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.

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.

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.

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.

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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!

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.

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

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

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.)

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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.

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.’"

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.

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.

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.

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.

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?

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?

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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.

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.

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.  

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.

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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.?"

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.

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HERtalk by Inga

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.

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").

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