From Rose Michaels: "Re: Epic. From a reliable source (you’re probably already aware) Epic will be implementing in Dubai. Not sure of the details but figured if anyone could get them, it would be you. Thanks for doing the fabulous work that you share with us daily!!" I’ve mentioned it a couple of times back when University Hospital first made their selection, but hadn’t heard anything since, other than I saw an Epic user group story that said folks had come from as far as Dubai. More information is welcome. Seems like a lot of big deals are in the Middle East these days, but of course they’ve got the cash and have always been fans of US-style healthcare (at least the kind we deliver to our ultra-privileged patients).

From Al Borges, MD: "Re: Magellan EMR. Jason Murdoch, MD was able to get in contact with John, the owner. The EMR formerly known as Magellan has run into some business problems relating to being a small startup in a vicious EMR world. Magellan EMR has not been scrapped but is on the shelf. John is a reputable guy and took the site down to not mislead people." John e-mailed Inga back after her incessant sleuthing (we help readers however we can). Dr. Murdoch concluded with, "Does anyone know if Inga is a hot, Swedish blonde?" I do, actually, and all I’m saying is that she is indeed hot (and talented, and fun, and smart …) Swedish and blonde? I’ll never tell.

From Cliff Williams: "Re: Lincoln Park Hospital. At a Chicago meeting, I heard the hospital closed up shop, literally an overnight decision. Without warning, they called nurses and told them to come in and get their final check and sent patients to other facilities. Done. Sign of the times?" The hospital couldn’t find a buyer after it failed to find financing due to its $15 million annual losses and high Medicaid patient load. Deteriorating margins and tough credit will take more struggling hospitals out of the picture, although better capitalized groups may take them over if they have a presence nearby. That kind of Darwinism isn’t necessarily a bad thing, but some of the bigger groups got that way by minimizing the amount of charity care they provide. As always, uninsured patients take the biggest hit.

And speaking of closing hospitals, Physicians Medical Center Carraway (AL) also locked the doors on short notice this week for the same reason – it couldn’t get funding. I’ve been warning of that kind of situation for quite some time, but nobody seems to be noticing that it’s happening now (both closings and scrapping expansion plans).

From Al Borges, MD: "Re: HIT stocks. HIT in the USA is still in somewhat of a slump as compared to ‘Other Technology Companies’. HIT companies showed an unweighted YTD average return of -22.4% vs -14.2% for the OTCs." Link. There are probably lots of caveats to the list. Stock price movement within sectors tend to be amplified in both the up and down directions, so looking back one year may not be enough since all you’re seeing is performance in a historically awful market. The companies on the healthcare list are also a lot smaller and more focused than those international giants on the OTC list (Merge Healthcare vs. IBM?) Putting GE, Misys (shouted out as MISYS on the list for some reason), McKesson, Philips, and Siemens on the HIT side certainly muddies the waters since that’s a tiny part of their business and GE and Siemens are highly exposed to general international economic conditions. And, is looks like they simply averaged the individual one-year change, lumping in obvious low-cap losers like Merge (-77%), Emageon (-74%), and whoever I-Many is (-76%) with the big boys (half of the HIT companies have a smaller market cap than the smallest OTC listed). The list is pretty, but I’m not sure it really contains a lot of insightful or useful information. And, lots of the bellwether HIT companies aren’t publicly traded any more because of acquisitions, going private, or preference.

From Mike Donovan: "Re: Bridgeport. Mark Tepping is retiring after a long and successful career, but Bridgeport Hospital does not use ProFit – it uses Eclipsys’ AM/PFM for reg and billing." Thanks for that. I admire anyone retiring in today’s financial thrill ride. I must have confused Bridgeport with a ProFit user, which is surprising since there are so few of them. I don’t know anything about AM/PFM. That’s the old SDK, right?

Welcome and thanks to new HIStalk Gold Sponsor Satyam Computer Services of Hyderabad, India. It’s a big company ($2.5 billion in revenue and 53,000 employees in 66 countries) with a strong US and healthcare presence. Satyam’s services include hospital systems, portals, telemedicine, application development and maintenance, ERP, and consulting services. The case studies on the Healthcare Practice site include a couple from the Centers for Disease Control and Prevention. Thanks to Satyam for supporting HIStalk.

Former Caritas Christi CIO Dan O’Neil is named CIO of Quincy Medical Center (MA). And speaking of Caritas Christi, it gets $100 million in funding from Ascension Health, which probably means they’ll buy it eventually (which is a pretty good example of what I wrote about struggling hospitals being bought by bigger groups, which I promise I wrote before I read this story).

A hospital manager in Ireland quits after signing an unauthorized $1.6 million contract for software that turned out not to work. The hospital found out about it when they got a bill, but could not get out of the contract nonetheless.

Apple takes out Microsoft’s dopey $300 million Seinfeld ad campaign in one devastating blow. And if you’ve missed Terry Tate, Office Linebacker like I have, you’ll like his new Get Out the Vote video (but Palin fans won’t like this one).

Inga and I are curious about 2009 marketing plans of industry vendors. If you’re a vendor marketing or advertising person, please complete our seven-question survey and we’ll share the aggregated results with you (company e-mail addresses only, please, so we know you’re legit). Surely you are curious (like we are) about what companies are doing in a volatile economy.

As a reader reported in an article comment, the FTC’s Red Flag medical ID theft rule has been delayed for six months.

I’ve mentioned the teen metal group Jessica Prouty Band before because her proud mom (who works in the HIT industry) sent over a CD that I liked. Check out the first video on the page from Hard Rock Boston – playing all those gigs has obviously made them tight and confident on stage (remember, three of them are 15 and the other is 13!) Anyway, they’re in a girl-led battle of the teen bands contest, so vote for them here by October 31 and they might get a shot at playing Hard Rock NYC. We could make it an HIStalk party if Fake Ingas are available.

I was watching a video on the Google Android operating system and API and thought the kid in the opening was a bit over the top: big hair, careful grunge look, and not very convincing as someone who would really get it. Turns out it was Google co-founder Sergey Brin, the #13 richest American, who’s worth close to $16 billion. He looks like a guy who might serve you coffee at Starbucks.

CPSI’s Q3 results: revenue up 8.4%, EPS $0.38 vs. $0.30, meeting expectations. Some of that was due to a tax change, but guidance was positive. According to conference call transcript, they’re doing a lot with Linux.

A University of Florida professor develops a "birthing computer" that uses wireless monitoring of uterine muscle electrical activity to advise doctors whether a Caesarean section is recommended.

Dr. Wes isn’t an ICD-10 cheerleader. "Imagine, 290 codes just for diabetes! Yeeeee haaaaa! Diabetes with foot ulcers on the right foot gets one code, diabetes with foot ulcers on the left foot gets another code, diabetes with foot ulcers on both feet, but not involving the shins gets another code… I mean, a new code for every nuance of disease! You get the drift! Isn’t this SPECIAL? Just think of the COST SAVINGS those clever bureaucrats have found!"

I admit I’ve never heard of Pop!Tech, a big-ideas organization (although I see Jay Parkinson was a speaker at its just-finished conference). They just announced Project Masiluleke, which will connect South Africans to HIV/AIDS information via mobile phones (daily text messages, reminding patients of follow-up visits for antiretroviral drug therapy, and patient-staffed virtual call center helplines).

A sad medical error in Ireland, where a resident performing his first unsupervised kidney removal ignores the family’s objections and removes a child’s healthy kidney instead of the diseased one. The doctor relied on an incorrect x-ray that was six years old because all the newer ones were missing and there wasn’t a convenient computer to look them up on.

An English arthritis patient can’t get pain meds or a referral because her specialist’s dictation, which was sent off to New Zealand for transcription, but never made it back to her doctor by mail. Seems like they could have sent the document by secure Internet connection instead of mail.

UPMC will lay off 500 employees this week. If they’re doing it, so will everyone other hospital (and every other business, most likely). UPMC made "only" $5 million in 2008 compared to $612 million the year before.

Shands HealthCare (FL) will close Shands AGH next year, citing anticipated big shortfalls because of Florida’s tanking economy, propped up until recently by unrealistic housing prices. It could be worse: they could be in Detroit, where employees of car manufacturers are being cut loose in giant waves, sure to hit hospitals there hard in uncompensated care.

A nanoengineering researcher at UC San Diego’s Jacobs School of Engineering wins a Navy grant to create a biocomputing "field hospital on a chip" that will monitor biomarkers in the body fluids of soldiers, detect common battlefield injuries, and then administer medications to treat specific conditions.

Varian‘s Q4 numbers: revenue up 15%, EPS $0.62 vs. $0.61, beating estimates.

A former hospital compliance officer is charged with defrauding her two former employers, a Hawaii hospital and a Florida HMO, by issuing millions of dollars worth of compliance contracts (HIPAA, charge master review, compliance training) to sham companies she ran herself. The HMO hired her even though she allegedly applied for the job using a phony name, fictitious work experience, and her former husband’s Social Security number.

Central Washington Hospital (WA) gets a local paper writeup for its use of a tele-interpreter company to provide remote Spanish interpretation via computer screen, cutting cost and wait times.

Vendor Deals and Announcements

• MEDHOST is now offering a patient self check-in kiosk option called Emergency Department Patient Access Self Service (ED PASS). MEDHOST’s first implementation will be at Northridge Hospital Center (CA).
• The Radiology Institute Imaging Center in Puerto Rico is adding Thinking Systems’ ThinkingPACS solution.
• St. John HealthPartners (MI) is purchasing licenses for the Web-based Cielo Clinic software to help manage their patient population and screen for chronic diseases.
• Robert Wood Johnson University Hospital (NJ) is deploying the Eclipsys access management solution. The hospital has been an Eclipsys client for 10+ years.
• Valley Medical Group (MA) has selected athenaClinicals for its 60+ providers. For the last eight years, Valley Medical has used athenaNet for practice management services.
• Arrowhead Radiology Medical Group (CA) is implementing McKesson’s Revenue Management Solutions for its nine physician clinic.
• NaviMedix has acquired TopLine Solutions, a provider of healthcare payment and collection solutions. NaviMedix has a solution that gives providers the ability to perform real-time financial, clinical and administrative communication with multiple providers.
• Olean General Hospital (NY) and Bradford Regional Medical Center (PA) have signed a letter of intent to integrate and create a new parent company.
• HealthFusion introduces a Web-based practice management system that integrates with HealthFusion’s clearinghouse services.
• Billing service Medrium acquires Wilmington Professional Associates. Though no terms were disclosed, Medrium recently raised $10.46 million in Series C funding.
• I like the clever name for MEDSEEK’s December 3rd webinar, “Do eHealth Portals Make a Difference to the Hospital’s Bottom Line: Calculating a Return on Information and a Return on Investment.”
• Presbyterian Hospital of Plano (TX) is laying off 17 people in the face of slower than expected growth. Presbyterian is part of the 18,000 employee Texas Health Resources.

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From rbsavage3: "Re: HealthVault. Microsoft scores with Aetna e-records pact. As a member of Aetna and an employee of a large hospital system, I’m not sure I like this. I wonder what the community thinks." Link. The deal connects Aetna’s PHR to HealthVault and adds a connection in the other direction next year. The pitch is that HealthVault lives on even if an employer change requires leaving Aetna’s coverage. I’m not sure how the information is coordinated between the systems, but I’m sure they’ve worked that out.

From Leopold Stotch: "Re: bikers. I know we’re all used to ‘Hospital X lost a boatload of personal information data’ stories, but you never know who you’re dealing with with the Mongols support themselves through identify theft." Link. Federal agents arrest dozens of LA members of the Mongols motorcycle gang on charges ranging from drug sales to murder after undercover agents infiltrated the group (which is an amazing story of bravery on its own). The former Mongols president, who wrote a memoir about his tenure, is a night shift CT tech at LA County-USC Medical Center.

From The PACS Designer: "Re: Web-oriented architecture. You are going to be seeing another fairly new concept gain some momentum in the next few years — Web-oriented Architecture, or WOA. While we have been familiar with service-oriented architecture recently, the move to WOA won’t replace SOA, but will provide an architecture that is resource-oriented rather than service-oriented. Since resource-based solutions are more plentiful, they will give the developers a quicker on-ramp to the Web and provide a easier way to test and use new Web applications." Link.

Inga did a little more sleuthing on Magellan EMR, although I’m not sure tracking down the founder will help if the company is kaput, which seems the case. Somebody put in a ripoff report about a problem with a non-medical software package from them. The founder is scheduled to speak at a technology conference this month. He was looking for a programmer last month. Inga e-mailed the founder and the conference planner but hasn’t heard back so far. She tried both phone numbers we found; one doesn’t answer, the other doesn’t have him in the PBX and the address for the company doesn’t come with their name in Google.

A reader asked about an acquisition rumor earlier this week. We’ll have an answer Monday when "An HIT Moment With …" features the company’s CEO answering five questions from Inga and me (and you just know what one of those questions will be). We haven’t seen the answers yet, so we may all be surprised. Our impression is that readers really like these abbreviated interviews and they are fun to do, so if you have an interviewee in mind, let me know.

I kind of hinted at this when talking about Greenway’s PrimeResearch EHR-to-research connectivity, so here‘s a coincidental prediction that’s similar: a patient’s tumor genes may someday be compared to EMR data to tailor patient-specific treatment, aka personalized medicine. I’m a cynic most of the time, but I think this is eminently doable. With an EMR full of patient data that can be linked to vast databases of other patient records, drug trial results, registries, etc. there is no reason to blindly go down the treatment tree in search of a winner for a given patient. Cancer is not one single disease. Even if you don’t buy the concept that evidence-based medicine works, the idea that looking at one patient in context with a bunch of similar ones to choose the best therapy is pretty compelling.

A Michigan doctor develops a disease database to be used in India, working with the Bill & Melinda Gates Foundation to make it available. NxOpinion apparently suggest a diagnosis from provided data. I don’t really understand parent company Robertson Technologies, but it lists a lot of management people, so maybe it’s big.

If you’re ever in Algona, IA, you might as well drop in and see the EMR you’re paying for. USDA gives Kossuth Regional Health Center $134K for it, calling it a "Distance Learning Telemedicine Grant," which sounds like a stretch. It actually sounds more like an portal-type project, but it’s hard to tell from the political high five-ing.

McKesson launches InterQual in the UK. I always called it case management software, although it’s now a bit more grandly portrayed as clinical decision support (i.e., "are you well enough to go home so we don’t lose money on your stay?")

I’m behind on e-mails, but I still like hearing from folks and, even though my replies are often long in coming (I usually try to catch up on the weekend), I read every one. A few folks have asked about the Brev+IT weekly newsletter and I had to admit that it’s "on hiatus." It was taking up a lot of time I don’t have and the e-mail spam filters were keeping readers from getting it. I may bring it back as a weekly HIStalk post if I can think of some other life activity to give up in its place.

I’ve also forgotten to recently recite the list of stuff you can do here, all to your right: (a) put your e-mail in the Subscribe to Updates box to get an instant e-mail update when I write something new (that list now has over 3,100 confirmed recipients); (b) click the "E-mail This to a Friend" to tell your friends about HIStalk, which I greatly appreciate because I want to be anonymously famous; (c) use the Search HIStalk box to sift through 5.5 years of HIStalk; and (d) click the ugly green Rumor Report button to securely and anonymously send me highly sensitive and scandalous information. And, some of the best parts of HIStalk live in the reader comments below each article, so click Show Comments to check them out.

My guest editorial in this week’s Inside Healthcare Computing, which the publisher said was "very sharp, well-written, and insightful" (I’m preening because I have perpetually low self esteem, maybe justifiably), is entitled Ask the Magic 8-Ball: Who HIT’s Winners Will Be in a Recession, Depression, or Whatever You Want to Call the Crappy Times Coming. Some of the 10 items I listed came from reader ideas here, like # 3: "Consultants of the non-PowerPoint variety. Nobody cares about a five-year strategic plan when financial survival into next week is questionable, so eloquent glad-handers or fresh-faced noobs need not apply for these gigs. We’re talking gunslingers here, the battle-hardened vets who simultaneously impress and scare the bejeebers out of you. When you want a system brought live quickly or a sleepwalking vendor slapped to attention, you need someone who looks and acts like Lee van Cleef in those old Clint Eastwood spaghetti westerns." I don’t put out unless you buy me dinner, so you’ll have to subscribe to see the other nine and to receive my routine literary emanations.

Allscripts posts its last results under the old company. For Q3: revenue up 17%, EPS $0.07 vs. $0.07, missing consensus estimates by a penny (or a pence going forward now that Misys is involved).

Speaking of Allscripts, if you want to support WakeMed in Raleigh, NC, watch this video sometime before Friday at midnight. Allscripts will donate $3 for each viewing to the Just for Kids Kampaign that supports construction of a new children’s hospital.

St. John HealthPartners (MI) signs for Cielo Clinic CQMS software from Cielo MedSolutions.

Bridgeport Hospital (CT) is looking for a CIO. I’m not sure what happened to Mark Tepping, who I’ve chatted with a time or two. Big Cerner shop including ProFit, its seldom-mentioned (and even more rarely praised) patient billing app.

This article describes what’s different about Mayo Clinic ("the Big House on the Prairie"). I like the point that there’s a "firewall" between the money and the doctors, who don’t even know or care what Mayo gets paid because they all receive the same salary after five years’ on the job. "We’re all salaried staff—paid equally. This is very good for collegiality, and people working together. The culture here at Mayo doesn’t encourage egos. There is not the same cult of personality that you find at other places.” I checked its tax forms and the highest paid people, all surgeons, make around $700K. Not exactly starving, but there are lots of boondock quacks swindling multiples of that from Medicare.

Congratulations to Cerner again on some damned impressive numbers. Companies are turning in bad reports left and right and there’s good old Neal chugging along like there’s no economic problems at all while expanding globally. That’s a big story. I noticed in the call transcript that the acquisition of LingoLogix was finally mentioned: "which strengthens our revenue cycle offerings immediately … the NLP component of this technology can change the landscape for clinical search by bringing clinical meaning to unstructured clinical documentation, helping aid research, clinical trials and potentially provide a bridge to interoperability constraints as the personal health record becomes more pervasive."

The local paper writes up McKesson Horizon Enterprise Visibility (which staff call "The View") at Oakwood Hospital & Medical Center (MI).

Patewood Memorial Hospital (SC) goes with Omnicell OptiFlex for surgery materials management, including preference cards and real-time usage tracking. I looked for a good picture but couldn’t find one.

T-Mobile’s G1 phone (powered by Google’s Android operating system) is now on sale. iPhone killer? Too early to say, but the T-Mobile part killed my interest. Medical apps on the iPhone are a big hit (partly because of the "store" concept), so maybe coders are working on stuff for this one.

Speaking of Google, the company joins the Continua Health Alliance personal health group. I should interview someone there.

Natividad Medical Center (CA) chooses the NeoIntegrate integration engine from NeoTool.

Some company is auctioning off "telemedical information management" intellectual property on October 30. Included: a smart card-based EMR, HIM workflow, and a implantable RFID chip reader. Actually, Ocean Tomo seems to be entirely reputable in the IP biz, even partnering with NASA, so maybe it’s worth a look if you’re a vendor. Maybe I should cover it live.

Houston emergency preparedness officials team up with the University of Texas School of Health Information Sciences at Houston, a biomedical informatics school, to develop a medical support system for disaster and to deliver more care by telemedicine. I didn’t know that open source guy Fred Trotter works there on its HealthQuilt project, an HIE prototype. I did know that UTMB has one kick-ass telemedicine program that probably leads the entire industry, yet is rarely mentioned, since we’re talking about the Gulf Coast of Texas.

I must have missed this: a new rule that takes effect in a few days that puts hospitals under FTC jurisdiction in requiring them to check for medical ID theft for patients not paying upfront. That sounds onerous.

Patty Miller, a Sunquest sales exec, is voted president-elect of the Central New York chapter of CLMA.

That’s all I have time for since I’ve now worked directly from the uninspired dinner I cooked for Mrs. HIStalk until boudoir time without a break. She just stuck here head in to see if I was still respirating, so that’s probably a hint. We’ll pick up here Saturday. Have a good weekend.

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HERtalk by Inga

From Janeen: “Re: RelayHealth booth. Did you come by? We were trying to keep an eye out for you at MGMA. We had a theater experience that involved a consumer/patient, physician and an administrator we were hoping you got to watch. Let us know if you saw it.” I did lurk by your booth a few times, and even chatting with someone about how PHR fits into the RelayHealth model. RelayHealth had an “exam room” setup with a cute doctor who explained the ins and outs of RelayHealth’s offerings.

Overheard in the San Diego airport: “MGMA was a really good show for us. Lots of traffic.” Standing in the security line, I stood in front of a guy from Fujitsu chatting with another vendor (sold lab coats, I think.) The Fujitsu guy said that MGMA and HIMSS were their two biggest shows and they were pleased.

On the other hand, I did hear a number of people say that attendance seemed a bit sparse. My opinion was I didn’t go to a single session that was standing room only and didn’t have to push through crowds at the exhibit hall. It wasn’t HIMSS, but there were folks everywhere all the time. With such gorgeous weather, I can imagine a number of folks stepped out for some sightseeing.

Anyway, I am glad to be home. I’m worn out from so much fun and long days in high heels (but I looked good.) I’m trying to tell myself that I’m tired because I am out of practice (not used to all that traveling, walking, sitting, wine-drinking, sleeping in a strange bed, etc.) and not because I am getting to be a 3-letter word that rhymes with cold.

Eclipsys co-founder and Carefx founder Terrence Macaleer joins Allscripts as VP of sales for Enterprise Solutions. I also see that Centra (VA) has selected Allscripts ED IS solution.

The VA contracts with Qwest Communications to provide $60 million worth of voice and data services to connect its 1,300 hospitals and other facilities.

More proof here that healthcare is not totally immune to economic troubles. Several new reports confirm that more of us are delaying doctor visits and tests, and skimping on medicine. Kaiser Family Foundation determined 36% of Americans are skipping recommended tests and treatment, up from 29% just six months ago. The number of prescriptions filled has fallen .04%, the first time in at least 12 years a drop has been recorded. Elective surgeries are falling; ER visits by the uninsured are rising.

Also suffering: Yahoo announces a 64% drop in Q3 profits and a plan to cut at least 1,500 jobs. On the other hand, Google’s are up 26%.

Sentillion adds a record 11 new customers and over 200,000 new user licenses in Q3.

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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.

Personal Health Records are Durable Medical Equipment
By Manfred Sternberg, J.D.
Presiding Officer, Board of Directors, Texas Health Services Authority

There is little debate that knowledge and information have always been among a physician’s best clinical tools. Consistent with this fact, information technology (IT) should be viewed by the healthcare industry as a medical device. With the advent of evidence-based medicine coupled with advances of IT, we are in many ways on the brink of a golden age of medicine.

In the relatively near future, information supporting evidence based medicine will translate from bench to bedside at speeds never before witnessed. We will have more accurate information to treat health issues more appropriately, based on the data, than ever before.

Admittedly, IT is in many ways a crude medical device, but that is today. Many of the now traditional medical devices that were introduced into the healthcare market throughout history started off as crude devices; think about surgical tools.

Like other medical devices, this device is certain to evolve with use, experience, and continued development and innovation. Many predict that the use of this IT device by healthcare professionals will become the standard of practice, like scrubbing in before surgery. The legitimate debate generally centers on how and when.

As with other changes in medicine, the adoption of this new tool will be an evolution. It will not happen by just flipping a switch at the end of any given year, it will evolve. Consumers and their physicians must participate in this evolution for it to ultimately be successful. The consumer’s best platform to effectively and economically engage with the industry is a standardized personal heath record (PHR).

What is a PHR?

A PHR is an electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.

PHRs may also include information that is entered by consumers themselves, as well as data from other sources such as pharmacies, labs, and care providers. PHRs enable individual patients and their designated caregivers to view and manage health information and play a greater role in their own health care. PHRs are distinct from electronic health records, which providers use to store and manage detailed clinical information.

The Benefits of using a PHR

There is consensus among stakeholders that the widespread adoption of health information technology will lead to safer, more effective healthcare. Experts believe adoption of technology will reduce preventable errors, such as medication errors, increase compliance with recommended treatments, improve treatment for people with chronic disease, and contribute to lower health care costs.

Ultimately, this new tool will allow physicians to benefit from improved information about each patient, and consumers and doctors can share that information to make the best decisions concerning their healthcare. Better data (e.g. timely, personalized clinical and billing data) provides better results whether in the hands of a physician, patient, health coach, or measurement program Additionally, care coordination from a process management perspective is critical to improved results

Consumer Empowerment

Consumers have great interest in the subject of healthcare. It is the most searched subject on the Internet, yet the long predicted wave of consumer empowerment in healthcare has yet to arrive.

Consumers, as well as the business community, are generally unaware of the healthcare cost and quality issues and interoperability issues. Nor do they recognize that they have a new, long anticipated, role as purchasers seeking value in the healthcare delivery system. They tolerate the existence of numerous inefficiencies and cost in the healthcare sector far more than in any other market, because of and in spite of its relative importance and their inability to judge value.

Today, the consumer is unable to identify value without information on cost and quality. Quality cannot be identified without measurement and it cannot be compared without standardization.

Since the mass adoption of the Internet, the benefits of IT have embedded themselves into society as one of the most powerful tools that consumers have ever had. Endless information is now available in everyone’s home. Society has embraced this new found consumer tool, but comprehensive personal clinical information has not digitally made its way into the consumer’s hands. To some degree it is not readily recommended or available, yet.

How does a consumer get educated about their new role in their own health and their interaction with the healthcare delivery system? Who do they trust to guide them? Consumers trust their physicians far more than any other group in the Healthcare system. They certainly value their doctor’s advice, even if they don’t follow it all of the time.

Today, the consumer is effectively, unwittingly waiting on their physicians to recommend this new medical device for their health. Therefore, engagement of the physician is the key to fostering consumer empowerment.

What is Durable Medical Equipment (DME)?

There is no single authority, such as a federal agency that confers the official status of DME on any device or product. A fairly comprehensive definition of Durable Medical Equipment as contained in a Texas Group Policy is as follows:

Durable Medical Equipment is defined as being equipment that:

• can withstand repeated use; and
• is primarily and customarily used to serve a medical purpose; and
• is generally not useful to a person who is not sick or injured, or used by other family members; and
• is appropriate for home use; and
• improves bodily function caused by sickness or injury, or further prevents deterioration of the medical condition; and
• is prescribed by a physician.

A consumer’s PHR fits the definition as follows:

Durable Medical Equipment means

equipment : Noun. An instrumentality needed for an undertaking or to perform a service.

that:

• can withstand repeated use. A PHR easily withstands repeated use.
• is primarily and customarily used to serve a medical purpose. A PHR contains a consumer’s relevant medical information so many medical decisions can be made based on the contents of the record.
• is generally not useful to a person who is not sick or injured, or used by other family members. A PHR is not useful to anyone in the consumer’s family but the consumer and only the consumer can use it to track and support her health or coordinate her care when she is ill
• is appropriate for home use. A PHR is appropriate for home use or anyplace a consumer has a connection to the Internet.
• improves bodily function caused by sickness or injury, or further prevents deterioration of the medical condition. According to the trade association that represents insurance plans and the executives of most plans, there is consensus among stakeholders that the widespread adoption of health information technology will lead to safer, more effective health care. Experts believe adoption of technology will reduce preventable errors, such as medication errors, increase compliance with recommended treatments, improve treatment for people with chronic disease, and contribute to lower health care costs.

and is prescribed by a Physician; Can physicians professionally make this recommendation to their patients? It depends on whether they can professionally agree with the statement that “a PHR is a medical device that in certain cases can benefit their patient’s ongoing health or illness.”

If physicians prescribe a PHR for their patients, and the Payers collectively agree to pay the costs, the standard of practice in a community will change. Physicians will create a new business model in order to pay for their EMR system, and the power of a new medical device can be leveraged for the benefit of the consumer.

The PHR information must be stored in a secure way with patient privacy a cornerstone of the repository. Physicians must play a role in the central repository of this clinical information in terms of governance and oversight with appropriate financial compensation for their participation.

If every physician in Harris County, Texas prescribes a PHR for every patient that could benefit from such a device, it will be a catalyst for the creation of a clinical information database that would be owned and controlled by doctors and their patients.

The opportunity for today’s leaders is to take steps to enable our community to appropriately leverage the power and value of the data. To be sure, this is not as much a technology problem as it is a sociology issue. The first step is for the Industry is to acknowledge IT for what it is, a medical device.

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From Elsie EHR: "Re: two I’ve not heard of. While reviewing the new 2008 CCHIT-certified EHRs, I saw two products I hadn’t heard of before … MedLink and SmartClinic. The web site of the latter looks a tad (how to put this delicately?) like it was created by someone whose full time job is not in the field of web design (I like the fact that the title of their home page is ‘home’). Oddly, despite being one of only ten 2008 CCHIT-certified EHRs, SmartClinic’s website doesn’t mention the certification." MedLink is here and VIP Medicine (the SmartClinic people) is here. I’ll refrain from snarky commentary on the latter except to say that you have to see it to believe it. I guarantee I could get an ultra-slick version done for a few hundred dollars (including graphics that are attractive and legible), so it seems like a poor investment to leave it hanging out there like it is.

From Ken Malansky: "Re: the former chairman of that fraudulent vendor you mentioned. He is GUILTY! I spent seven weeks of my life on that jury. The one holdout was star struck by his lawyer’s impersonation of Johnny Cochran." I thought they were going to retry him, but that was probably just prosecutorial chest-puffing after the hung jury in 2006. His attorney also represented Scooter Libby (where he parked his aging mother in her wheelchair where the jury could see him fawning over her), Eliot Spitzer, Exxon, Merck, and Philip Morris.

From Dave Dravecky: "Re: rumor. Heard at MGMA that GE is buying Greenway; can’t verify. Supposedly the VC guys want their money, the market is no good for going public, and GE needs a more up-to-date product."

From Salesgal: "Re: Sage. [name removed] got the axe." Unconfirmed. The person named was sales VP for the northeast, but I didn’t feel right about putting his name up here. If he’s gone (which I assume is the case) it’s embarrassing to him, and if he’s not, it’s embarrassing to me. Those who care will know who it is from the position (and whether it’s true or not).

From TalkoftheTown: "Re: Allscripts. I’m surprised you discount what McConnell says about the Allscripts/Misys headquarters situation. The guy has gotten more then 1.2 billion from the two companies for parts of what is left and it’s now valued at about 600 million. Which raises another issue on my mind – what was Allscripts worth when Tullman took over 11 years ago?" I don’t get the feeling that John is involved at all with the new Allscripts, so while his assessment about Raleigh may be interesting, I don’t know if he’s got any insider information now. I could be wrong. Most of the company is in Raleigh,I think I read somewhere.

From GirlGeek: "Re: Epic. Altru Health Systems, Grand Forks, ND, is switching from QuadraMed’s Affinity software to Epic. Altru is one of QM’s oldest clients dating back to the 1980s (or earlier?). Word is that Altru had to beg Epic to take them on since they don’t meet their bed count criteria."

From Al Borges, MD: "Re: Magellan EMR. Anyone know what has happened to them? Their website is dead. A physician who is still using the Magellan Writer can’t get in touch with them." I snooped around starting with the old domain name, registered by John Curtis of College Station, TX under the company name of BTQnet, a Texas corporation (custom software) with an Austin apartment address (the corporation is not in good standing with the state). He appears to have been at Quotient Integrated Solutions afterward (owned by BTQnet, I suspect) but their PBX doesn’t list him (this writeup says he ways still there in July). He’s on LinkedIn. Magellan was going crazy giving away tablet PCs back in 2005 and that’s all I ever heard of them. OK, can someone take it from there?

Just in: Cerner beats Q3 estimates: revenue up 13%, EPS $0.54 vs. $0.37. The company says it will exceed that in Q4. Well done.

A woman who waited 19 hours in Parkland Hospital’s ED and finally left without having her broken leg treated receives a bill for $162. They probably shouldn’t have let Parkland’s revenue VP go on record because he made it an even worse PR nightmare: "She’s not paying for waiting. She’s paying for the assessment she received." No she’s not, the woman says, who has no insurance and says she will not be sending Parkland a check for having a nurse take her blood pressure and tell her to wait.

McKesson will sell its specialty pharmacy business to Walgreen.

Listening: new AC/DC. It’s no Back in Black, but it’s good, straight ahead rock. I saw them live in the Bon Scott years — the guy in schoolboy knickers (guitarist Angus Young) doesn’t look any older even though he’s now 53.

RAND Corporation is all for NHIN and a unique patient identifier, but then again they’re not the ones who have to pay the hundreds of billions of dollars those would cost. The predict great cost savings and patient safety improvements, but they said the same thing about those EMRS that few doctors are using for various reasons unrelated to the quality of the doctors or the EMRs (poor adoption of which make NHIN and the identifier worthless since they add little value to paper charts).

Kaiser says HealthConnect is now live in 12 Southern California hospitals, bragging that its total of 22 hospitals serving 4.8 million members is the US civilian record.

Dr. Wes says it’s not an "electronic medical record," it’s "a sea of electronic medical servers," observing that every system at his hospital requires its own logon. Sounds like they need a physician portal at NorthShore to run Epic and those other applications mentioned.

Talyst announces its medication system (ordering, pharmacy, automated dispensing) for correctional facilities.

CareTech Solutions migrates the 80-server data center of Port Huron Hospital (MI) to its own Troy, MI headquarters in 36 hours as part of its outsourcing contract. The company has 1,000 employees and is bringing on many more. "Pretty much anything that has an electron running through it we are probably working on it," says Jim Giordano, president and CEO.

Arthur Clark is named VP/CIO of Haven Hospital (FL), coming over from John Sealy Hospital (TX).

A survey reinforces what everybody knows already: order sets improve processes and patient safety. The best time hospitals can spend in a clinical systems implementation or improvement is to develop an effective order set review process, starting with automatic inclusion and working toward evidence-based consensus.

Winchester District Memorial Hospital of Ontario, Canada signs for QuadraMed QCPR, document imaging, and enterprise scheduling.

ClearCount Medical Solutions, a Pittsburgh vendor of RFID surgical sponge counting technology, raises $4.1 million in Series A financing.

Daniel A. Krause, formerly of SciHealth, is named head of US business development for Satyam Healthcare.

Millin Associates announces a new practice management billing system for certain clinic types.

A new project named Wareed will electronically  link all hospitals in United Arab Emirates. Cerner is a participant.

A mob with iron rods storms and vandalizes a hospital in India, claiming that a patient’s lab tests were sent to an outside organization because the hospital’s doctors get a cut of the cost. The hospital says techs work only normal office hours and after hours work is always referred.

A man registering his pregnant wife online at Mary Washington Hospital (VA) finds that he can see the files of 803 patients on the site. The hospital said it was "an anomaly." The man got an invalid security certificate warning, then tried to delete some of the URL, which then took him to other pages that showed him the records of every patient who had registered online since December 2007.

Jack McCloskey joins Magruder Hospital (OH) as IT director, leaving a similar role at Floyd Memorial Hospital (IN).

NextGen Healthcare is named as one of the best places to work in the Philadelphia area.

Jobs: Epic Consultant, SIS Project Manager, Cerner PharmNet Consultant.

About 88% of American adults can’t make good health care decisions given the right information, an AHRQ study reports.

HLTH and WebMD cancel their $2.31 billion merger. I can never figure out that corporate mess where one owns most of the other and Marty Wygod is chairman of both companies. Conveniently, I have zero interest in both.

E-mail me.

Inga Live from MGMA

From Nasty Parts: "Re: political correctness. Did not realize the whole Obama thing was a done deal!” A couple of weeks ago I made one remark about Sarah Palin’s bangs and suddenly started getting hate mail from folks who treated that as a political endorsement. Yesterday I quoted someone else who mentioned “a possible role in an Obama administration” and suddenly I have written off McCain. I think everyone needs to take a deep breath and settle down. It will all be over in two weeks.

From Inga Wannabe: “Hi Inga. I am at MGMA and for some reason, several friends insist that I am Inga. I finally gave up and let them call me Inga. And, I actually decided it might be fun to be you.” Yea! We had a fake Inga at MGMA after all! By the way, it is pretty fun to be me. You are welcome to be Tina Fey to my Sarah Palin anytime (note to the crazy politicos: the previous sentence was not meant to be political).

From oneHITwonder: “Re: annoying texting. Man, I am so bummed out that I did not identify Inga in the relatively small CCHIT crowd. I will have to keep looking … hope she was not the annoying lady who was texting behind me during the entire session.” Likely not me since I sat up pretty close and (just like in third grade) would have been embarrassed if the speaker caught me not paying attention. As for the texting people, you have to remember that there are a lot of busy people in this world who believe the world may fall to pieces if they were unavailable to their underlings for an hour.

I got my first LinkedIn recommendation! “Not only does she give us great information, she also gives us humor, fun, and something to look forward to reading every day.” Thank you, Christianne for making my day. Mr. H and I, by the way, love to accept all LinkedIn requests.

It’s Tuesday afternoon in lovely San Diego. There is a reception tonight, but I don’t think my feet can handle any more standing or walking. I think I’ll go for dinner, a glass of wine, and an early night before I head for home in the morning.

Last night was a not an early night. I scored an invite to the Allscripts party, which was in a beautiful outside patio on top of the Hard Rock Café. It was pretty packed. Everyone seemed to be upbeat about the Allscripts/Misys thing, though it’s easier to be happy when you’re being provided all the free drinks you want. The only thing I heard anyone complaining about was the lack of food. Perhaps Allscripts decided to eliminate consumption synergies.

In a session yesterday, the speaker asked who had a hospital-provided EMR. Only about 10% of the hands went up, which surprised me a bit. I wish he had also asked if anyone’s practice had been offered the financial assistance from the hospital but turned it down. That’s the question I want answered.

I touched on this yesterday, but my impression is that the top concern for attendees is improving the bottom line. Hence, vendors are promoting many tools for increasing revenues and/or cutting costs. Even solutions like EMR are being discussed in terms of how it will help with pay-for-performance objectives. When I thought more about it, I remembered that the administrator is the one charged with taking care of the bottom line, so it shouldn’t really surprise me that they are less concerned with finding tools to make life better for physicians, etc.

A cool tool I checked out was from a company named Phytel. As I understand it, their Proactive Patient Outreach program works with any PM/EMR. It scrubs the offices’ data and finds all the patients meeting a particular set of criteria, such as all diabetic patients who have not had an office visit in over a year. Then it will call those patients, thus increasing revenue. Really simple concept, the technology works, and it produces results.

A couple of companies were promoting standalone products that calculate the patient-responsible monies at checkout and then place a hold on the patient’s card for that amount. Thus the patient has no surprises about the costs, does not have to worry about later paying a bill, and the practice is paid faster. Preferred Health Technology and mPay Gateway were the two I saw offering slightly different flavors of this concept. Both claim the PM vendors are lining up to partner with them.

One of the most entertaining moments of my day was a meeting with athenahealth’s Jonathan Bush, who gets excited about everything. He was clearly still pumped by a dawn surfboarding expedition. He’s about 100 IQ points higher than the rest of us, reflecting on recent industry consolidations and Marxist capitalism (consolidation is a predictable result of capitalism). We quickly jumped to his theory on software licensing versus software as a service, which is where he obviously believes the industry is heading. Finally, JB was gracious enough to say that HIStalk is about the only industry publication he reads (the always skeptical Mr. H says he probably says that to all the journalists).

A few other quick tidbits:

• I tried a couple of times to ask someone at the busy NextGen booth to explain more about their recent RCM acquisition. I never got a chance to talk to anyone in the know, but I did get a free t-shirt and a cool little flashlight.
• I spent a bit of time in Greenway’s booth and got the scoop on their new PrimeResearch product (they are excited about it) and quickly met EHRA chair Justin Barnes.
• Tried to check out PatientKeeper a few times, but every time I walked over there were busy, busy, busy.
• I met Sage VP Sharon Howard, who commented they were happy to be done with the turmoil a few months ago when her comments about some layoffs were misinterpreted. She thinks they did the right thing trying to be as forthright with the press as possible.
• I asked several attendees if they had an EMR and if they were on their first one, second, etc. Almost all claimed to still be on the first. Several vendors claimed they had replaced one competitor or another, but admitted that most buyers are on their first install.

Enough on my impressions! My wine is waiting. If you were at MGMA, please send us your thoughts!

E-mail Inga.

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Greetings from San Diego! It’s been years since I’ve been here and I had forgotten how absolutely perfect the weather is. Although, aside from the short walk from my hotel to the convention center, I haven’t had much fresh air!

I spent Sunday afternoon checking out the exhibit hall. Apparently there are over 350 vendors here to promote their wares to the 2,800 attendees. The traffic seemed pretty slow to me, and actually several vendors agreed. It’s Sunday as I write this, though, so it will pick up Monday.

None of the booths were over the top like you see at HIMSS. Cerner, McKesson, Sage, and Allscripts had some of the bigger booths, but there were plenty of small booths throughout. I also noticed what appeared to be 2-3 vendor no-shows.

One of my first visits was to Med3000/InteGreat, which was handing out cute little teddy bears. It probably would have been Mr. H’s favorite booth because two booth babes in black boots and white shorts were flagging those attendees who didn’t find the teddy bear to be an adequate draw.

Another memorable booth was Health Business Navigators. Everyone was wearing these silly white sailor hats, but they were being good sports about it and people were stopping. Plus if you sat through a five-minute overview of their ad hoc reporting tools, they gave you your own hat plus a $5 Starbucks gift card.

It’s been a few years since I had been to an MGMA meeting, but I seem to recall EMR being the buzz at that time. This year EMR is still hot, but revenue cycle billing services seem to be this year’s "it" product. Sage, for example, had a presentation by RCM expert Pam Moore, who is editorial director for Physician Advisor. I sat through her spiel, which was pleasantly generic and not a straight pitch for Sage. They also had really comfy chairs to sit in, and if you participated, you got your name in the hat for a $500 cash drawing (which, sadly, I didn’t win).

And speaking of comfy chairs, the Panasonic folks had this awesome massage chair. Full body massage. I want to marry the massage chair.

Anyway, my favorite booth pitch was Gateway EDI. If you gave them your card to swipe, they would donate $5 to Susan G. Komen for the Cure. Good stuff.

According to the exhibit information, Misys and Allscripts were each scheduled to have a booth. However, they used the original Allscripts space for all the demos (complete with the new orange, new logos, etc.) and turned the other into private meeting rooms. It’s actually pretty impressive that they had all the new branding in place a mere one week after the merger closed. I am sure the marketing guys were breathing a sigh of relief that there were no more delays in the merger.

Towards the end of my booth trekking, I stepped into the Workforce.com/OnBase booth. Tiki torches, thatch huts, and an open bar made it seem like a good stop (I actually did hang out at one of their tables for a bit, but drank only water). Unlike every other booth I popped into, no one really chatted with me for some reason. I kind of wanted to hear their story, but everyone seemed to be busy putting collateral up or conversing among themselves.

After a short break in my hotel room, I went over to the opening reception. Lots of folks there were using up their free drink tickets (I used mine up, too). They had an assortment of entertainment in place (my favorite was the lady making ice sculptures with a chain saw). I had fun chatting with a few administrators who were trading EMR implementation horror stories. I actually slipped out early lest I be tempted to find some after-party!

On Monday, I sat in on a CCHIT session. Not surprisingly, most of the attendees were looking for EMRs. Besides learning more about the certification process, there was some discussion on what other criteria CCHIT should consider. The audience recommended CCHIT consider adding more more portability requirements to make it easier to move from one EMR to another (when you dump the first vendor). Another couple of suggestions that I am sure would make vendors quiver: coming up with a certification process for physician PM systems and making EMRs more seamlessly integrate with PMs at a nominal cost. 

One session I missed: The Office: Manners Matter and Courtesy Counts.

I also  had a chance to hear Glen Tullman speak this a.m. The conversation was brief, but I heard enough to leave me convinced he really is passionate about this whole connecting healthcare thing. I’m sure he has shared his "connecting the community" vision hundreds of times, but  he still managed to sound genuinely fresh and passionate about advancing interoperability (between Allscripts products as well as other products). Someone asked him if he was making any plans for a possible role in an Obama administration or possibly as a senator. He stressed that he had signed a three-year agreement and wouldn’t have done that if he hadn’t thought long and hard about those options. He also said he has been vocal in his opinion that the HHS leader should be a physician and since he lacked that credential, it sort of hurt his chances. Of course, if that phone does ring, I imagine he’ll at least take Obama’s call. However, my impression is that he believes he has a chance to make a bigger impact in HIT staying in his current role.

I’m sitting in a session but I can’t absorb another fact about the benefits of interoperability. So, a few more notes:

• If you sit through a Navicure demo, you can get into a drawing for an Audi convertible. I am hoping to drive home.
• Magician fans could get their fill at the Greenway and McKesson booths.
• If advertising in the restrooms is appealing to you, you’d best stick to HIMSS. At least the ladies’ rooms were signage-free.
• Even though Medinotes is now part of Eclipsys, you’d hardly know it. Not only did they have separate booths, there was very little signage promoting the marriage.
• I prefer suits over those homogenous golf shirts. Don’t know if it is a trend, but a good number of the vendors wore "real" clothes and not those shirts that never fit the women well and in colors that real men would never wear. 

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