I now work, contains all this juicy info, right?  It’s just a Social Security number link away. And of course, since the patient doesn’t own their records, the facilities do, I have no control over who sees what. My hospital (employer) EHR now contains links to all this old stuff, right? Is this possible? What am I missing? I’m in the business and I can’t figure out how to reassure my neighbor that a certain degree of privacy IS possible with EMRs. Is some measure of privacy and personal control only possible if RHIOs fail?”

From For the Record: “Re: Cerner. For the record, John Goodrow used to work at Cerner as a lab sales person. Not sure how forthcoming he will be.” That’s in reference to the downtime rumor. I’ve heard from several readers that Cerner puts contract language in that prohibits hospital people from saying anything bad about them, but I don’t recall seeing that in there. If you have, send it over, please. That would be fascinating to know.

Several vendors e-mailed offering to hand out HIStalk goodies at their HIMSS booths. I’ve sent out the pitiful supply I have to the vendors who asked first, but if anybody wants to create their own HIStalk trinkets or arrange some sort of in-booth entertainment that would benefit HIStalk readers, I’ll promote it (I’m thinking a buxom Miss HIStalk in evening gown and sash — along with a male equivalent — to hold court at booths at an appointed time, but I’m open to ideas).

The VA’s had quite a few data leaks, but it’s the water variety that got them in Tennessee. A broken water pipe damages the VA’s servers, so clinics all over the state were shut down yesterday and today.

Leslie White, PR VP for McKesson, e-mailed to say that it’s not the end of the line for the Dubuque crowd. The company will move operations and 340 positions to a new facility in the spring of 2009 to provide space for growth.

I hoped you enjoyed the interview with Denis Baker. Denis noted that he’s getting calls galore from people he’s known but not heard from over the years because of my wide readership, many of them trying to sell him something. Surely salesfolk aren’t so desperate that just mentioning his name here would open the floodgates? (other than GE, which he called out specifically as ignoring him).

Marshfield Clinic CIO Jeremy Miller is nominated for a case study award on the use of Fujitsu tablet PCs at Healthcare IT Summit.

American Hospital Dubai announces what it says will be the most advanced integrated healthcare information system in the UAE, using technology from Meditech, Lawson, Siemens, Cisco, and HP.

The Military Health System will enhance AHLTA’s imaging capabilities for scanned documents and photographs using a Web-based front end for its Documentum content management system.

Sweeny Community Hospital (TX) is written up by the local paper as the CCHIT certification site of Prognosis Health Information System‘s inpatient EMR.

I’m really buried, so don’t give up that I may eventually reply to your e-mails. I barely have time to sleep between work and after-work. I’m sure it will build my character if I survive.

E-mail me.

Inga’s Update

I am still trying to figure out how I was on the mailing list for a particular mailing received over the weekend. I was notified of a new physician house call service that specializes in providing at-home Botox injections. (I was embarrassed to ask my more youthful neighbors if they got the same mailing). But, it does beg the question whether or not the cutie Dr. Parkinson provides this service. Anyway, I have spent too much time in the last couple of days looking in the mirror and wondering if someone in my life is suggesting it’s time for Botox.

Federal health inspectors fault Kaiser’s Fresno hospital for not acting on complaints and keeping a closer watch on its medical staff following an investigation into one its perinatologists. It’s a sad story with no winners and includes the death of at least two babies and the resignation of hospital administrator Susan Ryan.

Eclipsys announces the availability of Sunrise Clinical Essentials, a seemingly “lite” version of their original Sunrise Clinical Manager solution. It offers more pre-configured software and pre-defined implementation methodology for quicker setup and easier support. Coming soon to a small community hospital near you!

HIMSS Analytics announces they’ve doubled the number of free benchmarking reports available to healthcare providers. The only catch is that providers first have to complete HIMSS Analytics’ Annual Survey to populate the HIMSS Analytics database.

Re: RemedyMD. A reader considering a job with them recently asked for any insights from any current or former employees. A former staffer told me the CEO was great and they have some great products, although for a sales position, it’s always good to verify how ready they are for market.

Cerner Millennium will be implemented in the three hospitals that are part of Health Quest healthcare system in NY’s Hudson Valley.

EpicTide is now FairWarning. The supplier of privacy auditing solutions for EHRs also announces a 200% growth in software bookings for 2007 and expectations for a positive cash flow by the end of this quarter.

Newton Memorial Hospital is appropriated $146K from the federal budget, courtesy of the efforts of their Congressmen. The money will be applied towards their $7 million Cerner computer infrastructure. This announcement comes a couple of weeks after the hospital laid off eight people, blaming the cuts on $3 million in state Medicare spending cuts and squeezes from physician-owned ambulatory surgery centers. (The same article also indicated their marketing department had to be streamlined as well, but I would say they still did a pretty good job blaming others with nary a mention of the $7 million elephant in the room).

More CCHIT 2007 certifications: Allscripts Healthmatics EHR Version 2007.1 and MediNotes e Version 5.2. Both have pre-market approvals.

Here’s a new networking site for all the HIT geeks out there. The description: the Healthcare Technology Alliance is a group of technology specialists working in the health care industry. Clearly they are in need of a marketing specialist to help spice up that language.

If you haven’t already, check out the cool interviews at www.histechreport.com. Don’t miss Mr. H’s “Bottom Lines” which include a bunch of those well-loved “Mr. H-isms.” (Ok, that isn’t a word, but it should be.) The latest ones are on The White Stone Group and Stratus (both who are going to be exhibiting at HIMSS.)

E-mail Inga.

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One of Denis Baker’s employees e-mailed and said I had to interview him, including a long list of reasons she enjoys working for him. I knew of Denis mostly because of Sarasota’s work with Eclipsys and CPOE and was happy to visit with him by telephone.

Tell me a little bit about yourself and about your job.

I started in healthcare during Vietnam as a Navy corpsman, thinking that I would end up on a ship or a Navy base someplace. Then, out of total ignorance, I realized that I was probably going to end up in the Marine Corps, which I did for short while, but fortunately stayed out of Vietnam.

I got into laboratory medicine and then became a med tech. I worked in a hospital in Portland, Oregon for ten years, in a chemistry department. They were implementing their self-developed lab system. So I got involved interfacing all of the instrumentation to the computer system. This would have been early eighties. Then they thought the computer system was going to support itself, so they were going send me back to the bench. So I jumped to another organization and supported an HBOC Star lab system for a couple of years there.

I ended up being the manager of the clinical systems. Then a new CIO came into the organization and created a new position of Office Automation and End-User Computing Manager, which is the worst title in the world that I can think of. Was it meant, basically, was supporting PCs. It was a four-hospital system back then. They had no centralized support. So I pulled together a good support group for training around PCs.

I left the organization in 1991 and then ended up working for an outsourcing company that has since disappeared, moved to Cincinnati, and worked as a director of IT at one of the suburban hospitals there. Then, ultimately became the CIO for the four suburban hospitals who were part of the system. The whole consulting company crashed. At about that time, the CIO that I worked with in Portland, Jim Turnbull, had since moved down here to Florida and there was a Director of IT position. So I moved down here in 1995. I was the Director of IS for five years. Jim left in 2000 to go to Denver Children’s. I was promoted to CIO.

Your background is as a clinical department end user. Do you think that’s a good background for a CIO to have?

I think it so, because I looked around early on at who the early CIOs were. It seemed to be most of them were promoted directly out of IT and really didn’t have any exposure to the clinical world. I think that has really helped me as the whole shift in the industry is gone to clinical information systems. I can talk the lingo with not only lab folks, but also nurses and other clinical folks. Physicians as well. I think that’s been a leg up.

I think the future for healthcare CIOs in particular is to have a clinical background, whether that’s nursing or one of the ancillaries. I think you really need to understand what happens in a hospital, not just producing bills.

Should the ultimate goal be to have a physician running IT or does it really require that?

I think that physicians bring a certain aspect to the job, but I don’t think they necessarily know how a hospital works. I think they know how their practice works and how they interact with the hospital, but I don’t think they absolutely know what nursing does, or any of the ancillary departments, and what they do.

What do you like most and least about being a CIO?

Most is seeing technology applied to operational improvement in the organization and moving healthcare out of the dark ages. We’ve been on paper for a hundred years and many people have said there are industries that are far beyond us in adoption of IT. With good systems and good implementations, it’s remarkable what you can change within healthcare with IT.

Do you think clinical systems are realizing their potential, or are those systems still a generation away?

My chief medical officer asked a similar question a couple of days ago. He compared it to the automobile industry, where the tires might last for five miles and then you’d have to replace them. He thought that maybe we’d moved now into maybe the thirties or forties as far as automobile technology in comparison.

But I think we’re really in the fifties. I think the systems work, but they don’t have all of the bells and whistles that the current car today would have. It’s going to be an evolving process. We’ve been at this, with the clinical information system, for twelve years and it seems like the work is never done. There’s always something changing and something new. New functionality or, typically, some new regulation or reporting that has to be generated out of your clinical system, so the work never stops.

You never stop implementing a clinical system once you start. That, I guess, one of the downsides. You asked me the pluses and the minuses. I think the downside is, it’d be nice to wrap up a project and move onto another one, but it just never goes away.

Nobody can afford to replace those systems every few years. How important is it for the CIO to establish a relationship with a vendor and stick with them?

Let me start from day one, with negotiations with the vendor. Obviously the vendor’s interested in sales, market value, and stock price, but I think you need to reach a common ground on what you’re trying to achieve. I’m not a big one for really tough, upfront negotiations. I don’t try to nickel and dime them, but I do want performance guarantees. I do want access to senior management. I do want them listening to us as a customer base as to where their systems need to go, and hopefully they’re listening to us. Because you’re right, this system we’ve had for twelve years — I would not want to be here to be the one to replace it. I would not want to go through that agony again.

A lot of places just trade Vendor A for Vendor B while the hospital down the street is trading Vendor B for Vendor A.

Once again, I think it comes down to personalities, and if you can develop a relationship with your vendor at a personal level and not slam your fist on the table every time there’s a hiccup, but thank them for when they help you solve problems … I think that’s the key to the partnership. I think some people get caught up in egos. They’ve negotiated some super-duper contract and the vendor, for whatever reason, is unable to deliver, and potentially the CIO or whoever negotiated is being held accountable for making it happen. So the knee-jerk reaction is, “Let’s go find Vendor B. That’ll work out much better than Vendor A did.”

How much are hospital executives involved in IT decisions?

Well, here, they’re pretty involved. The Chief Operating Officer, my new CEO that’s been here for about two and a half years – both of them have been involved in some pretty major IT implementations where they came from. I think they have a good understanding of technology and what the limits of technology are. Their caution to me and the organization is, “Just because you’ve got a problem doesn’t mean IT necessarily needs to solve it. We need to focus on our workflow and the operational improvement.” And then if there’s an opportunity for IT to get involved and ease that along, that’s probably the best course to take. I think all of my peers within the VP ranks have that same understanding.

How often is IT part of the strategic solution?

It’s hard for me to gauge at this point. We’ve had a new CEO for two and half years. Our Chief Operating Officer, he’s relatively new as well. I think the last thing they look for is an IT solution, but we’re still going through our version of Six Sigma or Lean Management or Process Control Management, whatever you want to call it. And then you take a look at, “OK,is there an opportunity for IT to get involved and help solve that problem?” So as we have a fairly new executive team, I think we’re still working our way through that.

Every CIO wants to run a world class IT operation, but hospitals don’t usually have large IT budgets. How do you choose your battles and stretch your dollars?

Number one, I’ve got a great staff. I have about a hundred people on staff. Being in Sarasota, Florida, it’s fairly easy to recruit good talent to this part of the world. We pay well. So I think that’s the first key, I guess, to making it a success.

I can only think of one project in twelve years that we’ve backed out of. Some of the projects may have taken us a little bit longer or cost us a little bit more than what we thought, but we’ve only had one complete failure in ten or twelve years, out of I don’t know how many projects we’ve been involved in. I think we’ve developed a reputation, as a division, for getting things done on time and relatively on budget. That lends some credibility, not only among my peers at the executive level, but also with staff; and also, even more importantly, with the physicians. If you get them involved in something and it turns out to be a success, you get less and less resistance as you move into other things to implement.,

If you look back two or three years, what projects gave you a lot of bang for the buck or made you glad you did them?

Probably the first one would have been what’s now the Eclipsys Sunrise Clinical Manger. It was created by a company called HealthVision, then called CareVision, the product. We were the first customer. We started to roll it out in 1998 to deal with nursing documentation and physician order entry.

At some point, the voluntary CPOE hovered at about 25%  and finally, nursing got tired of having to deal with the paper and electronic world. Our elected board then told our physicians, “OK, a year from now, it’s mandatory that you put your orders in.” Almost immediately, we saw the percentage starting to rise. We run probably about 80% entered by physicians, 10% verbal, and another 10% written or faxed in.

I think the whole CPOE and at least the beginning of the medication order process of transcription illegibility and so on – that went completely away. It created other problems, but at least it solved the illegibility and who actually ordered something.

Another project that took us a few years, but I think was ultimately a good decision … we needed an ERP system. We looked at Lawson and PeopleSoft and ultimately decided on PeopleSoft. That product has been rock-solid ever since we implemented it, even after the Oracle acquisition. In fact, we’re going through an upgrade to the HR side of this system right now. We had to engage some fairly expensive consultants to help us get it implemented and augment our staff. But I don’t lie awake at night worrying about PeopleSoft at all. It really helped with supply chain management, on the one side, and then we also had some issues with HR and payroll on the other. I think Peoplesoft solved both of those.

Anything on the infrastructure side that turned out to be a good investment of time and money?

Early on, as we implemented the electronic medical record, we were looking for a fairly robust network infrastructure. At the time, about the only thing was available was a technology called ATM. Implementation was good. It provided campus-wide network backbone capability up to gigabit speed. That served us well for a few years, until Cisco and the rest of the world got Ethernet up to speed.

Since then, we’ve gone with Cisco and that’s been rock-solid for us. Built in an awful lot of redundancy to make sure that the network never goes down and, knock on wood, it never goes down. Early on, the intent with the electronic medical record was to maintain all of the records on everybody forever. So we made an early investment with EMC and their technology. This would have been back in 1996 or 1997. We’ve been with EMC ever since. So from a storage perspective, expandability, once again, that’s worked out very well for us.

You made CPOE mandatory in 2003. What advice would you have for hospitals considering doing the same thing?

I‘ve looked at some of the organizations that have tried the voluntary route, but I think you can only do that for a certain period of time before you have to make it mandatory. Like I said, we coasted along for a few years with a 25% compliance and that was driving our nurses nuts. Having to check not only the paper chart, but the electronic chart for recent orders and so on. That’s going to cause quality and safety issues. So at some point, if you’re not making it with the voluntary, I think you better go mandatory.

You’re not going win them over with technology. They’re always going to complain about the time it takes to log on and how much longer it takes to place an order. But after a period of time, in our case ten years, they can look at patient information back to 1998. There’s nothing archived. Everything’s available and I really think they see that as a value in exchange for the whole CPOE piece, but it takes a while for you to build up that database for them to appreciate that.

Are you seeing any impact of the Stark relaxation and are you doing anything with physician office computing?

In a very minor way. We’ve had Siemens’ PACS system since 1996. I think three to four years ago, we implemented Siemens Magic Web, which is the online retrieval of images. They were able to do that within the organization. Obviously, they came to us and said , “OK, we want to see those images in our offices, and by the way, we don’t want to buy any equipment.”

So we were able to seed a few workstations out into some of our specialty physician offices; orthopedic surgeons and so on. That’s all they can do with them, look at our images. They can’t load it up with games and other stuff.

Physicians have the expectation that the hospital should provide them with an office EMR. We’re trying to figure out if our direction should be in that area. Obviously we’d have to charge some nominal fee. On the other hand, as my CEO reminds me, there’s a whole host of other companies out there like eClinicalWorks and so on that are offering ASP models that have relatively reasonable prices. They offer not only EMR, but also practice management.

So why, as an organization, should we get involved in that? The only challenge I have to that is that it would be nice to be able to have longitudinal medical history on our patients, whether they’re seen in an office or in the hospitals. I’m not sure how well some of those ASP offerings could be integrated into what we’ve got. So we’re kind of exploring that right now.

Are you seeing any impact of interoperability?

We’re the only not-for-profit hospital in four counties, surrounded by HCA, Universal, and HMA organizations,and they really have no desire to exchange data. I don’t think it makes sense, from a corporate perspective, for them to get into that. So we’ve really not been too successful in creating a RHIO environment here locally.

I tried to get some money out of the State of Florida. Jed Bush budgeted $10 million to get RHIOs off the ground. I made an application and one of the requirements was that it had to be with a competitor. I tried to make the argument that, in some cases, our physicians are competitors, but the state wasn’t going for that, so I didn’t get any of that money.

How would you say Sunrise is working compared to a year or two ago?

We did the 4.0 upgrade probably close to two years ago. That was probably some of the worst software I’ve ever seen. It took us probably eight months and I don’t know how many hundred patches and service packs to get all of that fixed. But finally, everything settled down and the performance came back.

Two months ago, we did the 4.5 upgrade. That’s was probably the easiest upgrade that we’ve ever experienced. That was real quality software. I think you could see the impact of John Gomez and his development team on the quality of the software they’ve produced.

With Andy Eckhert involved, do you think the direction of the company or its likelihood to success has changed?

Yes. Andy made a few visits here since we were one of the early adopters and I’ve liked the changes he’s made in the company. I’m not sure how successful offshore development is. I’ve never dealt with a vendor who has really relied on that quite a bit. I know they’re expanding their office in India to four or five hundred developers. So hopefully we’ll see, once again, a continued emphasis on quality software when that’s released.

Some of the other changes he’s made is decreasing sales staff and so on, and focusing more on support and development folks. The consultants that we’ve had involved in the 4.5 upgrade … the quality of the individuals, I think, has risen dramatically as well. As I understand it, they have to go through a three-month boot camp to learn the system before they’re ever turned loose on the customer base. I can remember years ago when a new hire would get hired on Friday and be assigned to us to fly in on Monday, knowing little to nothing about the system. They were just here as a body filler. But, like I said, the quality of individuals we’re dealing with now is much better.

Their future success in a having a broad clinical offering like the market wants is based on making Sunrise Pharmacy work. What are your thoughts on that?

I always thought that pharmacy really needed to be, not an interfaced system, but integral to the whole order entry process. Because they didn’t have that product five years ago, when we needed a pharmacy system, we went with McKesson’s Horizon Meds Manager. We had some transition issues with McKesson. So we implemented their system; we interfaced it with a bi-directional interface. That has its own uniqueness and causes its own problems. Now that Eclipsys has a pharmacy component, we’re going through an evaluation of, “OK, where’s McKesson right now? How would their new Meds Manager and Admin-RX compare to an integrated pharmacy module with Eclipsys?” So we’re going through that process this week, comparing and contrasting that.

One of the things I remembered about the hospital is you were one of the first, if not the first, to offer a turnaround time guaranteed time in the ED. Were there technology implications to that strategy?

Actually, no. That was all workflow. A new CEO came in two and a half years ago from Detroit. At least a couple of hospitals had implemented the thirty-minute guarantee. She walked in the door and said, “OK, we’re going to do that here” and turned to the ED folks and said, “Make it happen. Figure it out.” And it really had nothing to do with technology. It was all workflow and handoffs.

Now, somewhat after the thirty-minute guarantee was in place, we purchased the Eclipsys ED module, displaced boards and all that other stuff in there, and I think that helped. Now we’re on ED doing nursing documentation. And then finally, ten years later, asking the ED physicians to do order entry. Back in 1998, they screamed bloody murder, so we started someplace else. So it’s taken us ten years to get back to them. I’m anxious to get that piece wrapped up. But no, the thirty-minute guarantee had nothing to do with technology.

Tell me more about your department.

There’s actually three departments that report to me. I had more at one point, but right now I’ve got Information Systems, which is the pure technology stuff: the servers, the network, PCs, and all of that. There’s about sixty people there. The original project team that implemented SCM has been maintained as a separate department. They used to be all clinicians, with nurses, pharmacists, radiology techs, whatever. Perhaps less so today, but I wanted to maintain a real emphasis that there was a support department called clinical systems. It was responsible for, not only SCM, but now they’ve taken on the rest of the world: radiology, pharmacy, laboratory, all the ancillary systems as well. Their focus is more on the application side, with the IT department really worrying about the infrastructure piece.

We’re about 3.1 or 3.2% of the operating budget. Our routine capital is about $30 million a year and typically we get $5 to $7 million of that, This year, we’ve got $7 million, which is about a quarter of it. In fact, that was one of the attractions when I came down here. I came from an organization whose IT capital budget for four hospitals might be $1 million. When I came down here, my predecessor Jim Turnbull had gone through a planning process and gotten a commitment from the board to spend $50 to $60 million over seven or eight years. So that was a big attraction — being able to do things without scrimping on the basics. And I’ve been able to maintain that capital commitment board and administration. This is my third CEO. I’ve been able to continue the capital investment in IT for the last seven years since I’ve been CIO. So I feel pretty good about that.

With a large amount of money being invested, how do you decide where to spend it and how to justify the ROI that results?

I think I’ve been fortunate. We’ve really never been an ROI organization, which I appreciated as well when I first walked in here. It’s been focused more on what are the problems that the organization needs to solve. What’s the solution to it? How much does it cost? And then it goes into the budget.

I don’t have an IT steering committee. My IT steering committee is my CEO and she can be very direct at times. We had a JCAHO survey a couple of years ago. We ran into a couple of situations that IT could solve and she said, “Go make it happen.” And the real focus over the last eighteen months, if not more, has been on quality and safety. Now that we’re doing CPOE and eliminated the upfront transcription errors, how do we solve the problem of wrong meds, doses, and all that on the back end. That’s why we’re really focused on the barcode administration piece right now.

Are you worried that vendors seem to be moving toward hiring inexperienced employees right out of college?

I can’t say that I’ve seen that within Eclipsys. Most of the people that I’ve interacted with, all the way from implementation consultants to project managers, these people have got a number of years of experience behind them. I’ve seen the comments about Epic and the implementations and so on, but I cannot say I’ve ever seen that with Eclipsys. There always seems to be a requirement that either they have a clinical background and know something about how the department operates. And then they get educated in IT. And as I reflect on our original project team for SCM, that’s the approach we took. We attracted the best and brightest clinicians in the organizations and then took them through the IT training piece. That worked out very well for us. I think it would be very difficult to take some computer science graduate that just got out of school and teach them how a hospital works without a whole lot of supervision and good mentorship and/or project management.

Then we get into my concern about a company that is publicly traded is having to pay attention to what’s going on in Wall Street, and try to come up with, may be not the best model, but the most economical model, and hope that it actually works. I wish there were more healthcare IT companies that were privately owned. I see Wall Street as a huge distraction. A good example — I don’t know if you remember Transition Systems Inc.?

Yes. Eclipsys bought their decision support.

They missed the mark on one quarter. Their stock price dropped and then they got scooped up by Eclipsys. At the core, I think TSI was a good company. I think they had a Cadillac of decision support systems at that time. Through acquisition, good talent left.

That’s what I get tired of — the mergers and acquisitions. When we were looking for radiology systems, Siemens had a partnership with IDX at the time. They didn’t have their own good solution. So we went with IDX for radiology. Then that faded after about two to three years. IDX went to GE, and I can’t say I’ve seen a GE rep in the last two years since the acquisition. So this whole vendor churn and having vendors figure out how the new products that they’ve just acquired are going to integrate with what they’ve got seems like a huge distraction, not only on the front end of the acquisition, but on the back end on how are you going to make this stuff work.

What technologies do you see on the horizon?

I’m not sure I’ve got any original thoughts. I know there’s a lot of negative bias against it, but it occurred to me after Katrina, the paper records in New Orleans were gone and the only organization that seemingly did well at recovery was the VA. They took their backup tapes from their data center in New Orleans to Houston and, within a week, everybody in the nation had access to those records. I was trying to think, since I’m in the potential path of a hurricane as well, what would we do?

The whole idea with smart cards appealed to me. Downloading the CCR from our inpatient systems; providing read-write devices to our physician offices so they can populate it as well. The card isn’t so much the issue. The opportunity is having a redundant data center in Dallas or someplace where all the data is stored. But from a smart card perspective, not only has the core clinical data on that card to be read any place, its also available on some website somewhere. It provides a marketing opportunity for us with our logo all over the face of it. And then from an efficiency point of view, them walking in with their card, we swipe them, they’re registered, and they are done. Then they can go on to their appointment.

One of the issues that I’m not sure is unique to us is the length of time to identify the right patient, get them registered, and double check the insurance information. I believe that smart cards would solve that. Some of the discussions I’ve heard is, “Well, we should be downloading that to people’s cell phones.” Somebody’s always looking for the next technology and we’re really focused on trying to do smart cards this year, but we’ll see how well I do. It’s kind of a data concept, but I think it’s potentially could solve three problems for us.

One of your employees e-mailed me to suggest that I interview you and said, “As long as Denis is the big guy, I will work at SMH.” How do you command that kind of loyalty?

I’m honest with them, sometimes to the point of probably saying things that maybe I shouldn’t. Like most larger organizations, there’s rumor mills all over the place and I want to make sure that my folks hear from me what I think is going on and what the organization is actually doing. So I think, honesty and also being upfront and fair. We’ve had certain situations with employees that have not been popular decisions. So when I go back to explain, to the degree that I can, what the situation was and why that individual no longer works here, they appreciate the fact that I made the right decision. They understand it.

I give them quite a bit of latitude into the decision-making, particularly to my management group. An idea will be thrown out on the table, we’ll talk about it, and sometimes I’ve overridden the consensus decision from the management group, and I’ve tried to explain why I made that decision. I’ve had very little disgruntlement because of that.

Who do you admire in the industry?

I would say John Glaser at Partners. He was way ahead of his time when they started writing their own MUMPS software in, I think, 1988. They’ve always been ahead of the curve as far as development of their clinical systems and the fact that they self-develop them. They’ve got a staff of six hundred or something like that, but to take something massive like that on and be that successful at that large an organization is remarkable.

The same employee that e-mailed me that said that you’re a faithful HIStalk reader. Why is that?

I appreciate the insight. You’re one of my twice-weekly reads and the Brev-It e-mails as well. It gives me an insight into stuff that typically wouldn’t be available to me regarding acquisitions of vendors. Sometimes the rumors are interesting as well. I appreciate the fact that you wait for secondary validation that its true. It’s well written. I think you cover the industry pretty well. Obviously I think you have the trust of your readership. It’s a good read. I guess the other piece that I appreciate is that but you’ve always got the link. The article allows me to go out and find out more about it, so I don’t have to go someplace else.

Is there anything that you wanted to talk about?

I just received the invitation for the Most Wired survey again. I wish somebody would kill that. I’ve seen your comments. I share your sentiments about it.

I’ve talked to some of my peers that have been on the Most Wired list and asked them if they’re really doing some of that, and they said, “Of course not.” So I think somebody needs to audit some of this and put this to rest. Fortunately my CEO doesn’t have a whole lot of belief in it either, so she’s not holding me accountable to what some of the other organizations are doing. Not that there aren’t some good, innovative things going on out there, but having an unaudited survey of what you’re doing … the polling results are in from New Hampshire. Everybody thought they had the pulse on what they thought was going happen and then it changed overnight. So in that case, the pollsters were throwing out the numbers, but the voters really showed up and indicated what reality was. So I wish somebody would do that with the whole Most Wired survey as well.

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From Mitt Romney: “Re: Lowell. Lowell General Hospital is the only full Cerner site in Massachusetts and a fairly new install. They had a multi-day,system-wide downtime last month that has been kept very quiet. It would be good to hear from CIO John Goodrow what the outage was and its impact on clinicians.” Inga will make inquiries.

From Big Fan: “Re: Cerner. Lazlo has the Cerner health plan mostly correct, but we associates have always been told that the TPA processors are not Cerner employees. Cerner has received numerous Top 100 awards for Best Places to Work, citing the health club, onsite daycare, etc. but to me, it is not as good as it sounds. The health club/associate center is more costly than the local gym, the onsite daycare is convenient and nice but more expensive than nearby places, and the health care plans are expensive compared to most area employers. Three days paternity leave – hey, at least it is something. They offer an FMLA-like option for people employed less than one year, which isn’t a bad thing. If that makes one a Best Place to Work, then I guess just having those sorts of things exceeds what most other companies do for their employees.”

From Dan Tanna: “Re: progress notes. We are moving our inpatient progress notes online. An issue that has come up has been during a code or RRT situation, people have to leave the bedside to find a computer and look at the ‘chart’. I recommended using one of the nurse’s medication carts since they are wireless, portable, and hooked up to the EMR, but was wondering if there are any better ideas. We don’t want to print out notes.”

From Walt Ducati: “Re: Cerner in the Middle East. Cerner was chosen by the American Hospital in Dubai, but later lost because ‘management couldn’t deal with the arrogant Cerner salespeople, so we took our next choice – Meditech.’ The hospital did not look at Epic because ‘they didn’t have plans to sell internationally.’”

From NY Customer: “Re: QuadraMed. Could someone please confirm the departure of Christine Stanfield from QuadraMed? She was one of the few who really knew the CPR system.” I’ll defer to anyone who knows one way or the other.

Intercepted e-mail: Drexel DeFord has resigned as VP/CIO of Scripps Health, according to an internal memo dated January 22. His last day will be February 22, after which he’ll head off to be SVP/CIO of Seattle Children’s after two years at Scripps. You may know him from his Air Force hospital CIO days or his HIMSS involvement. The anonymous source sent the e-mail over by confidential Rumor Report.

Jobs: MUMPS Software Engineer, Centricity Consultant, SCM Project Manager (Contract), Allscripts Consultant.

McKesson joins the “vendors laying off” club, wiping out 79 IT jobs in Dubuque, IA and announcing plans to sell the old department store it occupies. Sounds like the end of the line for CyCare, the practice management and EDI vendor that HBOC bought for $287 million in 1996.

The Raleigh paper declares that Misys Healthcare is “on the mend,” although its numbers don’t seem quite that rosy and betting its future on a relabeled competitor’s physician system seems both risky and uninspired. Maybe it’s just me, but they’ve got a lot of train wreck baggage to unload before I’d project their success.

HHS recognizes three of HITSP’s interoperability specifications.

Calgary Health Region reveals that a problem with fax software held up delivery of radiology reports to doctors’ offices last year. I’m still amazed that anybody faxes anything. If someone e-mails me some document to be signed, I print it, sign it, scan it, and e-mail it back. Primitive, but way better than faxing.

This seems preordained: in Michigan, St. Mary Mercy Hospital will join St. Joseph Mercy Health System.

Investigators say that an electronic medical records system is partly to blame for the low productivity of its contracted prison doctors, calling the documentation function “achingly slow”. Their recommendation: get rid of it.

I’m puzzled: Sumter Regional didn’t win the MRI from Siemens, according to announcements that proclaimed Lockport Memorial Hospital (NY) to be the winner despite what looked like about a 2 to 1 Sumter victory based on the online vote counts. I’ve seen no mention of how or why the auditors overturned the tally, although the phrase “qualified votes” has been thrown around. Still, Siemens is giving them a free MRI anyway, saving themselves a PR headache in having to explain how, in the absence of an electoral college, the popular vote winner lost. I’m trying to hold back on the Siemens bribery jokes.

Physician billing company MTBC is named a Microsoft Gold Partner, which I don’t care much about, but I did look at the company’s site since I’ve never heard of them. Looks pretty good and the management team has great credentials. Says they take care of all physician office billing for 4%. You can download their free EMR in case it’s a slow weekend.

Big problems at $3.8 billion insurance company WellCare Health Plans, which probably thought they’d bottomed after state and federal investigations and a stock price freefall. Well, maybe: the CEO, CFO, and general counsel all quit Friday. At least the CEO has an impressive resume to take job-hunting; he was also CEO of a subsidiary of Oxford Health Plans, which had a similar meltdown.

Nice reporting by an Idaho reporter: researching the governor’s claim that the RHIO he wants to start will be self-supporting after the grants run out, she dug up several sources from our industry citing how hard it is to wean off RHIO grant money. Both the writing and the research behind it are better than what most of the industry rags put out.

John Dvorak says Sun’s aquisition of open source database vendor MySQL is such a bad idea that surely Sun is trying to kill MySQL off to benefit Oracle. Evidence: Sun’s terrible acquisition track record and its willingness to pay $1 billion for a company whose annual revenue is only $60 million. I’ve also heard that the price was really too low and that the stalwart Swedes who run MySQL should have shopped it around before simply handing over the keys to Sun. Since its database runs most of the Internet (mostly because it’s free), it’s surely got a footprint.

Bizarre hospital lawsuit: an Illinois hospital will pay a $100,000 EPA fine but still faces a civil suit from a man who says he saw a hospital employee toss a cardboard box of body parts into the open grave of his father and stomp on it, explaining that the hospital contracted with the cemetery for such disposal.

E-mail me.

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