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IT Projects Resulting in Savings (for $25,000 or Less)
By Southeast CIO

These are based on my personal (15 years) experience in hospital IT. Some of these may be a little dated.

Medicaid Eligibility Double Check Before Aged Receivables Go to Bad Debt Agency
Annual Savings: $50,000

Hospital sometimes help patients apply for Medicaid, usually after the patient receives treatment. The patient is usually placed into some type of Medicaid-applied status. When the application is approved or denied, the status is changed. Sometimes all that works and sometimes it does not. We created a batch process that identified any self pay/indigent patient/guarantor ready for bad debt and applied that information against the Medicaid Eligibility source/TPA. Even in these HIPAA-friendly days, a second check will find an organization money.

Resigned/Terminated Employee Automatic Dis-enrollment from Benefit Plans
Annual Savings: $20,000

The base HR package didn’t automatically term benefits. HR had to dis-enroll employees manually from programs. Sometimes that would not happen in a timely manner or a step was missed. The option is to either buy an expense add-on module or script the series of key strokes. Scripting can resolve this problem, eliminating part of an FTE and saving benefit dollars.

Intranet Application That Assigns Registrars To Patients/Rooms, Reduces Overtime
Annual Savings: $15,000

Some hospitals provide bedside registration, especially for maternity wards. Registrars were constantly on the phone or going back to the main office for their next assignment. We created a basic application for the Intranet that could be updated showing next assignment. Registrars could access that from their mobile laptops on carts and indicate when done. Overtime went down, registration productivity went up. We also used instant messaging for these employees (policy was no IM at that organization).

Fax Server to Retain Surgical Case Documents Faxed To/From Physician Offices
Annual Savings: $50,000

Faxing with MDs office always has its challenges. On occasion, surgical cases are delayed, increasing overtime and frustrating many involved. A fax server that retains inbound and outbound faxes eliminates a lot of headaches.

Microsoft License Discounts for Educational Organizations – Teaching Hospitals
Annual Savings: $12,000

Microsoft provides discounts for educational organizations. A 400-bed hospital usually provides some type of education to residents, etc. Even if it is on a small scale, it will sometimes help qualify.

Reduction in Hospital Bill (claim) Hold from 5 to 4 days
Annual Savings: $35,000

Most HIS systems are set to hold charges for X days after patient discharge. The point is to enable all charges to be entered, scrubbed, then dropped on a claim. When most HIS systems go in, to be careful, bill holds are sometimes set high. With good charging processes and focus, you can reduce these days. Interest earned on one day of charges billed and paid one day earlier adds up.

Small Revenue-Enhancing Projects: The Rule of the Year for 2009-2010
By AgedObserver

You’ve preached for a long time that our industry, in many cases, has adopted technology for the sake of technology, without examining the fundamental reasons of “why” and “what benefit” (CPOE is the best example). There have been countless multi-million dollar projects in the last 10 years where the end result has been average technology, combined with poor execution, resulting in lousy adoption and no demonstrable ROI. 

Instead of accelerating the entity, the attempted technology has slowed the organization’s progress, and in the hindsight of today’s economic environment, has placed provider organizations at risk because hundreds of millions of dollars poorly invested has escaped from their bank accounts.

Jim Collins identified some key aspects of how leading organizations use technology as an accelerator, thereby “avoiding fads and bandwagons yet becoming pioneers in the application of carefully selected technologies.”  Clayton Christensen talks about innovation needs, not for the sake of innovation, but to move the business forward in a steady, directed fashion.

In today’s environment, where capital for large technology projects is very scarce, it’s important that every project be aimed at providing additional revenue to the organization for work already being done, i.e., if you’re leaving money on the table because you don’t have the right technology (square peg/round hole or one-size-fits-all) and you can get a vendor to guarantee financial improvement, you have a winning solution. Large projects don’t work today because the manpower and up-front costs lead to extended (if any) return on investment for the purchaser.  

Small, focused, revenue-enhancing projects should be (my prediction is they will be) the rule-of-the-year for 2009/2010. The tie between the clinical activities and revenue is obvious, but so many technologies put a 10-foot wall between the two, or try to solve only one part of the two sided-puzzle, and hence don’t resolve true issues and put more money into provider’s hands.

The Future of Primary Care
By TornMD

The NEJM just had a roundtable on saving primary care, with big names in the field talking about the usual things: medical home, changing reimbursement, etc. Personally, I don’t see how anything but a drastic increase in salary will attract people to the field. I’m also not sure those are the people you want as your doctor.

Even though most EMR systems are targeted to internists, more technology is not going to change the everyday workings of a primary care provider. I did an informatics fellowship, so I’ve never practiced more than three sessions per week, always in an academic setting (with two sessions of supervising residents). Though I’ve found my patient care sessions very rewarding, there’s no way I could have managed a full week of it. Primary care is just not that intellectually satisfying.

As our department chair told us when I was finishing residency (2001), there’s no future in primary care. PAs and NPs can handle 95% of the cases we see (as evidenced by the excellent PAs I work with in our walk-in clinic). I often feel that dealing with lower back pain, URIs, and diabetes management is a waste of an MD.

The reward I get from primary care is probably what most people in private practice find the most frustrating. Being in an academic setting without productivity constraints, I have (a lot of ) time to spend with patients. The whole medical home concept — case management, explaining lab results, dealing with specialists — is a lot of what I do (especially since I speak Spanish and may be one of the only providers who can talk to patients without a translator). It’s also a lot of what patients appreciate. I often feel much more like a psychologist than a doctor; however, I don’t need an MD to do what the patients appreciate most –  listen.

There will always (I hope) be people who go into medicine because of the rewards of patient interaction, but the current system makes that less and less viable. Because of the lack of intellectual challenge in primary care, I believe the only way to attract the “best” is to couple it with research or teaching and to work where patients really need you. I was miserable during my private practice sessions when I saw well-insured patients for yearly checkups, STDs, or blackberry thumb. When I see Medicaid, non-English speaking patients for diabetes control or atypical chest pain, however, I feel that I’m actually contributing and fulfilling my role as a physician. Unfortunately, a Medicaid-focused private practice is not really financially sustainable.

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The Washington Post reports that President-elect Obama has chosen former Senate Majority Leader and South Dakota Democrat Tom Daschle as Secretary of the Department of Health and Human Services. Sources also report that Daschle will be given broad healthcare policy responsibilities that include expanding healthcare coverage while reducing costs.

Daschle’s book, "Critical: What We Can Do about the Health-Care Crisis," called for a healthcare oversight entity similar to the Federal Reserve Board. He was supporter of the failed Clinton health plan in the early 90s.

The Republication National Committee is already criticizing the choice of Daschle, an early Obama backer, saying that both Daschle and his wife work for lobbying firms.

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From Jamie Sommers: "Re: Payerpath. Word is that Art Glasgow, the Payerpath president, resigned from Allscripts-Misys today on a town hall conference call. He was a good guy and the reason why Misys bought Payerpath in the first place." Unverified.

From The PACS Designer: "Re: federated identify. You will be hearing soon about a new concept called federated identity. Microsoft and other software firms are working on bringing this concept to fruition in the next year or so. Cloud computing requires a better method of identifying users that won’t overload requests for additions to Active Directories. Microsoft has a software download called Services Connector that provides the ability to identify authorized e-mail addresses from federated databases through its Live ID software when logging on to a cloud service." Link.

From Fourth Hansen Brother: "Re: FDA. Have they been cheating in medical devices?" Link. FDA scientists claim that agency executives pressured them to change their findings so that medical devices could get marketing approval. 

NotADupe claimed last time that a marketing person planted the Clara Barton comment about an Allscripts product at AMIA since it sounded pretty rosy and "I was at AMIA and I didn’t see Allscripts/Misys there." I thought it sounded legit, although it was borderline because it was so positive. My Allscripts contact saw the mention and quizzed all the marketing people there to make sure someone didn’t go rogue and post a fake comment here, then cast the net wider to see what Clara Barton was talking about. There was indeed an Allscripts demo at AMIA, although a brief and informal one. Jacob Reider MD, the company’s medical director, did a five-minute demo of Allscripts Prenatal at the Primary Care Informatics Working Group on Saturday night in front of around 40 people. The product isn’t GA yet, but I’m sure you’ll hear more when it is. I also appreciate that Allscripts was ready to go after anyone on their side who tried to mislead readers here, which is fortunately unnecessary since everything was above-board.

From HITPundit: "Re: Partners. There is a good read in the Sunday Boston Globe about the Partners effect. I thought it was about patients? Non-profit status for most of these places is a joke." Link. Of course it is. The story is about how Taj Mahospitals get paid more money to deliver average care for certain services than their less-ritzy but better-outcome competition. It mentions Mass General’s $686 million expansion and Partners’ $1.7 billion in profit in the last four years, while Caritas Christi was borrowing money to pay for oxygen tanks. It also mentions Partners’ leveraging its patient perception to manhandle insurance companies, resulting in 30% higher payment than similar hospitals (although Children’s Boston has the highest rates in Massachusetts). The quote HITPundit liked came from the chairman of Partners’ board: "Some are able to spend more than others. It’s our fortune that we’re probably in the lead on those investments. And several hospitals aren’t able to keep that pace. And that’s what I, as a businessman, call market forces, if you will." I thought this snip was interesting: "And it is there, in the workaday world of hospital care, that the hospitals’ reputation for unmatched excellence fades – and with it much of the rationale for the higher payments they receive for such treatments. The growing, if still inadequate, body of data available about hospital quality paints a fairly consistent picture of the care at the Brigham and Mass. General: often good, but rarely extraordinary, and sometimes inferior to the care available at other hospitals."

From Pacstech: "Re: stolen records. How about an arrest warrant for the idiot that allowed the records to be stolen? With 25 beds, how many people in medical records are we taking about here?" Bags of paper medical records stolen from Down East Community Hospital (ME) wash up on a local riverbank.

From HCC Princess: "Re: CMS. CMS is auditing 30-40 Medicare Advantage Plans. Claims from 200 random members will be audited and apparently any unsubstantiated claims will be extrapolated across the entire plan’s membership base. CMS is looking to recover a lot of money."

From Vern Den Herder: "Re: Epic. A healthcare organization in Connecticut recently signed with Epic. Wondering who?"

From Vince Ciotti: "Re: the $25K IT project. Spending more in IT won’t get you squat for recognition. Spend less! Use the $25K as rewards for ideas in a cost-cutting campaign that solicits ideas from your IT staff. $10K to the winner, $5K to runner-up, etc. Have finance vet the ideas and only the ones finance says will produce real ROI (that is, reducing someone’s budget next year) get considered. In the 100+ IT assessments we’ve done with The Hunter Group and Navigant Consulting, some of the best ideas have been given to us by IT staffer we interviewed. Why pay us to find them – get them yourself from your own staff!!"

Computerworld writes up Midland Memorial Hospital’s OpenVistA implementation, although emphasizing "cheap" rather than "works just fine" (the "old code" remark was snarky, especially given that many commercial products are older than VistA, which was rolled out in 1996). The hospital’s project was named as a winner of a 2008 InfoWorld 100 award.

I admit that I’m old-school patriotic, not a fair-weather flag-waver, so I was happy to join in the Valour-IT Veterans Day fundraiser, which ends next Thursday (Thanksgiving Day — how appropriate). My 401k may be hitting a rough patch, but I can darn sure find a few dollars to help buy a severely injured soldier, sailor, or airman some technology to help them recover from devastating war wounds. Their sacrifice (and that of their families) isn’t diminished one whet by the fact that I don’t always agree with the orders they are given (I’m sure they’re not always thrilled about it, either, which is all the more reason to get them back on track). It costs around $700 to provide a laptop with assistive technology and I was happy to provide one to someone who deserves it. Being a 19-year-old kid surrounded by the constant threat of harm and miserable conditions far from home is bad enough, but being shipped back to your family missing limbs has to suck big time. All donations of any amount are welcome and are tax-deductible.

Barry Chaiken MD, formerly of McKesson and BearingPoint, is now CEO at Medting of Palma De Mallorca, Spain (field trip!) Never heard of them, but it looks like a physician collaboration platform for sharing cases that can include media.

TELUS, the Canadian telecommunications company that bought Emergis a year ago, which had previously bought Dinmar in 2006 (and therefore its Oacis clinical system), creates TELUS Health Solutions and says it will invest $100 million over three years in it.

SCI Solutions wins two marketing awards: one for its ad graphics and the top award overall for its Access Management magazine.

CodeRyte gets $13 million in Series D funding, for a total VC funding of $50 million.

It took Inga awhile to get confirmation from some earlier reader rumor reports, but she has verified officially that Ingenix has acquired Global Works Systems, Inc. and will make them part of Ingenix Consulting.

This stock analyst says GE is in big trouble, calling it "a bank disguised as an industrial conglomerate" and an over-leveraged one at that, saying that if GE fails, it "could trigger the mother of all bailouts." I’ve speculated all along that its GE Capital exposure was a lot more than Jeff Immelt was owning up to. Speaking of which, may we assume that Intermountain’s CareCast pig-lipsticking project is either dead or at least so far behind that no one could possibly still care?

Right after I wrote the above, along comes a GE Healthcare press release touting "Digital Day One" without ever really saying what it is, although data-sharing and new hospital construction are mentioned. I read the release three times and I still have no idea what they’re talking about, with no clarification available on their site because the press release isn’t there at all. Marc Probst is quoted, so Intermountain is involved, apparently with regard to "timely sharing of newly published medical breakthroughs and best practices."

But speaking of GE, this Motley Fool analyst tries to figure out which company is more screwed up: GE (GE Capital) or Siemens (bribery).

Half of primary care physicians say they’d get out of medicine if they had an alternative, all because of insurance and government red tape. Everything said there is pretty much what Susanne Madden said when I interviewed her.

University of Toledo’s McKesson EDIS implementation is written up on its site.

Former Cerner sales guy Mike Fiorito is named chief sales and marketing officer of cardiac monitoring services vendor  LifeWatch Services. Hopefully he’ll direct better press release writing since I had to read the first two paragraphs of this one at least five times to make sense of it (and I read a ton of press releases).

Texas Health Resources demonstrates a patient-doctor relationship tool built on the Microsoft’s Surface computers, that "wave your hand over the coffee table" gadget that Steve Ballmer kept yapping about in his HIMSS keynote. More important applications have already been built for it, however, as Harrah’s has Surface computers running in Rio Casino "allowing customers to flirt and order specialty drinks using the technology."

Children’s Health System (AL) picks what sounds like the entire Eclipsys Sunrise product line. A big peds hospital customer is a great opportunity, but I’ve never seen one yet that wasn’t a pain in the adult-sized ass. I guarantee that a six-hospital IDN with one peds hospital will spend 50% of the entire project effort just accommodating the sometimes bizarre but indefatigably argued practices in peds, always defended with the reminder that "kids aren’t just little adults." Sometimes I think they’re as unlike general community hospitals as a veterinary hospital, occasionally for good reasons.

Odd: a former New Zealand health district CIO goes on trial for stealing $11 million US by submitting false invoices. He had "grand properties," a luxury car collection, and a 150-foot, 17-bedroom yacht.

Misys CEO Mike Lawrie on the prospects for Allscripts-Misys: ""Everyone recognises spending in US healthcare is out of control and is projected to consume 17 per cent of [gross domestic product]. And they’ve just spent a trillion bailing out the financial system. There is a limit to how much money you can print. And my view is there’s no way, with a new administration, [rising costs] can be left unchecked. And technology will be part of the solution."

Spheris names former Pediatric Services of America CEO Dan Kohl as president and CEO.

Glenn Dennis is named president and COO of Perry Biomedical Corporation, which makes hyperbaric oxygen chambers. He was previously with DataLoom, Exigent, SoftMed, and GE.

Chinese Internet company Baidu.com reels when it’s found that a chunk of its paid search revenue comes from unlicensed medical and drug customers, whose paid links were mixed in with real results based on popularity. Its a lot like Google, making its founder a billionaire.

Kenya has an ambitious plan to connect all hospitals over the Internet for telemedicine, ordering supplies, and providing second opinions. It will also support TelePresence, Cisco’s high-quality videoconferencing tool.

East Tennessee Heart Consultants brags on its IT outsourcing to Claris Networks, claiming it costs less and is more reliable.

Hospital layoffs: Beaumont Hospital (MI), 500 employees; MetroHealth (OH), 25 employees.

The University of Texas System, reorganizing UTMB after Hurricane Ike damage and massive layoffs that started this week, brings in Kurt Salmon Associates to help develop a plan.

E-mail me.

HERtalk by Inga

A computer virus at Barts and The London NHS Trust causes a system shutdown that lasts more than 24 hours. E-mail and Internet access were affected, but not the Cerner application (finally there is an issue that couldn’t be blamed on a Cerner application).

Speaking of hospitals across the pond, several are facing closure because they are not attracting enough patients. Recent reforms allow patients to choose where they’d like to be treated, which has shifted traffic to the more successful medical centers.

The University of Missouri and Cerner are winners of CHIME’s Collaboration Award for using HIT to help UM family physicians and patients manage chronic diseases.

NightHawk Radiology Holdings announces the appointment of David M. Engert as CEO, following the resignation of Dr. Paul E. Berger. Engert is a former McKesson and Quality Care Systems exec. Berger, who co-founded NightHawk along with his son Jon, will remain as non-executive chairman of the board. Jon Berger, an SVP and board member, has also resigned from both the company and board.

Barcode POC provider IntelliDOT and latric Systems sign an agreement that formalizes pricing for interfaces, implementation, and maintenance for customers using Iatric System interfaces between IntelliDOT and MEDITECH solutions.

Beginning in January, the Seton Family of Hospitals (TX) is implementing a new dress code for nurses and other patient care employees. Tattoos must be covered and piercings limited to earrings and a small nose stud. I personally prefer fashion accessories to permanent body adornment, but tattoos don’t particularly bother me (assuming everyone has had the appropriate hepatitis screening), although I find I can never quite look someone in the eye if they have a nose ring or piercings in their eyebrows. Even though they have no effect on the quality of care, I suppose some patients would be more at ease if they didn’t see a naked lady tattoo while getting a blood draw.

Eclipsys claims they’ve exceeded sales targets for the EPSi budgeting and financial decision support systems for the first three quarters. Their announcement doesn’t mention if their sales goals were set too low or whether the sales have translated to higher profits, but, it’s still good to hear that someone is making headway in these economic times.

A friend mentioned that his employer (a law office) is downsizing its holiday bash this year. Rather than renting a steak restaurant for an evening of expensive food and drink, they’re having a holiday luncheon delivered to the office. Some of the party savings will be donated to charity. It got me wondering what other companies are planning; hence the new poll to your right. This year, Mr. H and I are planning a Virtual Holiday Party. We are thinking perhaps setting up an online chat and he’ll drink his beer while I sip on my wine. Mr. H is tight with his money, so he still hasn’t decided if we can bring dates to the affair. Meanwhile, according to the Raleigh paper, the Allscripts-Misys folks will have a chance to act like one big happy family at their convention center holiday bash.

Red Hat chairman Matthew Szulik is named E&Y’s 2008 Entrepreneur of the Year for turning his company into a billion-dollar business. Glen Tullman of Allscripts was a finalist in the Technology division.

MedcomSoft announces its Q1 results. The news remains bleak for this 2007 Best in KLAS winner, now desperate for a buyer. Revenues were down 10% year on year and the net loss was almost $800K.

Former VeriChip CEO Scott R. Silverman regains control of the company after a $5.4 million purchase of common stock. In addition, the company purchased all intellectual property rights related to its human implantable RFID technology. Silverman claims he is eager to “re-ignite” the company.

Virtual Radiologic appoints Kevin H. Roche to its board of directors. He’s a managing partner at Vita Advisors and formerly the CEO of Ingenix and general counsel for UnitedHealthGroup.

Thomson Reuters releases its annual study of the top cardiovascular care hospitals.

Peter Dolphin is named VP of business development for Beacon Partners. He was most recently the VP of sales at eScription, and before that worked at IDX Systems (GE Healthcare).

E-mail Inga.

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An HIT Moment with ... is a quick interview with someone we find interesting. Liddy West is a principal with West Consulting and is working on the VUHID project.

What is GPII, who’s involved, and why is it a non-profit?

Global Patient Identifiers Inc. is the company started by Dr. Barry Hieb and myself to manage the Voluntary Health Identifier (VUHID) project. Barry, who left Gartner’s healthcare consulting group in August to work on VUHID full-time, has been focused on this effort part-time for a number of years, beginning with the work he led on two ASTM International standards that describe how to achieve unambiguous patient identification and improved privacy of clinical information.

As a medical doctor and a computer scientist, and through his wide network of industry leaders, Barry has thoroughly vetted the VUHID concepts and design from both practical and technical perspectives.

And, to your question as to why we’re a non-profit, one of our basic beliefs is that a universal patient identifier can neither be mandatory nor managed by any government. Nor can it be commercial in that neither patients nor providers can be asked to pay for it. That is, we believe that such an initiative should take costs out of the system, not add costs.

Citizens push back hard every time someone brings up the idea of a government-sponsored healthcare ID number, yet a RAND study advocates spending billions to create such a system. What are the benefits of an ID number and why does it have to cost so much?

We wholeheartedly agree with many of the objections to creating a massive, expensive, government-controlled national identification system. And based on our estimates, it simply doesn’t have to cost so much! That’s the beauty of the VUHID approach: cheap to develop and operate, no big software engine or data base of identifiable patient information, and no government agency to oversee it (lots more details at www.vuhid.org).

So, not only vastly cheaper to implement, but essential to making the healthcare delivery system more efficient. The RAND report (warning: PDF) estimates that savings running to tens of billions of dollars annually can be achieved if effective electronic clinical information exchange is implemented. Errors in current patient identification techniques estimated to be 8% or higher represent a major barrier to achieving these economies. And the benefits?

• The ability to accurately link patient records among participating providers for a dramatic reduction in duplicate registrations and more convenience for patients and staff.
• Reduced costs and medical errors. Fewer duplicate or unnecessary tests because patients are identified correctly and providers have access to clinical information from encounters across an HIE.
• Enhanced privacy protection. With VUHID, patients can elect to protect certain aspects of their clinical information based on data type and provider type.
• VUHID also reduces the risk of medical identity theft since no patient information is associated with the VUHID identifier.

He’ll blush to see himself referred to as the leading authority on the topic, but you’ll note that Barry’s work is cited no less than a dozen times in the RAND white paper.

We’ve only recently worked through the ROI model for VUHID and believe it will be vastly cheaper than the RAND estimates — by a factor of 500! In fact, one of our advisors who is involved with an emerging HIE project has reviewed our model and agrees that proposed VUHID pricing represents a “no brainer” decision for HIE executives based on savings and benefits described above.

How do you get around the inherent layperson fear of a government-controlled health ID number?

Again, it’s our intention to keep government out of it. We’re working with HIEs and EMPI vendors, taking a ground-up approach vs. a top-down, government-driven approach.

Now, if the government, state or federal, would like to sanction what we’re doing, we’d be happy to talk! Barry has presented VUHID to Rob Kolodner at ONC who is very supportive, but as you know, Congress specifically prohibited spending federal money on this effort several years ago.

We’ll continue to work with organizations such as HIMSS, NAHIT, IEEE, AMIA, JCAHO, Liberty Alliance, and the RAND Corporation, all of which have public statements supporting the need for more accurate patient identification methods. VUHID has good visibility with these organizations, as well as physicians’ groups, patient advocacy groups, and HIEs. We’re working to gain more traction as initial deployments are accomplished and real-world experience with the system is gained.

Some high-powered and well-funded groups surely have a strong opinion about the health ID concept. GPII is a tiny nonprofit. How will you get your message out and convince people that there’s no hidden agenda?

Well, as I mention above, we’ve been heavily involved in outreach efforts for some time. But, there’s a lot to do. This is really our biggest challenge, as we’re trying to raise funding to complete development and testing of the VUHID Web server, develop outreach and education programs, and build momentum with HIEs and EMPI vendors. Right now, it’s missionary work, with a little funding for technical work, getting the company set up and bare necessities (thanks again, Judy, for the grant from Epic).

As to hidden agendas, no one has ever come away from a discussion with Barry on this topic with any such suspicions. His dedication and our business model leave little room for doubt that we sincerely believe that this is the right thing to do and a necessary part of the infrastructure of a reformed US healthcare system.

Now that you’re out on your own as a consultant, what are the most interesting trends you’re seeing?

I’m seeing renewed interest in revenue cycle … or maybe that trend just comes back around every 10 years or so. But if you look at the age of the applications that are running the business side of most healthcare organizations, and the kludge of interfaces and bolt-ons that have been added over the years to keep them going … well, I’ve always thought there’s opportunity in this area. The current economic environment might just be the incentive for these organizations to finally take the risk on newer technology.

Also, I’m one of those people who believe that RHIOs or HIEs — whatever the acronym evolves to — are quietly taking hold, will persist and expand … with or without government mandate or funding. Maybe more successfully without government intervention! So, I believe systems integrators with infrastructure, tools, and the ability to “herd the cats” are companies to watch.

And relative to government, I do believe they’re here to stay when it comes to HIT. Many of the people I’ve talked to in Washington and here in Arizona who make or influence policy really do understand the benefits and challenges. The work of ONC has been important and hopefully will be continued under the new administration.

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From GatorFan: "Re: Philips. Rumor has it that Philips is undergoing a significant restructuring that could result in a layoff of 5,000 people. The announcement will supposedly be made early next week." Apparent confirmation is here — the Plain Dealer says 5% of the healthcare headcount will be cut loose.

From Carlotta Ailes: "Re: retail clinics. RediClinic opens that largest retail clinic in the nation with Memorial Hermann. The clinics are using athenahealth’s EMR/PM system." Link. It’s in a Houston H-E-B grocery store, 926 square feet with three exam rooms and a blood draw room.

From Bill the Cat: "Re: OSF. Our company was told by the higher-ups at OSF that they were moving to Epic about four months ago. Plans are in place and it should be done in 2-3 years (migration is never easy)." And from Techsan: "Re: OSF. They are already live on Epic’s Ambulatory EMR and Scheduling, but they are now also replacing existing ‘core’ systems (i.e., remaining rev cycle and inpatient EMR) with Epic."

From NotADupe: "Re: Clara Barton. Sounds like you were duped by a marketing plant. I was at AMIA and I didn’t see Allscripts/Misys there." Could be, but it’s hard to tell. The comment (barely) passed the sniff test, I admit, but it was just believable enough that I ran it. Companies try planting PR sometimes, but I don’t run it if I’m suspicious (a consulting company that I should name tried it today, posing as a customer innocently inquiring about a competitor’s acquisition). A few companies have also stiffed me on their HIStalk sponsorship in one way or another (want me to name them?) and they won’t be getting mentioned here, either, at least not in a positive way.

From Nasty Parts: "Re: Sage Healthcare. Rumor is that [name omitted]‘s days are numbered. Top consultants are looking at internal processes, comp plans, etc. All of Andy Corbin’s former hires are slowly being excised from the company. Everyone is happy." I didn’t feel right mentioning the name, but if it happens, I’ll give you credit for predicting it.

From Pro from Dover: "Re: layoffs. A week ago, McKesson began laying off salespeople, approximately 20% of ‘new’ salesforce. Also, Misys/Allscripts sales layoffs are beginning this week." It would be more newsworthy if a company wasn’t laying off, especially in sales, where "layoffs" is often a nice synonym for "parting ways with under-performers who aren’t making their numbers." It’s always been a cold business, but likely to be colder still for at least a short while. No one in sales would be surprised by that revelation. On the other hand, stocking up on cheaper noobs is hardly a recipe for success, so companies will have to balance expense vs. potential long-term benefit. 

From Chuck Lumley: "Re: Sensitron. Rajiv Jularia, CEO of Sensitron, died last month rather suddenly. The company and product status are unclear. While they struggled, they had an early stage, device-agnostic, Bluetooth-enabled vital sign data capture system."     

Listening: The Who, Live at the Isle of Wight Festival 1970. Video here. Keith Moon was the most exuberant and charismatic drummer in modern history, arguably the lead instrument instead of Townshend’s guitar, especially amazing since Moon was probably stoned out of his mind most of the time (a video from another concert shows him extracted unconscious from the drum kit by roadies and hauled offstage, with an audience volunteer chosen to finish up the set in his place). He died in 1978 at 32; bassist John Entwistle died in 2002. Daltrey is now 64, Townshend is 63. Also: The Dilettantes, 60s-sounding psych-pop.

Streamline Health isn’t so good at keeping secrets (or maybe they’re crafty about technically honoring a hospital’s wish not to be named, but identifying them nonetheless). This press release (warning: PDF) coyly refers to a "leading New York City-based medical institution" without naming it. Check out the link address, though. Super sleuth Inga noticed that. I told her this week that she’s like a terrier when she latches onto a rumor, instilling 60 Minutes-type fear in PR and executive offices as she starts bugging everyone she can find to tell her the truth. Readers benefit from that, of course.

Sentry Data Systems of Deerfield Beach, FL has shown its support for HIStalk by becoming a Platinum Sponsor, for which I am most grateful. If you’re in hospital IT, your pharmacy contact will be interested in Sentry because they offer Sentinel RCM (supply chain compliance, GPO, and 340b tracking), Datanex (secure technology backbone with APIs), and Sentrex (pharmacy claims, including 340b replenishment). Just announced: the HealthBIT business intelligence platform for hospitals, which constructs a queryable data set from clinical and administrative data sources and provides tools for reviewing clinical protocols, identifying patient safety concerns with pharmacy procurement, cost analysis, and a notification engine. Thanks to Sentry Data Systems for supporting HIStalk and its readers.

Nortel dumps ballast overboard (employees and executives) trying to stay afloat after a $3.4 billion quarterly loss. It appears to not be working as the stock sheds another 28% Friday to end up at $0.56 per share, dropping its market cap to just $278 million. 

Think your company is the only one struggling a little and laying off staff? Not so. I hear a lot of insider stuff and the headlines you see only begin to tell the story. Hospitals are getting stung hard by investment losses and lack of capital funds, so IT will take hits in many of them. I think that’s why companies are acquiring consulting firms — business should be good as hospitals try to implement and improve systems already on the books and new hires will be hard to get approved. Consulting firms are good at making a sound business case to strapped hospital CFOs (much better than the average IT department, unfortunately) so I think you’ll see more CIO replacements, more outsourcing, and more contract implementations tied to specific patient care and financial results. None of that’s bad unless you’re on the wrong end of it.

And speaking of providers, here’s a question for hospital CIOs, CTOs, and other IT management. Let’s say an average 400-bed hospital is cutting back on some big-ticket IT projects, leaving the IT department looking for high impact, short-term projects to knock out during the slack time. Let’s say the limits are $25,000 not counting internal labor, it can’t require capital funds, and it has to deliver high visibility/high ROI with immediate operational impact. What projects have you done that you would recommend?

Max Baucus (D-MT), chairman of the Senate finance committee, releases his Call to Action paper (warning: PDF) on health reform. From his remarks: "Let me be clear about one thing: There’s no way to really solve America’s economic troubles without fixing the health care system.If you fix Wall Street, you fix the housing crisis, you change taxes, you fix everything else, and you don’t fix health care, then government spending will keep going up. Health care costs suck up more than 16 percent of our economy, and they’re growing. Deficitswill continue to rise. And America will just have more economic troubles down the road."

Fundraising ends for Project Valour-IT on Thanksgiving, so click the graphic to your right to help provide assistive technology laptops to severely wounded soldiers. $37,000 has been donated so far and our Navy team is in the lead (although all money goes to all service branches – having teams is just a way to keep score). The project has no money for laptops at the moment and is hoping for $250,000 in donations to buy a bunch of laptops at around $700 each (DoD was so impressed with Valour-IT that they buy the Dragon NaturallySpeaking). Any amount is appreciated.

John at Chilmark Research likes the idea that big players are studying PHRs, but is skeptical about CITL’s optimistic, vendor-sponsored report. "For the cost/benefit analysis, CITL proposed a scenario of 80% user adoption within 10 years that will generate $19B in annual savings. 80% adoption? $19B is savings? What are they smoking over there?"

Odd: a Seattle dentist and oral surgeon (but also an MD) is sued for messing up a 15-year-old girl’s non-cosmetic breast reduction surgery. He’s been sued for malpractice at least 10 times, has paid out over $1 million in claims, and was mildly reprimanded (fined $4,000) for being implicated in the death of a liposuction patient, for whom CPR was initiated six minutes after the patient stopped breathing.

An industry rag wrote this, a reader reports, although it was fixed in the online version by the time I went for a screen shot: "In addition, Epic won the first certification for an enterprise EHR that provides comprehensive ambulatory, inpatient and emergency department EHRs that are inoperable."

Emageon’s acquirer HSS announces Q3 numbers: revenue up 106%, EPS -$0.42 vs. -$0.40. They’re good at hiding the loss, not mentioning it until the eleventh paragraph after leading off with a revenue headline and jamming in all the good-sounding numbers first. Readers with a short attention span might be impressed by their quarterly results.

Citrix will release its XenDesktop and XenApp software available for the iPhone in a few months, allowing all Windows applications to be virtualized and then run over an iPhone virtual desktop. That’s already available for Windows Mobile and Symbian devices, but the iPhone version will allow using the cool gesture stuff. I imagine this will be hot, although I don’t know how much work you could do on that little screen that doesn’t have a real keyboard.

An SVP of drugmaker Gilead Sciences advises Microsoft on healthcare IT: "If Microsoft really wants to own the world, create a standardized electronic medical records system and give it away for free the first five years. Then start charging." I bet he’s not nearly as keen on the idea of doing the same in his own industry, i.e. making generic Tamiflu and Flolan at a cheaper price instead of charging to much to treat diseases like HIV for a $2 billion annual profit. He’s got a point about standardizing by offering a free product that sets the standard by its own ubiquity, but then again, even a free EMR isn’t much of a deal for doctors unless it saves them time.

A British surgeon is suspended for downloading NHS medical information about his secretary, her family, and her boyfriend after becoming infatuated with her. He claims his current wife was a bad choice and he hoped to do better by turning the secretary’s information over to a private detective to check her out before he made his move. The secretary found out when the surgeon’s wife accused her of having an affair with her husband, after which the secretary then snooped around on his work computer and found her own medical records, the surgeon’s list of tactics on how he planned to win her over, and an impressively massive porn stash.

Cleveland Clinic doctors pick the Top 10 procedures and products that will influence medicine in the next year. On the list: NHIN (#10), which the good doctors must not know much about if they’re thinking it will have an effect in the next 13 months.

South Korea and its hospitals want a piece of the medical tourism action, trolling for budget-conscious Americans as well as rich Arabs who can’t get a US visa because of terrorism-induced red tape. One hospital is building a hotel, a concert hall, and an art museum to complement its 18-hole golf course. Immigration rules were changed to allow patients and families to stay up to four years without a visa. "For Hassan and Fatima Abdulla, the trip has been one seamless surgery/tourism package. When they arrived in Seoul in October, a car from Wooridul and an English-speaking nurse were waiting for them at the airport. Abdulla found his wife’s hospital room – furnished with a television, broadband Internet access, private bathroom, sofas and an extra bed – so comfortable that he decided to stay with her rather than go to a hotel." Reminds me of the old days of pre-outsourced, small-town hospital cafeterias, where local cooks made food that was good enough that townspeople would actually drop by for lunch. Now it’s just surly Aramark contractors heating up Sysco TV dinner quality fare, not much different than feeding prisoners.

University of Iowa Hospitals fires one employee and suspends seven more for snooping in electronic patient records.

Vendor Deals and Announcements

• Mac enthusiasts have a new kiosk option with the release of MacPractice Kiosk Interface with signature pad.
• Wandering WiFi is now providing wireless service at six Ardent Health Services hospitals in Oklahoma and New Mexico for patient and visitor Internet access.
• Perot Systems acquires Tullurian, a managed services hosting provider serving 13,000 physicians and 565 practices. Perot, by the way, has launched healthcare service operations in China. David Miller will serve as managing director for the region’s consulting and clinical transformation services.
• Lake Charles Memorial Hospital (LA) announces the start of a $6 million, three-year process of migrating to McKesson’s Paragon and Practice Partner digital health record solutions.
• Beaver Dam Community Hospital (WI) selects McKesson’s Paragon HIS and document management solution.
• Clarian Health (IN) activates a MobileAccess Universal Wireless network across three hospitals, covering more than 4 million square feet.
• HIE SharedHealth is using Orion Health’s Concerto Portal Solution to enable an EHR solution and provide access to its Clinical Xchange platform.
• Ochsner Health Systems (LA) is installing InterSystems Progeny Anatomic Pathology information system.
• Spectrum Health (MI) selects InterSystems Ensemble software for integration initiatives across the entire enterprise.
• Passport Health Communications and SelfPay Company announce a strategic partnership to provide electronic charity care assessments.
• Charlotte, NC-based Patient Care Technology Systems is more than doubling its office space to support its growing employee base.
• DocuSys names David Young, MD medical director for its Presurgical Care Management solution. Young founded Prompte, a company acquired by DocuSys earlier this year. He is also medical director of presurgical testing at Advocate Lutheran General Hospital (IL) and a faculty member at UCSD.
• The 45-radiologist practice Radiology Associates (AR) will utilize AMICAS Web-based PACS, AMICAS Reach, and AMICAS Teleradiology solutions.
• Former Misys Transaction Services and IBAX exec Denis Connaghan is named president and CEO of etrials Worldwide, a provider of adaptive eClinical software and services.
• Clinical Solutions will integrate HLI’s Language Engine clinical decision technology into its IntefleCS Telephone Triage and IntefleCS Face to Face applications.

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