A New York Times article reports that Wal-Mart will begin selling small-practice physician systems through its Sam’s Club division, pairing Dell hardware with software from eClinicalWorks in a complete package that include installation, ongoing maintenance, and training.

Marcus Osborne, Wal-Mart’s senior director of healthcare business development, was quoted as saying, "We’re a high-volume, low-cost company and I would argue that mentality is sorely lacking in the health care industry."

Sam’s Club will offer the package this spring starting at under $25,000 for the first physician in a practice and $10,000 for each additional doctor. Ongoing costs will be $4,000 to $6,500 per year.

The package will include a Dell desktop or tablet PC installed by Dell technicians and software-as-a-service applications from eClinicalWorks.

Wal-Mart says it got the idea from its own in-store clinics, which use the same technologies. It says it’s role is simply to bundle the products together into an affordable and accessible offering. "We’re the systems integrator, an aggregator," Osborne said.

David Brailer was quoted as saying, "If Wal-Mart is successful, this could be a game-changer."

I’ve asked Girish Kumar of eClinicalWorks for more information. Meanwhile, your comments are welcome.

UPDATE: notes from speaking with Girish Kumar Wednesday afternoon. Sorry that they are terse and a little raw, but I had 15 minutes between meetings at work and Girish was in the car on the way to the airport.

If a physician buys from Sam’s, will it be the same product, implementation services, and support that eCW offers directly?

Absolutely. We’re trying to make it simple. Everybody says EMRs are hard and implementing change is hard. We realize that. We’ve been doing SaaS since 2003 and have invested a ton on a data center. We wanted system that is ready out of the box, configured, with content, although it will still require on-site implementation and services. It’s the same in terms of product, services, training, but faster and easier to deploy.

Why would a customer buy from Sam’s? Do they save any money? Can they choose a no-services option?

Wal-Mart used its Sam’s Club division because it has a lot of small business customers as corporate members. They buy ongoing stuff every month, not just simple things like gloves and bandages, but have a corporate account and buy copiers, payroll software, etc. They don’t have to go into Sam’s. You call a corporate number, get an assigned representative, talk to them about what you need, and the item is shipped. eCW salespeople will still show the product and talk to the customer. There are packages we want to give them that are pre-configured. The customer will not pick blindly – they will still consult with an eCW person.

Will Wal-Mart do its own advertising and marketing?

There will definitely be a significant campaign. They have 200,000 healthcare professionals today as members, mostly as doctors.

Any projections on volumes?

I have to keep that confidential, but there was a lot of planning on the eCW side. Investments have increased, made the company even more ready. This can have a significant impact on how physicians look at, evaluate, and purchase EMRs. We would like to see taking it away from being a niche sales process, where sometimes we confuse the customer, to make it a very streamlined process so that a customer can make an educated decision. They know how many days to go live, how many days training, cost, etc. eCW does 30 Webinars every week that every customer has access to with a live attendant and all Sam’s members will be able to avail themselves of that.

We believe we are the largest SaaS EMR in the country with 4,000 physicians. If we include hospital customers hosting affiliated physicians and RHIOs, that’s another 4,000. That’s 8,000 today of our 25,000 physicians. We’re trying to leverage that scale to make it easier and cheaper to deploy.

Do you anticipate any product changes?

For primary care, we spent two years working with New York City. We put into the product all the content needed to run a primary care practice – templates, order sets, clinical decision support. That is years of content that we jointly developed. That is all pre-packaged with the product – it’s not just the software any more. On the specialty care, we have about 50 specialty databases. All of that will be available pre-configured when they sign up. When the trainer shows up, all the content will be there and if we want to change it, we can change it together. We will go live with a comprehensive data repository with clinical decision support at no extra cost for the content.

A primary care doctor can go live with the system as it is, with rich content.

What does this to do the competitive landscape?

We’ve always taken tremendous pride on our leadership on price and functionality. 97% of eCW customers surveyed said their total costs met their expectations when they bought and implemented eCW. 93% of physicians said the EMR met or exceeded expectations. I still have to worry about the 7% and I lose sleep about it more than I take advantage of the 93%, but if a package with those numbers is readily available, people will ask the question: if I’m able to get a comprehensive product that people are happy with at this price point with content and support, why should I spend more? Price visibility will be black and white. No longer will you see those quotes saying an EMR will cost $300,000. You will see more informed questions, pricing pressure, and frankly, higher expectations if content is provided. I don’t want to take six months to implement PM and another six months for an EMR. This is a unified product we’re offering, by the way, both EMR and PM. We’re offering five days of implementation on site with the Sam’s Club package and they can buy more for $750 a day plus travel, but our track record is that we can do it in five days.

What are the benefits to eClinicalWorks?

There are many benefits. We want to be a company with 100,000 physicians using our product and 100 million patients whose lives are positively affected by it. There’s a lot more work to be done, but this platform gives us more opportunity.

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From Paul Pott: "Re: grocery code barcode article. Didn’t you write some commentary awhile back? Maybe Dennis Quaid should read it …oh, wait, he is too busy solving the problem with his easy solutions." A couple of readers recalled a piece I wrote two years ago called Want to Anger a Nurse? Make Smug Coments about Grocery Store Barcoding. And regarding Dennis Quaid, I should say that I have no problem with his being mad, disillusioned, distrustful, litigious, and now vocal. Its HIMSS that I have a problem with, putting him onstage in an HIT keynote as though we are ignorant to medical errors without having a layperson challenging us at a conference, particularly one who suffered no loss other than some panicky moments (unfortunately, there are plenty of people whose experience with medical errors is far more tragic). Well, HIMSS has made some odd keynote choices before (Dana Carvey, for example) and I suppose this one’s no worse when the objective is simply to pay a big celebrity to bump up the cool factor. Maybe he’ll do something interesting like have someone from Cedars on stage with him (I’m predicting that).

From xtremegeek: "Re: Akron General Hospital. Heard they laid off over 100. Can anyone confirm?" The body count was 145, according to an article in today’s Plain Dealer.

Fountain Valley Regional Hospital (CA) is using video-equipped robots to connect doctors with patients. It is law that every IT system intended for nurse use must have a contrived acronym name chosen by contest (as a thinly disguised ploy to increase rank-and-file support, of course, and highly insulting to nurses if you ask me), so theirs is called ERNI. A patient is quoted: "They said a doctor was going to talk to me and then it came wheeling around. I just figured that was the new era. I didn’t feel like it was impersonal at all."

IBM works with a hospital in Denmark to develop a 3D anatomical view of available EMR information, allowing doctors to click on a body part to drill down into related information. Sounds cool, although I don’t see how it affects outcomes.

Analytics vendor Enclarity raises $5.5 million in Series C funding, bringing its total to $22 million.

Marlin Equity Partners acquires billing and collections vendor MDeverywhere, adding it to a stable that includes MedAvant. I Googled HIStalk to see if I’d mentioned MDeverywhere previously and darned if I didn’t mention a company by that name (maybe not the same one) in my 12th-ever HIStalk post, June 30, 2003. That was right after I boldly predicted that Epic would no longer be a serious HIS competitor because it had just signed the Kaiser deal (which I also predicted would fail). Well, I was young and foolish and so was Epic back then, so you will have to forgive us both.

Thanks to GetWellNetwork of Bethesda, MD, a brand new Platinum Sponsor of HIStalk. Premise Chairman CEO Eric Rosow (now Eclipsys) introduced me by e-mail to GetWellNetwork Founder and CEO Michael O’ Neil, we did a Moment With, and he must have gotten a lot of response because here they are a new sponsor. The company sells interactive patient care solutions (bedside education, safety, pathways, pain assessment, etc.) and patient entertainment and communication systems. I appreciate their support.

The medical director of O’Connor Family Health Center (CA) tries to make the best of its transition to an EMR, saying he doesn’t regret it despite (a) the fact that it cost $250,000 and required an army of people; (b) patient backlog was up and revenue down for three months after go-live; and (c) their vendor has gone belly-up since their implementation and product support ends in two years. I bet that particular Mrs. Lincoln really liked the play.

I bet HIMSS was hoping for some rosy survey results about ARRA after all the cheerleading it did for it, but HIT professionals think differently: only a third of them believe all those HIT stimulus provisions will end up saving healthcare dollars.

Thanks to those who RSVPed for our HIMSS reception and apologies to those who missed the cutoff (some folks took heed when I wrote Saturday that the cap was imminent). The most common titles of attendees: VP/EVP/SVP/RVP (76), CEO/Chairman (45), and Director (40). I’m happy to see that some of my provider-sider peers jumped in there too, with some doctors, nurses, IT people, and CIOs. Title counting aside, thanks to every single person who signed up – it means a lot to me. It never ceases to amaze me that people pay at least a little attention to an anonymous blogger who’s sticking to his nonprofit hospital IT day job (as some of you less impressed readers have recommended).

A reader had posted a comment about IntrinsiQ, the folks who sell the IntelliDose oncology system. Inga connected with Jeff Forringer, the company’s new president, who was good enough to provide a response. "Thanks again for reaching out to me directly. As I said in my initial response there is no planned reduction in force for 2009. As a matter of fact we plan to invest even more in software development and client service this year. Overall I think you’ll be happy to hear where IntrinsiQ is heading – especially given your concerns about the ongoing importance of our clinical software business. While we’re still putting the operational roadmap in place to achieve our goals, here’s an overview of our vision. (a) Extend the improvements we made in version 3.8 to the e-nurse and charge capture modules to the order writing module in our 3.9 version this year. (b) Use these changes in the underlying architecture to develop a light version of the product that can be used by smaller facilities. (c) Continue our cooperative approach with full service EMR vendors to be the oncology module that makes their systems better. (d) Use our data processing and analytical skills to provide sites with information about how they practice and how that compares to the rest of the country. (e)  Develop new modules and services that help sites improve the quality of care. On the software management side I have made two changes. I hired Rich Gray as the GM of our software division. Rich was with IntrinsiQ for a number of years and has rejoined. Rich’s experience with the software, healthcare  IT space and his clinical background are a great addition to the team and will help us reach our goal of becoming a bigger part of helping sites improve the quality and understanding of care The other management change that I made was to promote Steve Hamann to the management team. Over the past 2 years Steve has led the effort to improve IntelliDose’s user interface and the underlying architecture. I hope this gives you and ideas of where we are headed. I would be happy to talk more about what we would like to do long term, the commitment of our board to the process and how the software and data business work together if you are interested."

Philips expands its headcount by 30 in its Belfast office, the Northern Ireland location that was formerly part of the acquired Tomcat Clinical Systems.

QuadraMed announces Q4 results after Tuesday’s market close: revenue down 6%, EPS $0.14 vs. $0.52 (after excluding a one-time tax treatment from last year).

We did an interview with Cheryl Iseberg, COO of Renaissance Resource Associates, an HIStalk Platinum Sponsor that provides consulting services for GE Centricity Enterprise, Picis, Epic, and other systems.

Another example that consumers don’t think doctor bills are real: someone complains to a TV station that if a doctor doesn’t write off charges for a test his insurance company said he didn’t need (after refusing to pay for it, of course), his credit score will suffer because he’s not planning to pay the bill.

Jobs: Project Office Manager (NC), MEDITECH Financial/Billing Expert (national), Director of Business Systems (CA), MEDITECH Consultant – Advanced Clinicals (national).

A RAND Corporation study says pay-for-performance plans sell a lot of IT, but haven’t improved healthcare quality, based on its review of a big California project. The problem: doctors weren’t interested in major change when only a couple of thousand dollars a year was at stake.

MEDSEEK is offering a free Webinar in its series on eHealth, this one on Wednesday, March 18.

Southern Arizona HIE is working with Wellogic to roll out more electronic patient information. Also mentioned: it hopes (like everybody else) to get a slice of the Obama Pork Pie (actually, I shouldn’t say that since I’m almost but not quite convinced he had no choice).

CVS Caremark closes 16% of its MinuteClinic locations, placing them on a "seasonal schedule" to supposedly reopen later. I’ll give its PR people credit for putting a positive spin on closing stores because of poor sales: they are doing it "to align with consumer demand."

The Conficker worm is still out there, infecting networks at two hospitals in Scotland last week and requiring a two-day downtime that forced the rescheduling of cancer patients.

Maybe this is an argument for EMRs: the family of a 60-year-old woman who died of an E. coli infection gets a $2.6 million jury verdict from a hospital. They had taken the patient to the ED, which drew positive blood cultures, but the nurse put the paper result in a folder on the doctor’s desk, where it went unreviewed for 12 hours.

E-mail me.

HERtalk by Inga

From Spicey: “Re: HIStalk/Ingenix reception. You guys should be flattered it’s sold out … everyone thinks this is the ‘must do’ of HIMSS!” We are flattered that so many want to attend this sure-to-be-fun event hosted by the wonderful Ingenix folks. I hear the location (Trump Hotel) is gorgeous and I am sure the food will be divine. If, by chance, you did RSVP and your plans change, let us know if you can’t make it. We’d love to free up some spots for people who missed the cutoff (some of whom are e-mailing frantically hoping to get squeezed in, but we have a space limit).

From Shoe Diva: “Re: HIMSS footwear. I went shopping a couple of weeks ago for comfy shoes … none of those beautiful shoes for me. I swore last year I would resort to black tennis shoes. What about you?” This is one of life’s biggest dilemma: function versus fashion. Why can’t someone design a gorgeous shoe that you can walk around in all day without killing your feet and your back? And, that is also suitable for Chicago’s potentially frigid weather?

Speaking of HIMSS, the obvious buzz this year will be around HITECH, including how each vendors have the perfect solution and what providers will need to do in order to get their money. Coming in a distant second, I predict a good deal of talk of products and services to help providers adapt to a more consumer-driven healthcare world. Next, look for cool ways to use your PDA.

Thirteen hospitals reach HIMSS Stage 7 EHR ranking and all but one are part of Kaiser Permanente. NorthShore University HealthSystems (IL) was the other system to make the list for three of its four campuses. Interestingly, all Stage 7 honorees use Epic for their core HIT system.

A new study suggests that as many of half of the country’s physicians will determine that HITECH financial incentives are not enough for them to move forward on EHR adoption. Avalere estimates that the average solo or small group practice will spend $124,000 over five years to adopt EHR and will receive $44,000 in incentive payments. That’s a $14,000-a-year deficit compared to an estimated $8,500 a year Medicare reimbursement penalty for non-adoption. The biggest problem with this argument, however, is that it does not address any potential savings and efficiencies physicians gain as a result of implementing EMR, such as reduced transcription costs, savings on charts and chart storage, lower malpractice rates, etc. And what about the value of improved patient safety?

Health Systems Solutions announces it will de-register its common stock and stop filings with the SEC following the collapse of its planned Emageon merger and the fraud investigation of its principal investor.

The US unemployment rate continues to climb and now sits at 8.1%. Meanwhile, healthcare remains one of the few bright spots, adding 27,000 more jobs in February.

Integration firm Bostech Corporation partners with HIT consulting firm Orchestrate Healthcare to promote open and integrated healthcare technology solutions.

Allscripts-Misys finds a buyer willing to pay $26 million for its medication services business. A-S Medication Solutions will pay Allscripts $8 million in the 4th quarter and $3.6 million per year over the next five years in return for A-S sales and marketing services.

St. Joseph’s Hospital Health Center deploys RelayHealth’s IntegrateRX Prescription History to aid with medication reconciliation.

CHRISTUS Health implements Picis LYNX E/Point in 18 of its acute care hospitals and plans to add three more sites soon.

The Department of Justice files suit against Community Health Systems (CHS) for allegedly defrauding Medicaid of $47.5 million. A whistleblower originally alerted officials of possible fraud after three New Mexico hospitals and CHS allegedly collected disproportionate share payments to which they were not entitled.

The 235-bed Children’s Hospital (LA) successfully installs Sunquest LIS specimen Collection Management and Encompass Web-based ordering, resulting, and reporting systems.

Satyam Computer Services starts a competitive bidding process to find an investor willing to acquire a majority stake in the scandal-ridden company.

Memorial Hospital and Health Care Center (Indiana) migrates to Corepoint Health’s Integration Engine.

For $199, you can purchase a new genetic test that predicts the risk of male and female hair loss. Though I personally would hate to lose my hair, I’m quite fond of bald men, so I wonder why a guy would waste this kind of money? I suppose the idea is that if you are going to go bald, you can take medications early to slow the hair loss, though apparently the meds include a threat of “sexual” side effects. Men: bald is sexy.

Ambulatory surgery center operator AmSurg selects ProVation MD software by Wolters Kluwer Health.

A new P4P survey reports that P4P payments have grown to over 7% of physicians’ total compensation and 4% of hospitals, with some physician programs producing 30% of physicians’ compensation. Since 2006, the percentage of programs reporting quality improvements due to P4P has doubled and more than half of P4P programs cite measurable increases in their providers’ clinical quality.

The Alaska Native Tribal Health Consortium awards GCI $250,000 to provide a statewide broadband network to give health care provides more ready access to patients’ EHR.

WestCare Health System (NC) implements Preferred Medical Marketing’s Estimator PRO software to provide patients written estimates for expected payments due.

The Michigan Health & Hospital Association commits to a three year contract with ECRI Institute Patient Safety for ECRI to provide support for the Association’s patient safety data collection and analysis project.

Residents strolling their Aurora, CO neighborhood find personal medical documents littering their streets. Apparently the “trash” came from a healthcare facility eight miles away and included names, addresses, social security numbers, and other personal data. The healthcare facility is uncertain how the papers got there and is investigating.

Finally, a San Diego State University study finds that there are more indoor tanning salons than either Starbucks or McDonalds. Did my tax dollars help pay for that study?

E-mail Inga.

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An HIT Moment with ... is a quick interview with someone we find interesting. Lawrence M. Pawola, PharmD, MBA is Associate Dean of Academic Practice and Program Director, Health Informatics, Operations and Curriculum, at the University of Illinois at Chicago.

Describe the MS in Health Informatics at the University of Illinois at Chicago (UIC), what kinds of students are attracted to it, and what graduates are doing.

As one of the oldest programs in the industry, the HI/HIM programs at UIC have a long history of excellence, consistently preparing graduates who become leaders in the Health Information Management and Health Informatics professions.

The HIM program was established in 1965 and has graduated many of the top contributors to this profession. Coursework in health informatics was originally built in the early 1990s, with the Master of Science in Health Informatics degree formally established at UIC in 1999. We are by far the largest and one of the oldest health informatics graduate education programs in our industry. Our multidisciplinary program is housed in the Department of Biomedical and Health Information Sciences in the College of Applied Health Sciences, which is one of the six primary health discipline colleges located on our campus just west of downtown Chicago.

UIC, being one of only several universities having all medical disciplines on one campus, is recognized as a national hub of medical research, being designated by the Carnegie Foundation as 1 of 96 “Very High” Research universities, as well as consistently ranking in the top 50 of national universities in federal research funding.

The Master of Science program has been delivered in an online fashion for the last twelve years. Courses have been built to better understand the social and behavioral attitudes and issues that inhibit the effective use of information technology in healthcare organizations. Our faculty guides students to assimilate theory and apply it to everyday activities. Many times, the students work in groups, sharing their professional perspectives, as they discover new knowledge.

Our goal is to produce graduates who can assume higher-level staff, management, and other leadership positions in a variety of healthcare, supplier, payer, and consulting organizations; they will lead their organizations to achieve greater value from their systems investments. UIC’s HI/HIM alumni are highly coveted and have created an elite network of industry leaders. They have been hired by a number of leading healthcare providers, leading supplier companies, and consulting firms. Their achievements are recognized by their individual companies, organizations and agencies, as well as national industry groups such as AHIMA, HIMSS, and AMIA.

Keep in mind that our Master of Science degree is not our only online program. Our highly-respected BS in HIM is a blended program, offering students the opportunity to combine classroom instruction along with online courses. We also offer an online Post-Baccalaureate Certificate in Health Informatics that consists of three courses, as well as a seven-course Post-Master’s Certificate in Health Informatics that offers those with a graduate-level degree an excellent credential signifying they are highly proficient in the analysis, evaluation, implementation, and control of healthcare information systems and related technologies.

We are very excited about the launch of our new online Post-Baccalaureate Certificate in Health Information Management that will permit healthcare, business, and IT professionals to be eligible to sit for the RHIA certification exam. We will begin accepting applications for that program in late April.

Students from all of the health disciplines are attracted to our programs. We have physicians, nurses, pharmacists, medical and radiology technologists, therapists, technology and computer science professionals, engineers, and other professionals in our programs. Because we are online, students come from all over the United States and the world. Military personnel serving overseas, as well as professionals from India, China, Korea, and several other countries have participated in our courses.

Studies have indicated that there aren’t enough people trained in health informatics to advance electronic medical records. Do you agree it’s a problem and, if so, what’s the solution?

Yes, this is definitely a problem, but frankly, this has been a problem for a long time. The recent stimulus bill will set a number of activities into motion during the next few years, which will further increase the demand for informatics-trained professionals.

At UIC, we have been scaling our HI/HIM programs and preparing to educate even greater numbers of students while maintaining quality at all levels of instruction. Industry-experienced faculty have been hired in anticipation of increased enrollments and we have modified our student enrollment/registration, research, and advising processes to accommodate this growth. We emphasize quality and service, which are hallmarks of our programs. Furthermore, our courses continually change as the industry demands new knowledge and experience, so keeping an eye on what is needed for success is critical to maintaining an edge on what the industry requires.

People working in healthcare information technology must realize their customers are highly educated individuals who demand the best of customer service and response. Clinicians, for example, are trained to assess evidence as an essential element of any decision-making process. The ability to research an answer and support one’s conclusions and recommendations with evidence has become a critical skill set in today’s healthcare society. This is also a requisite skill set for people who support information technology and electronic medical records.

Having worked in this industry for almost thirty years, I, like others, realize the evolution toward electronic health records is a series of long-term projects that change culture, processes, attitudes, and jobs. Organizations need to grow into most effectively using EHR capabilities; these aren’t “slam-dunk” solutions. As a result, there will be a need for trained informatics professionals through the next 10 to 20 years and beyond.

While the government’s stimulus program may provide a jump start, the solution requires formal training and continued education over many years. The industry needs experience. Educational programs like UIC represent one of the tools of a total solution set required for the long term.

Are you seeing increased interest in your program because of economic conditions?

Yes, our enrollments have significantly increased during the last two years. We have more applications for our programs at this point in our summer and fall enrollment cycles than we have ever had before. I have talked to others here at the University of Illinois at Chicago and they said that the “hot areas,” such as engineering during the last major economic downturn back in the 1990s, have always been good arenas for individuals to reinvent themselves for new careers and employment when the economy begins to pick up again; health informatics is definitely "hot”.

This economic downturn is not any different than any past one. The current conditions have forced many workers to think about their futures, to assess new working careers, and to try something different. This is a definite opportunity to retool oneself to be eligible for a position that is in high demand in a growing industry, and will have a tremendous impact on all of our futures. With the new administration’s desire to emphasize electronic health records, the future is bright for individuals who have requisite skill sets in informatics.

What surprises me is the intense interest we receive from physicians, nurses, pharmacists, and other clinical professionals. In spite of having relatively stable employment through most economic downturns, a number of clinical professionals are students in our programs, partly because they not only desire to take advantage of opportunities in their current positions, but also to become educated to take on even greater responsibilities and leadership.

Though our program is not specifically meant to attract just healthcare professionals — in fact about half of our students come from backgrounds other than clinical — our curriculum emphasizes skills that will give everyone rounded backgrounds to be successful in healthcare. We need to remember that these are complex software systems and to successfully use them, a number of issues must be understood, dealt with, and solved. One does not need to be a clinician to be successful in our informatics programs and in the healthcare information technology industry.

Economic stimulus funds will likely change the healthcare IT industry. Do you have any predictions on what will happen?

I have talked with a number of consultants, supplier representatives, providers, and students during the last few weeks, and as expected, there is a wide variety of opinions. But in spite of the best of intentions, I don’t believe there will be a mad rush for systems in the next few months. Like other segments of the economic recovery plan, the stimulus is somewhat vague in many areas; wise providers will wait for some period of time until there is better definition of what demonstrates success under the stimulus. The plan will result in incentive payments for those providers who demonstrate meaningful use of their EHRs. We will see a last minute push to purchase and implement new systems as we get closer to deadline dates, with a resulting crush on experienced resources, and a cry to change the legislation and move the deadline.

Most everyone agrees there will be entrepreneurs developing and pushing their ideas as the best available solutions, so one needs to exercise caution as they purchase. Historically and generally speaking, healthcare organizations have had difficulty realizing value from their information technology investments. Because of the push for new systems during the next two years, and with many new users implementing complex functionality into resistant cultures for the first time, there is tremendous risk that money will not be spent wisely.

My advice for any organization is to conduct thorough planning and evaluation, make well-thought-out selection decisions, and understand how your business operations will be affected by new technology. Build on the available experience in the industry and seek high value and return from the investment you are making. While the money may be available and the “candy store” is now open, spending it wisely requires thought and careful effort. As I said earlier, these are long-term projects that require significant cultural, behavioral, and process modifications for every organization to achieve success.

Do you enjoy working in higher education after a long career as a management consultant?

Yes, very much. This is the right spot for me at this point in my career.

I spent over twenty years as a management consultant and have a plethora of stories about client situations and business travel difficulties. I have never regretted my many years in consulting at American Hospital Supply Corporation (remember it?) and with Dorenfest & Associates. I respect the people I worked with and learned much from them. I worked hard to achieve good results with my clients and always gained additional knowledge from each one of them. These experiences have helped position me to lead and grow this academic program.

Higher education is not without its own set of problems. With decreasing budgets and increasing competition for students, academia is very much like any other business. An understanding of basic business principles, such as strategic planning, marketing, and management is as critical to success in the academic environment as it is to any healthcare consulting or software business. My additional experiences as a consultant have taught me to appreciate these challenges, to be patient with the change process, and to respect others for their attitudes, personalities, and agendas. While a large university like ours may appear to be slow to change on any given day, comparing a snapshot of today to one taken a year ago will illustrate tremendous changes. My organization has smart, committed people. We have terrific students with the maturity and desire to learn. The Dean in our college and the campus administration support me, providing me with the opportunity to build something I truly believe in to be a leader in our industry. What more can I ask for?

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From Bill Swerski: "Re: negativism. I can’t tell you how much I look forward to your news blogs. They just keep getting better and more informative. Your statement regarding not worrying about the economy and working harder is one of the most prolific statements I have heard in the past few months. The negativism to me is what is hurting the economy. This single quote needs to be plastered on billboards, bathroom stall walls, and anywhere else a Sharpie can be held! Our statement here for the bad times is ’Suck it up, cupcake!’"

With those kind words, let me say for the record that I’m just as hard-hit and discouraged as anyone else (my IRA and 401k are down 60%, so I’ll probably be working until I drop). I also don’t like the idea that I did the apparently unfashionable — paid my mortgage and taxes on time, lived within my means, and didn’t start crying for help because my house payment went up while its value went down, so there’s no bailout in my future (except paying for one to help the irresponsible people). Still, whatever degree of intelligence, ambition, and resourcefulness I had hasn’t seeped out of me just because others (some of them elected to high office) made truly boneheaded decisions. I’m knocked down, but not out. If your priorities were based entirely on accumulating wealth, it’s a great time to re-evaluate. One of my favorite sayings: I’ve never seen a hearse pulling a U-Haul.

It may already be too late, but if you want to attend the Monday, April 6 HIStalk reception at HIMSS, please RSVP immediately as we are just about to hit the cutoff of 300 (or it may have been 400 — hopefully the Ingenix folks sponsoring kept better notes than I did of what we decided). Please don’t RSVP if you aren’t sure you’re coming since someone else will lose their chance. Pretty nice digs: the 92-story Trump International Hotel is right on the river at the Loop and North Michigan. We will be in the largest room, the Grand Ballroom, which has views of Lake Michigan and lots of historic buildings through 24-foot windows. If you are the sort that likes to hobnob with movers and shakers, the RSVP list includes 27 CEOs and presidents and 56 VPs so far, plus an assortment of financial types, media people (what are they doing attending a blogger’s event?), and friends of HIStalk (that’s all of you, of course, but some of these are names you would know from reading). Thanks to Ingenix and Ingenix Consulting for sponsoring and for everybody attending. If it’s a great event, it will be because of the cool folks who chose to be there.

Speaking of the reception, a reader informs me that the NCAA basketball championship tips off the same night at 8:21 Chicago time. I wouldn’t have known since the only sport I care about is college football, but I know people obsess over their brackets and all that. Hopefully it won’t be too much of a conflict. That reader suggested a post-party viewing event and is looking into underwriting a modest one (heck, all you need is some Chicago dogs, a keg, and maybe … just thinking out loud … a couple of cheerleaders).

Gwen at Healthcare IT Jobs was curious about the University of Illinois at Chicago’s online MS in Health Informatics program whose ad is running to your right and on Healthcare IT Jobs, so she assembled some information (warning: PDF) about it, just in case you are curious. People often decide to further their education when the economy is unfavorable, so it’s a timely topic.

CalRHIO and OCPHRIO will launch a statewide system providing secure access to patient information in 23 Orange County, CA EDs in July. The Orange County group will use CalRHIO’s electronic platform, which I believe (but the press release doesn’t say) is Medicity.

Hopefully your Daylight Saving Time switchover went OK.

Young adults ages 19-29 make up the larges group of uninsured citizens, all 13.2 million of them. One reason: they’re too old to stay on the plan of their parents, but their employers don’t offer coverage or they can’t afford it. These are the folks, of course, who will have to bail out Medicare, fund the retirement of all of us baby boomer geezers, and pay massive interest on the federal debt racked up trying to keep an economic balloon with a hole in it inflated. Somehow I’m not feeling real good about their willingness to do that when the time comes.

A New York Times op-ed piece called The Computer Will See You Now seems to have gripes about EMRs that aren’t really described too well, but seem to be: (a) using the computer in front of patients is intrusive; (b) standard questions must be asked in order even when they clearly don’t apply; (c) the doctor might swear in front of patients when the computer does something wrong; and (d) computers lose context because doctors can’t underline, write bigger, or otherwise highlight something important. From those observations, the author suggests further studies are needed and perhaps EMRs should be maintained only on tablet PCs. That’s a pretty big and unconvincing leap from the anecdotal experience of one user, but lay readers will unfortunately assume it is authoritative since the Times ran it.

The Minneapolis-St. Paul paper highlights Amcom and VisionShare, healthcare software companies that "are proof, even amid all this economic turmoil, that we can build growth companies by making health care and other industries simpler and more efficient." Probably true.

Lobbying experts say Nancy-Ann DeParle’s industry ties shouldn’t disqualify her from being health czar, saying experience "on the other side" is not a negative because you need people who have worked in the field. I would ordinarily agree, but much of the Obama stimulus and reform plan is prescriptive in specifically advocating and advancing EMRs and she has profited greatly from being involved with companies that sell them. Still, I agree that shouldn’t rule her out. I think some in the industry would have preferred someone who has actually worked in healthcare, but I suppose at high-profile levels you’re always going to have someone who has risen to heights above the majority of us who actually do the work as non-profit employees.

Healthcare expert Dennis Quaid revisits Cedars Sinai with Oprah’s TV people and cameras, "to see what steps have been taken to ensure a similar mistake won’t happen again." Apparently the best case study on medical errors involves his twins, who unlike some victims had no lasting ill effects whatsoever, and the best investigator for the job is their actor dad. I thought his movie Everybody’s All-American was pure dreck, so I plan to call up Oprah to film me as I meet with studio executives to demand an explanation of how they will make sure something that horrifying never happens again. Dennis, of course, can do whatever he wants at Cedars because he’s hanging a potential lawsuit over its head, so they have to grit their teeth and pretend he’s got insightful thoughts as he lords around the place with the TV crew catching his good side. He’ll be great at HIMSS in any case since actors can make you love them by just being whatever you want them to be (I bet actors would make great salespeople).

A Massachusetts doctor who writes best-selling novels says the inspiration for his latest, The Second Opinion (# 1,563 on Amazon) came from a visit to his own doctor, who was too busy entering information into the computer to make eye contact. "I started thinking about electronic medical records and HIPAA (Health Insurance Portability and Accountability Act, which requires standards for electronic medical records and also helps to ensure patient privacy.)  So that’s what I wrote about."  

Nuance announces that its SpeechMagic has been rolled out in 12 London sites of HCA.

GE and Siemens are upset that Obama’s plan calls for cutting government spending on MRIs and X-rays, so they’re threatening to turn the lobbyists loose to argue that it would deny seniors "life-saving medical services" (taking a cue from HIMSS in using the term "advocacy" instead of the much less noble-sounding "special interest lobbying"). Like everybody else, they’re all for cutting massive healthcare expenses as long as it doesn’t cost them anything. Another entirely impartial group, the American College of Radiology and its radiologist members, also doesn’t like the plan. Both like to raise the specter of "actuaries" making medical decisions.

Healthcare IT mecca Beth Israel Deaconess Medical Center is on track to lose $20 million this year and layoffs are apparently coming. The Most Wired folks are always stretching to try to correlate IT investment to outcomes, so I expect they’ll modestly look away.

Some highly insightful equities research: an analyst notes that AMICAS offered $1.82 per share to buy out Emageon, so his target price is $1.82.

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From Bignurse: "Re: concierge practice. The New York State insurance department says that a New York City physician’s concierge medicine practice ‘amounts to insurance and requires a license’." Link. State insurance regulators order AMG Medical Group to shut down its $79-a-month practice. They are obviously wrong – if it was insurance, you couldn’t touch it for $79 a month. A bad call by the state, if you ask me.

From Leland Palmer: "Re: KP. Hearing any chatter that their CTO is seeking pastures of the greener variety?" Not so far, anyway.

From Harold Kumar: "Re: layoffs. The IT department at my hospital is sure to get hit next round. I am really worried." Worry is not a constructive action – it doesn’t change the odds that the next pink slip will have your name on it. Stop reading the negative financial news, work harder than you ever have, and keep your eyes open for opportunities. It’s all you can do. No matter how tough the times, some percentage of people will do even better than they did before and there’s no better place to do it than here. All of us in hospital IT are feeling the same way, I expect.

From CS Guru: "Re: Cedars-Sinai. Grand kudos to the folks at Cedars-Sinai as they went live this weekend with the full Epic revenue cycle suite. It is the biggest Epic install for revenue cycle ever (except of course KP). This is a huge success by all measures, but mostly for new CIO Darren Dworkin. The word is they are closing the command center early as support calls have slowed to a drizzle."

As you would hope, new health czar Nancy-Ann DeParle has resigned from Cerner’s board.

News flash headline from HIMSS: "Quaid to address ‘broken healthcare system’". Great! An actor who’s never worked in healthcare, who didn’t finish college, and who showed no interest in healthcare whatsoever until Cedars Sinai overdosed his twins on heparin is ready to tell industry experts what we’re doing wrong. I guess the non-celebrity parents of the other Cedars-overdosed baby weren’t invited because they don’t have The Right Stuff (my favorite Dennis movie, but he’s also been in some real crap, like Jaws 3-D and Wilder Napalm). He could bring his brother Randy to talk about Christmas Vacation.

Bret Jones of Leerink Swann was one of the best HIT analysts in the financial industry in my opinion, recently doing a ton of work following the stimulus goings-on and setting a contrarian (and accurate) tone in saying it wouldn’t boost the bottom line of vendors until at least next year. I say "was" because the company sent e-mails indicating that a "change in personnel" cause it to drop coverage of HIT companies and his bio page gives a 404 error. I assume he’s gone.

The country’s newly announced and first CIO, Vivek Kundra, booted Microsoft’s office tools in favor of Google Apps when he was CTO of the District of Columbia and said in a Thursday conference call that he wants the government to use more cloud computing.

Brooke Army Medical Center chooses the anesthesia system of DocuSys.

A New Zealand IT healthcare IT executive says governments should provide incentives for clinicians to use IT. Panelists said Australia’s e-health policies are falling behind UK, Northern Ireland, and New Zealand (the US wasn’t mentioned). Suggested initiatives include a SNOMED terminology project, a national provider and citizen health ID, and a user authentication system. Actually, the US was mentioned in lauding the potential of telehealth, with a Hawaii project as the poster child. An Intel healthcare guy said, "I’ll be honest; vendors are sometimes as much to blame for [e-health] challenges as policy makers; there needs to be a shift to [coalitions of] healthcare providers."

Vitalize Consulting Solutions announces its acquisition of 70-consultant r3 Health Partners of Santa Ana, CA, expanding its West Coast capabilities. Vitalize Chairman and CEO Bruce Cerullo dropped no hints that I could detect in my interview with him a few weeks ago.

A Washington hospital’s board approves motions to decline to participate in assisted suicide and to approve a $6 million EMR upgrade. The minutes do not indicate whether the decisions were related.

Thanks and welcome to new Platinum Sponsor 3M, specifically its transcription, dictation, and document and chart management business. Thanks to 3M for supporting HIStalk and its readers. It’s really gratifying that even in tough times, companies still want to support what Inga and I do.

The military’s Tricare system is cross-checking prescriptions for duplicate therapy and drug interactions, alerting the pharmacist to discuss the issue with the patient’s doctor. Also mentioned: a DoD/VA partnership with the FDA to track adverse drug events. The article slips in referring to AHLTA as "Altha," but it’s still interesting.

Jobs: Clinical Pharmacist, Director of Business Systems, EpicCare Ambulatory Consultant, Cerner CoPath Plus Consultant.

A couple of folks have had trouble registering for the HIStalk reception at HIMSS (probably some browser setting-specific Javascript error if I had to guess) so the folks at event sponsor Ingenix added e-mail and telephone options. Problems aside, something like 150 people registered in the first day. It’s RSVP only, so if you want to come, you might want to sign up before we hit the cutoff.

Vince Balsamo of Cisco e-mailed to say that someone either shares his name or used it in posting a recent comment. In any case, it wasn’t him.

I don’t know where expensive conferences are finding enough attendees willing to miss work and spend big money on education, but here are two: the X3 Summit on health design (notice the eye-rolling misspelling of Johns Hopkins as John’s Hopkins, which sounds like a Hopkins owned by a prostitute’s customer) and the HealthCare New Media Marketing Conference (warning: PDF). I know I’m a cynic, but here’s an idea: stay home and try to save your struggling non-profit employer instead of screwing around at conferences that cost thousands of dollars by the time you add in travel cost and missed work. I’m still puzzled that all these 2.0 and new media conferences still require you to travel to some remote site to physically sit in front of a speaker who’s pitching the benefits of online video and connecting with audiences via new media. That’s not exactly living the message.

Interesting: Pennsylvania’s state senate wants to copy an Altoona health clinic that treats patients whose incomes fall between Medicaid and private insurance. The mostly volunteer-staffed clinic treats 3,500 people a year for $207 each vs. the $4,470 it would take to insure them. The idea should appeal to everybody except insurance companies (which is why everybody else likes it) and hospitals, who would somehow have to be paid for rendering inpatient services. I would be surprised if it will scale, though, given the requirement of using volunteer doctors whose supply is finite.

Listening: Trion, symphonic progressive, on Prog.FM via my little Aluratek USB radio gadget. I know prog is pretentious, soulless, and overwrought, but I still like it.

Orthopedic surgeon and Time writer Scott Haig writes a piece critical of government-pushed EMRs. He says hospital-forced CPOE turned a lot of docs off and left them puzzled how to handle orders like "patient may wear her own flannel nightgown" and also made it less obvious how long it would take for a living, breathing nurse would find the order and act on it. "Before we had them on every countertop, computers held such promise for us in medicine: doctors and patients live in a world of painful, pressing questions, the answers might be in there. Or so we thought. Twenty nine years from the night I first sat in a hospital in front of a computer screen the questions persist. And I still don’t see the profit-maximizing, cost-controlling physician with his nationwide computer treating patients any better than the great physicians I’ve known have. With pen and paper, personal commitment to each patient and judgment born of practical experience. None of which I have found in a machine." I’d like his arguments better if they weren’t all about him.

MUSC chooses Horizon Enterprise Revenue Management from McKesson. CIO Frank Clark mentioned that deal when I interviewed him a year ago, so I’m not sure why it took that long to be announced.

Picis announces Picis InSight ED Charge Rules and Picis LYNX E/Point, two products that simplify ED documentation of infusions and injections. They say 15% of ED revenue comes from those items but is often lost because of deficient documentation.

API Healthcare has joined up as an HIStalk Platinum Sponsor. You may have noticed a new name for the #1 time and attendance vendor (seven years’ running) formerly known as api software, inc. (all lower case, so I like the name change since all upper or lower case names drive me nuts, ee cummings included). The name change was announced (warning: PDF) this week to emphasize that, unlike some of its competitors, it will tend to its healthcare customers instead of chasing new ones in other industries. New web site, too. The company was acquired by Francisco Partners in November and brought on J.P. Fingado as president and CEO. He and I have swapped e-mails a few times since about this and that, but it was still a pleasant surprise to have them sign on. I appreciate their support.

The Boston paper’s photo site shows two images (#3 and #12) of the da Vinci robotic surgery system. Reader Andy says, "While not in the typical bailiwick of your IT coverage, it is technology, and it is really cool." Agreed.

Baxa acquires ForHealth Technologies, the Daytona Beach, FL developer of the IntelliFill i.v. and IntelliFlow RX pharmacy robotics and software products.

eHealth Initative founder CEO Janet Marchibroda quits to become chief healthcare officer at IBM, thus neatly closing the loop: pushing hard for stimulus money from an independent non-profit, then cashing in with IBM once Big Blue got a whiff of the green chum in the HIT waters that resulted. I expect we’ll see more of this as companies (especially the big ones) try to beef up their lineups to improve their chances in the ARRA lottery.

A Medicity white paper says that CalRHIO’s Medicity-powered HIE project is "shovel ready", has a sustainable business model, and is ready for rapid expansion.

February’s HIStalk stats: 74,599 visits, 106,055 page views, 3,804 active e-mail subscribers. Not bad for a short month (both are records, in fact). We might hit the two million visit mark by HIMSS.

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From Nurse Chris: “Re: Who invented the hormone patch. Inga, my BFF … you know it had to have been a man who invented the testosterone patch. Heaven forbid they take any personal responsibility for our low libido It must be something wrong with us…” ‘Nuff said.

Google Health introduces a new sharing feature that allows users to invite others to view their health records. The “Share This Profile” enhancement works similar to Picasa or Shutterfly when a user sends you an e-mail link and password to view their photos. Also new from Google: the ability to print a wallet-size listing of your medications and allergies.

After losing $22.5 million in state funding since October, the College of Medicine at the Medical University of South Carolina plans to trim at least $3 million in expenses. Officials plan to consolidate programs and eliminate jobs.

The board of directors of Virtual Radiologic Corporation approves a $5 million re-purchase of common stock. Dr. Sean Casey, the company’s co-founder and chairman, also plans to sell up to 1 million shares to diversify his holdings.

Providence Alaska Medical Center implements Philips VISICU to connect off-site critical care specialists to ICU patients.

Patient Care Technology Systems announces successful implementations at three hospitals. Moses Taylor Hospital (PA), Providence St. Vincent Hospital (OR), and Stafford Hospital Center (VA) all have the Amelior EDTracker software in place.

Pediatric Associates (WA) selects Greenway Medical Technologies for its PrimeSuite EHR solution. The 70-physician group is the country’s largest pediatric practice.

An independent study concludes that Midland Memorial Hospital (TX) has reduced patient deaths, medical errors, and infection rates since implementing Medsphere’s OpenVista EHR.

Christiana Care Health System (DE) selects the financial decision support software suite of MedAssets.

Monroe Clinic (WI) becomes the first site to benefit from the integration of Epic’s Radiant RIS and the AMICAS PACS.

Catholic Healthcare West will test the EverOn patient monitoring technology from Israel-based EarlySense. The EverOn device is a wireless patient supervision system installed underneath the hospital bed mattress. EarlySense just raised $2 million in private placement from shareholders.

7Medical Systems announces it added 11 new contracts in the fourth quarter for 2008. 7Medical provides on-demand PACS, teleradiology, and EMR solutions.

Healthcare data exchange vendor Certify Data Systems hires Jeffrey Rideout, MD as its Chief Strategy Officer. Rideout previously served as chief medical officer at Health Evolution Partners, and as the global leader of the healthcare division at Cisco Systems Internet Business Solutions Group.

An anonymous donor provides an $880,000 grant to establish a Medication Management Research Network at the University at Buffalo’s New York State Center of Excellence in Bioinformatics and Life Sciences. The organization will use electronic medical record data to research how specific health care decisions impact patient outcomes and health care costs.

The 24-bed Eastern Plumas Health Care (CA) goes live on its $750,000 EHR system from Healthland. The local paper reports that it meets “HIPPA” security regulations.

A jury finds a veteran guilty of altering his medical records to collect more benefits. He apparently fixed up his records a bit so that his tonsillectomy and circumcision looked like a heart attack, thus earning him an extra $200,000 in benefits. He now faces 30 years in prison and a $1.5 million fine.

A 35-year longitudinal study finds that kids who had the most friends grew up to be the adults with the most wealth, indicating the same social skills used to build friendships also serve you well in the workplace. Typically our social worlds consist of an inner circle of five core people, an additional layer of 10, then another 135 or so. Based on my social success in junior high, I am stunned I never made the Fortune 500 list of wealthiest people.

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