News 10/1/08

September 30, 2008 News 9 Comments

From oneHITwonder: "Re: a low-tech PHR. Pros: providers might actually look a a piece of paper vs. a flash drive or log onto the Internet. Cons: storage space limited for anyone with a chronic condition." Link. Great idea. It’s the one platform that’s compatible with what 99% of doctors use.

From Spart: "Re: private enterprise. You obviously have a very right-leaning and libertarian slant on things, with one exception. You deride HIMSS for being pro-industry and private enterprise." I’m right-leaning and libertarian on fiscal and government role issues, liberal on social issues (don’t you get my grassroots populism and anti-establishment tone?) HIMSS is a nonprofit member organization and I pay dues, so it’s a little different. Like RSNA, AMA, ASHP, etc., they need to work harder to keep the commercial side away from the supposedly scientific side if you ask me. Like they used to, in other words. I wouldn’t enjoy the conference nearly as much if vendors weren’t involved, but I might like it a little more if I didn’t feel constantly manipulated by HIMSS to consort with them. It’s like having the junior high school dance chaperone pushing you publicly toward the wall-hugging row of girls before either of you have worked up the nerve to talk. In my generation, anyway.

From OB1: "Re: HIStalk. I just don’t know how you do it. You have a full time day job and yet you are able to post regularly and troll to find relevant and interesting information. Have you managed to slow time in your universe?" Apparently not because it’s flying by on this end. I can’t wait to get home from the day job to do HIStalk stuff, although it takes many of my waking hours (counting all the e-mail and web maintenance stuff I do that I don’t mention). You know I enjoy it when a cynic like me blathers on about how much fun it is, as though I had Kim Kardashian’s hand in my back pocket or something. As I write this, I’ve been at it for 3.5 hours without even getting out of the chair and another hour to go and I’d swear it was only 15 minutes. The saddest sound of the day is when XP shuts down. What a nerd.

You may have noticed that Leah Binder, CEO of Leapfrog Group, added a comment to Monday’s posting. I’ve invited her to me one of our "An HIT Moment With …" guests and sent her five questions, so she’s got the floor if she wants it.

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Listening: King’s X, hard rock/prog/semi-Christian from some mighty talented guys from Katy, TX. And speaking of Texas (maybe my favorite state), I had barbeque at the epicenter of brisket above on a recent trip. Name the place and you get … well, satisfaction.

GE Healthcare acquires Agility Healthcare Solutions of Glen Allen, VA. The privately held company uses a Real Time Locating System for enterprise visibility and patient flow management. I knew CEO Fran Dirksmeier in a previous life.

University of Washington’s Institute of Translational Health Sciences and Seattle Children’s Hospital sign for Microsoft Amalga (just the Azyxxi part, apparently, since they’re a little sloppy with that name).

Jobs: Soft (SCC) Implementation Manager, Developer, Customer Support Representative, Solutions Executive. Employers who ask Gwen nicely will get her Halloween gift – a free introductory job posting in October.

A Cisco survey says outsourcers in China, Brazil, and (to a lesser extent) India are unsure how their employees handle sensitive data or already suspect they’re sending it outside the company. Employees there are more likely to tamper with the security settings on their PCs, use P2P networks on work devices, and install unauthorized software than in the US. The Grady transcription breach is mentioned.

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Exempla Healthcare (CO) signs a deal with Novo Innovations to deliver data directly to practice EMRs, moving up from Novo’s drop box data exchange.

Since I’ve never had anything to do with Virtual HIMSS, I didn’t realize that the signup page requires answering questions similar to those asked by the "never had a paid subscriber" rags before sending you the subscription you don’t really want, leading you to just randomly check blocks here and there to be done with it. The footnote suggests that if you aren’t a hot vendor prospect, you’ll pay $79 instead of getting in free like everybody else, a reader tells me.

FDA will spend $2.5 billion on new IT systems over the next ten years as part of what’s called a bioinformatics initiative, but it mostly sounds like infrastructure and data center relocation.

Victoria, Australia is going back to the drawing board on its ambitious HealthSmart project after falling two years’ behind schedule and failing to bring up even one site on Cerner Millennium. "A $79 million deal with Cerner was signed in March 2006, but costs had risen by $17 million to $96 million in 2006 – the biggest price blowout so far, the audit office found."

Speaking of Millennium, a key Connecting for Health doctor thinks iSoft’s Lorenzo will be used more than Millennium because Lorenzo is newer and better suited for web deployment.

Yet another medical helicopter crash: four die in Maryland when a helicopter goes down taking a patient to Prince George’s Hospital. One of the two teen patients being transported was the only survivor. Condolences to those affected.

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Doctors in Iraq will be allowed to carry guns to encourage them not to leave the country in fear. Over 2,200 doctors and nurses have been killed since the 2003 US invasion. The article says at least 20,000 of the 34,000 are already gone and healthcare is worse than it was pre-invasion. Bet they’re really glad we John Wayned right in there.

HIMSS backtracks on its curt statement that it won’t support Pete Stark’s HIT bill because it calls for making open source systems available. HIMSS says "there has been some confusion" and claims "with some modifications to the legislation, common ground can be made to meet stakeholders’ goals." You know they’re sweating when a fact sheet (warning: PDF) is produced. It says, "This would be like the Department of Defense developing a new automobile to compete against Ford and Chrysler." First, we’re already bailing Ford and Chrysler out of their own stupidity with taxpayer billions, so that’s not much of a free market example. Second, much of healthcare is non-profit and we all pay for it without having a choice like we do with cars. Third, the bill doesn’t require developing new systems; VistA is the obvious incumbent and nobody seems too threatened by it other than HIMSS. Last, why does HIMSS even need to weigh in on whether the government builds an IT system? And while I’m at it, maybe HIMSS should have polled use dues-payers before presuming to make snide statements on our behalf. This might be the second case in a couple of days where an out-of-touch administration misrepresented its constituency and was shocked at the backlash.

Speaking of HIMSS, open source advocate Ignacio Valdes, MD, MS leads off his editorial with, "HIMSS response, while predictable, is misguided on so many levels that it is difficult to know where to begin." But he does.

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A Florida newspaper article covers a local women who, faced with an estimated $4,000 to $5,000 worth of diagnostic tests in multiple locations even after her insurance paid its part, heads off to India and gets it all done in six hours in one place for $350. Unlike HIMSS and its anti-open source stance, AMA’s board chair actually sees it the patient’s way: "We are not opposed to the idea, especially when institutions are accredited properly. Some of these institutions overseas are wonderful, and many of their physicians have trained in the United States." In another example, a woman went to Mexico for two root canals, two extractions, airfare, and three nights in a hotel in a mini-vacation with her daughter for $1,600.

QuadraMed will offer real-time BI tools from InterSystems in its revenue cycle applications, providing dashboards and key performance indicator monitoring.

Moses Cone (NC) will spend $2 million to put Centricity in its 29 clinics and physician offices.

In the UK, Ascribe Group acquires the healthcare division of WCI Consulting.

A Florida ambulance service gets a local paper mention for its unnamed technology that sends a patient’s EKG results to the hospital ED, reducing the door-to-balloon time for a heart attack patient to just 12 minutes vs. the national average of 112. Now that’s cool.

A note to the entire world: please hold down the Shift key when you resize PowerPoint or Word images so they don’t get distorted. Thank you.

Greenville Memorial Hospital (SC) will require ED and night visitors to wear electronic security badges linked to their driver’s license and destination.

Ontario restructures its eHealth programs under one organization.

A Massachusetts company’s technology allows filtering text messages and BlackBerry e-mails, using the example of a hospital’s blocking all outbound messages containing the name of a VIP. From the website, the product also allows setting white/blacklists for user smartphones, archiving messages, and maintaining BlackBerry PIN addresses even when devices change. Sounds like a big brother’s delight. I just wish restaurants and other public places would install that technology that blocks all cell phone use.

Lawson’s CEO obviously has vested interests, but his quote is still fun: "Getting signed up as a SaaS customer is fast, but getting out is just as fast, whereas traditional software is like cocaine — you’re hooked. It’s too difficult and expensive to switch providers once you’ve invested in one. If it were easier to jump ship, a lot of people would’ve hit the eject button on SAP a long time ago."

I wish I hadn’t found this page because I screwed around with it for most of Sunday afternoon: a complete list of Web 2.0 applications and descriptions. Some I liked and may use, most I laughed at, especially the dumb "you can’t sue us because it’s not a real word" names.

E-mail me. I read every one and always reply to the nice ones. I thank you – seriously – for reading and contributing. Over 61,000 visits and 94,000 page views in September … I’m honored and pleased. Thanks, too, to BFF and co-conspirator Inga.

HERtalk by Inga

Misys announces its Q1 earnings. The healthcare division’s revenue was flat compared to last year, with ILF revenue falling seven percent. Not too surprising given the uncertainty associated with the Allscripts acquisition and iMedica lawsuit.

I wonder if this is a sign of the times? Virtual Radiologic’s stock fell 34% Monday after the company announced weak September sales. The company continues to sign new customers but the number of procedures performed dropped. The company speculates that higher gas prices have resulted in fewer motor vehicle accidents and thus fewer radiology tests. Or perhaps people are avoiding medical treatment all together to avoid co-pays. Is it a start of a trend?

CCHIT announces the first 10 products to receive ’08 Ambulatory EHR Certification.

Cardinal Health is spinning off its clinical and medical products business as a separate company. Current Cardinal vice chairman David L. Schlotterbeck will lead the group. When the spin-off is completed in 2009, current Cardinal Chair and CEO Kerry Clark will retire. His replacement is George Barrett, who has served as vice chair and CEO of the Healthcare Supply Chain Services group.

Baptist Healthcare Services (KY) is rolling out in-building cellular infrastructure across its five acute-care hospitals.

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In case you missed it, we debuted last night our latest HIStalk feature, “An HIT Moment With…” We will run these periodically and will include just five questions. Thanks go to Matt Grob for agreeing to be our guinea pig. Check out Matt’s comments about the state of the economy and the effect on HIT budgets. Here’s something to add to your stress level if you are a techie type: “Interestingly, here in the New York market where some of our clients are hiring for technical positions (i.e. those that do not require specific healthcare knowledge or expertise), the candidate pool just got a bit more sophisticated and bigger with jobs lost at Lehman Brothers and the like.” Anyway, if you would like to participate in our HIT Moment (or nominate an interesting person) let us know.

MediConnect Global announces it will provide at no charge digital backup copies of archived medical records to any patient or organization losing medical records during one of the recent hurricanes.

Stratus Technologies and Orion Health are teaming up to offer continuous availability of patient health portal data running on Stratus servers.

Emdeon acquires GE Healthcare Technology’s patient statement business.

Several readers have mentioned they’d like to hear where our presidential candidates stand on healthcare IT policy. Here is a bit of information courtesy of Health08.org:

McCain

  • Supports the rapid deployment of 21st century information systems and technology that will allow doctors to practice across state lines.
  • Believes if the system demands information on outcomes, then the market will respond to provide the HIT infrastructure.

Obama

  • Believes the use of HIT should be a requirement for participating in government health programs.
  • Supports a government investment of $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records.
  • Would phase-in requirements for full implementation of HIT and ensure that patients’ privacy is protected.

Innovative Consulting Group, a healthcare IT support services provider and HIStalk sponsor, sent over a link to their latest newsletter (warning: PDF). In addition to some tech tips and client profile, they feature an interesting by a Cerner practice director about maximizing EMR for quality initiatives.

One of my official HIStalk duties has become tracking the HIStalk Web traffic. I am pleased to report that September has been our biggest month ever in terms of number of visitors. So, thanks, readers, for allowing us to keep you current and/or entertained!

E-mail Inga.

An HIT Moment with … Matt Grob

September 29, 2008 Interviews No Comments

An HIT Moment with ... is a quick interview with someone we find interesting. Matthew Grob is Director, Health Care Consulting with RSM McGladrey, Inc.

Of all the ways you could have gotten involved with HIMSS, why did you choose CPHIMS?

I had been an annual conference reviewer for a few years and then served for three years on the HIMSS Foundation Scholarship Committee. I was looking for something a little more involved and the CPHIMS program had always interested me.

I sat for the exam at its inaugural offering at HIMSS 2002 in Atlanta and truly saw the value in the credential – what it means to clients, colleagues and employers as well as the personal satisfaction in having it confirmed objectively that I actually know something about what I do for living.

In 2005, I applied and was accepted for a two-year term on the CPHIMS Technical Committee. At the end of that term I was asked to chair the committee for the next year. I must have done something right because they asked me to chair for a second year, which is where I am now.

It has been an exciting time because aside from having the opportunity to work with some really smart and dedicated people who really know their stuff, we recently revised the exam content to reflect both current practice as well as the fact that it is quickly becoming a global credential – I will be presenting on it at the World of Health IT in November in Copenhagen.

For next year, I will be on the ballot for the HIMSS Nominating Committee and urge all your ultra-hip and sophisticated readers to vote for me!

What hospital trends are you seeing in your consulting work?

My practice also deals a lot with the ambulatory and primary care side of the business. We are seeing a shift in hospital environments to tying the two sides of the house together.

There are so many good reasons to do so. The benefits on the clinical side are clear for safety and continuity of care, but we are also seeing it come together on the patient accounting/practice management side as well. Layering business intelligence tools on top of all of those systems are also on the uptick as organizations want a better way to monitor and manage the health of their patients, populations, and their organizations utilizing the wealth of data that is collected throughout the continuum of care and the organization.

How do you think the economy will impact IT budgets in hospitals?

Wow, what a timely question. I see it as a chicken-and-egg scenario. It is clear that the way to better manage the health of our population is through IT and that will, in turn, result in reduced healthcare costs. Payors already recognize that through pay-for-performance initiatives. But to get the benefits, it all takes investment and I suspect that access to capital will be that much harder as we enter this uncertain time in our country’s economic history.

Interestingly, here in the New York market where some of our clients are hiring for technical positions (i.e. those that do not require specific healthcare knowledge or expertise), the candidate pool just got a bit more sophisticated and bigger with jobs lost at Lehman Brothers and the like. I suspect that will be happening elsewhere as well.

You spent a lot of years as an analyst at NYU Medical Center. If you had to take a hospital job again, which one would you want to work for, what job would you want, and why?

I don’t see myself leaving New York in the near future. Given that, I would want to go back to NYU. They were the gold standard when I was there and continue to be leaders in the industry.

Paul Conocenti, the CIO, came from banking but managed to understand pretty quickly how to run IT in a large medical center that has a history of innovation and success. Pravene Nath, the CMIO, is also visionary and understands how to do things right the first time. I would want to use my leadership skills and abilities to improve workflow and operations using technology as an enabler, with a focus on clinical systems. I’ve worked on the revenue cycle side of the house, but my first and true passion is the clinical.

If I were to leave New York, I would love to work with John Glaser up at Partners, Edward Marx at Texas Health Resources, or Buddy Hickman at Albany Medical Center as they are all great leaders and thinkers and they just plain get it. When I started in consulting at Ernst & Young back in the mid-90s, Buddy was one of my team leaders. I often point out that we share not only that history, but a hairline (or lack thereof) as well.

What do you like about living in New York?

I think the question with the shorter answer would be what I do not like about living in New York.

My wife and I were both born and bred on the Upper West Side where we live now. We live a block and a half from Lincoln Center, steps from both Central Park and newly developed waterfront along the Hudson River, and walking distance to most museums. It’s about a 30-minute walk to my office, so I actually get to see my kids most nights when I’m in town rather than sitting in traffic or on a train or bus.

But I’m also spoiled. I am used to being able to find pretty much anything I want 24/7 and within walking distance. The city has a rhythm and vibe that is very hard to find elsewhere and diversity in all aspects is what keeps it interesting. Growing up in apartments, we never had a lot of space and the city and Central Park were our backyards so while yes, it would be nice to have some more room, we’re pretty well adjusted to the confines of a Manhattan apartment. I’m just happy we bought ours 11 years ago. We’d never be able to afford one today!

Misys Gets Allscripts Merger Funding

September 29, 2008 News No Comments

Misys PLC announced this morning that it has signed agreements to obtain the $325 million it needs to fund its proposed merger with Allscripts. A group consisting of HSBC Bank, Bank of Ireland, and Royal Bank of Scotland will provide $150 million as a revolving credit facility over 18 months, while ValueAct Capital will provide $175 million under a subordinated credit facility over 20 months.

A revolving credit facility provides funds that the borrow can draw down and pay at its discretion over the specified time period. A subordinated loan is repayable after all other debt has been satisfied and is therefore riskier to the lender.

The Financial Crisis – Let’s Hear Your Thoughts on How It Will Affect Healthcare

September 28, 2008 News 20 Comments

As I write this, it appears likely that Congress will approve spending $700 billion to bail out financial companies whose risky investments came back to bite them. They don’t really have a choice, of course, since the alternative is even less savory. Even Warren Buffett says the alternative is "the biggest financial meltdown in financial history." Gee, everybody said things were great until just a few months ago.

Some of that money may be repaid in sales of assets, but that’s only slightly likely. In the worst case, the national debt jumps to $11.3 trillion, the dollar tanks even more against more stable currencies, and inflation jumps along with unemployment. Foreigners start buying everything in sight at fire sale prices. All of that reduces tax revenue.

Average citizens are hopping mad that Wall Street is dumping its garbage on Main Street, which seems to have surprised the Washington insiders. They’ve been burned before by false declarations of national urgency (chasing nonexistent WMDs in Iraq). As in that situation, the demand is that full trust is put in a very few hands inside the administration to spend the money wisely and to prop up a system that isn’t working efficiently.

It looks like the same government insiders helping out their private industry pals behind closed doors. It doesn’t help that Treasury Secretary Hank Paulson’s last real job was CEO of Goldman Sachs, which made a bundle on subprime mortgages and short selling and gave him compensation of up to $37 million a year and a net worth reported to be $700 million (giving Sachs a nice position as all of its competitors are now out of the picture and making Paulson something close to the CEO of the country when the bailout passes). Or that his views on exactly how much the socialist-like help Uncle Sam should give failing financial houses seemed to change day-by-day as the government reacted to the crisis only after it happened.

Those who pay their bills and taxes on time will suffer. Those who don’t, the same folks who simply walk away from financed cars whose value is "upside down," are likely to take advantage of loose bankruptcy laws and simply stop paying for houses worth less than they owe, reducing the value and future prospects of Uncle Sam’s cash flow stream on so-called "toxic" investments (homeowners were speculators, too, after all). And, there’s no guarantee that banks will start lending again just because they get to dump their failed bets onto the backs of taxpayers. Formerly affluent neighborhoods may look like Rust Belt cities, full of boarded-up houses that the collapsed real estate market can’t absorb.

Unemployment is reminding middle income citizens of just how much wider the gap has become between them and the highly compensated CEOs, and more than 1,000 billionaires whose net worth jumped a lot more than theirs, especially since the homes and 401ks of the average citizen suddenly don’t look so lucrative. The illusion that all of us were getting wealthier together has been shattered. The "have nots" will likely use the one advantage they have — at the polls — to punish those they see who prospered while they didn’t.

Some reactions seem obvious. Democrats will claim it’s yet another example of Republicans favoring the wealthy and will benefit at the polls, yet they won’t have anything left in the federal till to pay for their expensive social programs even if they win offices. The financial industry will wither, with high unemployment and a loss of luster that may never be regained. Taxes will rise, entitlements will finally have to be curtailed, and uncompensated healthcare will certainly rise with unemployment and debt.

Here’s where you come in. HIStalk has a lot of smart readers, some of them in the investment industry and in executive positions. What will the impact be on healthcare and, specifically, healthcare IT? Click Comments at the end of this posting to share your thoughts, maybe thinking about these areas:

  • How will hospital IT spending change?
  • Will physicians keep buying EMRs?
  • What exposure do vendors (publicly traded and private) have to changes in financial conditions?
  • Will market conditions cause vendor consolidation and discourage new entrants?
  • What changes can we expect for HIT industry employment?
  • If healthcare costs have to be dramatically and painfully cut, can IT justify its cost?

Nobody else is talking much about this. It’s not about politics, but about reality. Let’s hear what you have to say.

Monday Morning Update 9/29/08

September 27, 2008 News 7 Comments

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Goroko General Hospital in Papua, New Guinea (148th of 190 countries in world healthcare) is the first hospital in the country to set up a web site, which was created by its volunteer IT manager Robert Schilt. It looks great and is running in WordPress. Schilt has also established a 12-PC training center, rolled out 50 PCs, set up Internet and e-mail access for staff, built several departmental applications, and almost finished a hospital Intranet and a discussion forum for doctors. He build everything using open source software. He’s also looking for second hand items to help the locals, who he says "do not have two spare coins to scratch together." You’ll notice that his own family has donated a long list of items. Why can’t we get a selfless volunteer IT guy like Robert on the HIMSS podium instead of the usual Taj Mahospital people?

Microsoft chooses Philips SpeechMagic for Amalga. Wonder if the reader’s rumor will pan out that Philips will sell it? Maybe MSFT is interested.

Tom Skelton’s new company, MedcomSoft, turns in not-so-great FY2008 numbers: revenue down 46%, expense up 5%, losses up to $5.8 million. They’re running low on cash, have never made money in seven years, and need ongoing financing to stay open (good luck with that). Surely Tom’s job is to clean up the books and shop it around. Shares are at $0.06 and market cap is $6.2 million. If you want to pick up a CCHIT-certified vendor as an acquisition (and consider MEDCIN to be an advantage), you could probably get a great deal. I had heard it was expensive, but the company claims it’s $11,500 for the first doc and $6,500 for additional ones, still not the cheapest, but far less than some.

Fred Trotter seems surprised that "HIMSS is a lobby for proprietary for Health IT vendors," basing that on its refusal to support Pete Stark’s health records bill that includes pushing open source systems (not necessarily new systems – you may recall that the President’s early call for HIT specifically said VistA was to be made widely available). I’ve been pointing out the HIMSS business model for years:

  • Bring in provider members cheap ($140 a year, now basically free for Organizational Affiliate organizations that pay $2,975 a year for the all-you-can-eat plan for unlimited employees, apparently designed to boost the numbers and increase booth traffic at the conference)
  • Sell the usual books and all that, but push the annual conference like crazy since that’s where the profit comes from (cheap, too, for provider attendees – the Ladies Drink Free approach to bringing in the horndog men — vendors — who pay full price and expect ROI)
  • Charge vendors astronomical prices for booth space and ad exposure during the conference (aka Boat Show booth)
  • Provide feel-good infomercial publications that send a message that buying IT is always the right thing to do, making sure to spin or avoid stories suggesting otherwise and minimizing the organizational expertise needed to actually get ROI (you saw it in a booth, so write that check and don’t worry about the change management aspects that most hospitals do poorly)
  • Give CIO decision-makers extra special treatment during the annual conference and CHIME, letting vendors pay the tab in return for even more access to them
  • Provide some OK education during the conference (even letting vendors themselves take the podium for some of it), but make sure to leave huge swaths of non-education time during prime hours to force attendees into the exhibit hall, which will be even easier in Chicago in April when it’s too cold to be tempted away by golf or enjoying nice weather
  • Buy up vendor-specific user groups (Cisco and Microsoft, for example) to give even more sales opportunities to vendors
  • Get provider members to give HIMSS Analytics all kinds of internal information for free, then sell their information dearly to the vendor members so they can make well-informed cold sales calls to those same members who willingly participated
  • Create advocacy organizations whose charter is 100% vendor-driven (buy more stuff and lobby politicians to use taxpayer dollars to do it)

HIMSS should not disappoint anyone since its methodology is obvious: get providers to join and attend its vendor-heavy conference, a neatly closed loop that makes HIMSS the paid matchmaker. There is absolutely nothing wrong with vendors and they are straightforward about participating in HIMSS to get an audience with prospects. HIMSS members sometimes are naive to that fact (although they’re rarely decision-makers anyway) and somehow expect that HIMSS will advance only inarguably noble and unbiased causes (no different than they expect of hospitals, and with which they are equally likely to be disappointed). I pay membership and conference costs out of my own pocket, so obviously I think it’s a good deal. You just have to swim against the tide sometimes to avoid being controlled. Do I feel they represent the best interests of my hospital employer or me personally? Absolutely not, nor do I expect them to. It’s a trade show, nothing more and nothing less, and free software doesn’t pay those bills. That’s my opinion and you are entitled to your own, of course.

Ivor Kovic, an ED physician in Croatia, likes the iPhone and lists some applications that are useful to doctors.

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SCM Microsystems is rolling out this smart card reader, the eHealth 100, to support Germany’s electronic health card for 82 million people.

A city government uses cool PR technology that I’m surprised hospitals and vendor haven’t thought of (assuming they haven’t, of course.) Cheap 1 gB flash drives with logos are handed out to potential investors. Plugged in, they refresh themselves over the Web, then play a slide show, video messages, and provide links to detailed reports and electronic books. The "refresh" part allows running seasonal pictures and other fresh information, infinitely extending their useful life and also allowing the city to track how often they are used.

I noticed that the HIStalk e-mail blast list has just hit exactly 3,000 recipients, so thanks to all of you reading (blasted or not). Daily visits are at over 2,000, so this may be a record month. Thanks, too, to those who signed up for the reader-created HIStalk Fan Club on LinkedIn, now at 264 members. If you’re on LinkedIn, Inga and I would be honored to boost your connection count by approving all requests. You can help spread the HIStalk word by clicking the "E-mail this to a friend" graphic to your right and e-mailing a few of your colleagues about HIStalk.

Paul Newman dies at 83, having given away $200 million to causes such as his Hole in the Wall camps for sick children. He was also a World War II veteran. I can’t imagine today’s pack of shallow "celebrities" doing anything close.

Idiotic lawsuit: a TV reporter (an Air Force veteran) spices up her gun story with a showy stunt in which she fires a semi-automatic weapon at the police gun range wearing a noise-protecting headset. She claims she suffered permanent hearing damage and is suing the police department for medical bills, pain, suffering, and anxiety. The police department says she was negligent and didn’t see a doctor soon enough.

UCI Medical Center (CA) is put under state supervision and could lose its CMS funding over poorly kept anesthesiology records. Inspectors found some post-op forms that were signed and filed before surgeries were performed. Half of the anesthesiology professors signed a 2003 letter complaining that its mission had been altered from education to money-making. Previous scandals include selling body parts and implanting patient eggs in other patients without the permission of either.

Leapfrog Group’s "Top Hospitals" are trending down in number, although not as starkly as its drop-off in members. The numbers: 50 hospitals in 2006, 41 in 2007, and 33 in 2008. They blame a new requirement that requires hospitals show that their CPOE systems provide clinical alerts. If they add a future requirement that CPOE show a demonstrable benefit in cost or patient outcomes, that 33 number will look huge by comparison. Maybe the goal is to have no top hospitals.

Vendor Deals and Announcements

  • Virginia Cardiovascular Specialists selects MedAptus’ Professional Intelligent Charge Capture and eRx applications for its 38 physicians.
  • The Family Health and Help Center (IN) is implementing PracticeOne’s e-Medsys Solution for their community health center.
  • QuadraMed’s Pharmacy Integrated Management solution is now implemented at Ashtabula County Medical Center (OH).
  • DB Technology announces the release of its Enterprise RAS solution to automate and streamline paper-centric processes.
  • El Camino Hospital (CA) selects eClinicialWorks for its affiliated physician groups.
  • Picis announces several new enhancements to its core perioperative and critical care applications. Also introduced: Picis’ new eView for CriticalCare Manager solution to consolidate clinically relevant information for the ICU census and present in a concise web-based view
  • With technical assistance from Medicity, the Delaware HIN has become the first fully operational statewide HIE and successfully connected with other NHIN participants.
  • Jefferson Community Hospital (NE) has implemented IntelliDOT Bedside Medication Management system at its 25-bed facility.
  • BayCare Health System (FL) is using Fujitsu’s PalmSecure biometric security system integrated with its Siemens’ HIS to protect medical record privacy.
  • St. James Healthcare (MT) signs with AHI Software for registration QA service.
  • Phytel is becoming a member of the American Medical Group Association’s Value-Added Services program to promote the proactive management of health and disease management protocols.
  • Sentillion is positioned in Gartner’s “visionary” quadrant in its recently published Magic Quadrant for User Provisioning, 2008. The evaluation was based on Sentillion’s ability to execute and its completeness of vision.
  • CareTech Solutions is chosen as IT outsourcer for Port Huron Hospital (MI). The company also announced that it earned the top score (94.6) in a recent KLAS study on extensive outsourcing, including a 100% "would you buy it again."
  • United Hospital System (WI) is replacing its McKesson Orbit surgical scheduling system with Unibased Systems Architecture for its periOperative Resource Management System.
  • Florida Cancer Specialists is contracting with Fletcher-Flora Health Care Systems for their LIS solution.
  • Sacred Heart Medical Center (OR) has implemented Versus Technology’s wireless locating system.
  • Harrisburg Hospital (PA) claims a 12-month payback after installing Radianse’s RTLS solution.
  • The Health Alliance of Great Cincinnati is deploying Streamline Health’s documentation workflow and coding products across their five hospitals.
  • Neurological Associates (LA) has selected CureMD’s EMR/PM SaaS solution.

E-mail me.

News 9/26/08

September 25, 2008 News 7 Comments

From EMR Wannabe: "Re: Philips. Within the next ten days, Philips will announce divestiture of its SpeechMagic division. Conjecture is that SpeechMagic is getting resistance from large inpatient vendors because Philips competes in areas where GE, Siemens, and others make big money (radiology and PACS systems). SpeechMagic is about to take another run into the U.S. market, starting in 2009, but it does not fit into the Philips technology portfolio."

From Mrs. Lab Queen: "Re: Sunquest. The Tucson GM initiated a program to turn over the lower third of the staff and 50% of sales as well. Believes this will help increase performance numbers to pay for the sale to Vista. Does this tactic really work?" I‘ll go out on a limb and say yes, sometimes (if the good people don’t leave along with the not so good). Other than the tremendously cold-hearted aspect of that plan, it has always made sense to me to richly reward the top 20% of performers, take your chances in replacing the bottom 20%, and try like crazy to move some part of the middle 60% into that top 20%. The problem, of course, is that it always ends up being subjective since it’s hard to objectively measure who’s contributing, so it turns into a popularity contest and a breeding ground for showy but marginally useful extra effort (people sending e-mails at 2 in the morning just to show how dedicated they are). Tough times make job competition more intense, so it’s probably not going away. Companies may run businesses as though everybody’s a contractor, a concept that I like only conceptually.

From Tina: "Re: Sunquest. As an employee of Sunquest who went through the Misys national nightmare, I love reading all the bad news about Misys. They just about ruined a good company and we are trying to resurrect ourselves to the great company we were before Misys screwed everything up." You will probably enjoy the certain upper management confusion that will arise when Glen Tullman becomes their boss. They’ll be going, "Hey, I thought it was us acquiring Allscripts."

From Joe: "Re: PACS patents. DR Systems has taken to suing a variety of PACS vendors for patent infringement. One of those vague ‘idea’ patents (patent 5,452,416), where the idea may have already been in circulation at the time of filing in 1992.  Basically, DR claims they invented the PACS idea/interface and everyone owes them for it. Currently in the dock: Siemens, Fuji, Kodak, Emageon, eRAD, and NovaRad.  Already sued: Vitalworks and Merge. No way to know who else has settled. If your name hasn’t been mentioned yet, get ready. This has all been conducted on DR’s home court in the Southern District of California. The implications for future of PACS sector are potentially profound." The fulltext patent with drawings is here. Also, a mention of their suit against Emageon (news story here) and settlement with Merge. I also found this mention of a suit against Kodak. Old court records show a suit against Fuji in November 2007. Notice that the About Us /Company link of their site has two entries: Patented Technology and Executive Management Team.

From The PACS Designer: "Re: Top 500. TPD wants to congratulate the healthcare providers who were selected by InformationWeek for their 2008 IT innovations by being selected to be in the InformationWeek Top 500. The top healthcare provider at #7 was Advocate Health Care, led by Bruce D. Smith, Sr. VP & CIO. Baylor Health Care System, led by David S. Muntz, SR.VP & CIO, was #16. Congrats to all on being the best in the eyes of InformationWeek."

An English hospital’s Cerner system crashes again, this time for 12 hours. It’s odd that stories like that always make the papers there, maybe because of some NHS resentment or something.

Odd lawsuit: a patient claims his surgeon stapled his rectum shut, leaving him unable to move his bowels for 17 days.

maine

The local paper writes up the EMR go-live of Blue Hill Memorial Hospital (ME), part of Eastern Maine Healthcare Systems. The paper doesn’t say, but I think it’s a Cerner shop.

WCA Laboratory (NY) goes live on SCC Soft Computer lab. I hadn’t heard much from that vendor in quite some time.

The missing British hospital CDs containing information on 18,000 employees turn up, but the hospital isn’t that happy about it after spending $46,000 sending out employee notices. They thought the CDs were lost in the mail on their way to McKesson, but it turns out a hospital employee had them all along. According to an employee, "It was a massive waste of time and money although everyone seems to be breathing a sigh of relief. It was all a bit stupid. We knew the CDs would turn up."

AHLTA cost the government (us) billions, but now its CDR is getting so big that it’s nearly unmanageable. An MHS engineer called it "failed" as it tries to keep up with a data growth rate of 1.4 terabytes a month, although a couple of statements in the article make it technically suspect.

First they stopped serving meat, now they’re cutting back on patient care. An Australian hospital had to temporarily shut down its X-ray services because of unpaid bills.

The president of RJL Sciences gets three years’ probation and a $10,000 fine for creating FDA-unapproved software for AIDS drug maker Serono that falsely diagnosed AIDS "wasting" that would help sell Serono’s Serostim, which cost Medicaid $21,000 for 12 weeks of therapy. The drug company already paid $704 million for being scumbags, pocket change compared to the $13.3 billion that Merck paid to buy it two years ago.

Scribe Healthcare technologies offers a free version of its dictation, transcription, and document imaging system to solo transcriptionists and small physician practices.

Indian mob hospital news: a group storms a hospital and "blackened the faces" of husband-and-wife doctors, claiming that the gynecologist half of of the couple left a surgical mop in a woman’s abdomen during a hysterectomy.

Kaiser and the VA waste their time demonstrating the Nationwide Health Information Network that works only in the one country that’s too mired in debt to afford it. They should be in the printing press business since it’s going to take a lot of them to crank out the declining value dollars needed to bail out all of our suddenly needy and formerly anti-government capitalists in investments and car-making.

Off topic, I’ll side with non-candidate Senator Ron Paul, MD on the whole bailout issue: "The very people who have spent the past several years assuring us that the economy is fundamentally sound, and who themselves foolishly cheered the extension of all these novel kinds of mortgages, are the ones who now claim to be the experts who will restore prosperity! Just how spectacularly wrong, how utterly without a clue, does someone have to be before his expert status is called into question? Oh, and did you notice that the bailout is now being called a ‘rescue plan’? I guess ‘bailout’ wasn’t sitting too well with the American people."

GE takes a minority position in home monitoring company Living Independently Group. GE Healthcare also announced that it’s shutting down a Maine plant and GE cut its outlook because of its GE Capital unit.

Siemens Healthcare bags a $70 million imaging deal in Korea.

Charlotte, NC-based hospital operator Hospital Partners of America files Chapter 11.

Medical device maker Medtronic encouraged spine surgeons to use its products by lavishing gifts, phony patent royalties, and strip club visits, the company’s former lawyer says.

UPMC implements a salary cap and may lay off employees.

Medical records of 45 patients of Grady Memorial (GA) were inadvertently posted on an unsecured web server in July. Here’s the interesting part: of the article "Grady outsourced the job of transcribing the notes to a Marietta firm, Metro Transcribing Inc., which outsourced the work to a Nevada contractor, Renee Lella. Lella, in turn, turned the work over to a firm in India, Primetech Infosystems." I found this message from Lella on the website of the Republic of the Philippines looking for transcriptionists, so she was going international (beyond the arm of HIPAA enforcement, as it turns out). I wonder who’s held responsible since Grady probably didn’t know their information was headed overseas?

A patient in a Canadian hospital’s ED dies after waiting 34 hours for treatment, although they’re not quite sure since he may have been dead for several hours before anyone noticed.

No amount of pleading and common sense gets some caregivers to wash their hands, so Arrowsight Medical’s Hospital Video Auditing system offers a solution: put video cameras (warning: PDF) in the ICU. That’s like measuring the medication error rate by observation, but like the lawyers say, don’t ask questions whose answer you don’t really want to hear. That’s where Suzanne Delbanco went, by the way, which we just told you about Tuesday.

lansdale

Speaking of handwashing stubbornness, that’s one gripe of a Baltimore internist who is quite unhappy with medical centers. "We remain absurdly complacent about rising iatrogenic infection rates, knowing all too well that we are allowing immunocompromised patients to die unnecessarily in our intensive care units. There are alcohol-based hand-washing gels everywhere, but no police or policy with teeth in it to enforce handwashing. We lurch toward physician computer order entry, clinging to the false belief that software programs will prevent adverse drug reactions and delivery of the wrong dangerous drug to the wrong patient. We understaff our pharmacies so that they can’t get the medications to the patients on time or alert us to our own prescribing errors. We burn out our nurses despite years of loyal service. We capitulate to the for-profit insurance industry that informs us they won’t pay for day 4 of Mr. Jones’ hospitalization because he has failed to meet some arbitrary criteria in their manual." His full article (warning: PDF) is here. It’s causing heated debate because it bluntly says what a lot of we hospital people know to be at least partially true nearly everywhere. I notice he’s in private practice now in a concierge model, charging a $1,500 annual fee for unlimited visits and not accepting insurance. Pretty reasonable if you ask me. I might want to interview him.

Big veterinary hospital chain Banfield sells its veterinary telemedicine systems company to a veterinary imaging and practice management software company.

pillphone

Cell phone maker Qualcomm talks about the Pill Phone, which contains drug information and sends patient reminders.

Joint Commission says heparin mistakes should encourage hospitals to use CPOE and barcoding.

E-mail me.


HERtalk by Inga

From In the Know: “Re: Medcomsoft. The former CEO and VP of Business Development at Misys Healthcare are trying to raise money to invest in Medcomsoft. Tom will be CEO and Rich COO. Likely a new EMR/PM home for the employees lost in the pending Misys-Allscripts ‘synergies.’" Skelton and Goldberg were engaged by Medcomsoft back in June to serve in a ‘consulting role.’ As I went back and read Medcomsoft’s September 8th press release, I realized I may have overlooked this section the first time: ‘In conjunction with development of the revised business plan and associated financing requirements, the Company has identified a senior management team with deep domain expertise and a track record of success in the U.S. HIT market. Subject to completion of the targeted financing and final negotiation of mutually satisfactory employment terms, this senior management team would join the Company to drive execution of the revised business plan.’ Makes sense they would take a few displaced or disgruntled Misys folks with them.

From Fanny Mac: “Re: cell phone pictures of patients. There are bunch of poorly educated, lower-class clowns in hospitals that will always do this or snoop in patient charts. With the significant dumbing down of ‘grunt-level’ hospital workers in the last 25 years, this problem will never go away. Finding top-notch hospital workers is always a major effort nowadays and many are forced to accept – er, marginally capable individuals, primarily aides, therapists and technicians. This security breach and others make a mockery of HIPAA. Those of us in executive positions wring our hands, but simply don’t know about or understand the lower rungs of the hospital staff and what makes them tick. Is this an issue of class? You decide.”

CCHIT reports that there are at least 90 public and private EMR incentive programs. The combined programs represent at least $700 million in potential funding. I wonder how many of those organizations agree the study finding that despite relaxed Stark laws, EMR adoption is still moving slowing.

While I am all for clinical excellence, I wonder how many people would brag about receiving this EIC award to anyone outside of healthcare? Would they include it in their Facebook profile?

Cooper University Hospital (NJ) agrees to pay $3.85 million to the federal government to settle a whistleblower lawsuit. The case alleges that between 2001 and 2003, the hospital submitted Medicare claims that inflated its actual treatment costs in order to qualify on paper for outlier payments.

NIH director Dr. Elias A. Zerhouni announces he is leaving the agency by the end of October.

The Leapfrog Group names (warning: PDF) 26 hospitals and seven children’s hospitals its list of 2008 Top Hospitals. Winners are selected from a Leapfrog survey that evaluates patient safety. To make the list, hospitals must have implemented CPOE and use it to alert physicians of common and serious prescribing errors.

E-mail Inga.

Readers Write 9/24/08

September 24, 2008 Readers Write 28 Comments

Submit your article of up to 500 words in length, subject to editing for clarity and brevity. Use your real or phony name (your choice). Submissions are subject to approval and become the property of HIStalk.

Why Sarah Palin is Relevant to HIT
By Wilma Pearl Mankiller

I found it amusing that so many people took Inga’s comments about Sarah Palin and bangs and Botox and turned it into something political. I agree with the readers who think HIStalk isn’t the right forum for politics. We get plenty of that from every cable news channel every night.

That being said, the Sarah Palin story is relevant to our little healthcare technology world. There are some excellent women leaders in our industry, but men far outnumber the women in the top spots. With Palin, we see a working mom who has a realistic chance to be the #2 “guy” in the country. This makes her story relevant, interesting, and inspiring for those of us who have struggled to advance our careers while also balancing our family lives.

Years ago, when I was first newly pregnant, I went to dinner with my husband, a male co-worker, and the co-worker’s high-level executive wife. All but my husband worked for HIT vendors. At that dinner, I recall the wife warning me that no matter how much my husband claimed he was going to help carry the weight, some things would always fall to the wife/mother. At that time, I was young and naive and didn’t fully comprehend what she was telling me. All I really understood was that she and her husband had successfully raised three great kids and she managed to rise through the professional ranks at the same time. I aspired to be like her.

Fast-forward a few years. I supposed I can say that for the most part I achieved what I had hoped for: kids, a nice house, enough money, and some time as an executive. I suppose some would say I had it all. Perhaps I did. But the reality is that getting it “all” can include a few things you never expected or wanted, such as:

  • Tears, while sitting in the parking lot of my son’s daycare the first time I dropped him off.
  • The discomfort and inconvenience of expressing milk in airplane bathrooms and rental cars.
  • Resentment, from both men and women who felt it was unfair that they had to pick up the slack for me while I was getting paid time off just to hang out with a baby.
  • Frustration and guilt, for cancelling product demonstrations because I had a sick child at home who needed me.
  • Ambivalence, when removing my name from promotion consideration after learning I was (unexpectedly) pregnant again.
  • More ambivalence when I asked for lesser job with lesser pay so I would no longer have to travel.
  • Guilt and self doubt when others questioned (judged?) my career advancement decisions and my commitment to being a mom (and for some reason, the highly paid men with stay-at-home wives were the worst because they never seemed to understand that not every husband is the family’s major breadwinner).

Obviously and unfortunately, my frustrations weren’t unique to HIT. In fact, the same challenges exist in just about every industry, which is probably why there are only eight women CEOs running Fortune 500 companies. If you are a woman who chooses a career AND motherhood, you face challenges that only other working moms appreciate. The role models in our hospitals and companies are few and far between. While we can all name a few women that have shattered the glass ceiling, these leaders are the exceptions.

So, here we have Sarah Palin, a real mom who is potentially the country’s next VP. She got where she is by some combination of brains, ambitions, timing, good looks, and luck. We can appreciate that she has to take a baby on the campaign bus. Her kids aren’t perfect. She has critics who think she should be staying home with the kids. Unlike Condoleezza Rice or Janet Reno, she has a family. And if she can succeed, then it gives the rest of us hope that maybe more of us will have a chance to run a hospital/IT department/software company one day.

That’s how Sarah Palin is relevant to HIT.


Observations from the Epic User’s Group Meeting
By SNL

Epic is an engaging, dynamic company. They definitely put on a good show. But the smart observer can figure out their MO.

When Epic wants to build a new software tool or enhance an old one, they put a couple of recent college grads on the project. After "research", and whatever that involves and an hour or two of client Webex’s, they release the upgrade. If QA is done, it’s by other non-clinical people.

When a client complains, especially a doc, they shower them with attention, phone calls, a trip to Madison. "We want to work with you and hear your feedback." Then, after a number of back and forths, all volunteer time on the doc’s part, the module is improved. This can take years.

Meantime, no one really asks "Why didn’t you do a better job building the thing before you released it?" Anyone who does and doesn’t volunteer to pitch in is not a "team player".

Who loses in this game? The doctor/nurse/lab tech, and then the patient, who suffers through the risk of alpha software.

Who wins? Epic, who doesn’t seem to ever pay a dime for this expert help. Kaiser Permanente seems to be learning this the hard way.

Do other companies play this game? Has anyone ever been a paid expert for Epic design? Does Boeing design airplanes this way?


From the Mailbag

Got questions for Mr. H or Inga? E-mail them over!

inga125


Dear Inga,

Did you see where one of the AAFP directors suggested EMR vendors are part of a big Ponzi scheme and the only ones making money are the vendors? What do you think? – Carlo P.

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Dear Carlo,

Dr. L. Gordon Moore is the doctor who apparently doesn’t like EMR vendors. What Dr. Moore said supposedly said was, “Beware of the monolithic, expensive IT vendor, because there are always things they don’t do well. The whole thing can be a Ponzi scheme. The only ones making money from most of these products are the vendors selling them.”

First of all, is there something about making a profit that should make a vendor ashamed? Of course EMR vendors are trying to make a profit. Making a profit is a good thing because it means your vendor is more likely to stay in business to support you and continue developing the products.

So, was Dr. Moore suggesting his EMR did not help his practice become more profitable? Is that why Dr. Moore bought an EMR??? In my experience, the physicians who utilize EMR most successfully are those who initially went into the project looking to improve patient care (by making information more readily available, records more complete, reminders automated, etc.) EMRs can definitely increase efficiencies, which might make the practice more money. Of course some vendors and solutions are better than others and there are always things a particular vendor doesn’t do well as another. This is true with both the monolithic and expensive vendors and the nimble and inexpensive start-ups.

Bottom line, Carlo, I don’t think Dr. Moore is the kind of guy I’d have fun chatting up at a cocktail party.

Dear Mr. H,

I saw a reader comment in an earlier Readers Write about the problem with meetings. What is your take on them? – Lorena

Dear Lorena,

I detest meetings. Really. They are like gases – they expand to fit whatever space and time is allotted to them, yet nothing ever results except a vow to hold even more meetings to which even more people are invited. I don’t like attending them and I don’t like conducting them. I will do anything, including faking an emergency page or coughing spell, to escape back out into the sweet, cool air of freedom.

The really bad ones are when the suit-du-jour is running a meeting of the worker bees. Everybody’s jockeying for the boss’s love and admiration, so it will take twice as long as usual to achieve nothing. When a boss is present (hint: they’re the ones with the suits who came late and are furiously keying BlackBerry e-mails instead of listening to people who actually showed up in person) they will pretend to be fully engaged by randomly spouting out one of these non sequiturs:

  • Make sure you document that
  • Let’s put that in the parking lot
  • How about a bio break?
  • Schedule another meeting with (cast of thousands)
  • E-mail me the details
  • Give me a completion date
  • Send me a list of the risks involved
  • I need to review that before you send it out

Notice how none of these items really adds any value except to support the illusion that the boss is vital to the outcome?

Some people are meant to conduct valiant battles on a field of laptops, armed with minimal knowledge and maximal need to prove it. Others just get the job done instead of yammering about it.

Dear Inga,

What kind of sales tricks should doctors look out for when considering the purchase of a PM/EMR system? – Suspicious Doc

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Dear Suspicious Doc,

Are you buddies with Dr. Moore, by chance? Since when did EMR vendors get put in the same category as used car salesmen? Although I do recall hearing about this sales guy who used to “hide” a second PC and switch box underneath the table during a demo. At just the right moment, he would switch from the computer running the PM software to the one running the EMR. He was such a pro at it that prospects never realized the two products were in no way integrated. He was smooth.

Anyway, I think one thing important to understand is if the software version you are reviewing is actual live and in production. If it is a pre-release version, that is ok, but it’s important to understand whether or not the version you are looking at is fully tested and the one you will be getting. Also, definitely talk to other practices and ask them about implementation, support, and whether or not the software works as advertised. If you believe a particular function is critical for your operations, make sure you talk to at least one practice (anywhere, any specialty) that uses that feature.

Finally, assume that in most cases that whatever price you are presented initially can be negotiated. It’s likely that the vendor is more concerned with the total contract amount than individual line items. If they throw in a PC or an extra day of training, understand the value of the item so you can access if it represents 1% or 10% of the total deal. If you are offered a lease option, keep in mind the sales rep (and maybe the company) receives some sort of commission for the lease, so they may be willing to give you a little bit better deal on the total price. Also, lease rates can usually be negotiated if your credit is good.

Dear Inga,

I know a female sales rep who slept with a hospital IT person and her company’s product was chosen. Is that common? – Ms. Kitty

clip_image008

Dear Ms. Kitty,

That is a one of the oldest sales tricks ever (check out the Old Testament). Seriously, I guess I am just naïve enough to believe that women (or men!) don’t give up their bodies to win business. I bet what happened with your female sales friend is that she just happened to find true love with that IT person and her product just happened to be the best solution.

Dear Inga,

I loved your avatar! I was in love with your mind before, but now that I realize you must also be beautiful I’m beginning to think we might be made for each other. By the way, are you getting all sorts of cyberspace love letters from wacky IT nerds? – Obsessed Fan

Dear Obsessed Fan,

Um, you are the first. (that was a pretty creepy e-mail.)

News 9/24/08

September 23, 2008 News 4 Comments

From shimshamrich: "Re: Thompson, HPA. Tim Thompson is the new CIO at Houston’s Methodist Hospital. Also, VCU Health System (Richmond, VA) had a very successful go live on GE HPA. Converted $3.4B of accounts from old McKesson Mainframe system to HPA with 100% accuracy."

From Bob Arann: "Re: Misys/iMedica. I heard Misys let Allscripts look at iMedica’s source code, which led to the lawsuit. Could Misys have been that stupid or were they trying to find a way to get out of the original agreement and take over development themselves?" Pure speculation, I should add, although the nature of the iMedica complaint hinted at something like that.

From IsItTrue: "Re: Hersher. I hadn’t noticed, but did you report the Hersher-CES Partnership?" Link. I missed that. Betsy Hersher’s company is working with executive recruiting firm CES Partners. She’s still doing her CIO coaching thing.

pronovost

From Rodney Dangerfield: "Re: Peter Pronovost. He’s a new MacArthur Fellow." Link. Peter gets one of 25 $500,000, no-strings "genius grants" for 2008. I interviewed him in February about his "surgical list" idea that was so simple that only a genius would have suspected the massive patient care improvements it could support. From the interview: "I pulled all the teams together and said, ‘Is it acceptable that we can harm patients here in this country?’ And everyone said, ‘No.’ So I said, ‘How can you see someone not washing their hands and keep quiet? We can’t afford to do that. In the meantime, you can’t get your head bit off, so docs, be very clear. The nurses are going to second-guess you. If you don’t listen to what they say, nurses page me any time day or night, they’re going to be supported. There’s really no way around this. We have to make sure patients get the evidence.’"

layngospasms

From The PACS Designer: "Re: CRNAs singing. TPD knows how much Mr. H. likes singing groups, but I bet he hasn’t heard the Laryngospasms! Check out their ‘Breathe’ and ‘Waking Up Is Hard To Do’ videos." Link. They sound good for gas-passers. Seriously good doo-woppy harmonies. "CO2 is high, I think you’re going to die, and this won’t look good on my resume … your sputum is as thick as Cheez Whiz, I’m kissing my stipend goodbye." Found their site here. I’m rocking out to "Little Ol’ Lady with her Fractured Femur," sung to the tune of "Little Old Lady from Pasadena," of course. Excellent.

From HITpundit: "Re: sponsors. Gee, with all the ads on the site, HIStalk is starting to look like Times Square!" Where are those hookers and crackheads I ordered? But seriously, the long-awaited improvements are now finished (smaller ads, better layout, etc.) As of today, the ads are being displayed by a brand new and highly efficient method (one call to the adserver database for the whole page, not once per ad) so HIStalk will display ridiculously faster, so I’m really happy with that improvement. Also, the ads are now displayed in random positions (other than the Founding Sponsor ads), so you’ll get a different arrangement every time you refresh the page.

A couple of new text ads are to your right: DB Technology just announced its Enterprise RAS and Matthew Holt is offering HIStalk readers a $50 discount on registration for the Health 2.0 conference in SFO on Oct. 22-23 (featuring big names Kolodner, Shirky,  Neupert, Shreeve, Parkinson, Bush, and Bosworth).

From Kaimuki: "Re: Sermo. Any thoughts on them?" Not from me, although this guy ("Ben Dover, MD" – nice!) has some major gripe with them that isn’t clear (Sermo tried to have his sermosucks.com domain revoked, but lost). They’re getting investor money and trying to walk a fine line of selling anonymized doctor information to drug companies while not appearing to have gone over to the dark side. I suppose I’m indifferent to Sermo … if doctors like it and use it, more power to them.

thomas

From Helskini Hank: "Re: Thomas Hospital. Seen in the wild. The ‘Starting July 15’ signs are still up and they had 12 hours of Soarian downtime Friday."

ChartOne completes the spinoff of eWebHealth, which offers HIM workflow solutions via Software-as-a-Service. George Abatjoglou will run the new organization.

Listening: Dungen, trippy Swedish prog-pop.

a2m

Welcome to new HIStalk Gold Sponsor A2M Resources. Vic Arnold (formerly of GE and IDX) has put together a highly experienced consulting team that can handle revenue cycle work, assessments, process redesign, and working in a management advisory capacity. I asked Vic what made A2M different and, to summarize, he said: (a) solving problems that everybody sees over and over; (b) fixing lame technology integration ("paving the cow path"), and (c) overcoming the myth that technology is the answer to every question. Thanks for the support, A2M Resources.

Brian McAlpine, formerly with Emergin/Philips, joins medical device connectivity vendor Capsule as director of strategic products.

Cosmo Battinelli is named SVP of product support services at Eclipsys. Most notably, he’s from Symantec, not ADAC.

palmscanner

BayCare (FL) is using Fujitsu biometric palm scanners to register patients.

St. James Healthcare (MT) signs with AHI Software for registration QA service. I’d tell you who’s involved in the company except their web site doesn’t work with Firefox, so they’ll have to be happy with IE users only (which counts me out).

Almost forgot: I added an "E-mail This to a Friend" button to your right that will pop up a handy e-mail form that you could use (theoretically, let’s say) tell everybody you know about HIStalk, complete with a link to the page you’re on at the time. Just sayin’.

Jobs: Implementation Consultant, Data and Interface (GE Healthcare), Application Development Manager (4Medica), Implementation Project Manager (MedAptus), Regional Sales Manager – Toronto (Apollo PACS).

A New Zealand hospital decides to pass on a project to use RFID chips to identify hospital bottlenecks. "We would be following the patient’s movements from A to B to C, but we already knew what that was."

From an offline conversation I had with a highly informed reader, here’s some bad news. The economy is tanking and Uncle Sam’s only answer is to pump more tax dollars into trying to prop up businesses that deserve to fail (see: France). Big deficits are about to get bigger, tax collections are headed south, and former Wall Street investment sharks are demanding unsupervised control of a $700 billion piggy bank to support current Wall Street investment sharks who screwed up. The result: politicians can no longer avoid the huge chunk of GDP that healthcare and entitlement spending eats up. That’s bad for healthcare, probably.

Hard times could put us in the same predicament as Australian hospitals that are so broke they had to stop serving meat to patients.

And speaking of ridiculous healthcare costs, GE Healthcare’s new CEO blames Washington’s rare desire to save taxpayer money by not subsidizing highly profitable imaging machines for the company’s declining fortunes. He’s working on the bureaucrats: "I don’t think that cutting or limiting the use of technologies like ours is the right answer. I think there’s a better answer. And it’s clear that we have got to be involved in coming up with that answer." I’m not seeing masses of people dropping dead from lack of imagery, so I’m not so sure there is a better answer.

I’m a little more upbeat in this week’s newsletter editorial: "This Is No Time for Timidity: Why Contrarians Taking Bold Steps Instead of Moaning About Poor Financial Conditions Will Win."

I got yer Windows Mobile 5250 emulator right here, pal.

uconn

A UConn nursing professor rolls out her NIH grant-funded patient education application, which collects information from patients on a touch screen in the physician’s office, provides education, and summarizes the information for the physician.

A patient dies from a chemo overdose at a London hospital, which the hospital blames on its computer system.

Wake Forest University (NC) will host an EHR conference October 1-3. I’ve heard of nearly none of the speakers other than "of course I’ll be there" John Halamka and I’d question the wisdom of giving Microsoft and IBM a speaking slot, but it might be OK.

E-mail me.


HERtalk by Inga

El Camino Hospital is offering its affiliated physician group subsidies for eClinicalWorks. Members of the Independent Physicians of El Camino Hospital will have the option to use ECW’s PM/EMR interfaced with the hospital’s systems.

Ashtabula County Medical Center (OH) has successfully implemented QuadraMed’s Pharmacy Integrated Medical Management solution.

AHIC Successor announces the appointment of its 15-member board. Members include an assortment of people across the HIT spectrum.

Orlando officials and local healthcare leaders are working together to expand the area’s medical tourism. By leverage its vast tourism resources and ever-growing healthcare infrastructure, Orlando hopes to increase visitors to the region. I can think of all sorts of bad Mickey Mouse surgery jokes, but I will leave those to readers.

Speaking of medical tourism, a Deloitte Center for Health Solutions study concludes that 750,000 Americans traveled abroad for medical care in 2007. The number is anticipated to be six million by 2010.

I am an official Chrome convert, finding it so much faster than Internet Explorer. An annoying problem, however, is that I can’t seem to view YouTube videos with Chrome (I get about two seconds and it stops). I happened to be looking for a video version of the reader-recommended song, “You can have my husband, but please don’t mess with my man.”

What were these guys thinking? Two University of NM Hospital employees are fired for using their cell phone cameras to take pictures of patients receiving treatment, then posting them on MySpace. The photos were mainly close-ups of injuries. The pair was fired for violating a hospital policy against using cell phones in patient areas. Obviously the hospital just wants the matter to go away, calling the situation an employment issue that has not involved law enforcement. Hopefully no ambulance chasers, either.

Picis launches its new eView for CriticalCare Manager solution. The product is designed to consolidate clinically relevant information for the ICU census and present in a concise web-based view. Picis also announced several enhancements to its core perioperative and critical care clinical automation solutions.

Former LeapFrog CEO Suzanne Delbanco is named president of Arrowsight’s new healthcare division. Arrowsight Medical will use video auditing to assure that employees are following quality and safety protocols. Sounds kind of big brotherish to me.

CareTech Solutions is chosen as IT outsourcer for Port Huron Hospital (MI). The company also announced that it earned the top score (94.6) in a recent KLAS study on extensive outsourcing, including a 100% "would you buy it again."

Another organization announcing a milestone is the Delaware Health Information Network (DHIN). Less than a year after being named one of nine initial HIEs to participate in HHS’s NHIN trial implementations, DHIN became the first fully operational statewide HIE. With its partner Medicity, DHIN has also successfully connected with other NHIN participants. Got acronyms?

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Meanwhile, the MidSouth eHealth Alliance, a Memphis-area RHIO, announces it has completed two years of data sharing and interoperability. The Memphis RHIO serves over one million lives. If Elvis were still around, I bet he’d be covered, too.

Vendor Deals and Announcements

  • Adventist Health System signs up for GetWellNetwork’s Interactive Patient Care solutions.
  • El Camino Hospital (CA) is partnering with Microsoft’s Amalga to provide data integration onto a single platform.
  • Oncology management system provider IMPAC Medical is teaming up with Accuray to connect Accuray’s CyberKnife Robotic Radiosurgery system with IMPAC’s EMR.
  • OrthoArkansas (AR) has deployed athenahealth’s PM and billing service for its 21 physician organization.
  • Integrated Health Systems of Alabama will use MicroMD electronic health records software from Henry Schein Medical Systems at its 42 community care centers.
  • EDI company ZirMed is partnering with Worflow.com, a provider of PM/EHR solutions.
  • Elizabeth Wende Breast Care (NY) will outsource its long-term data storage to InSite One.
  • Surgical Information Systems honored four hospitals and medical centers with Client Recognition Awards for their effective use of SIS software to bring out remarkable results in their operating rooms. Not among the winners (yet) is MetroSouth Medical Center that just installed SIS.
  • Cerner completes its first sale in Latin America. Clínica Las Condes in Santiago de Chile will implement Millennium at its 220 bed hospital.
  • athenahealth signs up for another five years of business process services with Perot.
  • Community Hospital of the Monterey Peninsula (CA) is expanding is use of Eclipsys by activating Sunrise Ambulatory Care. I wonder if the hospital will have a chance to offer Medinotes as an alternative?

E-mail Inga.

Monday Morning Update 9/22/08

September 20, 2008 News 10 Comments

From Reality CCHIT: "Re: CCHIT participation from vendors. Let’s be clear about the goals of vendor representatives participating on CCHIT commissions and committees. The primary role of these participants is to watch out for the interests of their employer. That may mean adding onerous requirements already met by their company that sets a higher bar for less well-funded competitors or making the case against functionality their employer doesn’t have. A secondary role is to be the first to know what’s coming for technology that will take months or years to complete. Finally, participation looks good on resumes and RFPs."

From Medicman: "Re: Misys. Despite the financing issues with the Misys/Allscripts merger, Misys reps were in Raleigh earlier this week being trained on the Allscripts products. Someone is fairly confident this will go through." It probably will, although who knows what it will cost to get financing in this market. Analysts would say that the expected benefits outweigh the deal’s cost. I would say "expected" rarely proves to be the case. I can’t think of even one good strategic decision that Misys Healthcare has ever made (buying CPR, selling CPR, botching Sunquest, botching ClearPractice, copping out by relabeling iMedica instead of building or acquiring its own product, etc.) Maybe the best value of the merger won’t be the vaunted PM/EMR cross-selling opportunities, but rather clearing out what appears to be several corner offices worth of underperforming executive talent.

It’s not news to HIStalk’s readers since we told you on 9/15 after reader tips, but Eclipsys will acquire physician EMR vendor MediNotes for $45 million in cash and stock. I interviewed MediNotes CEO Don Schoen two years ago, where he said, "This is a huge market with potential and some people will benefit greatly from it. I hope to be one of them." Sounds like that’s what happened.

Parts of Microsoft’s new post-Seinfeld ad campaign were made on a Mac, geeky sleuths have determined. The article says the "Vista sucks, but less than you think" campaign (I made that up, but it has a nice ring, I think) will cost $300 million. The self-congratulatory article announcing the campaign basically says that Microsoft will copy everything that Apple does: hip ads, in-store kiosks, and free expert bars. That’s going to be a tough sell given that Windows 7 hints are already being dropped. Vista could be the next Windows ME. I’m running it on my laptop (not by choice since it was bundled) and it’s working fine, although I don’t really do much on it.

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IT folks at the Houston VA hospital scrambled to prepare for Hurricane Ike and are now trying to recover 35 PCs lost when its Galveston clinic was destroyed. "As the storm approached, employees transmitted hourly updates of patient records over a VA network to the Little Rock facility, he said. They continued to do so the weekend the storm hit. Seventeen of the hospital’s 40 technology employees and 23 family members camped out in the facility’s library and server room from Friday, Sept. 12 until the evening of Sunday, Sept. 14, to keep vital computer systems running."

Allscripts sells its Physicians Interactive business unit, which pushes drug company sales pitches to doctors over the web.

Housekeeping: the Google Search box to your right lets you dig through over five years’ worth of HIStalk. Put your e-mail address in the Subscribe to Updates box to get blasts when I write something new (sometimes it’s breaking news, so you will often be the first to know). Click the ugly green Rumor Report graphic to securely and anonymously send me those secrets you’re itching to tell. And, as always, thanks to readers and sponsors for keeping the HIStalk flame lit.

A woman bringing her disabled veteran father to the Boise VA hospital refills her mug with soda from the cafeteria as usual, for which she has always been charged $1 or $1.50 even though no refill price is posted. On a recent visit, the cashier tells her it will be $3.80. The woman refuses to pay, the manager says they won’t take the soda back, and the woman dumps it on the counter and leaves. A reporter calls to tell her that two federal charges have been filed against her, each of which carries a maximum sentence of up to six months in jail. She claims she was identified by looking up her father’s electronic medical records. "They should not have used a veteran’s medical records to find me," she told reporters.

The government of Belize signs a contract for a national health record that will connect every citizen and the entire health sector. "The BHIS consists of a set of mostly interdependent modules surrounding the central Electronic Health Record (HER) and Admissions-Discharge-Transfer functions. The chief functions of BHIS key modules are, electronic health record and admission discharge transfer, clinician order entry, financial, maternal child health, HIV/AIDS, laboratory and testing, supply chain management, public health and human resources." Careful readers will notice the EHR/HER transposition, which surely means Microsoft Word was used to compose the story.

Hamilton Health Sciences, an Ontario hospital group, builds a technology hub for its IT department and vendor test bed. It’s doing innovation work around mobile caregiver technology.

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Doctors in Scotland report great success with their Mobile Clinical Assistants, which I assume is the Motion C5.

UCI Medical Center (CA) overhauls its anesthesia information systems by bringing in SIS, putting an end to handwritten reports last week.

Apollo Hospitals, which operates 41 for-profit hospitals in India, will develop a centralized patient records repository in which birth-to-death records are indexed by an Apollo-assigned patient identifier.  

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UMDNJ made up a no-work job to keep a powerful former state senator from going to work for a competing hospital, an administration official testified Wednesday. The former senator is charged with bribery and fraud for steering $12 million of public money to UMDNJ in return for the job. The dean of the medical school arranged the job, which officials said was created when the school hired high-salaried doctors for a cancer institute that it lost to Cooper University Hospital when that hospital’s own power broker, "the political boss of South Jersey," shifted the project to Cooper. Do you suppose sick patients realize how much sleazy jockeying is being done by seemingly reputable organizations?

New York eHealth Collaborative issues proposed guidelines for patient consent for electronic data interchange. Public comments are welcome through October 3.

Vermont Information Technology Leaders capitulates to state government demands that it reduce its board size, cutting back from 21 to 11.

E-mail me.

News 9/19/08

September 18, 2008 News 11 Comments

From The PACS Designer: "Re: cloud map. Peter Laird, who works for Oracle, has done an excellent job of creating a ‘Visual Map of Cloud Computing’ which gives you the full spectrum of the cloud environment. His map details suppliers of the types of clouds, storage, integration, value-add, and SaaS applications." Link.

From Deb Ridement: "Re: Misys. Both CEOs are way out on a limb with no turning back. If Misys, which has contacts with the CEOs of every bank and lending institution, can’t get the money, the banking industry really is in the toilet. That also says volumes about the HCIT industry and US economy. Employees and shareholders of both companies must be holding their breath."

From Inside Outsider: "Re: GE’s HPA. GE seems to be pushing HPA and they believe that the product exceeds what is in the market, particularly with the CBO product that combines both the hospital and physician billing. In fact, GE reiterated this at their GE Summit this summer."

From GE Centricity HPA Customer: "Re: HPA. I’m a senior IT person at a GE HPA site. At last month’s GE Healthcare Users Summit, Centricity Business leadership stated the HPA billing system was the go-forward billing system for hospital customers. As such, they are continuing to enhance and support HPA. This was the same message GE leadership gave us in March in a private executive briefing. They implied they would be migrating their clients using the old Phamis / CareCast hospital billing system to HPA. But, it was pretty clear Carecast sites hadn’t gotten the message yet. Moreover, I don’t think GE has figured out how to migrate everyone."

From Interested: "Re: GE. Has GE made a big sale EMR in India?"

From Justasquirrel: "Re: the Evanston / NorthShore moniker. They have a contractor going through everything in Epic using Chronicles to change the name on every document. I wonder how much money they are investing in changing all letterhead, business cards, invoices, etc.?"

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University of Iowa Hospitals and Clinics votes down the Vocera VoIP communication system for what sounds like a bizarre reason: "There are certain areas of the hospital that cell-phone use is prohibited, for example. Whatever technology you install, you have to make sure that it’s not going to harm patients." I’m going to assume that the reporter or spokesperson got in over his head in trying to explain it because surely the hospital hasn’t found previously undocumented interference issues with the wireless network they’re already running.

Center for Information Technology Leadership says (warning: PDF) that a recent report by the Congressional Budget Office, which concluded that previous analyses (including CITL’s) overstated the benefits of IT in healthcare, is wrong. I admit that I’d probably go with CBO’s assessment, only because I never believe the optimistic outcomes industry folks usually predict. I’ve been jaded by hospitals creating expectations for big savings and improved outcomes, but failing to do anything to actually deliver them.

Former Cernerite Guillermo Moreno joins kiosk vendor Aurillion.

Someone from Microsoft e-mailed to say they had located and removed the PHI-containing Amalga/Azyxxi presentation that an HIStalk reader had reported to us and, sure enough, it’s no longer available via a Google search. Somehow it got out on the Web with some full patient names, diagnoses, EKG strips, and other confidential patient information.

Speaking of Amalga, El Camino Hospital buys it.

David Brailer’s Health Evolution Partners invests in Chrysalis Ventures.

HIMSS supports its big vendor constituency by declining to support the healthcare IT bill that Pete Stark just introduced. HIMSS doesn’t want a new group usurping HITSP’s work and is against the idea of the low-cost open source systems called for in the bill. In other words, the screwed up healthcare system we have has been berry, berry good to HIMSS and all the other member groups out there, so they aren’t about to advocate widespread reform that might reduce their own influence. You can’t blame them, I guess, but it’s a shame that AHA, AMA, HIMSS, etc. talk about real change to improve outcomes and reduce cost, but only in ways that don’t threaten the big money folks.

Mass General will cut 200 jobs.

Akron Children’s Hospital took IT damage Tuesday in its outpatient building when a water main blew out and flooded the ground level data center.

E-mail me.


HERtalk by Inga

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From ORLabRat: “Re: Seinfeld show. Did you notice that Jerry’s computer (on the table by the window) morphed from what looked like a Mac to a PC somewhere around the third season? My timing could be off, but it’s interesting now that he’s a Microsoft pitchman.” I never noticed, truthfully. However, there it is on the desk in the back. Looks like a PC to me.

From Elsie EHR: “Re: Justin Long. As you mentioned, Justin Long — the Apple computer nerd cutie — is known for his role in Dodge Ball; certainly a classic in the genre of ‘nerds band together to save the (choose one) neighborhood / school / summer camp / nursing home / gym / world from corporate goons.’ However, he’s better known for his appearance last year’s explosion-filled Bruce Willis epic, Live Free or Die Hard, in which Long played a (drumroll, please) computer nerd cutie who joins a Luddite cop (Willis) to save the world from evil hackers.” Those Apple guys are marketing geniuses!

Meanwhile, just days after Jerry Seinfeld cashed his $10 million check for his Microsoft spots, Gates and company are pulling the ads (claiming it was all part of the original advertising plan). Yeah, right. Obviously those MS guys read my post on Tuesday.

CCHIT announces eight new commissioners and the reappointment of five others of its 21-member board. The appointees were selected from 85 applications and will serve two-year terms. Among the new folks is Sarah T. Corley, MD, CMO for HIStalk sponsor NextGen. CCHIT also announced it will begin its new HIE certification program on October 1.

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According to a poll, 63% of us spend our lunch at the desk plowing through e-mails. Compare that to the 20% who lunch with colleagues or friends, the 8% who work out, and the 9% who have a working lunch with colleagues / prospects / partners. Remember the good old days before e-mail, voice mail, and virtual offices when we actually went to lunch with the office crowd?

Not to bring up the taboo world of politics or anything, but the whole Sarah Palin phenomenon got me curious about how many women are in HIT’s higher ranks. Rich Correll, CHIME president and CEO, informed me that only about 25% of his organization’s healthcare information executive members are female (Rick says he remembers when CHIME was 90% men, so at least the trend is going in the right direction). That is still probably much better than the stats with healthcare IT vendors.

If you are curious what is going on in post-Ike Galveston and UTMB in particular, ER Dr. Angela Gardner has been posting interesting (if not depressing) updates. “80% of the island is damaged. UTMB is not seeing patients of any type at this point. DMAT teams are providing any necessary care. There is no electricity, no running water, and not enough fuel to start pumping water out of the flooded areas. Many of the emergency generators were damaged by storm. Phone lines and Internet connectivity are spotty. Even cell phone coverage is unreliable. Today, UTMB estimates re-opening the doors with a skeleton crew next week. Services will be added as it becomes possible. It is just a guess that we may not be able to have inpatients for 4 to 6 weeks. Full operability of all the hospitals/clinics/outpatient services/area clinics will probably take months. Much of the operability of the hospital depends on the time it takes for the city/county infrastructure to be rebuilt. This is emergency medicine’s surge capacity nightmare. The nearest fully functional hospital is 60 miles away.”

Cardinal Health is awarding more than $1 million in grants to help health care providers improve patient safety and health care quality. Last year Cardinal offered a similar program that resulted in grants ranging from $5,000 to $50,000.

Enterprise portal provider MEDSEEK announces its eMarketing Advisor service to assist hospitals improve web site effectiveness.

The Center for Studying Health System Change finds that, despite relaxed Stark laws, hospitals are not rushing to assist physicians with EMR costs. The Robert Wood Johnson Foundation-sponsored study found limited hospital budgets, conflicting projects, and lack of physician interest were all contributing factors. The third point goes back to a often discussed point that even a free (or almost free) EMR still isn’t enough to entice some doctors.

Note to Dysf(n): if “Tim” is a palindrome, perhaps “Inga” is actually “Agni”. (For the record, I’ve been told more than once that I am "hot").

E-mail Inga.

News 9/17/08

September 16, 2008 News 13 Comments

From Rogue: "Re: Epic clients. Children’s Omaha, Fairview, Carilion Clinic, Sisters of Mercy Health System, Ohio State University Medical Center, Children’s Hospital of Philadelphia, Sutter Health, Cleveland Clinic. I cheated – I read the User Group Meeting brochure. Some of the dozens presenting." Thanks to all those who named clients, most of them in the comments to the earlier article asking for some names.

From Pistol Pete: "Re: Adventist. John McLendon, CIO of Bayfront Health System, is leaving to take the CIO job at Adventist Health System. No word on where Tim Thompson landed this time."

From The PACS Designer: "Re: presentation software. Mr. H has posted about TechSmith’s SnagIt being one of his favorite inexpensive software tools for capturing images and text for use elsewhere. TPD has also used SnagIt and has noticed the improvements to another TechSmith software tool called Camtasia Studio 5 that provides for better video presentations. The software would be a good solution for numerous medical image files that require additional annotation of data elements from CT and other modalities." Link. I’m a longtime Camtasia user as well and I agree that it’s just great. I have, in fact, used it to capture and annotate cine loops from PACS as you mentioned. It streams in Flash, so it’s fast and high quality.

From Rudy Washington: "Re: GE. Does anyone have any insights as to the future of GE’s HPA patient accounting system? HPA was originally developed by IDX many years ago. Are they migrating current clients to a new patient accounting system or do they plan to enhance and support HPA?"

Going back to the Misys-Lehman mess, some now-tarnished names were all over the March announcement. Lehman Brothers brought the money and Goldman Sachs brought the advice. I think there’s little doubt that only two outcomes are likely in the few weeks until the scheduled shareholder vote: (a) ValueAct Capital jumps in with the cash, or (b) the deal falls apart completely because conditions are terrible and the merger will be reevaluated in an entirely new and harsher light by both lenders and shareholders. Given a long and nearly unbroken string of Misys incompetence and/or bad luck, I wouldn’t want to bet either way.

Speaking of Lehman, they spent $309 million on IT in the most recent quarter. Other than the bankruptcy thing, I’m sure they’re happy to be Most Wired.

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Conditions are are grim in Galveston, but at least UTMB’s IT department gets some nice kudos right on the main hospital web page. Sounds like they did a great job in recovering vital IT capabilities.

I don’t watch HIStalk’s stats too much, but Inga does, so she’s just squirming to have me mention that we’re on track for a record number of page views and visits this month unless everybody stops reading at once. So, please don’t.

The Madison paper runs a pun-laden preview of Epic’s user group meeting, currently underway with 3,900 attendees.

Listening: Hyppio FM, a hard-rocking Helsinki radio station that my little Aluratek thingie turned up. You can click the Listen link on the web page and tune in from there if you don’t have the gadget.

Pete Stark introduces a new HIT bill that would charge the federal government with creating standards and "creation of an open source HIT system that will be made available at little or not cost to providers." Open source expert Roger Maduro sent me this: "There are several sections recommending the use of open source software. It references VistA as a model but it leaves the door open to other open source solutions. This is a very big step for Congress."

Cerner gets its first Latin American customer, a 200-bed hospital in Chile.

Another Indian hospital mob attack: a doctor is assaulted over admission of a patient.

Little Company of Mary (CA) gets a local paper writeup for its medication management systems: smart pumps, a dispensing machine, and a barcoding packager.

I was looking at the results of a survey in which Alan Greenspan was voted most responsible for today’s dire economic conditions. You can ask him about that when he keynotes at HIMSS, at least if we’re not all selling apples on corners by then.

Microsoft may spin poor Vista sales, but actions speak louder than words: they’re already getting ready for developer testing of Windows 7. I’m sure those handful of hospitals actually thinking about rolling out Vista will pass now. I also noticed that MSFT is selling perennial cash cow Office Ultimate 2007 (including Access and Publisher) for just $60 to anybody with a .EDU e-mail address, which seems desperate (it’s a real perpetual license, not a subscription). Maybe they should replace Ballmer with Jerry Seinfeld.

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Computer disks full of NHS employee information are lost in the mail while headed off to payroll outsourcer McKesson.

GE Healthcare and Cerner are going after a big PACS contract in Ireland valued at up to $175 million.

Evanston Northwestern Healthcare, convinced by its marketing people that having a sensible, descriptive, and correctly spelled name is so 1990s, "rebrands" itself NorthShore University HealthSystem (they apparently have something against the space). The hospital claims it had "outgrown" its name (huh?) and offers this marketing gibberish as a half-hearted excuse: "The core of the new name/brand is ‘NorthShore,’ according to the firm. NorthShore not only signifies a geographic area — and a much broader terrain than ‘Evanston’ — but also serves as a state of mind. Prestige, quality and a favorable destination are a few of the attributes people say come to mind with the name NorthShore." What NorthShore brings to my mind is painfully obvious attempt at trendiness and a preoccupation with marketing BS. Just do your damned job and patients will show up in droves (the hospital is probably already full, for that matter, making the entire exercise even closer to pointless).

Speaking of rebranding, Dairyland is now Healthland (which we told you earlier). The company also announced the acquisition of Advanced Professional Software (which we told you earlier).

Jobs: Cerner CPOE Consultant, EHR Account Management Associate, Regional Sales Manager – South, Cerner CCL Custom Report Writer. Sign up for weekly job blasts here.

You know this article is going to fun from its subtitle: "Soldiers at the military hospital languished in part due to incompatible databases and dismal record keeping. Welcome to the Pentagon’s $20 billion medical-records boondoggle." It’s critical of AHLTA, saying it should never have been allowed to continue in the presence of the far superior VistA and did so only because of DoD arrogance. It also mentions a couple of things that I reported here long ago: that CHCS II was renamed AHLTA only because nobody could stand it and that former CIO Lt. Colonel Mike Fravell cranked out a $300K system that was better than the $5 billion AHLTA, which got him shipped off to South Korea for questioning the value of fat cat contractors like Northrop Grumman.

I’ve heard no announcement, but according to bid documents, the Mississippi Coastal HIE has chosen Medicity for its proof of concept, six-county RFP, with a three-year value not to exceed $3.5 million.

Who knew that Mayo Clinic is doing a joint venture with a disease management software vendor in the Netherlands?

Idiotic hospital lawsuit: Missouri hospitals are suing American Tobacco for $8 billion, claiming that they should be reimbursed for uncompensated care rendered to smokers.

E-mail me.


HERtalk by Inga

Here are some thoughts about the whole Seinfeld/Microsoft/Apple discussion and whether Seinfeld is the right guy to deliver Microsoft’s marketing message. I loved Seinfeld. It was a classic 90s show. If you are over the age of 30, you can probably name all the main characters. Maybe you watched Seinfeld while you were sitting in front of your TV with your new 4.3 lb IBM ThinkPad 701C (50MHz 486DX2, 14.4 kbps modem, 540MB hard drive with 8MB RAM) with its very stable Windows 95 OS. When you see Jerry on those commercials, it just reminds you of those good old days when Bill Gates was first named the world’s richest person. Compare that to Justin Long, the Apple cutie (in a computer-nerd sort of way). Other than the Apple commercials, he is known for some silly movies, including the Dodgeball: A True Underdog Story. If you missed the movie, the basic story line is that the small local gym misfits enter a dodgeball tournament to save the gym from the big corporate health fitness chain. Anyway, with those images in mind, does anyone really think paying millions for Jerry was a genius decision?

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Nuance announces the release of Dragon Medical 10, which is said to recognize dictation nearly twice as fast as previous releases and to be 20% more accurate. Also included are new medical vocabularies, improved EMR integration, and regional accent support.

Secure authentication enthusiasts might enjoy this article. After the initial roll-out of its Epic system, Children’s Hospital Medical Center (OH) incorporated both RSA’s Secure ID tokens and Sentillion Identix fingerprint readers for medication prescribing and dispensing.

Pattie A. Clay Regional Medical Center, Princeton Healthcare System, Riverview Hospital, and Frederick Memorial Healthcare System are named 2008 QUEST Award winners. The QuadraMed-sponsored awards honor hospitals for innovative and impressive use of QuadraMed products.

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Cerner completes its first sale in Latin America. Clínica Las Condes in Santiago de Chile will implement Millennium at its 220 bed hospital.

HP announces restructuring plans following the EDS acquisition. HP plans a 7.5% staff reduction (24,600 employees) worldwide over the next three years. Nearly half of the cuts will be in the US.

Speaking of layoffs, MedZilla.com reports that in August more than 25,000 new jobs were created in health care, with about 14,000 being hospital-based positions.

CAQH announces that providers now have a source for checking patient deductible balances online, at the point of care, and potentially any health plan. Insurers participating in the voluntary program cover an estimated 130 million lives.

Sounds like the Epic’s user group meeting is quite the affair. The event is following a Much Ado About Healthcare theme and Judy apparently dressed as Portia (of “Merchant of Venice” fame) as she welcomed attendees. Word is that having an extra 3,900 people in Verona caused some traffic snarls. On the agenda: Steven Levitt and Roy Blount, Jr. Meals are under a temporary tent and Epic is running 100 shuttle buses, according to local reports. If you are there, send us a update from the field.

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athenahealth extends it business process services agreement with Perot Systems for an additional five years, extending a seven-year relationship.

Next time you need a massage, head over to the hospital. Health Forum, a subsidiary of the American Hospital Association releases a survey indicating that more than 37% of hospitals offer one or more complementary and alternative medicine services, with massage therapy taking one of the top spots.

E-mail Inga.

Misys Postpones Allscripts Merger Meeting Due to Lehman Brothers Collapse

September 16, 2008 News No Comments

Misys PLC announced this afternoon in London that it will delay its its scheduled September 22 extraordinary general meeting to approve its merger with Allscripts until October 6. Its lead advisor, Lehman Brothers, filed for Chapter 11 bankruptcy protection yesterday, leaving Misys scrambling for the $330 million it needs to pay off existing shareholders of Allscripts under terms of the merger agreement.

The analyst who led the story had this to say earlier today, before the meeting date was changed:

"The major cash outgoing is the $330m dividend to be paid to Allscripts’ shareholders five days after the deal closes (around 1 October). So we imagine Misys has some two weeks to find funding in a tricky (and possibly expensive) market. It is unclear whether the EGM [on 22 September to ratify the deal] can proceed if the facilities are no longer in place, but we would assume so.

"While this must be the worst two weeks of the crunch so far to go shopping for a $305m facility, we assume one is available at some price and as such we imagine the deal should still go through. Certainly Misys must be working overtime to ensure it does. Its own healthcare business was already in sharp decline. It has stopped investing in R&D in its own business and we suspect business has continued to be poor. Quite apart from any break fees (£7.1m), the business would not be in good shape on its own. While we do not believe that will happen, the risk has just increased."

CIO Unplugged – 9/15/08

September 15, 2008 News No Comments

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Staying Tethered to a Disconnected World
By Ed Marx

Much has been written about the multi generational workplace. Thanks to advances in science, health, and technology, most institutes encompass a blend of 3 generations with the delivery of a fourth (Gen Z) on the way. Heck, even the age of my running group back in Cleveland ranged from teen through every decade to include the 60s. That made it fun, and inspiring.

With the exception of two individuals, my current leadership team is made up of baby boomers—though in truth, I overlap the Gen X periphery. That likely classifies us as average in this regard. Raised by the “greatest generation,” we have observed and participated in the most rapid advances the world has ever known, across all disciplines. For the first time in history, we now lead a vibrant force of multiple generations. This adds fresh challenges and opportunities.

If your leadership team is anything like ours, you’re struggling to ensure a sense of connectedness in an untethered culture. I am blessed to be part of an IT team that is nationally recognized as one of the best in areas of innovation, leadership, and infrastructure. Just this year, we ranked in the “Top 50” places to work across all industries (Computerworld). Be that as it may, fostering connectedness within a team that telecommutes extensively and where the focus has shifted to performance, as opposed to time in a cube, remains a daunting task. The Boomer leader’s comfort zone requires everyone to see each other daily and nurture a home-away-from-home feeling, while Gen X and Y don’t necessarily desire that environment. Is having a “best friend at work” (Gallup Research) still the most important criteria for connectedness in a post-modern workforce? What can leaders do to reconcile this conundrum so performance remains high and connectedness manifests itself in ways motivating to all generations?

Here is what we do.

· Social Networking- Encourage the use of networks such as Facebook and LinkedIn and develop your own networks within each

· Technology- Provide communication tools such as IM, VPN and video

· High Touch- As much as I value technology, I still handwrite an average of 10 cards per week

· Dinners- Have people over regularly

We purchased a second dining room table and extra place settings a few years ago so we could serve 40 people at one time.

Singles, including single parents and their kids, have been invited on many a Thanksgiving and Christmas to celebrate with us.

· Parties- Hold two huge shindigs each year for all staff, one of which is formal and includes significant others

We host smaller parties at our home to celebrate successes. Ideally, these include the employees’ families

· Play- Volleyball tournaments, foosball, kickball

This fall: six vs. six soccer

· Give- Take numerous opportunities to come together and give

Sometimes we help one of our own who is dealing with a personal struggle.

We participate in United Way and food drives, etc.

· Community- Volunteer with Habitat for Humanity, building homes or at various local outreach centers

· Phone Calls- Well-timed phone calls to chat with colleagues has proven critical

· Voice Mails- Stay an extra thirty minutes one evening and leave voice mails for individuals on different levels, thanking them for their impact

· Book Studies- Have numerous book studies taking place all the time, which brings people together to discuss specific topics

· Events- Most organizations have some sort of season tickets whether for the opera or local sports team.

Whenever possible, I take advantage of these and give first priority to non-management staff. While I find some of the events are boring (baseball is way too slow), I love hosting these activities simply to connect

· MBWA- For in office employees, walk through work areas regularly

My assistant knows that sometimes it takes me 45 minutes to return from a meeting a few hundred yards away because I love to engage my team

· Unique Meeting Places- Why hold meetings in boring conference rooms? Especially for teleworkers. Meet at Starbucks or Paneras

· Big Dates- Acknowledge your leadership’s birthdays and employment anniversaries

· Lead by Example- I work from home weekly and use all the aforementioned technologies and actions to foster connectedness.

· Transparency- Regardless of the medium, be transparent. Show your warts. Be human. Remove the formalities. A true leader earns respect by respecting others

For those who respond to this by asking “what about work?” I say look at our performance. Additionally, I firmly believe, and my experience will attest, the team that incorporates such connectedness will outperform those who insist it is all about butts in seats.

Do you want to reach across all generations and connect to a disconnected world? Incorporate compassion, acts of kindness, empathy, laughter, and fun into your workplace. Revamp your culture, watch performance improve, and then join us on the list of best places to work. See ya there!


Ed Marx is senior vice president and CIO at Texas Health Resources in Dallas-Fort Worth, TX. Ed encourages your interaction through this blog. (Use the “add a comment” function at the bottom of each post.) You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook, and you can follow him via Twitter – User Name “marxists.”

HIStalk Interviews Todd Park, athenahealth Co-Founder

September 15, 2008 Interviews 10 Comments

Todd Park-1 

I probably wouldn’t enjoy being Jonathan Bush’s athenahealth co-founder. JB is as magnetically drawn to a TV camera as a moth to a bug zapper and vice versa, so he’s always going to be seen as the company’s voice to outsiders. Todd Park doesn’t seem to mind too much, explaining that their original plan for the company called on them to use their respective strengths to build it successfully. They’re still best buds, it seems, sometimes wandering into man-crush territory with their unabashed admiration of each other after a bunch of years of being joined at the hip.

Eleven years after athenahealth’s founding but only a short time after its most noticeable success, Todd has retired from the company at 35, moving on to serve on its board, raise a family, and start other ventures.

I usually provide interview context by noting when the subject laughs, but it’s pointless here because Todd talks fast, laughs constantly, and seems to be having a ball. He’s putting the same energy into his latest startup: a son born last month (he ended his e-mail inviting me to call at any time with, "I’m generally up at night these days, feeding and burping the baby, so am available literally 24-7 :)"

I originally pictured him as Apple’s Steve Wozniak, the ultra-nerdy limelight-avoiding engineer who helped build the company, then left at 36 with mountains of cash and turned it over to the intense visionary Steve Jobs. I think Todd and JB are a lot more alike than the two Steves, though, and I expect that Todd’s business ideas will keep in a non-nerd limelight of his own.

Let’s start with a little background about yourself.

I co-founded athenahealth with Jonathan in 1997. Before that, he and I had met at a consultancy, Booz Allen Hamilton. We were the two entry level analysts in their new managed care strategy practice in New York, so we spent more time with each other than we spent with our significant others. We worked 24/7 traveling around the country together and fell deeply in love with each other. He’s my brother from another mother.

We decided to start a company together and started athena in 1997 as an obstetrics physician practice management company. We bought a couple of practices and got our butts handed to us by how hard it was. We discovered the root cause was that we didn’t know how to bill and get paid. Tried to find an answer to that problem. Couldn’t find one so, built our own. We were the first Web-based revenue cycle management service. Then we were told politely by the doctors that the solution to their problems was not to work for us, but for us to work for them by offering this Web-based “get them paid” solution. So we morphed athena into that, raised venture capital, and then took the company out from there.

I guess that’s my story. I’m so intertwined with athena, I don’t know how to tell my story without talking about athena.

I don’t know you personally, but I can’t imagine Jonathan working happily as a consultant. Still, it must have been a big jump.

Absolutely right. I loved Booz Allen. He did too. We loved being there. We loved learning tons about what was going on in healthcare, but, yeah, you’re absolutely right. Both of us were entrepreneurs at the core, and while we were very appreciative of the time we spent at Booz Allen and the people we met there, we really did want to start an actual business together.

We considered a bunch of different ideas, ranging from disease management to demand management. We briefly considered an air ambulance transport company and a healthcare venture capital company, but then, for a variety of emotional and business reasons, we focused on OB.

The emotional part was through Jonathan’s wife, Sarah. She was training to be a certified nurse midwife in the public health system in New York City. She would come home and tell us stories of what she had seen that were really frightening, actually, in terms of … shall we say, room for improvement … in how babies are delivered in America. From a business standpoint, being analytical geeks, we learned that America spends a lot more per pregnancy than any country in the world, but has outcomes that rank 23rd or 24th. We saw a big opportunity to be helpful there.

We started athena as a baby company. Yeah, we had run nothing but laps before in our entire life, so it was a crazy kamikaze move, but I think that every entrepreneur, at some point in their life, has to have some of that crazy kamikaze spirit to try to do something that hasn’t been done before.

We went to go talk to Bill Donaldson, who is one of the founders of Donaldson Lufkin & Jenrette and later chairman of the SEC. We wanted him to give us money for our new business, so we gave him the business plan for the OB company. He read it and said, "I don’t understand this plan. It doesn’t make any sense to me. But listen, kids, I’m going to give you some advice. I’m going to give you a pearl. This is, generally speaking, probably not going to be the business plan that ultimately you follow. It’s an excuse to get close enough to the customer — the doctor — to understand what they really want. And once you understand what they really want; once that opportunity comes knocking on the door; for crying out loud, answer the door.”

At the time we said, “Oh, this is just a bunch of platitudinous advice.” We really wanted his money. But then, when we were in the middle of getting our butts handed to us as OB practice managers and realized that we’d stumbled across this opportunity to help doctors nationwide with medical billing, we suddenly had Bill Donaldson’s words come back to us. Actually, it took running a medical group to understand what was really going wrong with them and what the root cause of their issues are and to give us the kind of experience we needed to create the business that athena would ultimately ride to success.

So, I would say that the first company that Jonathan and I started failed: athenahealth Version 1.0, the OB practice management company. But like a phoenix from the ashes, the athenahealth Web-based business services company arose from that experience and would never have happened if we had not gone through the inferno of trying to run medical practices ourselves.

So the conclusion is that you might as well jump in, do something, and then react to what happens.

Exactly right. Put enough of an idea together to inspire a team of really good people to jump with you into a general zone like medical practices. Then, just learn as much as you possibly can and what you really can do to be helpful and then act against that opportunity. No question. There was a study I heard about recently that I’ve been trying to track down that looked at 150 companies from start-up to ultimate conclusion. They found that something like close to 100% that had actually survived had changed their fundamental business model at least once, but not more than once. So I think that again speaks to the truth of what Bill Donaldson was talking about.

All we knew is that we wanted to help doctors be the best they could be. In fact, the vision statement of the company hasn’t changed. It was and is, “To help make healthcare work the way it should.” We just thought that meant that we needed to go and run doctors’ offices. It turns out that there are a lot of people that know that really well, but they need help and the kind of help that athenahealth was ultimately able to develop.

Jonathan obviously comes from a privileged family with connections. Was your background similar?

No. My father emigrated to the United States from rural South Korea in the late 60s on a scholarship to the University of Utah. He got a PhD in chemical engineering and joined Dow Chemical. He worked there for the next 30 years. He actually has about 72 patents, more patents than anybody in Dow Chemical’s history except for Dr. Dow himself.

He raised me in a small town in Ohio. He sacrificed a lot to try to give me the best options he could. I went to Harvard for my undergrad education. I actually wanted to be in the Naval Academy and I really had my heart set on that, but then Dad and Mom sat me down one evening and said, “Son, no pressure, but we’ve wanted you to go to Harvard since before you were born.” The way they said, that I knew there was no hyperbole. I knew they were serious. I said, “Jeez, if you’re that serious about it, fine, I’ll go.” So I went.

In the matter of what I do in my life, nothing will ever compare to what my dad did: growing up in the Korean War, born dirt poor, emigrating to a brand new country, and becoming one of the most decorated chemical engineers in the world. My entire life is a quest to live up to half of what my dad actually did in some ways. That’s my background. We’re an immigrant family.

If you hung a label on Jonathan, he’s the Steve Jobs, the charismatic visionary. Are you his Steve Wozniak?

That’s actually an interesting question. Your Wozniak analogy is interesting. I actually don’t know enough about the history of Apple to know whether that’s a direct analogy or not.

What I would say is that he and I have been partners in building athenahealth from the ground up. He’s Yin to my Yang and we have collectively co-led and co-built athena from the very beginning.

One of the things that I insisted upon from the very beginning is that we not be co-CEOs because I didn’t believe in the idea. I believe in clear chains of command, so I said, “Look, you be the CEO. That that doesn’t mean I’m not going to be committed to building this thing together." And so we did, and I think that we’ve got really complementary experiences and skill sets and mindsets.

For example, he’s a terrific spokesmodel with the media and does that really, really well. I prefer to be on the quieter side of things. What’s interesting is that people who meet us say, “Wow, you and Jonathan are so different.” In fact, deep down, he and I are really, really similar. We both have the same world view, the same values. We both believe in doing well by doing good. We both are passionately committed to healthcare and trying to make a difference in a practical and tangible way in healthcare. So we’re bonded at a very deep level, even though we may physically and in other respects look very different from each other. We’ve been partners in building athena like I imagine Jobs and Wozniak were, and each being what the other needed us to be to lead the building of this company.

Have there been times you’ve wanted to put a muzzle on him?

No. Truthfully, yes, but that being said, it’s a package, right? So Jonathan’s great strength as a communicator is that he is a completely frank, completely open, completely honest guy. If you want him to be that way, and he’s incapable of being any other way, he’s going to do things and say things which come straight from the heart and straight from the top of his head. Sometimes the darndest things pop out there, but I’m sure that from time to time he says things he’s wishes he could reel back. But I’d say that 95% of the time, he says stuff that’s spot on. He says things that no one else wants to say that need to be said. I think that athena loves that.

I love that, and frankly, that’s my style as well in a lot of ways. I just don’t talk quite as much as he does. The industry needs people like that. The industry needs more people like you and Jonathan who bring frankness and pizzazz and a sense of humor to a space that badly needs that. I think that he and you have done this industry an enormous favor by doing that.

I worried that his style might be a problem for the CEO of a publicly traded company. Did you guys sit around before the IPO and say, “All right, here’s a list of things we can’t say any more?”

That point was raised to us by the people who were helping us to go public. What we said very explicitly was, “Look, we’ve always been a really open, really honest, really frank company. We’re not going to suddenly change our personality as a public company.”

Yes there are certain rules about what you can and can’t say by virtue of SEC regulation. That, of course, we’re abiding by very strictly. But in terms of being frank about our point of view about what we think is going on, we actually have explicitly said that we want to stay that way. Our early experience is that in a lot of ways, that’s actually potentially, ironically enough, been helpful to us as a public company because people are so used to being spun and getting half-truths that it’s different for them to actually to get a company that just talks in as straight a line as it possibly can all the time. That’s what we always have been and what we feel like we need to continue to be.

Frankly, we couldn’t be any other way if we tried. I think, in the long term, it will actually be an asset for us because it will build a level of trust with our constituencies that we wouldn’t have gained if we were much more carefully controlled and were spinning much more tightly than we do as a matter of course today.

Was it anti-climactic to actually be in operational management as opposed to the thrill of actually starting a company and taking it public?

No. I think that each phase of athena has been incredibly exciting. I would say that the phase that we’re in now is equally exciting, as exciting as each stage we’ve been in in the past. In fact, the IPO itself was a bit anti-climactic, in the sense that it was great and we got together to talk about and celebrate it and then everybody got back to work. The company didn’t think or act any differently to pre-IPO.

Jonathan and Todd 008

You got up on IPO day, got dressed, and then what?

I have to say it was one of the more surreal experiences. We got up and we knew that we had sold our blocks of stock to all the people that we had talked to on the road show. We went to the NASDAQ. Of course, there is no NASDAQ in the physical sense, but they have this little show site in Times Square, right, where they bring you? They’ve got these people on terminals just to make you feel comfortable, like there’s something that’s happening. I don’t know what those people are doing, but it’s like Disneyland, it’s cool.

I remember the first truly surreal moment being that there was this six-story spherical billboard planted on top of the NASDAQ Building in Times Square. They took us outside and they flashed a “Welcome athenahealth ATHN” sign with basically a picture of a baby and a doctor and stethoscope and our slogans and whatnot, six stories high on the NASDAQ. I said, “What is going on here?” I took a picture on my iPhone and e-mailed it to the company and everyone circulated it and was struck by it and said, “Wow, that’s really surreal.”

Then we went in to a little conference room and they had, like, a couple of crackers, which was nice, and there was this screen, and they said, “You’re going to start trading at 11 o’clock.” Great. So we counted down: five, four, three, two, one, and nothing happened. We said, “Uh, did we do something wrong? Is the NASDAQ broken? What’s happening?” And he said, “Oh, we’ll figure it out.” And we waited for what felt like forever. It was probably only a couple of minutes.

Keep in mind, we had gone out at $14 to $16 a share; been lucky enough to get oversubscribed, like 27 times at $18 a share. So we said, “OK, let’s see what happens. It’ll be interesting.” And the first number that flashes on the screen is 30. We said, “Wow, that’s pretty amazing.” Then it floated downward to like 26. Then it shot up again, something like 34, 35 … I don’t remember any more. I just remember just feeling crazy.

Then we flew back, met with the whole company, and explained what happened. We emphasized that the IPO itself isn’t the achievement. The achievement is that we’ve collectively built something that the world is beginning to embrace. Ten years of incredibly hard work to build something that is actually helpful to healthcare. It was beginning to find a broader audience, so everyone should be happy about that. And everyone was happy about that, and then everybody went back to work.

The thing I’m happiest about is that, actually the next day, you couldn’t tell the difference between that day and any day prior to the IPO. That was fantastic, because the thing I’d been most worried about was that the culture of the company would change; the openness would change, the frankness would change; the irreverence would change; focusing on the long-term would change. And none of that has changed, which is testament to the culture that everyone holds so dear here and also to the strength of our recurring revenue business model, which is just a great, predictable foundation upon which to build a business in a really rational, predictable way and be able to stay focused on the long term.

But somewhere in the back of your mind, you must have been thinking, "Holy crap, I’m now worth $25 million and I wasn’t yesterday.”

Of course, intellectually, I understood that, but it still hasn’t really hit me, to be honest with you. My wife resolutely refuses to believe that that money exists. My wife fell in love with me seven years ago when I wanted to be a writer, so she was not expecting to be worth whatever it is that we’re worth now.

Hang on to her.

Absolutely. In fact, she was the trigger event for my recent retirement. So I am hanging on to her and doing everything I can to make sure I hang on to her. From a personal standpoint, my burn rate hasn’t changed pre- versus post-IPO. I don’t plan for it to change.

Surely you bought something cool.

I gave half a million dollars to a charity called VisionSpring that’s mass producing eyeglasses in China for the global poor. That’s something I wouldn’t have been able to do pre-IPO, but that’s about the only thing I did, actually.

What kind of car do you drive?

I drive an Acura TL. I would have bought a Honda Accord because I’m a lifelong Honda Accord driver, but I wanted a GPS because I have bad sense of direction and Bluetooth because I’m menace enough to other drivers without talking on my cell phone. The Accord at the time didn’t have GPS and Bluetooth, so I had to buy this thing called a TL instead. It seemed pretty good value for money. I’m not kidding about being a menace to other drivers and having no direction sense. If we ever get together, Tim, don’t let me drive you anywhere. Actually, now I that have the TL I’m a bit safer, but still, don’t let me drive you anywhere.

It doesn’t seem like a really emotional purchase that you went with something with a GPS.

Ha. Actually, I specifically told the dealer I want to buy something that just blends in the road. I do not want to drive anything that calls attention to itself, so get me the most generic-looking car that you have that has GPS and Bluetooth. He said, “Well, I’ve got this thing called a TL.” I said, “Well, I’ll take a look at that.” I still don’t remember what it looks like, so it’s very forgettable. It’s great. It’s perfect for me.

I’m absolutely delighted that athena is a huge financial success, but the thing I’m actually prouder of is that we’ve collectively built an amazing company that is actually doing something to be helpful in healthcare. If you wanted to make a fortune in 1997, you probably wouldn’t have started a company to buy OB practices and run them and you probably wouldn’t have bought, as your first OB practice, one in San Diego that serves undocumented immigrants and Medic-Cal patients, which was the practice that we bought and the practice from which athena was born. If you wanted to make a killing, you would have started buypottedplantsonline.com. You wouldn’t have started with an indigent OB women’s health practice. But that’s what we did.

What’s wonderful to me is that there are a whole bunch of people that jumped in feet first with Jonathan and I to do that, including the doctors and midwives at that practice, who suddenly found themselves holding stock in the company worth over a billion dollars, which is crazy to them, but it couldn’t happen to a better group of people. That kind of financial reward to me is not the end goal, but is just a wonderful by-product of what is really wonderful, which is building an institution that actually helps, that is actually helpful in a concrete way. That’s what I’m proudest of and that’s what makes me happiest.

It’s hard to believe you’re retiring permanently. What led you to that decision?

The root of why I’ve retired as an employee is that I made a promise to my wife years back that, as soon as we’d gotten athena to be strong enough such that it could fly without me on a day-to-day basis, at that moment, I would take myself out of the day-to-day management, we’d move to California where Amy’s from, move next to her parents, and start a family. That’s what we’ve always wanted to do.

Being a first-time entrepreneur, I didn’t really have a good sense of the entrepreneurial space-time continuum, so I told Amy, “I’m positive this will take me no longer than 2004.” And it turns out it took a little longer than that, but by 2007, I was sure that we were there. Actually, it wasn’t the IPO that convinced me, it was the state that the company achieved in order to be ready to be public. So the IPO was more the functional fact that we’d achieved that state, as opposed to the actually certification of it.

I feel that athena is now strong enough to be an institution to withstand the loss of anyone day to day. So at this point, I really have to keep my promise to my incredible wife and do this thing. I retired from day-to-day management in January of 2008 and joined the board and then took on this Chief Athenista role. The title was not my idea, by the way. The root of the title, in case you want to know, which you probably don’t, but in case you do … remember our first practice when we were an OB company was in San Diego and we were serving a predominantly Latina population and our workforce was predominantly Latina. They started calling themselves Athenistas and to this day everyone at athena calls themselves an Athenista. So they gave me this title Chief Athenista.

Basically, the function was to be a long-term strategist. I’d spent so much time nose to the grindstone, nuts and bolts building athena, that I hadn’t actually in quite awhile taken a step back to take a look at what was going on in healthcare and to plot where I thought athena should ultimately go, in the next 10 years anyway. I spent the next six months interviewing over 150 leaders across healthcare and reading through about 50 major studies on the healthcare system and various aspects of it. I put together an assessment of state and direction of U.S. healthcare and a long-term, 10-year vision for athena.

What was interesting, when I initially started, people gave me all kinds of ideas: athena starting a data business, athena going international, athena doing all kinds of things, athena Intergalactic. The most interesting was that I’d traveled the furthest reaches of the healthcare system and was looking for the boat we had missed. The more I learned, the more I actually became convinced there was no additional boat to launch; that in fact, the sweetest spot in healthcare to be was the space that we were already in and that we had less than 1% market share.

So I came back and I said, “Look, I’ve walked the furthest reaches of American healthcare and what I’ve concluded is we need to double down and focus on executing the bejeebers out of what we’re doing right now in creating a national infrastructure to help doctors be the best they can possibly be and do that for more than 1% of American docs."

So that’s what I put into my long-term vision for athena. I profiled a bunch of different trends that you’re familiar with: consumer-directed healthcare, pay-for-performance, medical home, all of which are things that I think that athena, through our national platform, can do a lot to facilitate and to help doctors deal with and actually turn to their advantage and to the advantage of their patients in the next ten years. I said, “Look, let’s just double down on this national infrastructure play for docs, nurse practitioners, and midwives. Let’s do that play and not get distracted by delusions of grandeur.”

Once I’d presented that and once our board and management team had bought into that, I said, “There’s no athena Intergalactic for me to start, so what I should do at this point … thinking about our long-term strategy is not going be a full-time endeavor unless I’ve really gotten it terribly wrong, which I hope I haven’t, so let me hang up my cleats as an employee entirely, which I did at the end of August, and convert to a pure board member.”

One of the reasons I wanted to do that was because I wanted to become an independent board member so I could take a bigger leadership role on our board, eventually, in doing things that independent board members can do that non-independent board members can’t. I’m actually now functioning as a very active athena board member, functioning as a godfather/co-founder, visiting athena every other month. I’m writing an internal blog, inspired by HIStalk. I’d actually like to get some tips from you if you wouldn’t mind at some later point.

I’m thinking about long term strategy, networking across the industry, speaking on behalf of athena at conferences, hosting brown bag lunches with our employees, starting an athenahealth Foundation, which Jonathan and I are going to start funded by $1 million each of our own money, and just taking a godfather/co-founder role and a board role, and then moving to California.

I just had a son at the beginning of August. I’m trying to be the best father I can possibly be. Over time, what I anticipate doing is investing my time and money in a set of entrepreneurial ventures, both not-for-profit and for-profit, that can advance the ball in healthcare; that can advance the cause of healthcare in a variety of ways. athenahealth was obviously my first corporate child and I’ll continue to serve on athena’s board and be its godfather for as long as I draw breath. I have recently got involved in another venture which was mentioned in the Washington Times article, called Maria Health, which I’ve started with Giovanni Colella, who was CEO of RelayHealth and then Sapient before that. Our venture capitalist is Bryan Roberts of Venrock, who is one of the lead VCs behind athena.

It’s actually a consumer-oriented company. It’s super duper early so I can’t really get into specifics at this point, but generally speaking, it’s a company that’s seeking to take an athena-like approach to helping healthcare consumers navigate an increasingly complicated healthcare system. It’s got a great team, veterans of athenahealth and Yahoo who are part of it. It’s off to a great start. It’s too early to talk a lot about, but it’s been a ton of fun for me to learn more about the consumer space.

As you know, consumerism is a force of growing power in healthcare. I think a lot of what’s going to be happening in healthcare is going to be consumer-driven in the next ten years, so it’s exciting to be learning about that. I’m looking at a number of other both not-for-profit and for-profit ventures in which to invest time and money to help these entrepreneurs make the differences that I think they can make in healthcare for the better. So I think that’s what I’m going to do. First and foremost, be the best dad and husband I can possibly be going forward.

There’s one question that has come up in the past, maybe kind of a dweeby technical question. There’s been some speculation that I’m going to dump all of my shares in athenahealth. I just wanted to say that I’m not. I’ve actually exercised and sold a set of employee options that were “use them or lose them” as a function of my employee agreement. When I transitioned from employee to chair board member, I had to use or lose them, so I exercised and sold them.

But even after those transactions all go through, I still hold 900,000 shares of athena stock. I am very, very bullish on athena. I will hold a lot of stock athena for a really long time and continue to a very active board member and godfather to athena. Again, the proof is in the pudding. So people can watch and see if I dump my 900,000 shares or not, but I thought I might communicate more expeditiously and say that that was behind my recent sales and that’s what my plans are going forward with athena.

You’ve been attached by the hip to Jonathan for all these years, but now you’ve got a chance to do some things on your own. It must be satisfying to have feet in both courts.

I’m grateful that Jonathan is here to continue to lead athena, because if Jonathan weren’t here, I couldn’t retire and go on to the next phase of what I want to do. So, I’m grateful for that, but honestly, if I had a choice, I’d want to do the next set of things with him, actually.

I think that starting any business is incredibly difficult. Starting a business in healthcare is especially difficult, and if Jonathan and I didn’t have each other, then athenahealth wouldn’t be here now. Frankly, if Jonathan and I didn’t have a whole bunch of other people, athenahealth wouldn’t be here right now. There’s too long of a list.

I’m not a big believer in the epic hero theory of entrepreneurship that “One man, in a world filled with chaos and darkness, takes a stand.” That’s bullpucky. I think that it’s a small group of people that decide to take a stand and make something happen, each of whom couldn’t do it themselves, but collectively they render it possible to do something really unbelievable.

It’s one of my favorite quotes. I don’t remember who said it. but it’s a question and answer. Someone says, “Is it possible for a small group of people to change the world?” and the answer is, “Yes. In fact, it’s the only thing that ever has.” I think that athena is a great example of a change that’s helpful that couldn’t have been done by any one person, that was engineered by a group of really committed people.

One of the best parts of athena has been the privilege with that incredible group of people. The reason why I was so confident that athena would continue to rock the house even though I’m not there day to day is because that group of people is still here and bringing on wave after wave of new people who are incredible to perpetuate the beneficial change that we’ve gotten going in our corner of the world here.

How do you scale it up, though, and make sure that what made you special when you were small can still make you special when you’re huge?

That is a terrific question. I don’t think that we necessarily can come up with a definitive answer to that question even if there is one. But what I can say is that we’ve fought harder about that question than any other similar question.

I think the gist of our answer is culture, at the end of the day. We have a culture that’s extremely focused on dong well by doing good, a culture that’s focused on teaching and learning and playing for the team to win, and a culture that makes each of those things a living and breathing art of how we operate, how we recruit, how we pay, how we think, as opposed to just banners on a wall somewhere. It’s that culture that I think, more than anything, has attracted the people we have attracted.

It might be the fact that medical billing is so super sexy, but actually it’s probably the case that it’s less the sexiness of medical billing and more the fact that there’s a do good, do well team-oriented, continually teaching and learning focus culture at athena that attracts the best people in the world. Those best people recruit more of the same kind people. They come up with the best strategy, the best technology, the best operations, and execute the best. I think it’s that culture that’s our greatest asset.

It’s a culture Jonathan and I are no longer required to continually breathe into the company every second. We think that there are many people now that do that, in the sense that its part of the fabric of the place, as opposed to pumped into athena by a couple of people.

Some would say you’re in the billing business and others that you’re an advocate for physicians. What I heard you say is that there’s value in the network that you’ve built that makes the footprint valuable. What is the business going forward?

I think it’s all the above, but it’s in the proper sequence. I think that the business that we’re clearly in today is getting doctors paid. We’re growing really rapidly and have a lot of traction because we are really, really great at getting doctors paid. We do that through a combination of workflow and rules and back office operations on a single living, breathing, Web-based platform. The whole point of the platform is to get the doctors paid more faster with less hassle. That will continue to be the focus of our business, I think, for the next 10 years. We have less than 1% market share of that business, so it’s something we’ve got to keep executing on.

That being said, as that business grows, we are as a function of that business, building a national network for doctors on a single Web-based platform with a single Web-based rules engine and a single back office working on their behalf. Once that network gets to a certain size, there are a bunch of things you can do with that network. They go beyond just getting doctors paid more, paid faster with less hassle. I think the first thing we’ve got to do is just get big enough for this network plays to really be viable and our ticket to get big enough is to continue to be the best at getting doctors paid. So even stuff like EMR.

We recently launched athenaClinicals, which is our version of an EMR. We think of an EMR in the lens of getting doctors paid, and so we’re fusing our EMR with our practice management and billing service and using the EMR as an engine to make sure that our revenue codes are right, to make sure that charges flow smoothly, to help optimally manage the increasing array of pay-for-performance rules to help blow away paper in the back office. That is a function of and part of clinical paper and part of the whole billing process. We even view athenaClinicals as part and parcel of an overall engine, and overall service, that gets doctors paid more faster with less hassle. I think that right now, and for the foreseeable future, we’re in the “get doctors paid” business, but eventually that business will build itself into a network upon which athena can do more things that are really useful and are additional excellent lines of business as well.

How much of the company’s success is because of the work your brother Ed did technically?

A huge portion of it. There’s a long list of people that deserve to have their name in lights, not just me and Jonathan, a long list of people, without whom athena’s success would not be possible. One of the prime names is Ed Park.

Basically, he was superstar young Internet consultant at Silicon Valley Internet Partners in 1998. I was a practice manager of a failing OB practice in San Diego, California. We needed to get a handle on this billing problem and we needed to get a handle on our operations and build technology that could help with that. So I called Ed, rock star Internet consultant, and said, “Ed, I need your help.” And he quit his job that day and flew to San Diego and partnered with another guy named Bob Gatewood, who was our CTO at the time, to basically build athenanet. Without athenanet, athena wouldn’t be possible.

There’s a long list of names like Ed. One of the things that actually I have a private pet peeve about is entrepreneurs who portray themselves as God’s gift to humanity and as the epic warriors who single-handedly built their business from the ground up. Those entrepreneurs are either full of it or have faulty memory. Businesses like athena are built through collective effort. Not just by one or two people, but by a lot of people, so there a bunch of Ed Parks that we owe this company to and I’ll be forever grateful to them.

I saw that you have donated money to both the Obama and McCain campaigns.

Yes, I have. You really do your research!

Who do you want to win, or who do you think has the better story?

Obama. We talk a lot of politics here at athena. By the way, athena is 98% Democrat and 2% Republican, which is interesting, actually.

So, I was talking with one of my buddies and we were saying, “Wow, wouldn’t it be great if Obama and McCain were the nominees?” This was when it looked like Clinton and Romney were going to be the nominees. We said it would be great if it was an Obama-McCain contest because they seemed to be terrific guys and potential presidents, but that’s not going happen. So I gave money to both Obama and McCain in hopes that one of them would break through and, lo and behold, both of them got through by some strange twist of fate to be the nominees, which put me in a real quandary.

I think actually either one would make a really terrific president. I think The Economist cover was dead on with the “Best in America” over the American flag with McCain and Obama on it. I think they got it right on. But I’ve picked Obama for a bunch of different reasons, less anti-McCain and more pro-Obama. People keep calling me and I have to say, “Look, I really like your guy, but I’ve actually picked the other guy.” But I’m an Obama guy.

When you look at healthcare, both as a campaign issue and in general, do you think it’s broken, and if so, what will it take to fix it?

I think healthcare is incredibly broken. I can’t think of a word that does justice to how broken it is at so many levels. I think we all intellectually understand that, but it was really eye-opening for me in my walkabout when I talked to these 150 leaders, to understand just how broken it is looking at the underlying data in terms of cost and quality and access. So I think it is actually broken.

I think the silver lining is that everyone knows it’s broken. It’s hard to find people in any position of responsibility that believe it’s not. There was a Commonwealth Fund and Modern Healthcare that was done recently. It surveyed leaders specifically in healthcare and it found that 9 of the 10 leaders in healthcare say that not only is change required, but fundamental transformation of the healthcare system is required. And that is certainly what I learned about on my walkabout as well.

There’s also a pretty surprisingly broad consensus about why it’s so badly broken at the end of the day. The consensus that I heard on my walkabout is that it’s fundamentally the massive misalignment between payer, provider and consumer. A key to actually healing the healthcare system is to realign those incentives between payer, provider, and consumer such that savings from smarter care and better health are shared with provider and consumer so they are incented to move in that direction through a variety of different means. So that fundamental incentive alignment problem is at the root of the issue and we need to address it in order to heal the healthcare system.

Len Nichols, who is a great healthcare economist at the New America Foundation, has a great sound bite he uses to describe this. He says, “Fee-for-service payment for providers plus low cost-sharing by consumers plus a very small effective evidence base on what works and what’s cost effective equals number one in the world in healthcare spending and 37th in the world in outcomes behind Slovenia and Costa Rica." I think that was a great sound bite that kind of puts it in a nutshell.

Everyone in the system has a different theory about what to do about it. I actually think there is no silver bullet. I think it’s actually a collection of initiatives, public and private, that will be required to put the healthcare system on an even keel. I think a system that’s more consumer-directed. A system has better incentives for provider and provides better funding for providers to do population health management. An innovation on the delivery system side along the lines of retail clinics, medical homes, virtual care teams around care episodes, and the government doing something about the insurance coverage situation, helping to facilitate broader coverage.

Healthcare IT, not technology sitting there naked and expensive and not very effective and efficient at actually helping, but technology utilized to help re-architect the business and care processes in healthcare to make it more efficient and effective and to help consumer-directed healthcare and pay-for-performance move along more expeditiously. It’s not a situation where there’s going be a solution that’s sent from the heavens that will fix everything. I think its actually going be from the collective work of a lot of people, public and private, and a bunch of different ideas that mesh together into a much healthier healthcare system where there’s a better incentive alignment where we’re getting more bang for our buck.

A lot of folks are happy with it, including those that vote and legislate who have access to good healthcare and may make a lot of money from it. Politicians don’t like to take away the lollipop of entitlements, either. Who will come forward to say it’s not working?

I think the most encouraging thing I learned in my walkabout is that I talked to a fair number of people who were pretty influential and pretty powerful. Not just entrepreneurs at the margins throwing stones at the center, but people who were actually at the center.

It was very interesting and refreshing to me. They are very actively thinking about how the system needs to evolve. Now, no one things the system is going to evolve overnight, but they’re thinking of evolutionary innovative change at a level that is more intense than I could certainly remember.

It goes back to something that Winston Churchill said, which is, “America can always be counted on to do the right thing after it has exhausted every available alternative.” I think that healthcare is finally at the point where it really can’t continue in its status quo state. Healthcare consumed 9% of GDP in 1980. It’s up to 16% now. It’s going to be 20% by 2016. It’s going to be 30% by 2030. Simultaneously, we rank 37th in the world in outcomes, according to WHO, 42nd in infant mortality, 46th in life expectancy from birth. More and more Americans are underinsured and uninsured.

There’s a great survey done by the Center for Studying Healthcare System Change. They looked at access to care, measured by, “Were you able to access medical services when you needed to?” That figure of those who couldn’t jumped massively from ‘06 to ‘07 to an all-time high. Every metric you look at. We spend 2.5 times as much on healthcare per capita as the developed world average. Our outcomes are the worse than the developed world average. We spend 2-3 times as much on health benefits per worker as our competitors in the developed world, let alone the developing world. Healthcare premiums are rising at triple the cost of wages. Healthcare costs are rising at 2-3 times than the rate of growth and productivity of GDP.

These are all unsustainable trends. We can ignore them for awhile, but they’re getting to a point where we can’t ignore them any more. Everyone talks about Social Security being bankrupt. Social Security is something like 8-10 trillion dollars underfunded. Medicare is 30 trillion dollars underfunded, meaning that to cover the gap between benefits and revenue for existing Medicare beneficiaries, we have to put 30 trillion dollars today into an interest-bearing account to cover the difference.

It’s getting to the point where I think that healthcare reform on a political level is actually increasingly not going be the third rail. I think at a private sector level, even people in a positions of power are sensing they are going to have to do something, otherwise risk potentially near-catastrophic events. I’m not predicting any tsunami-like change in the industry. The industry is too big, too complicated, but I do see the winds of change starting to blow through in a really meaningful way.

When I interview people, most of the people I talked to didn’t just have ideas, they were actually in the process of doing things that were really interesting. So crossing the line from “say” to “do” is something that is happening more and more and that’s really encouraging. So I’m an optimist. Maybe that’s because I’m an entrepreneur, but I think that we are just in time as a country going to figure this out and get ourselves to the other side without getting too many bones broken in the process.

Fifty years from now when someone is looking at your picture on the wall at athenahealth Intergalactic, what do you think your legacy will be or what would you like it to be?

That’s a really great question. I haven’t really thought about that. I guess I would say someone who, in some small way, helped to show that you can actually make healthcare better in a meaningful way. Someone who helped inspire other people to in small ways, medium-sized ways, and big ways make positive changes to healthcare and demonstrate that change is, in fact, possible.

Misys, iMedica Reach EMR Agreement

September 15, 2008 News 4 Comments

iMedica announced this afternoon that it has reached an agreement with Misys Healthcare Systems that will grant Misys a license for iMedica PRM 2008 PM/EMR and the SP1 release to follow. Misys and iMedica will not share further software enhancements and Misys will not be entitled to future iMedica releases beyond SP1.

Misys will pay iMedica $12 million in cash and all remaining royalties due under the original agreement between the companies. In addition, Misys will give up its 18.4% ownership stake in iMedica.

Monday Morning Update 9/15/08

September 13, 2008 News 4 Comments

From Epic Gossiper: "Re: Epic. We all read about Epic’s elitist, snobbish way of picking customers, but now it seems there is reason behind this madness. Is it true that Epic refuses to work with hospitals of fewer than 500 beds? Another case of success intoxication or just down to earth good business practice?"

From TiredCIO: "Re: naming rights. It’s amazing what a non-profit healthcare organization can find to spend money on. Parkview Health System buys naming rights to a new minor league stadium." I’m with you there. The Indiana hospital lays out $3 million over 10 years to name the new ballpark of the current Fort Wayne Wizards to Parkview Field. Half of the money goes to the city, half to the team. I bet you could find quotes somewhere in which hospital executives moaned mournfully about how hard it is to keep the lights on given their financial hardship. Their argument: (a) they want to be a good corporate partner (do people really expect their large hospital bills to be used in a Robin Hood like manner and spent on community projects that they wouldn’t support on their own?) and (b) they can market services to a captive audience (hospitals marketing their services gives me the creeps, I have to say). On the other hand, the hospital showed an $82 million profit in its most recent tax year (time to drop those aspirin from $8 to $7?) The CEO made $600K. I’m really beginning to believe that the model of having "nonprofit" hospitals billing the heck out of private insurance and government is responsible for much of what’s broken in healthcare.

parkview

Detroit Medical Center’s Cerner systems go down in at least four hospitals on Friday.

Someone who should know says it’s Eclipsys that’s working on a deal to acquire MediNotes. That would be the first Eclipsys foray into PM/EMR systems, I believe, if it actually happens. 

Inga contacted Bill Bates, CEO of digiChart, to ask about the layoff rumors (60% of staff cut loose) that we mentioned on Thursday. Here’s his e-mail response: "For several months, digiChart, Inc. has sought creative opportunities to expand its sales force, automate software development and streamline implementation and training of new clients. As a result of these opportunities, digiChart was able to decrease its staff and gain the benefits of a wider distribution and training model. Like Southwest Airlines — a contrary business model to the standard airline model — digiChart, Inc. has identified ways to gain efficiencies at lower costs. As a result of these strategic decisions and its committed employees, digiChart, Inc. will achieve another level of growth."

Listening: The Kilaueas, an obscure German surf rock band I ran across. Also, Elvis Costello, a favorite I’d forgotten about until I saw him on some TV special the other night. He’s one angry little Brit.

Emdeon files for a $460 million IPO.

redhat

Welcome to HIStalk Gold Sponsor Red Hat of Raleigh, NC. I have to admit that, years ago, I never thought that open source would be popular in hospitals or that Red Hat would be a household name in them, but they proved me wrong, creating a highly successful company whose market cap is $3.5 billion at the moment. You can read about their SOA solutions for healthcare here (warning: PDF). Thanks to Red Hat.

UTMB says it weathered Hurricane Ike fairly well, with only one minor injury but unknown campus damage. They’re on generator, of course, and providing only ED services. From the hurricane updates, it sounds as though they were quite well prepared. Hospital updates from the area are welcome.

If you’re not getting updates when I write something new, just drop your e-mail address in the Subscribe to Updates box to your right. The mailing list has nearly 3,000 confirmed subscribers, all of whom will know important stuff before you do if you don’t sign up. You should see the server light up when I send a new e-mail blast, especially if it’s a news story (I don’t waste your time e-mailing out questionable news. If you get a blast, it’s important). Send the HIStalk link to your friends, too (your enemies already know about it, probably).

Providence Health & Services and Inland Northwest Health Services move their squabble to court, with a key element of the spat being MEDITECH. I’m not interested enough to wade through all the corporate entities named in the articles or what the MEDITECH argument is all about, but feel free.

Philips will acquire Alpha X-Ray Technologies, an India-based cardiology imaging vendor.

I finally saw one of the Jerry Seinfeld ads for Microsoft (the shoe store one) and it was just dumb (long, pointless, and tragically un-hip). What a waste of $10 million. Does Microsoft really think that Jerry is happenin’ enough to out-cool Apple, even with bonus bad acting from Bill Gates? Steve Jobs can take both of them with one pancreas tied behind his back. It’s not cool enough to be viral and not focused enough to sell anything (it never mentions the product or company). An expensive embarrassment all around. Microsoft IS your father’s Oldsmobile, I’m sorry to say.

seinfeld

UCSF Medical Center starts a $1.6 billion, 289-bed hospital project. Is it not possible to render quality medical services for less than $5.5 million per bed just for the physical plant? Those buildings seem to be nonprofit executive’s way of memorializing themselves as an emotional substitute for the shares that their publicly traded counterparts give themselves (or maybe it’s one of those "mine is bigger than yours" things).

ucsf

Siemens may lose another medical equipment deal amid claims of bribery, this time in India. Wipro Health said its technology was better and cheaper, but authorities rigged the bidding at the last minute so that only Siemens could qualify (Wipro got Strogered, in other words).

Wednesday is Readers Write day, so dip your quill and tell us what’s on your mind. I’ll also have a cool interview on Monday and, coming soon, the first HIStalk online CEO chat (once certain news is announced).

Vendor Deals and Announcements

  • Stillwater Medical Center (OK) has administered more than one million doses since 2004 using IntelliDOT’s BMA solution. Stillwater was IntelliDOT’s first customer to implement the solution. IntelliDOT, by the way, made the “100 Best Places to Work in Healthcare” list.
  • Medicalis signs a distribution agreement with MedLink International, giving MedLink the ability to offer Medicalis solutions to its radiology customers.
  • CapMed is now offering “smart messaging” to its PHR users. This feature will analyze inputted information and provide gaps-in-care notices for relevant treatment options and reminders.
  • Tony Bellomo takes the helm as TriZetto’s new president.
  • Affiliates in Imaging (CA) selects AG Mednet’s diagnostic imaging network.
  • The Minnesota HIE will use Covisint technology to build its e-health exchange.
  • Alameda County Medical Center implements Concerro’s web-based staffing services to manage nursing shifts.
  • AmeriHealth New Jersey is sponsoring the NJ HIE. HxTechnologies is building the exchange.
  • GE Healthcare introduces Centricity Enterprise Orders and Pharmacy, which provides customizable order sets and embedded real-time clinical decision support. The new module was created in partnership with the Mayo Clinic, University of Virginia, and UCSF.
  • Valley Baptist Health System (TX) selects Trintech’s ClearContracts Payer Compliance suite to more accurately calculate managed care and government payments.
  • Sisters of Mercy Health System completes implementation of an upgrade firewall from Palo Alto Networks. The new security infrastructure serves Mercy’s 28,000 employees across seven states.
  • Virtual Radiologic announces the addition of Brian F. Sullivan to its board of directors.
  • The 1,300-bed Wake Forest University Baptist Medical Center (NC) is now wire-free following the installation of a 900-access-point wireless LAN.
  • Picis announces a new webinar series featuring healthcare providers, IT execs, and clinical managers. Participants will be discussing best practices for using healthcare IT in the high-acuity environment.
  • Eclipsys names Bill Bregar as VP of Quality and Total Quality Management. Bregar is leaving Philips to take this newly created role.
  • Perot Systems has successfully rolled out a hospital information system in multiple hospitals and primary care centers in Abu Dhabi.
  • athenahealth completes its acquisition of MedicalMessing.net for $7.7 million in cash.
  • El Camino Hospital selects ITelagen to provide healthcare IT and EMR support for the hospital’s independent physicians.
  • Siemens Soarian Financials customers can use payer validation edits and rules within the revenue cycle workflows. A new agreement with the SSI Group for its ClickON LinX product provides Siemens clients with new claims management tools.
  • McKesson introduces InvestiClaim, a new web-based fraud and abuse detection and management application for health plans.
  • Adam Gale is taking over as President of KLAS Enterprises, replacing Kent Gale.
  • Mercy Merced Medication Center (CA) contracts with Thomas Reuters to use the Clinical Xpert CareFocus solution. CareFocus allows physicians to rapidly identify high-risk patients within the active hospital census.
  • WakeMed Health and Hospitals (NC) selects Peopleclick to automate their recruitment and hiring process.

E-mail me.

News 9/12/08

September 11, 2008 News 24 Comments

From Elliot Carlin: "Re: Kaiser. Bob Newhart is a friend of mine and he says this Dr. Tupperman is a urologist at the Rimpo Medical Arts Center in Chicago. Bob says Dr. Tupperman has yet to chip in his $575,000-per-doc share of the RimpoConnect [over]budget so far. Budget numbers ($3.2 billion before 2006 + $1.7 billion for 2006 + $1.6 billion for 2007 + $1.5 billion estimate for 2008) / 13,750 docs." Good work on catching the Bob Newhart reference I slyly inserted as a phony name (and inserting one of your own since I didn’t know that Rimpo was the name of the practice on the show). That $575K is the per-doc cost of HealthConnect if you divide the cost by the number of physicians.

From Kaimuki: "Re: RHN. It looks like Revolution Health Network & Everyday Health are going down the altar." I’m finding it hard to get interested in that shotgun wedding. Free websites that claim success based on page views instead of profits seem doomed to fail. Google raised the bar on those expectations when it was cool, free, and highly profitable all at once.

From Betsy: "Re: workshop. The Cooperative Exchange is doing a workshop in DC on Wednesday Sept. 24th. Wondered if you might give mention of it for anyone within driving distance? Agenda is pretty impressive. Check it out at www.cooperativeexchange.com. Also, I have an interview idea The SSI Group, Inc."  The meeting is about revenue cycle management. I tried SSI once before for an interview and they didn’t even respond to the e-mail, so I’m banning them (symbolically since they were already ignoring me).

From Rudy Polanksi: "Re: bloodbath. digiChart in Nashville, TN fired 40 people yesterday, leaving ~ 27 folks left." Unverified. Inga is seeking a company response.

From Jane: "Re: Epic. I’m doing an internal presentation for work and wanted to know if your readers could provide a list of some of Epic’s clients. I know about Stanford, Allina, Geisinger, and Kaiser." There are so many that I don’t even know where to start, so let’s divvy up the work and each reader contribute a couple in a comment until we get a bunch.

From Miss Pittman: "Re: possible HIPAA violation. I was doing a search on Microsoft Amalga and found what appears to be PHI on the web." It certainly does look like PHI. One screen shot with key information blurred out still includes zip codes for patients over 89, which is a HIPAA no-no unless I’m mistaken. More seriously, several more shots weren’t whited out at all, showing what appears to be a full set of ICD-9 codes and EKG strips for a patient whose name matched someone I Googled on the web, right down to the approximate same age and his address in DC where Azyxxi was born at Medstar. Well, they appear to have goofed, although I didn’t verify. I thought about e-mailing the guy to confirm they’re his records, but that seemed tacky (I bet that newspaper and TV reporters would do it since Microsoft’s name right is on there). I don’t like seeing people get sued over honest mistakes.

From Denver Umlaut: "Re: my favorite Web tools. www.jott.com – the basic service is free (it just left Beta – it’s worth paying for ), with reasonable plans that add options. AWESOME service – email yourself, set reminders, get alarm emails/calls/texts, for anything, from anyone, anywhere, all with your phone. I call their number and can say "Jott HISTalk", speak the message, and it would e-mail you the transcribed message along with an attached copy of the recording. It’s awesome for tracking and task management – anytime I have a thought I can’t forget, I Jott myself and get an email/task/text depending on my settings. http://www.grandcentral.com/ – you get one phone number (free), all your calls go to it, and you tell it what number to pass them through to – so you can designate a phone as active, and all calls go to it. Or you can set all work calls to go to your cell, and all other calls to your home line. Plus, when it puts a call through, it gives you the option to accept, accept and record, pass to voicemail, or pass to voicemail and listen in. And it’s free. www.xobni.com – resource intensive but awesome Outlook plug-in that trends e-mail and provides really cool features."

Agfa’s board says stories claiming it will sell off its healthcare unit are not true.

caretech

Hey, whose ad is this? Why, it’s that of brand new HIStalk Platinum Sponsor CareTech Solutions, I do believe. They’re in Troy, MI and offer a variety of IT services (including outsourcing), HIM services, web-based applications, and cabling and wiring services. They also offer outsourced help desk services that include staffing by certified professionals and analysts with healthcare and healthcare application experience. Thanks to CareTech Solutions for supporting HIStalk and its readers.

rra   novo

And speaking of sponsors, thanks much to Renaissance Resource Associates and Novo Innovations for upgrading their HIStalk sponsorships to Platinum level. We like those votes of confidence.

ISO publishes a Health Information Security Management standard.

Jobs: Regional Sales Manager, Healthcare IT Sales, Clinical Consultant, Sales and Marketing, Consultant, Account Manager.

Medsphere is having its First Annual Collaborative Healthcare Forum on October 2 in NYC, with John Halamka there to talk up open source applications like VistA (which he doesn’t use at his place, but he does have other open source stuff there).

Hong Kong will spend $4.5 million USD for security technology and will make hospital CEOs responsible for information security and privacy following a series of hospital breaches. 

Shahid the Healthcare IT Guy referenced these truly outstanding articles on how to do a startup demo (Part 1, Part 2). Vendors should study this as though another set of stone tablets just got handed down. I like this: "Horrible ways to start your presentation: a) Talk about your bio and your business accomplishments. (We don’t care, we can talk about that later if your product is any good.) b) Talk about the market size. (We don’t care, we can talk about that later if your product is any good.) c) Give an overview of the competitive landscape. (We don’t care, we can talk about that later if your product is any good.)"

Reporter inquiries: if you can help with sources for these stories that various publications want to write, e-mail me. Hospitals that have outsourced some part of IT but then brought it back in-house; hospital CIOs willing to talk about recovering from one of the recent floods or hurricanes; and hospitals doing creative things with low-cost data mining or dashboards. Thanks.

Newcastle NHS breaks ranks from NPfIT, going with UPMC for its Cerner-based systems, even though it will cost them more (but get them live quicker). Odd: "Therefore we believe they have got – and this is part of the reason we partnered with them – a tremendous amount of clout with Cerner. They have the ability to influence the way that product is developed. We are hoping that through that relationship we will get a version of the product that’s more advanced than the ones that have currently been implemented." They had to go to another customer to get clout despite being a customer themselves?

flight93

I gotta talk to this guy: Geary Davis, a biomedical engineer, Dartmouth MBA, and former hospital CIO, is now a practitioner of Chinese Energetic Medicine and acupuncture. You know there are some good stories there.

I’d watch this company: HIM vendor Precyse Solutions puts Pam Arlotto and Carl Witonsky on its advisory board, giving them a lot of strategic horsepower.

Norton Healthcare goes live with Sentillion Vergence for SSO.

Augusta Medical Center is using a flu pandemic prediction system developed by students at James Madison University. You’ve probably never heard of the university or the town it’s in, Harrisonburg, VA, but it’s a super school and a nice town, up the road from another really excellent school, Washington and Lee University, although I don’t know why I’m telling you this except that I’ve been on both campuses and was impressed.

A Columbia Memorial Hospital (NY) employee and her boyfriend are arrested for posting the names, addresses, and Social Security numbers of family members of the man’s former girlfriend on MySpace. The woman got the information from the hospital’s computer system.

Goldman Sachs predicts a drop in IT spending this year, but says winners will be Apple, Oracle, Red Hat, and Google. Losers: Microsoft, IT employees, and onsite service providers.

Odd hospital lawsuit: a woman visiting a hospital claims she was knocked to the ground by faulty automatic ED doors. She was treated and sent home, only to return with "head, neck, back, and leg problems" that required "extensive treatment," resulting in her husband’s loss of consortium. They’re suing. Maybe he needs the money for alternate sources of consortium.

E-mail me.


HERtalk by Inga

From Former Soccer Mom: “Re: Sarah Palin. Loved your comments. She may very well be the first female president someday.”

From EMR Gal: “Re: mail bag. I love the mail bag. ‘Governors with five kids simply don’t have time for botox’- classic. Loved all of them. Perfect.”

From Manly Man: “Re: swine. Oh, Inga. A pig? Really? Ouch. I like your responses, though. Will this be a regular feature? I like your portrait as well.” As I mentioned in yesterday’s post, if it weren’t for Mr. H’s suggestion we get some “hottie” to provide psychiatric commentary, the mail bag piece would never have come about. Let us know if you think it should have a permanent place on the blog (do we just need to stick to HIT?) Meanwhile, if you have any neuroses you would like analyzed, drop me a note.

From Thriving in CA: “Re: A little correction to your post. Patrick Heim is the Chief Information Security Officer here at Kaiser (CISO), not the CIO. The CIO here is Philip Fasano. Keep up the good work…” Whoops – sorry about that.

With mandatory evacuations in place for Galveston, TX in preparation for Hurricane Ike, UTMB closes its clinics, cancels classes, and evacuates patients.

clip_image002

Modern Healthcare releases its “Best Places to Work in Healthcare” report that includes 100 companies. Is your employer there? Do they deserve to be?

Virtual Radiologic announces the addition of Brian F. Sullivan to its board.

MSNBC was running the replay of the Today Show’s actual September 11, 2001 broadcast this morning. I was actually watching the Today Show that morning, so reliving the whole plane/tower thing was pretty creepy (and disturbing and sad). I’m sure we all have stories about how that day affected us. I hope we never forget them.

Marlin Equity Partners is the winning bidder in an auction for bankrupt MedAvant Healthcare Solutions. The $24.35 million transaction is scheduled to close September 22.

Researchers find that Botox helps in the treatment of migraines. Coincidentally, I feel a bit of a headache coming on.

eHealth Initiative releases its 2008 Fifth Annual Survey of HIEs, which includes responses from 130 community-based initiatives. Some key findings: operational HIEs have increased 31% over last year (to 42); 82% claim developing a sustainable business model is moderately to very difficult; and 69% of the operational exchanges report reductions in health care costs.

Picis announces a new webinar series featuring healthcare providers, IT execs, and clinical managers. Participants will be discussing best practices for using healthcare IT in the high-acuity environment.

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