From Sharp-End: "Re: bedside barcoding. I’m interested in talking to people from hospitals who have purchased BPOC systems or are looking. Questions: how important is system price vs. total cost? Is your implementation queued behind that of other clinical applications from the same vendor? Have you assessed total costs?" If you’re willing to swap e-mails or chat with Sharp-End (who’s an independent consultant), e-mail me and I’ll connect you.
From Little Enos: "Re: CliniComp. Rumor has it that owner Chris Haudenschild is back on top as CEO. They have acquired some great deals without him running the mother ship. Can you confirm? Why now? They’ve turned over several CEOs." We’ll try to confirm. I used to mention it when they changed CEOs, but it got old.
From The PACS Designer: "Re: Web 2.0. The mainstream media are starting to pickup on the Web 2.0 theme due to the Web 2.0 Conference being held in San Francisco. The BBC reports that ‘Web 2.0 is set to be embraced by Enterprise 2.0 as businesses prepare to spend nearly $5 billion by 2013 on social networking tools and over half of the companies in North America and Europe see Web 2.0 as a priority for next year’. TPD has posted numerous comments about Web 2.0 in the past and is happy to see the concept gaining some traction with financial backing from the C-level types." Link.
From Bird Fidrych: "Re: Cerner. I was telling a friend what a great read HIStalk is and how much I enjoy it. She sniffed that you’re a paid shill of Cerner’s and have no credibility. Say it ain’t so, Joe!" It ain’t. The only vendor money I get comes from those companies whose ads are staring at you on the left. I’m surprised someone would even make that claim given the ripping Cerner often takes here (not to mention the pretty good record of accuracy I have, which would seem to squash the "no credibility" theory). She’s sniffing, all right.
Listening: Sinch, thinking man’s metal/prog/alt from Philly.
CalPERS, the retiree system for 1.2 million retired California public employees, announces that it will support CalRHIO’s statewide RHIO. Medicity is involved, I assume, since CalRHIO uses its technology.
AHA’s for-profit subsidiary endorses Vocera badge communicators (in return for? …) That got me interested in digging: the "non-profit" parent AHA took in $102 million in one year, according to its most recent federal records, enjoyed an $18 million annual profit, has $126 million in assets, and paid its CEO $1.9 million. That CEO was previously a member of Healthcare Research Development Institute, an "exclusive club" that got the attention of state attorneys general (here’s the story from The New York Times and here’s the list of the pocket-liners who couldn’t eke out a living on their massive non-profit hospital salaries alone). Gary Mecklenburg was its CEO; he was also the CEO of Northwestern Memorial who earned $16.4 million as a parting gift (the hospital’s CIO got $665K in comp that same year, close to a record). We’re not exactly talking vows-of-poverty nuns selflessly taking care of the sick, are we?
Speaking of salaries, NHS’s Richard Granger was so good that it will take two civil servants to replace him (his was the highest-paying job in British government). They’re adding a CIO position in addition to the Director slot, each advertised at an annual salary of $400,000 (at current exchange rates, which values US dollars at slightly less than Confederate ones).
Cerner’s shares get a nice pop after the earnings announcement, going from the high 30s to today’s close at $46.49. Now if Neal will just send over my check for shilling, we’ll be all set.
Medsphere announces an OpenVista go-live at Lakin Hospital (WV).
CPSI’s just-announced Q1 numbers: revenue up 13.8%, EPS $0.33 vs. $0.24. Sweet.
Transaction processor MedAvant (aka ProxyMed) gets a nastygram from its auditors: they think the company’s about to go belly-up. Market cap is below $14 million. The CFO just quit, revenue is down, losses are up. Other than that, it’s going great.
GE’s Jeff Immelt makes excuses about the company’s performance, ending with a tag line of "building the best products." Ironic in healthcare IT, of course, since its products are at or near the bottom in most of the important KLAS categories (well, technically speaking, it bought them instead of built them, so maybe that’s his out).
Microsoft’s Q3 numbers: revenue flat, EPS $0.47 vs. $0.50.
The CEO of the healthcare business of Siemens quits after an investigation finds new evidence of corruption in the former Siemens Medical Solutions Group. At least 10 countries are investigating the company for bribery.
Varian Medical Systems’ Q2 numbers: revenue up 19%, EPS $0.56 vs. $0.46.
FDA problems didn’t help GE’s financial performance. Now, the agency has warned Philips Medical Systems about manufacturing practices in an Ohio plant.
Shares of WebMD Health tank after the company warns of weak advertising demand. The stock was down 12.2% Wednesday. Earnings will be announced on May 6.
Art Vandelay on VistA Outages
The VA’s recent experiences with server consolidation are not surprising. The root cause for one of the incidents is no different than the Parkland experience with their Epic outage (operator error). The VA’s other major incident was caused by a hardware failure.
In my experience, the two other common causes of outages are human failure to execute some manual task during an upgrade or poorly written software (ex: memory leak, runaway process). When consolidating servers, testing is a must. Back-up/restores, fail-over, and monitoring must all be tested in the backroom. User downtime processes and the communication plan should also be tested.
With M platforms, the monitoring and automation tools are rarely present. Epic has actually put a significant amount of effort into building the "RedAlert" Toolkit to assist its users. I am not sure if the VA has done the same development. I have also found the attention and rigor behind smaller and distributed environments is usually lacking.
In the non-M world, the architectures are usually already integrated with monitoring tools at various layers. This includes the OS, app. server and database layers. These vendors have also matured enough to provide the basic SNMP traps. Those of us from the early mainframe era were in a similar position and "rolled our own" utilities. Now these utilities can be purchased at exorbitant prices from IBM and CA.
To compound the problem of a lack of tools for M platforms, I rarely see the mainframe rigor in the client-server and web environments. The rigor comes with documentation, change control procedures, well-understood dependencies, defined testing plans and separate environments. It is a must to test these plans in the real world.