From Dr. Yes: “Re: athenahealth. Because of the big deal Athena did today, Jonathan Bush was just on CNBC. He was almost as funny as he was at your HIMSS party. The guy is truly charismatic. I’ll bet the stock goes wild.” The company bagged a big win today, signing University Hospitals of Cleveland (450 doctors) for revenue cycle services. The stock was actually down around 1% today even with the early morning announcement, but the market was down overall.

From Clarence Trauma: “Re: Orlando Health’s Web site. Are women are not adults, or possibly in this politically correct world, are men are no longer referred to as such, but rather addressed merely as Adults? Or, based on the cozy couple next to the Adults button, maybe they’re tapping into the XXX market.” I’m not a fan of the pinkish-red design, I’ll say that. The marketers have been allowed to run amok, obviously, given the biggest headline on the page: Learn About Our New Brand. Your Brand is like your high IQ or dynamite sexual prowess — don’t yap about it constantly; let the few people who care arrive at that conclusion themselves.

From Shawn Spencer: “Re: Tom Skelton. Going to work at MED3OOO, supposedly, maybe to run sales and work up from there. There’s a Pittsburgh connection and some former Misys people at MED3OOO.”

From Songbird: “Re: Hayes Management Consulting. They reportedly laid off consulting staff this week.” We have a contact there since they’re a sponsor (Pete Butler, president), so Inga asked him. “It is always interesting to see how rumors can get blown out of proportion. On January 13th Hayes did make a 7% reduction in force. Some segments of our business are exhibiting significant growth while other segments have slowed due to vendor slowdowns and market conditions. We continue, however, to hire selectively in areas that we have identified as growth areas for Hayes. As the unprecedented economic uncertainty continues to challenge the healthcare industry everyone is being compelled to make adjustments. We consider ourselves fortunate that our adjustments are small relative to those of the industry. We credit this to Hayes’ history of being a well run company that has grown prudently over the years. In 2008 we experienced 15% revenue growth over 2007. We expect our revenues to continue to grow in 2009 including in areas of federal initiatives in Health IT. We remain committed to building long term trusted relationships and we look forward to continuing to serve our clients for many years to come. Honestly Inga, this was a difficult action for us to take and one Hayes has never taken before. We consider all of our employees close members of the Hayes family yet we need to remain good stewards of this company in these challenging economic times. We have a confident outlook for 2009 and continue to experience growth as we kick off this New Year.” Hayes runs a good shop and is #1 in KLAS in overall services, so you can bet it’s not just them. And if you know which areas they pruned back, you’d also know which systems vendors are struggling since it’s a direct relationship.

From Mr. G: “Re: Eclipsys. According to MorningStar analysts, 40% of Eclipsys’ revenues are attributable to the 20 largest clients. One client represents 10% of revenue. Does anyone know who this client is?”  

From Carol Dedmon: “Re: Jeff’s comment. Jeff is a sourpuss – the whole freaking world is celebrating a new beginning and our industry is hopeful of renewed energy and investment. He slaps you down with a ‘mind your knitting’ remark. Jeff left a curt comment on Tuesday’s post saying he was tired of the Obamafest (his word) and that only political pundits should discuss such sensitive topics like the inauguration. I compared Obama’s speech to Jimmy Carter’s, so I figure Jeff was sniping at a brief Inga mention since she’s gushier than me. Well, no hard feelings. At least I found someone even more cynical than me.

From ORISpilot: “Re: Alert. The president of Alert Life Sciences publicly berates the executive sales team from North America for low Q4 sales in front of a large crowd at its annual retreat in Portugal. Staff are being let go.” Unverified. They made a big splash at HIMSS in 2007, but I haven’t heard a word since and had completely forgotten about them. I don’t see anything about US customers on their site, which claims $34 million in 2007 sales but no 2008 number yet. I remember it as being exceedingly cool, but the US is a tough market to crack from Portugal. Or here.

From Spencer Haywood: “Re: HealthVault. I signed up for Microsoft’s HealthVault and starting playing with it. You can enter e-mail addresses to give others access to your records. You can choose spouse, domestic partner, … and pet. Good thing my cat signed up for Gmail last week. Not on the list: provider or physician. Guess my cat needs access to my record more than my doctor.”  

Listening: Fiction Family, brand new duo pop, not my usual cup of tea, but some nice hooks. One guy’s from Switchfoot, the other from Nickel Creek (for bluegrass fans like me). 

Not available in Hallmark stores: e-cards that allow people to anonymously notify sex partners that the sender has a sexually transmitted disease. Noting that gay men often exchange bodily fluids but not e-mail addresses, health departments are also setting up profiles on gay Web sites as an outreach. I don’t know how well it works, but it’s certainly worth trying.

HISsies voting. Be there. Thanks.

You may have noticed that industry news is picking up quite a bit, as is HIStalk readership (keeping me extremely busy). If you don’t get the e-mail updates, you might want to sign up over there to your right. That list is up to over 3,500 confirmed, active subscribers, so everybody will be walking around knowing stuff you don’t if you don’t sign up. It would be cool if we hit the 2 millionth visit by HIMSS, but I’ve counted on my fingers and I don’t think it will quite make it. Still, I’m staggered to have that many folks reading, so thanks much for that. I’m really honored by the number of people who e-mail nice comments and tell me how important HIStalk is to them (Mrs. HIStalk isn’t one of them since she feels she’s been denied my consort, but I’ve tried to explain the whole HIT thing and she just glazes over).

Eclipsys shares hit a five-year low after the company announced low Q4 preliminary earnings yesterday. Shares closed at $8.01, down over 29%, giving ECLP a market cap of just $438 million. I don’t get the primary excuse, that customers planning to go with a traditional license purchase decided to take a subscription license instead and therefore delayed revenue. First, ECLP must be offering bad subscription terms if customers were even considering buying a license instead of stretching out the payments by subscription. Second, the company has always said that the subscription model would provide a nice recurring income stream, which still isn’t clear after all these years. The good news for them is that Cerner doesn’t seem to be making any new sales, but the bad news is … well, Epic’s everywhere you turn, especially when your product line is limited. ECLP has made some nice acquisitions in MediNotes and EPSi, current management is better than the old regime, and the yearly numbers still look good, so here’s my impression: the company needs to fix some problems, but this may just be the first wave of bad news when it comes to the big iron boys whose only customers are cash-strapped hospitals.

Maybe J&J will  buy them. Drug maker Johnson & Johnson is not expecting a great 2009, but is still looking to pick up some acquisitions that have had the wind knocked out of their sales (pun intended) by the recession. The CEO says he’s especially interested in healthcare information technology and wellness and disease companies.

More layoffs at GE’s Burlington office. Songbird had tipped me off that it would happen yesterday and he or she was right.

I heard (indirectly) from a consultant who just lost his ambulatory EHR consulting job after the main vendor his company supports (I won’t name them, but they’re big) had major product issues, causing users to put upgrades on hold, which dropped the demand for consultants. His employer was small, so they didn’t have the resources to cross-train people on products with a higher consultant demand. The person who passed his message along is considering dropping that same vendor’s product and moving to another vendor, possibly eClinicalWorks.

Some Houston fans of open source software in healthcare are holding a July 31 weekend conference, promising good speakers and some cutting edge companies. Only $60 if you sign up stat.

Microsoft was to have laid off 1,400 people Thursday, the first wave of an eventual 5,000 jobs cut in the company’s first-ever layoff. Q2 profits were down by 11% and the company declined to forecast earnings for the rest of 2009. Also announced: travel budgets have been cut, salaries are frozen, and physical expansion of the Redmond campus has been scaled back. Shares were down almost 12% today, dragging the entire market down with them.

Microsoft’s arch-competitor Google did a little better, maybe. The company just announced Q4 numbers: revenue up 18%, but earnings were down 68%, the first time in the company’s history that earnings dropped. It, too, laid off employees, but just 100, and also wrote down most of its $1.5 billion investment in AOL and Clearwire. Cost control was obviously excellent. Shares are up.

A fire broke out at Mount Sinai Medical Center (NY) Thursday, forcing the horizontal evacuation (my HEICS training shines) of 600 patients. Flames were visible from Madison Avenue, but the fire was contained to a mechanical room and was put out with no injuries reported.

Internet inauguration watchers overloaded the network pipes at University of Kansas Hospital (KS), causing patient records to be unavailable for around 30 minutes. An e-mail was sent telling employees to get off, which apparently worked.

TriZetto’s CEO says that government and payers are going down the wrong road with EHRs. “For example, the new Obama administration is promising to spend a good portion of a $50 billion investment with physicians to adopt EHRs and the infrastructure to share them. But, those plans indicate that many in Washington are overlooking a faster, far less costly path to ubiquitous PHRs. Health plan information systems are the single richest repository of comprehensive diagnostic and treatment data and benefits information in the entire U.S. healthcare system. Both government and payers are missing a key opportunity.”

St. Clare’s Health Services (NJ) fires five VPs so the CEO, who’s been there since last May, can bring in his own people. He told employees that operational changes are being considered, but a source tells me that hundreds of employees will be laid off in the next few weeks.

Thanks to Barbara Benson, a reporter for Crain’s Health Pulse and Crain’s New York Business, who e-mailed me to let me know that she had written about NYU’s $186.4 million Epic project. Having run across it while researching the state’s certificate of need records, she checked HIStalk to get some background (it was reported here back in July by Motown HITman and Mad Man). They told her that Eclipsys Sunrise won’t go away, which seems highly unlikely. Here’s what Mad Man said then: “I have heard, from multiple sources, that NYU is moving off of Eclipsys to Epic because Epic provides a comprehensive (i.e., inpatient, ambulatory, physician EMR) solution where Eclipsys XA does not. I find this very interesting since NYU just went live with XA to much hoopla in the trade papers. The system move has caused a lot of chaos in the NYC Eclipsys office.”

John Glaser gets a Wall Street Journal mention in a political story about the economic stimulus. He warns that trying to spend a bunch of federal healthcare IT money too fast may be wasteful and counterproductive, especially if systems are slammed in without regard to the needs and work flow of users. I agree, but Uncle is looking for some fast spending, so here’s a question: if you were doing the disbursing, which projects would you choose that would require hiring lots of people, have good oversight already in place, and are ready to provide near-immediate return on investment?

I think Marshfield Clinic CIO Bob Carlson agrees. In Part II of an excellent interview, he says, “Implementing an EMR can be a very dangerous thing. There are studies that show that given the complexity of healthcare, it’s easy to miss steps in processes and delay important information; in essence, instead of a positive impact on healthcare, if done wrong it may actually be a step backward. That being said, EMR is the first step toward moving healthcare where it needs to go. Once you’re in the electronic format, now you have the ability to take all the tools, the technology, the intelligent assistants, the data mining and trend analysis, and the outcomes and start bringing them to bear where the rubber meet the road – at the point healthcare is being delivered.”

An audit of California’s prison medical system finds that $27 million in technology contracts were issued without legally required competitive bidding. One IT manager was fired in June for being involved, although there was no evidence that the prices were out of line or that employees benefited.

RSNA 2008 did OK considering the economy, with attendance, exhibitors, and exhibit square footage down only in the single digits. Will HIMSS be so lucky, especially since they’re in Chicago for the first time, in April instead of February, and starting on Saturday?

Hospital layoffs: King’s Daughters Medical Center (MS), 21; Memorial Medical Center (PA), 47; Providence Saint Joseph Medical Center (CA), 94; Blue Hill Memorial Hospital (ME), 15; Excela Health (PA), 70; Butler Hospital (PA), 18; Southcoast Hospitals (MA), 12; Grenada Lake Medical Center (MS), 14.

Saint Luke’s Health System (MO) adds ePharmacy to its eICU center, scanning physician paper orders to a remote pharmacist for computer entry, which releases the correct meds from the dispensing cabinets for nurse administration.

Duke University School of Medicine gets a $1.25 million federal grant to develop an infectious diseases ontology for Staph aureus.

Cardinal Health fires an employee for refusing to work Sundays, saying they told him he could take off, but only if he arranged his own coverage. The employee, a minister, is appealing to a higher power – Charlottesville Federal Court, where he’s suing Cardinal for religious discrimination.

E-mail me.

HERtalk by Inga

From Mikey Likes It: “Re: LinkedIn photo. Nice shoes.” So far I have made it a week with my contraband LinkedIn photo. I have the same kind of feeling I did when a bouncer would let me into a bar, even though I was underage. (Geez, I hope my mother isn’t reading this.) I see the HIStalk Fan Club has swelled to 511 members, so we’ve all got to get together sometime.

In case you missed Mr. H’s recent commentary for Inside Healthcare Computing (The Obama-HIStalk Digital Stimulus Grants: Why Letting Me Hand Out the Freshly Printed HIT Cash Makes Sense), he is angling for the chance to hand out $20 billion of economic stimulus money at HIMSS. Personally I think his approach makes as much sense as anything else we have seen recommended so far. Plus it might help boost conference attendance (and thus stimulate the Chicago economy, no doubt), I’m thinking if he gets that gig, I will follow behind him and film the whole thing to post on YouTube.

Just in time to train people to on ways to spend all that economic stimulus money, American Sentinel University (CO) adds a Bachelor of Science degree program in Health Systems Management.

AHRQ releases a series of new reports highlighting the lessons and best practices from the recipients of AHRQ grants. The reports focus on the implementation and use of such technologies as CPOE, EHR, and BCMA.

Minnesota’s attorney general sues Allina Health System for charging illegally high interest rates. The lawsuit contends that Allina charged as much as 18% on unpaid medical bills, which is substantially higher that the 8% cap allowed under the state’s usury laws.

The recession and rising unemployment rates creates unprecedented increases in Medicaid rolls. Many states are seeing 5-10% more Medicaid recipients than a year ago. Growth rates have at least doubled from the previous 12 months.

Earlier this week Mr. H mentioned that Haywood Regional Medical Center (NC) named former EDI and McKesson leader Sheldon Tyndall as interim director of IT. Haywood is bringing on a new CFO, Gene Winters, who has served as CFO HCA, Acadia Healthcare, and Transitional Hospital Corp. Haywood made headlines last year following a temporary loss of Medicare and state certification after inspectors found potentially dangerous problems with medication administration. The story included whistleblowers, lawsuits, and a replaced CEO. Tyndall’s most pressing challenge is to complete the hospital’s EMR implementation.

I must confess that when I heard the names of this new Web site, I immediately envisioned some sort of virtual haircut, or at least someone like Vidal Sassoon administering the latest hairstyling advice. Elsevier announces eClips Consult to help physicians identify and assimilate information from professional medical journals.

Highmark Inc. and Independence Blue Cross announce they are withdrawing their merger applications with the Pennsylvania state insurance department. The companies believed the transaction would not be approved because the state insurance department believed it would adversely impact competition.

Precyse Solutions and Ingalls Memorial Hospital (IL) sign a five-year outsourcing agreement. The $4 million deal includes technologies and services to support Ingalls’ medical transcription functions.

Yalobusha General Hospital (MS) chooses a financial system from Healthcare Management Systems for its 26-bed hospital and two rural health clinics.

Partners HealthCare (MA) selects MDsoft’s MetaVision for acute care and preoperative technology. The system will be used at both Mass General and Brigham and Women’s Hospital.

Oasis Medical Solutions, a UK HIT provider, appoints Chris Spence, formerly with GE Healthcare IDX, as CEO.

Anne Arundel Medical Center (MD) implements VISion: Asset Management by Versus Technology, an RTLS solution the hospital is using for asset tracking.

Edward Hospital (IL) successfully deploys InfoLogix for wireless asset tracking.

Clara Maass Medical Center (NJ) selects Axolotl to support its HIE initiative.

Baptist Healthcare System (KY) signs with McKesson to manage the revenue cycles of its affiliated physicians. The deal includes McKesson’s Revenue Management Solutions group overseeing all facets of the physician billing and collection process. McKesson, by the way, was just named the #1 place to work for Six Sigma professionals.

Nuance Communications appoints a new head of marketing for its India operations.

MEDSEEK announces a new Webinar entitled Hope is Not a Strategy: Neither is Web 2.0 for a Hospital.

E-mail Inga.

Are Portals Becoming Obsolete?
By Robert Connely, Medicity

I wanted to add a comment to the question you raised – are portals becoming obsolete? 

From my perspective, it’s a bit like asking the question “Have mainframe computers become obsolete?” The answer is, of course, that they have not. They have gotten smaller and faster, but they’re still in place, doing their work day-in and day-out. By the same token, portals are not obsolete, they’re just not sufficient by themselves to address all of the information needs of an organization like a hospital in today’s world.

I believe that hospitals need to think more broadly in terms of what I refer to as an “information outreach” strategy. Let me explain.

Today’s CIO is faced with a plethora of requirements that they’re charged with addressing, including:

• Providing remote access to physicians that need data that’s often found in multiple systems
• Exchanging information with an affiliate physician’s EMR
• Participating in the sharing of information in initiatives like HIEs or RHIOs

In these three common examples, there is often a desire to use a single technology to address all of them. This is, of course, nothing new. 

When portals emerged in the late 90s, CIOs would say, “I already have a remote access solution – why use a portal”? The answer was that portals made it simpler for physicians to access a broad range of data from a single, personalized view. As advanced features like electronic signature emerged and physicians could perform useful work remotely, the use of portals expanded.

When new technologies like agent grids evolved to push data to EMRs in the early 00s, CIO’s would say, “I already have a portal – why do I need an exchange solution”? The reality is that if you have an EMR, accessing data from the portal is no longer acceptable. Instead, you want the data pushed to the EMR, where it can be viewed alongside other data on the patient collected by the physician.

In the mid 00s when RHIOs and HIEs emerged, CIOs would either say, “I have an exchange solution, so I don’t need the HIE”, or, “I’m planning to join the HIE, so I don’t need an exchange solution.” As we learn more and more about this emerging world, it is clear that the needs of sharing information in an HIE is quite different that those required to exchange data with an EMR. Considerations like identifier reconciliation, local queuing of information if participating in a federated HIE, and others must be addressed by the chosen technology.

Now add the fact that hospitals serve a large number of physicians who are themselves at various levels of technology use and it becomes clear that there will always be physicians who need to interact with the organization in a variety of ways.

Thinking in terms of an information outreach strategy accepts this condition as a fact that must be dealt with to enable the organization to conduct business. It will likely require an array of technologies to address these varied needs. Because, just as you would never play a round of golf with just a putter, why try to use a single technology to address a wide range of information needs that are substantially different? It will only do one thing well, and everything else poorly. I suggest that instead, we think more like a golfer and have at our disposal a broad array of technology “clubs” to ensure that we have the right one for the shot we need to make.

Using this logic suggests that:

• Portals will continue to be useful in addressing the needs of physicians who either don’t have an EMR or want to access inpatient data that they don’t want in the EMR (physicians often elect to not receive inpatient lab tests in their EMR), or to perform workflow functions like signing off reports that are generated within the hospital.
• EMR exchange solutions must be put in place or risk losing business to another hospital or lab that accepts orders and delivers results electronically to and from the EMR. While it’s true that only 17% or so of physicians use an EMR, these tend to be larger, high revenue-generating practices that few hospitals can afford to lose to the competition.
• As HIEs evolve, the CIO may one day be told that the organization must participate in the initiative, which requires new consideration to what it means to “publish” information to the entity or entities (multi-system organizations often are required to participate with many local HIEs). In this case, portals or EMR exchange strategies are by themselves insufficient, and newer technologies that cache data outside of the internal systems must be put in place, with mechanisms to interact with the HIE core that may or may not include Record Locator Services, Master Patient Indices, and the like.

There may come a time when portals finally do become obsolete (for example, I don’t imagine many hospitals still using analog dial modem banks for remote access), but I can clearly see them continue to play a significant, albeit not an exclusive role, in the hospital’s “bag” for many years to come.

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Eclipsys shares are down over 17% in after-hours trading following a disappointing Q4 preliminary earnings report. For the quarter ending December 31, 2008, the company expects flat revenue and GAAP EPS of $0.07 to $0.11 compared to $0.45 a year ago. Revenue for the full year is expected to be up around 8%, with full-year GAAP earnings of $1.82 to $1.86 compared to $0.76 for FY07.

President and CEO R. Andrew Eckert called the quarterly results "disappointing," blaming delayed customer closes, a shift to back-loaded subscription deals, reduced customer utilization of professional services, an increased allowance for doubtful accounts for specific customers, and lower margins on third-party software due to market pricing pressures. "Economic factors are affecting our business, and the business of our clients," said Eckert. "In response to this uncertain environment, we are taking actions to adjust our cost structure and business practices." 

Eckert announced that Robert Colletti, senior vice president, CFO, and treasurer, resigned his position on January 14. David Morgan, VP of finance and assistant treasurer who joined the company in August 2008, will assume those roles in an interim capacity.

Meanwhile, an article published Wednesday reports that NYU Langone Medical Center will purchase a fully integrated clinical and patient financial system from Epic Systems Corp. with a total project cost of $186.4 million. The hospital installed an inpatient system from Eclipsys in 2007, but says it will be enhanced rather than replaced.

Unverified rumors reported to HIStalk today suggest that Eclipsys may reduce professional services headcount and announce the discontinuation of bonuses and merit increases for employees later this week. 

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An HIT Moment with ... is a quick interview with someone we find interesting. Michael Christopher is CTO and senior development analyst with Healthcare IT Transition Group.

Healthcare Transition Group has an interesting mix of reference, educational, and consulting products. Give me a short summary of your offerings.

When we put together this new version of our company three and a half years ago (we had been set up as a straight consulting operation for about ten years before that), we had all this on-the-ground expertise in healthcare IT, software development, and capital development, but we wanted to start creating scalable products. Billable hours are about the least scalable business model on the planet, next to maybe cattle ranching.

The kinds of research and analysis we had been doing for clients seemed to fit nicely into packaged business intelligence products, comprised of documents, tools, and video of us splainin’. Consulting had always been mostly about learning and teaching, and now the videos teach what we’ve learned from all those gigs. And instead of paying us $20k over several months, our customers can order a package for a few hundred bucks and have it now. It’s way more scalable and frees us to go out and find fresh heroics to get up to. So far we’ve done "BI Packs" on real-time adjudication, getting ROI from HIT, funding, and various topics related to maximizing reimbursement, including one on the new Denial Engines.

To support that, we began to grow a media side. We had been doing the HIPAA Transition Blog since the birth of the HIPAA era, so we renamed it HIT Transition Weblog and developed some related channels. We started doing lots of Webinars and developed a complete media studio.

Then it was time to leverage our NPI and NPPES (National Plan and Provider Enumeration System) chops and all that new computing power to expand into data products. We had done NPI remediations, working with the official enumerator Fox Systems and others, so we knew some ropes that maybe hadn’t dawned on everybody yet. Like greasing your 837s to glide through adjudication and maximize reimbursements by updating your NPPES record with every legacy identifier you’ve ever used (taxonomy codes, UPINs, Medicare PINs, OSCARs, license numbers …) 

You’ve written extensively on funding for RHIOs and other IT projects. What are some creative ideas that most people haven’t figured out?

Taken together, our backgrounds are split between in-the-trenches HIT implementation, software development, and capital development. I owned a software company in the early ‘Naughties that built finance and constituent management applications for the human services sector, so then I got to do it all at once, develop the software, implement it, and the raise the money for the company (and for our customers, too). A large part of my finance side has been with nonprofit organizations, as executive director, director of development, or marketing VP, and as a consultant in fundraising. So RHIO made immediate sense to me and I started following it very early on. Marty Jensen, our COO, suggested the initial study. We did the first deep analysis on RHIO business models and funding sources based on the RHIOs’ own data, and updated it a little over a year later. We’re considering whether and when to revisit that research in light of changes in mission at the federal level.

What we found and reported was actually shocking. Nearly all RHIOs are constituted as nonprofit organizations under the IRS "charitable" rubric. Logical, since they are in the business of doing public good. But only two of the fifty RHIOs we studied had developed private foundation grants. All but one in our sample said they plan to be self-sustaining through earned revenues, but more than 80% said they expected to rely on grants into the foreseeable future.

Doh! Where do they expect the money to come from? One word: Government. No, three more words: And Big Hospitals. Private philanthropy is responsible for the vast majority of the money for public projects in this county, a 180 flip from Europe and elsewhere, where government has that task. So it made no sense to us: here was this nascent public good looking only to government and its members for its survival while leaving vast quantities of philanthropy untapped. RHIO leadership still seems frightened of the word "fundraising." That’s what drove us to create the Health IT Grant Resource Directory. As far as we know, it’s the one resource that will take you directly to the prospects for private involvement in health IT funding.

I recently sat on a panel with Jack Anthony of Beacon Partners and Cheryl Austein-Casnoff of HRSA to hopefully give the industry some guidance on health IT funding in light of the new Administration. They asked me to talk about strategies, so I picked two: the "Study/Meet/Case" method of capital development (don’t Google it, I made up the name) and vendor Grant Assistance Programs. The latter is where a vendor develops the fundraising/grant writing resources on behalf of its customers so they can buy their systems.

You are doing some interesting work to make actionable data available to providers for billing and for targeting service opportunities. What products have resulted and what ideas do you have for the future?

Two product lines here: NPIdentify Desktop Provider Directories and CarePrecise Data Services. NPIdentify is available as a free download and it looks like it’s starting to go viral. The idea was to put state-by-state NPPES data in a fast, cool application that would fit on your own computer and that your average non-technical office manager would find user-friendly. But since just anybody can download it, NPIdentify is being used across the industry in practice management, health plans, marketing, and even scientific research. You would not believe the customer list. We figured out that we can sell ads (hint, hint) for mad money.

The newest line, CarePrecise, is just now starting to roll out in tests. It will leverage our provider experience, software and data management, and research assets to offer not only provider data sliced and diced for various systems and applications, but also to pull business intelligence out of it. Let’s say you’re planning a clinic expansion. What specialties will thrive there, and which will shrivel? Where should you site a new group practice based on a given stable of specialties? Or if you want to reach a particular underserved population, we can map where they live. We’ll be rolling these out as standard products over the coming months. One product, CarePrecise Access is already available. It’s the complete, huge NPPES database in a form you can easily manipulate on a laptop in Microsoft Access. Way cool for people who want to develop their own products.

Give me some predictions on the healthcare IT industry for the next 1-3 years.

When the numbers start flooding in on IT-driven patient safety and more effective care that go hand-in-hand with cost reductions and revenue increases, we’ll see a rapid expansion in our industry like little else that’s gone before. I would be the first to agree that there’s plenty of evidence here already, but it has yet to begin steering the provider zeitgeist like it will in a year or two.

We need to make better arguments for health IT. Actually, we need to learn how to argue all over again. Health IT has never enjoyed the same focus as that new MRI, and now that could be changed. Sitting in the hospital basement all morose about how we’re being treated like the light bulbs never got us anywhere. We need to organize, bone up on regional strategic initiatives in healthcare, get to know all the players and make them know us, and hit the ground. I want to see a poster that says "HIT Workers Unite: Take It To The Suites!"

I think if I say the "I Word" one more time, I should have to wash my mouth out with soap. But the babble of interfaces and other short-sighted proprietary interests are still the huge barrier to adoption of HIT. Systems that can talk to one another fluently should be the simple, no-excuses objective. Cooperation, or coopetition, needs to be the deep green valley for all our roadmaps in this space. Everything we build needs to plug into what everybody else is building. Whether you are an open source fiend or not, I think that open sourcery, and especially FOSS, is drawing the maps right now, and you really have to look at them.

The NHIN seems to be stirring awake with the recently announced SSA application. RHIOs won’t look the same in a few years, but there will definitely be a network of essentially egalitarian, provider-agnostic information exchange that starts winning goals (i.e., reducing medical errors, containing costs resulting in expanded access to care, and boosting profits across the board) on a game-changing scale within three years. And there will also be rapid growth in proprietary exchanges — possibly faster than the community-based RHIOs — as we watch the technology fragmentation get sorted out. We might see those perceptions of maturity shift enough within a year to start looking for a few hockey sticks on a two- or three-year horizon. I’d like to promise more, but our most recent RHIO data suggest that the dollar size of the RHIO vendor space is still in pancakes.

What’s it like working for a small, agile company and what do you do for fun?

I never want to work anywhere else! … unless the money’s right. Seriously, at HITTG we can be basically autonomous, sprouting new stuff that we see as a need in the industry whenever we like. And when we get opinionated about something, we can just say it out loud; I don’t need to scream at anybody (although that can be fun!), I just make an animated cartoon when I need to vent about HealthVault and the patient privacy folks. Or I draw a comic. Now that we’re shifting to these really scalable products, I can also see a heavier consulting load, and maybe we, too, like our friends in the financial industry, can become as obscenely wealthy as we were truly meant to be.

Never been to the Googleplex, but we’ve decided that our corporate culture must be a lot like Google’s, only a little bit more compact for now.

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From The PACS Designer: "Re: Microsoft Photosynth. TPD has been experimenting with Microsoft’s Photosynth and its 3D capabilities for photo collections. It appears to be a nice way to enhance the photo experience after using your digital camera. It could enhance your photo skill level and at the same change your perspective on creating better photos. Once you download Photosynth, you’ll have to reboot your system to activate the software and also obtain a Windows LiveID before you accessing the application." Link. It takes a bunch of digital pictures and turns them into something like Google Maps Street View, from what I can tell, allowing you to navigate around by clicking arrows (but obviously without a BIG bunch of pictures, you’re just jumping around jarringly). Maybe the technology could be used to create 3D images from plain old X-rays.

From Dillinger: "Re: medical weblog awards. How could Medgadget not even have HIStalk listed as a nominee in the informatics category?" Beats me, but I’ve long ago figured out that blogs giving other blogs awards is nearly always a ploy to get traffic to their OWN blog, hoping nominees will send their readers there to vote. HIStalk has been around since June 2003 with quite a few readers, so I’ll satisfy myself with that accomplishment more than having some other blog declare me a winner.

From Elsie EHR: "Re: TV knee-slappers about Jonathan Bush being the President’s cousin. According to a Chicago Sun-Times article, he and Barack Obama are 11th cousins." Link. The only good thing is that since their last names aren’t the same, it will sail right over the talking heads. That makes two reasons to be grateful that his first cousin has joined the ranks of the unemployed.

From Webbed_feet: "Re: OHSU. Article on the layoffs and IT restructuring." Link. Oregon Health & Science University will eliminate 60 of 400 IT jobs and reclassify another 80, giving employees the pure joy of interviewing against their peers to see who gets to stay on the payroll. The union representing IT (who knew?) claims the university just wants to change the employees from hourly to salary to avoid paying them overtime and differential.

From Microsoft Guy: "Re: dabbling in healthcare. You were puzzled about the value the Senate and NRC place on Microsoft’s input on healthcare IT when we’re ‘dabblers at best’ but then highlight the work we’re doing at MD Anderson a mere half-page later." I don’t know that selling a hospital copies of Visual Studio and Windows 2000 (!) qualifies the company to pontificate to Congress on lifelong wellness, healthcare reimbursement, and appropriate IT investments. All those millions of physicians, informaticists, nurses, management engineers, and healthcare executives out there go unheard so someone who’s never worked in healthcare can advise Congress on healthcare reform? That’s somewhere between arrogant and preposterous. Dabblers like Oracle and Microsoft pop in every now and then as the healthcare market opportunity looks more or less lucrative (see: Healthcare Transaction Base and Amicore, respectively). The rest of us have been here all along.

Obama mentions healthcare IT in his inaugural speech: "We will restore science to its rightful place, and wield technology’s wonders to raise health care’s quality and lower its cost." He gave a stirring, impressive speech (pretty similar to that of Jimmy Carter, in fact, so caveat emptor). The campaign and the fanboy fawning are over, so now he gets judged on actions just like his predecessors. I’m cautiously optimistic so far.

HISsies voting is now open. Thanks to those who nominated the slate you’ll see (some no doubt motivated by the not-so-subtle urging of their employer). Anyway, use your inaugural enthusiasm to get your participative democracy on. The future of The Pie is in your hands.

Jobs: Senior Application Analyst (Sibley Memorial Hospital), Clinical Pharmacist (MedVentive), Chief Applications Officer (Snelling Executive Search), Chief Technology Officer (Snelling Executive Search).

We’re finding a comfortable voice for HIStalk Practice, including regular interviews with private practice physicians and industry experts. We’re up to 300 or so subscribers and a few thousand visits, which isn’t bad for our first couple of weeks. Sign up there for e-mail updates if you follow the EMR market. We’ve already filled our two Founding Sponsor slots there and also added some Platinum ones, so we will announce those shortly. Thanks to everyone supporting us there by reading, commenting, and writing – like the early days of HIStalk, it takes awhile to build up a readership.

Have physician portals become obsolete just as hospitals finally get them up and running? Robert Connely of Novo Innovations (now Medicity) said so when I interviewed him in 2006: "If you’re a doctor with an EMR, you don’t need a portal. In fact, you hate the concept. You want to see the data in your own system … Your physicians are bringing on EMRs and you need another way to get data to them." Stephanie Massengill says pretty much the same thing in a new article: "It seems the time for portals has waned. The marketing value of them is dubious, as the physicians have found that always seeking information is time consuming and, therefore, have stayed away in droves." Not that you need a third opinion, but here’s mine: portals are exactly what you would expect hospitals to have come up with given that they see themselves as center of the data universe, in charge of the conversation with physicians, and pleased to offer a solution that could be checked off as mission accomplished while missing the mark completely when it comes to physician workflow ("if you want to use the data in our systems to help our shared patients, even though it doesn’t benefit you or your practice personally, dial in and look it up yourself, make a copy or manually enter it into your own system, then repeat for each competing hospital in which you practice.") Portals were a good 1.0 stopgap and surely will continue to provide patient value, but for the ever-increasing number of practices with an EMR, better integration tools are available than that busy guy or gal wearing a stethoscope.

Just in: HIMSS announces the winners of its industry service awards. Pat Skarulis of Sloan-Kettering is CIO of the Year, Rosemary Kennedy of Siemens wins the nursing informatics leadership award, and Brian Jacobs of Children’s National is named for physician IT leadership.

Consumers are interested in personal health records … or do actions speak louder than words? A new report (which I’m not about to pay for, so I’m citing only the press release) says that only about a tenth of those people who claim they’re interested are actually using personal health records. Not surprising: if you believe self-reported consumer surveys, Masterpiece Theater is the most popular show on TV instead of innumerable morgue yarns and junk reality TV.

Sheldon Tyndall is named interim IT director at Haywood Medical Center (NC). He used to be at West Georgia and McKesson.

Danbury Hospital announces HealthLink, some kind of RHIO/HIE. Seems like the lawyers should be all over that choice of name since it’s been used about a zillion times.

An interesting article in The New Yorker (thanks to SQL_Goddess for the link) postulates that healthcare reform successfully happened in other countries not because it was rigorously planned, but because it evolved from experience to address current conditions. "Yes, American health care is an appallingly patched-together ship, with rotting timbers, water leaking in, mercenaries on board, and fifteen per cent of the passengers thrown over the rails just to keep it afloat. But hundreds of millions of people depend on it … In designing this program, we’ll inevitably want to build on the institutions we already have. That precept sounds as if it would severely limit our choices. But our health-care system has been a hodgepodge for so long that we actually have experience with all kinds of systems. The truth is that American health care has been more flotilla than ship. Our veterans’ health-care system is a program of twelve hundred government-run hospitals and other medical facilities all across the country (just like Britain’s). We could open it up to other people. We could give people a chance to join Medicare, our government insurance program (much like Canada’s). Or we could provide people with coverage through the benefits program that federal workers already have, a system of private-insurance choices (like Switzerland’s)."

So where does this guy fit in when talking healthcare reform? Yelling, bearded, ubiquitous cheeseball infomercial pitchman Billy Mays ("IT’S NEW OXICLEAN DETERGENT — GET ON THE BALL") is hawking health insurance. I’ve seen the commercial dozens of times already, even though I don’t watch much TV. Of course, he doesn’t scream out how much risk you take on when you sign up for "affordable" insurance (its mini-medical plan pays just $100 per day for a hospital stay). You know hospitals and doctors are going to eat the balance when the "insurance" covers next to nothing and the "insured" can’t pay, which is sad because they at least tried to do the right thing instead of just dropping all coverage. As highly recommended as the ultra-annoying Vince the Slap Chop guy ("YOU’RE GONNA LOVE MY NUTS").

Hospital layoffs: Waterbury Hospital (CT), 160; Integris Health (OK), no number given; Inter-Lakes Health (NY), 15.

South Australia’s Department of Health plans to deploy an ERP system covering all of its hospitals.

E-mail me.

HERtalk by Inga

I’ve been glued to the TV all day and have gotten teary a few times. It’s been an extraordinary day. I keep hearing Lee Greenwood singing in my head. It’s great to see so much pride and optimism. Oh, and I loved Aretha’s hat!

The Pennsylvania Medical Society has followed Mr. H’s lead and is now twittering (OK, maybe they didn’t start just because we did, but Mr. H likes to think of himself as a trailblazer), I know there of a number of hospital CIO’s twittering – I wonder if there are any hospital systems?

Canadian EMR vendor MedcomSoft fails to reach an agreement with creditors and files for bankruptcy. The company is now in trusteeship. The press release warns that it contains "forward-looking statements." Hardly.

A hospital-owned clinic in rural Colorado prepares to close its doors, falling victim to difficult financial times.

Nuance Communications continues to bid for Zi Corporation. The current offer was scheduled to expire January 16th, but Nuance as extended it until January 30th. So far, Zi’s stockholders have indicated they aren’t interest in the $.40/share offer. Zi’s stock closed at $.39 on Tuesday.

In Washington, House leaders suggest a December 31, 2009 deadline to complete an initial set of HIT standards. Also under consideration: $65,000 per physician in provider incentives; payments for hospitals that become fully wired; and penalties for not adopting HIT beginning in 2016. Privacy advocates are paying close attention to make sure their concerns are not overlooked.

The majority of Americans don’t consider HIT spending a priority, which may not be a surprise given the turbulent economic times. A recent study by Kaiser Family Foundation and the Harvard School of Public Health finds that 79% of the 1,628 participants want spending for HIT to decrease or stay the same, dead last by far of all the healthcare spending possibilities.

Revenue cycle solutions are all the rage in Michigan, as hospitals attempt to maintain revenues. With rises in unemployment and uncompensated care, hospitals are seeking new tools to update their billing and collection procedures.

Anesthesiologists have a cool new iPhone application available to them. iAnesthesia provides case log tracking, drug calculations, and administration guidelines.

Tomball Regional Medical Center (TX) equips its physicians with real-time patient updates on their mobile devices. The hospital is sending critical patient information to physicians using Clinical Xpert Navigator solution from Thomas Reuters (the former MercuryMD MData solution).

Pathology Service Associates launches a pathology CPT coding services Web site, PathLab Coding Solutions, that will provide responses to coding inquiring and access to automated and online coding resources.

Parkland Health & Hospital System (TX) licenses Lawson Software to automate administrative processes, simplify reporting, and improve data access.

Andrew Bolles joins Zotec Partners as director of business development. Bolles most recently worked as a VP and national sales manager for Dominion Medical Management.

United Regional Health Care System (TX) activates multiple Eclipsys clinical solutions across 35 inpatient units and two locations.

Marion General Hospital (IN) selects MEDSEEK to develop and implement an enterprise-wide healthcare portal.

South Jersey Healthcare (NJ) chooses Sage’s Intergy EHR for its affiliated physicians. The health system will subsidize the cost of the EHR and interfaces to the hospital’s IS/HIE.

Hayes Management Consulting announces that MedicalEdge Healthcare Group is providing MDaudit software for its physician clients.

E-mail Inga.

Ricky Roma Responds

… to comments from his recent guest posting.

A few people asked about the Site Visit problem, especially with respect to compensation. These questions actually highlight the root of the problem. Yes, site visits are lengthy and expensive. Risky? Not so much. 

I completely agree there are plenty of opportunities for sidebars and candid discussion, but these are the customers that the vendor has hand-selected to show off. These are the customers that get things like the best PMs; customized software; direct lines to the vendor’s senior leadership; discounts all over the place; pizzas sent Fridays; paid trips and dinners out with their Inga wannabes at trade shows; and anything else they so desire. These site visit hosts do not generally intend to mislead their wide-eyed visitors — they are just the beneficiaries of a relationship that is rarely repeatable at scale (“at scale” being vendor-speak for “you”).

Are the hosts compensated? Abso-fugly-lutely. Do they get better service than the average bear? Of course they do! That is the very reason why you are being directed there, so you can be guided into thinking ALL of said vendor’s customers live in this state of perpetual bliss. If this utopian state is something that can, in fact, be delivered “at scale,” there is only one way to find out — do your evaluation at scale (“at scale” here being my speak for, well, “at scale”).

The remedy here is to stack up the references. Stay away from the airport and choose quantity over false quality. Use the phone and your Web meeting tool-of-choice. Also, do back channel references — ask one or more of your Good sales people from a different product category if he or she knows any hospitals using Product X and would they facilitate an introduction. The time invested in 5,10, 15 or more calls will pay much greater dividends than getting a fancy trip somewhere.

I would augment this recommendation by having key members of your evaluation team each make calls to their respective counterparts. Find hospitals that are much like yours as possible and avoid the eight-person conference call. Make them one-on-one instead. A direct conversation is much more likely to generate an honest answer than from a crowded conference room. Plus, think of all the new LinkedIn contacts that can be made!    

Make sure your team agrees on a basic set of questions (actual, real, usable functionality; implementation reality; support reality; hidden costs; etc.) so that you can compare notes on the same topics. Also, be sure to ask the classic, "Knowing what you know now, what would you do differently if you came to work for us on this project?” The Dark Side HATES all this and will work hard to discourage this type of enlightened behavior. We want you to follow our script in showing off our wares, not yours!

If you follow this process and have five or more of your team calling at least 5-10 references (more for bigger projects, fewer for smaller), you will have developed a powerful matrix of 25-50-100 or more interviews. This information will serve as a great big spotlight to illuminate the future path you will be headed down with that potential decision. THEN, if you really want to go see this s#@& running somewhere, hop on that airplane and go.

While you are there feeling like a big shot, insist upon dinner with your Good sales person and the company’s CEO (aka, Mr. Discount) and let the negotiations begin …

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In about a month, it is highly likely that our industry (healthcare information technology) will be very different. In my almost thirty years in this industry, there has never been an industry change of the depth and breadth that we are about to experience.

Last week saw the introduction of the first of the Congressional bills that will cause this change. These bills are part of a broader set of government efforts designed to stimulate the economy out of its distress. The healthcare IT portion of these bills intends to rapidly accelerate the adoption and effective use of information technology in healthcare. The House Ways and Means bill (PDF – go to page 138 and read from there) describes some proposed changes:

• Provision of $40,000 in incentives (beginning in 2011) for physicians to use an EHR
• Creation of HIT Extension Programs that would facilitate regional adoption efforts
• Provision of funds to states to coordinate and promote interoperable EHRs
• Development of education programs to train clinicians in EHR use and increase the number of healthcare IT professionals
• Creation of HIT grant and loan programs
• Acceleration of the construction of the National Health Information Network (NHIN)

All of these changes (and more) are accompanied by the infusion of $20B into the healthcare sector. To put this in perspective, in 2007 the HIT industry in the US was $26B (Gartner).

The “final” form of these changes is not clear. The Ways and Means bill and the Energy and Commerce bill and the Senate bills need to be reconciled. As I write (a snowy Sunday morning in Boston waiting for the NFL playoffs to start) I am sure that a wide range of industry professional associations, lobbying firms, and interested individuals and organizations are plowing through the language to identify improvements, concerns, and sections that need further clarity. Their voices will need to be heard.

And while the legislative process and discussion that arrives at a final bill will be (as it often is) complicated, confusing, and full of ups and downs, we should fully expect that sweeping changes will pass within 30 days.

What should you do about this?

First, to the degree that you have time, you should weigh in on the legislation. Your comments can be sent to your employer (if they are planning to provide feedback to Congress), your elected officials, and/or to industry professional societies (CHIME, HIMSS, AHIMA, AMIA, AHA, etc.) that will be providing feedback.

Second, get ready for an interesting 2009.

John Glaser is vice president and CIO at Partners HealthCare System. He describes himself as an "irregular regular contributor" to HIStalk.

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