The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Health Information Exchange Begins at Home
By Ed Marx

To date, I’ve had the privilege of holding three CIO positions. First, for a physician managed services organization. Second, in an academic-based multi-hospital system. And currently, as CIO for a large faith-based community hospital system. In my first C-suite gig, we talked about CHINs, which morphed into talks of RHIOs, while today we discuss HIEs. All of these have had the big, hairy, audacious goal to exchange information on increasing quality and decreasing costs.

Clinical, financial and now federal incentives generate a noble rush to participate. As I dug into details of certain opportunities at current and former organizations, I discovered that neither technology nor the sustainable business model posed the greatest challenges. Instead, the information exchange within the walls of my own institutions verged on nonexistence or lacked vision. We talked at high levels about exchange while knowing full-well we had not yet achieved this nirvana internally. Much work needed to be done at home, and we had to act with purpose to prepare for HIE.

In 1995, at Parkview Episcopal Medical Center, we reached advanced stages of interoperability. First, we implemented strong inpatient clinical systems and practice EMRs. We began sending electronic scripts to the local pharmacies. Participating physicians received a 10 percent discount on their malpractice insurance. We stopped printing and sent all reports to our medical staff electronically. Only after getting our own house in order could we achieve this exchange.

At University Hospitals, our team was awarded the very first NHIN grants. We freely exchanged data with other sites across the country. We exchanged clinical information with our joint-venture hospitals, with federally qualified health centers, and with others. We achieved our increased quality and reduced costs objectives. Our success came after we laid a firm internal foundation and developed our own portal.

At Texas Health, we’ve used a similar approach. Because we had disparate applications early on, we built a portal that essentially mimics an HIE but fits our health system. We exchange externally but on a limited basis. We’re just now completing our overall HIE strategy that might be as simple as plug-and-play going forward. Despite the years of futile conversations regarding data exchange taking place in the region, we would not have been ready without the current portal.

HIE is a critical component of our American health care landscape. It’s the right thing to do. Caution! First look in the mirror and ensure that you’re exchanging data internally before placing your expectations externally. We don’t want to find ourselves saying "do you remember the word HIE," just like we do today with CHIN.

Take action now.

Ed Marx is senior vice president and CIO at Texas Health Resources in Dallas-Fort Worth, TX. Ed encourages your interaction through this blog. (Use the “add a comment” function at the bottom of each post.) You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook, and you can follow him via Twitter – User Name “marxists.”

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From HIPAA Hound: "Re: another example of poor privacy practices. Perhaps more disturbing than the loss of the patient data was that affected patients were not notified of the compromised information for a full 30 days." Link. A laptop belonging to Moses Cone Health System (NC) and containing information on 14,000 patients is stolen from a VHA office in Georgia, which was doing quality analysis of the hospital’s data. The hospital said it regrets waiting a month to let the affected patients, employees, and the public know. The laptop wasn’t encrypted, of course, and the hospital didn’t say why sending the VHA a laptop was the best way to get them data. If anyone can think of ways to screw up that the hospital missed, please let them know. And in a similar story, Southwest Mississippi Regional Medical Center finally comes clean to patients after a PC used by the billing company of its radiology group is stolen — in February.

From Skip Stephenson: "Re: diagnosis code for a tree growing in your lung?" Link. Russian surgeons looking for a suspected lung tumor instead find a fir tree growing in the patient’s lung. Also from Skip: a surgery nurse at Dean Health (WI) is called out of the OR by her manager so she could be laid off. Now those are stories you won’t read elsewhere.

From The PACS Designer: "Re: native virtualization. As we hear more about the virtualization concept in daily media presentations, it appears that still more education is warranted since there are still doubts about its versatility. Sun Microsystems has just released a new open source software version for its VirtualBox. It will give experimenters the ability to apply ‘native virtualization’ to their installed systems using a desktop workstation" Link.

From Just the Beginning: "Re: Google Health. Blasted for data inaccuracy & raises questions about data exchange." Link. I don’t blame Google, at least not entirely. Hospitals are so terrible at capturing and exchanging complete, meaningful patient information that billing data is about as good as you can get (arguably better than nothing). Google’s mistake, if it made one, was either (a) not letting patients know that its information is suspect, or (b) trying to roll out a fully functional PHR knowing that it’s way too early to expect much in the way of available information except what the patient is willing to type in, so then dropping back to claims data to sex it up a little.

From Daryle Lamonica: "Re: eHealth Initiative. Interesting way to recruit a CEO. Saving executive search fees?" eHI e-mails out a notice of its job search, providing a direct link to its site to apply via its law firm.

From TrashTalker: "Re: the incestuous relationship between CIOs and their vendors. Sad but true. When is the healthcare industry going to wake up and kick these self-promoting, mostly non-tech CIOs out?" If you’re a Maslow’s Hierarchy of Needs fan, they are just attending to their basic and safety needs, thinking that buying the big-name products is not only safe, but also a better path to a future job should one be needed. And, buying same-vendor application clusters (all clinical apps, for example) from the same vendor provides that "one number to call" peace of mind even though it drives clinicians crazy to be overridden by a CIO looking out for #1. Every provider I’ve worked for, mostly big ones, encouraged clinician input into product selection, but then ignored it in buying more stuff from the same old underperforming vendor. The predictable result: low utilization ("you asked us what we wanted, we did the research, then you just ignored our recommendation and bought what you originally wanted").

From Hello Kitty: "Re: ACS. Rumor has it that while ACS Healthcare Solutions is announcing the Marin outsourcing deal, they are losing Southwest Washington and Princeton." Unverified.

From Cheezborger: "Re: ‘the power is in the network, not the desktop’. While I agree that there is power in simply getting data online now (e.g. access, potential for analytics, personalization, etc.) we can’t put the chicken before the egg. In other words, how do we think the data is going to get there in the first place? We often seem overly focused on the end effects of the EMR without giving enough respect to the concept of GIGO. If we can’t create an EMR that makes it easy to input and read data, then don’t expect too much from the output. While INTEROPERABILITY is a big buzz word due to this network effect concept, I’d strongly argue that the real key is USABILITY – we need systems that allow for easy interaction (better input of data, better display of data) before we need to worry about how they will share data. Said a simpler way, there is no payoff without use. What was so nice about Dale’s ‘story’ was the incorporation of both these facts — creating easier systems to engender utilization, then using the network effect to make the systems even easier and better to use!"

From Da Bear: "Re: Chicago. Chicago is the greatest convention city in the U.S. My company has also exhibited there annually at RSNA. But for crying out loud, can we settle on a month that is actually nice? RSNA is locked in the Daley Machine’s death grip and can’t move off their post-Thanksgiving date. HIMSS is under no such political obligation. Late May is usually wonderful."

From Bill Kinsella: "Re: Qualcomm video. Like the fake article Lyle sent you, the following Qualcomm (or is it??) video is worth a peek. I don’t know whether this was produced within Qualcomm or by a competitor." Link. "We came up with this idea to implant tiny base stations into thousands of pigeons and have them fly around and form a dynamic network." Pretty funny and very well done. Bill sent the YouTube link, but I found it directly on Qualcomm’s site, so they’re going all viral on us.

Now that we’re back into the usual post-HIMSS routine, we’ll get back to the interviews, HIT Moments, etc. If you know interesting people we should talk to, let me know.

Listening: new from Metric, indie/pop/new wave from Canada. Video here. Kind of a Throwing Muses meets the Pixies sound if you ask me. I like it very much.

University of Florida Physicians posts its Epic outpatient project Web page.

The authors don’t claim a high correlation, but this study suggests that states with strict privacy rules have a lower EMR adoption rate, but that the network effect means each hospital that implements electronic medical records increases the chances of others doing the same. I wouldn’t bet the farm on the privacy correlation since I can’t imagine hospitals sit around worrying about that, but certainly the lemming-like behavior of many hospitals makes the second conclusion reasonable.

New York City’s health department uses drug company marketing techniques, such as memorized pitches and free pens and condoms, to educate doctors on desirable practices.

Eric Fishman, MD (of EHR Scope, EMR Consultant, MCM-Medical Content Macros, and Dragon reseller) is the mastermind behind EHRtv, a wide-ranging series of professionally recorded interviews and tutorials by Dr. Eric himself. I’m enamored with the video quality, the layout, and the idea, especially since I saw him doing interviews for it at HIMSS. He captured some of the HIStalk reception and speeches, not easy since we had low light and iffy audio, and it’s a fun watch. He caught a nice speech there by Todd Cozzens of Picis.

Students from four big-name MBA schools participating in a "war game simulation" last week make interesting predictions: (1) EMR resistance will remain high, but P4P may help; (2) there won’t be enough HIT experts to implement all the EMRs being sold; (3) Allscripts and Epic will use cloud computing to drive down the cost of today’s client-server systems and make them affordable to small medical practices; (4) risky EMR implementations will push small medical practices to band together or merge; (5) Kaiser Permanente will take an active role in setting EMR-related best practices and standards; and (6) McKesson will use its logistics and value chain to increase its provider and payor IT offerings. I’ll say this: all sound reasonable, even when taking the dynamics of the organizations into account.

On HIStalk Practice, we’ve got a couple of docs sharing their thoughts about the HIMSS conference.

Excluding the university president and coaches, all of the 21 people at Ohio State University making more than $500K work for the medical center. The university claims that both the jocks and the docs are paid what the market demands even though the university’s own industry comparisons show it pays above its comparable peers in both categories. Isn’t that kind of admitting that nobody would want to work there if it wasn’t for the money? Seems like a trap hospitals everywhere have gotten into – paying more because they think they have to in order to get competent leaders (meaning: bribe them to leave somewhere else for a bigger paycheck just like when universities raid each other’s coaches). Once you’ve established yourself as a generous John, the best-looking hookers will always want more.

I’ve decided that since my day job title isn’t sufficiently lofty and I can hardly put HIStalk on my resume, I’m just going to start calling myself a thought leader and futurist. Those titles seem to be reserved for those willing to anoint themselves knowing that no approval is required, so I’m going to pad my resume. If anyone calls you to check, vouch for me.

ARRA is drawing companies into healthcare that have had zero interest previously, The Washington Post reports. Named: FreightDesk Technologies (cargo trackers turned Medicare auditors), RollStream (partner interactions), and the usual lame, just-started social networking startups (i.e., Web sites) masquerading as fervent healthcare consumer advocates.

Odd lawsuit: a woman dies a few hours after being sent home from a West Virginia hospital’s ED. Two years later, her husband gets an unsigned letter urging him to call an enclosed telephone number to find out what really happened to her. The ED doctor working that night calls back, saying nurses had killed his wife with an accidental overdose, that he had kept the original chart to prove it, and would testify on the family’s behalf. The doctor then allegedly changes his story, allegedly, telling the family there wasn’t really a medication error but he just wanted to get back at the hospital. In the mean time, the family found that the ED doctor had lost his privileges at another hospital, was not certified in emergency medicine, and had been the subject of review by both the hospital and the ED contract employer for poor care. The family is suing the hospital, the doctor, and the contract ED company.

E-mail me.

HERtalk by Inga

From Fisher of Men: "Re: changes at Sage. I hear Sharon Howard from Sage is no longer there and they have hired a new VP of Sales." Unverified, though we did ask Sage and she’ no longer listed on the Sage Healthcare site. The leadership page says Jason Dvorak, formerly of TeraMedica, joined the company this month as senior VP of sales.

From Prairie Statesman: "Re: Illinois. Sure, the weather wasn’t perfect for HIMSS, but at least our governor wasn’t asking for Illinois to be declared a disaster area." Prairie Statesman sent this link with a copy of the Florida governor’s request for federal assistance following severe storms earlier this month. I responded (I think rather cleverly) that Illinois seems to be recovering from its own disaster area, right in the governor’s office.

HIMSS releases attendance numbers from last week’s conference and the numbers are down only slightly from 2008. An estimated 27,500 attendees traveled to Chicago, compared to the 29,100 participants at last year’s Orlando meeting. HIMSS attributes the drop numbers to general economic conditions and fewer personnel staffing exhibit booths. Based on conversations I have had with various health systems, I would also say many organizations sent a smaller contingent than in past years. Apparently the figures are based on registrations, so it’s quite possible a number of organizations ended up not sending everyone originally registered. Regardless, I’d say the numbers are respectable.

This is undoubtedly one of the gutsiest PR moves I’ve seen in awhile. SRS announces that Valley Oak Orthopaedics (CA) de-installed a CCHIT-certified EMR and replaced it with SRS hybrid EMR. The legacy EMR is not named, but the administrator is quoted as saying, "We chose the SRS hybrid after the existing traditional EMR in our practice drained our productivity and became unusable." Obviously it would be fun to know who is being replaced. Will the unnamed vendor speak up or ignore SRS?

A consumer survey concludes that 55% of us want the ability to talk to our docs via e-mail, 42% want to set up a PHR, and 57% want to schedule appointments and complete other transactions online. I think the e-mail and transaction figures look about right. On the other hand, I question whether 42% of Americans really want to set up AND maintain a PHR every time they go to a doctor, get a test result, or add a new prescription. Not too many people have the time or discipline to keep that up. Great idea whose time has not yet come.

Lehigh Valley Health Network plans to leverage the training resources from Greencastle Consulting to enhance its EMR implementations process for its ambulatory care practices. I believe Lehigh Valley is rolling out GE Centricity.

The India tourism ministry is finalizing a plan that would allow medical tourists to pay for one medical treatment and receive a second, smaller procedure for free. That sounds even better than Nordstrom’s annual shoe sale!

Congrats to Jodi Amendola, CEO of Amendola Communications, for her appointment to the board of directors of The X2 Healthcare Network. Jodi’s company is a healthcare and PR firm and X2HN is a not-for-profit organization of women healthcare executives representing more than 50 companies. I don’t know Jodi, but she clearly must be cool and has the PR thing figured out because she lists the HIStalk Fan Club as one of her important professional social networking organizations.

Perot confirms the elimination of 30 to 40 jobs at its Plano, TX headquarters.

Mark Anderson mentioned the term ICE on HIStalk Practice last month, which was the first time I had heard it. It seems to be catching on since I’ve now heard others use the term. ICE is  an acronym for Integrated Community EHR (wow – an acronym that includes an acronym!) Essentially it’s a patient record produced from an IHE (integrated health network, yet another acronym.) BTW, all these acronyms make me LOL!

A federal judge sentences the former president of Roger Williams Medical Center (RI) to three years in prison for corruptly employing a former state senator to advance the medical center’s interest in the General Assembly. Supposedly Robert A. Urciuoli paid former Rhode Island state senator John Celona $260,000 in consulting fees in return for taking steps to support legislation favorable to Roger Williams and to kill bills deemed unfavorable. In October, Urciuoli was found guilty of 35 counts of mail fraud.

If you are a healthcare informatics specialist, you have one of the hottest jobs right now. According to the president and CEO of the American Medical Informatics Association, the recent passage of the ARRA legislation is creating a need for as many as 70,000 health informaticians.

E-mail Inga.

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The foundation of any high-performing organization is talented, experienced, and motivated staff. Attracting and retaining these staff members requires that the IT organization be seen as a great place to work. Over the years, I have learned that six factors form the foundation of an organization that people want to work for.

1. For any organization to function and for its staff to get work done, it must be organized. Departments must be formed. Processes are needed for making decisions and performing recurring activities such developing applications. People want to work for well-managed organizations.
2. The IT organization must hire well, bringing in the talent, skills, and experience that it needs. If a person turns out to be a less than satisfactory addition to the team, the organization has to handle the situation quickly and with humanity.
3. The IT organization has to help its staff grow and learn. Training and professional growth opportunities are needed and staff must be given time to pursue them.
4. There should be ongoing efforts to improve the work setting. These efforts can range from events such as social functions to tele-work programs to improving space.
5. Organizational problems need to be fixed. Process redesign efforts that streamline requests for new applications. Changes to the organization structure to reduce confusion over accountabilities. At any point in time, the organization is not firing on all cylinders across all functions. Problems need to be assessed and fixed.
6. And finally, a tone must be set. I am not sure that I have a good definition of tone other than it is the climate of the organization. Tone results from the daily actions (or inactions) of IT management and IT staff. It seems to me that the tone of a great IT organization has several characteristics. The actions:

• Inspire and motivate. The work is interesting. We believe that the work is important and we know that each of us is needed if the work is to happen well.
• Exhibit integrity. The actions and words of individuals are true to their values and beliefs. There is little tolerance for dishonesty and “games.”
• Demonstrate courage. There is a willingness to make hard decisions and stand by them. There is a realization that you may personally have to absorb the blame and anger of others.
• Show caring. We reach out to those who need personal or professional help. Disagreements and debates avoid personal attacks. We take the time to give someone a heads-up.
• Are demanding, but tolerant. The organization sets high standards for the work that it does. However, it recognizes that even the best people screw it up from time to time (sometimes in very big ways) and the organization does not eviscerate those who make mistakes.
• Exhibit accessibility. Those who need us can get to us. One may or may not be able to help or help right away, but one is not sitting behind a moat.
• Are comfortable with personal limitations. All of us have strengths and weaknesses. It is important to know yourself and be comfortable with the fact that, in some ways, you are limited. And it is a sign of personal and management strength to surround yourself with colleagues who have the strengths that you do not.
• Being a great place to work is important. While making sure that the necessary factors are in place is a key responsibility of IT leadership, this responsibility is shared by everyone in the organization.

Of all of the factors, tone is the most important. If the tone is a good one, the climate will exist that enables all of the other factors to happen well. And tone is set by everyone.

Making sure that the IT organization is a great place to work is something that each of us does every day.

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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From Ben Mehling: "Re: open source. I can state emphatically that Medsphere is ‘truly open source’. This fact is easily verifiable with a quick visit to http://medsphere.org where anyone can download copies of our software and use them within the provisions of OSI (http://opensource.org/) and FSF (http://www.fsf.org/) approved licenses under which we release software. Medsphere.org is also our community’s central hub for discussion, support and development activities — anyone interested in open source and healthcare is welcome. We’re happy to discuss this with anyone that still has concerns, either publicly or privately." Ben is director of advanced technology at Medsphere.

From MiamiRocksters: "Re: Satyam. Looks like IBM is still in the running." The company will be sold off by the end of the month, with bids due Monday. IBM said it was pulling out because of Satyam’s exposure to US class action lawsuits for accounting fraud, but I bet they’re still in the hunt (building the net present value of the lawsuit risk into the offering price, of course). Two Indian companies have been bandied about as front runners to buy Satyam, but Cognizant, HP, and CSC are also said to be interested. And why not? The accounting scandal was limited to a few hands and the business should still be sound, at least once the bad PR can be soothed. The Pricewaterhousecoopers auditors are still in jail, as should be whomever thought up that ridiculous company name.

From Kenneth Parcell: "Re: HIMSS. It was OK. The traffic seemed lighter, but the transportation was reliable and convenient. My only beef was that the shuttle service to the airport took over one hour. Chicago is a wonderful city and I would definitely enjoy it if HIMSS decided to return. Most interesting technology was Google’s PHR suppository repository. Wish I had a picture, but it looks like a little white capsule with Google written on the side. I assume it is placed in the appropriate orifice where it seeks all health information from the source. When finished, the collected data is linked to your PHR and you can Google search clinical information about yourself, such as ‘Find abnormal growths’ and ‘Am I getting enough fiber?’ Not sure why I saw others rubbing the repository on their lips … perhaps they were salesmen and were confused about where to stick it." So far, the poll to your right is running 2:1 for a Chicago return.

From Being John Doe: "Re: Cerner’s answer to HIMSS?" Link. It’s a Cerner YouTube video about its Second Life world or whatever the fantasy-nerds call it. I have to think all those companies that hired hipsters to create Second Life sites are regretting that decision. I didn’t see or hear Second Life mentioned even once during the entire HIMSS conference.

A New York Times article profiles the use of an EMR (from e-MDs) of a rural doctor, who summarizes as follows: "I’ll never go back to the old system. I can always look at the records by Internet, whether I am seeing patients at the nursing home or a clinic or the hospital, or even when I’m as far away as Florida. The change has been tremendously beneficial for my productivity.” This is what I’ve been saying here for years: the main value of electronic records is being able to review and create electronic data from anywhere. Just getting data into an electronic form is where the payoff lives. I’ve argued that HITECH should have rewarded providers for sharing data on a national framework such as NHIN, paying them per patient (or, even better, per record type). Using technology is one form of "meaningful use," but making data available to other providers is more so. The power is in the network, not the desktop.

And in that regard, Dale Sanders, CIO of Northwestern Medical Faculty Foundation (thanks to Dr. Lyle for the link) might change your EMR perception with his phony news article about an EMR created by Amazon.com. It’s a deceptively simple and light-hearted piece, but think about what he’s saying about software personalization, analytics, architecture, and social networking, a contrast of pre-Internet EMRs to what could be given what we know today.

C-Span has video coverage of a White House discussion on healthcare reform led by Nancy-Ann DeParle this past Wednesday. She seems fun.

The AMICAS-Emageon headcount reduction, according to one very informed source, is over 100.

Global nonprofit IntraHealth International launches IntraHealth Open, offering free downloads of celebrity remixes of "Wake Up (It’s Africa Calling)" and accepting donations to support open health software solutions for the developing world.

CCHIT musings: everybody wants CCHIT to "certify" EMRs on everything from usability to the financial stability of the vendor. Is that really necessary? Stimulus payments will be tied to using a product certified by CCHIT (or some other group), so it doesn’t make sense for users of already-certified systems to lose money because their vendor can’t meet new usability standards (even though that provider is actually using the product without complaint). CCHIT was formed to evaluate interoperability and reduce physician risk, back when its certification had little impact on the income of either vendors or providers. We need to be careful about wanting CCHIT to turn into KLAS, churning out a "Top X" ranking instead of certifying minimum requirements and letting the market decide which vendor is doing all the non-essential stuff better. Surely doctors are smart enough to buy wisely.

Ivo Nelson e-mailed to say his ongoing pub event HIMSS was so popular that Encore might do it next year in Atlanta. That’s the home base of the Fado’s chain, about which he mentioned that his deal with a more authentic Chicago pub fell through at the last minute because it decided to close for the weekend (hey, if they’ve got Guinness and a green flag or two, who cares?) I’m also interested in ideas for the HIStalk bash there, assuming I can get sponsors and all that. I have thoughts on just about everything except location since I don’t know Atlanta very well.

A note to all you supposedly expert media people covering Dennis Quaid’s speech: please stop capitalizing heparin. It’s a generic name, not a brand name. Thank you.

Some open source people believe they saw the beginning of mainstreaming of open source at the HIMSS conference. I don’t see that happening. Reason: hospital CIOs were raised under the influence of application vendors, often have worked for them in the past, and even more often hoping to work for them in the future, and overseeing Epic or Cerner shops is a resume builder. CIOs, like the hospitals they work for, don’t like to be the first in their area or size range to do something different. Most importantly, healthcare is driven by special interests, lobbyists, vendor people volunteering for influential committees, and job-creating potential. Open source doesn’t have any of those (not to mention a non-government track record). Even the VA seems to be itching to dump VistA in favor of commercial products (again, rightly or wrongly). When you talk about hospitals using open source, that’s mostly VistA, which would be fantastically lucky to get 1% market penetration. Not a rosy opinion, I know, but I promise to update it when any open source clinician application hits 50 hospital clients. If hospitals aren’t interested even when starved for capital as they are today, they never will be.

Since the President is promising everything to everybody and printing whatever amount of current those promises require, he goes ahead and adds "give all veterans a new electronic medical records system" to his Santa list.

New York offers $60 million in financing for HIT projects, this time targeted to medical home applications.

I see the e-mail update signups have been going like gangbusters, so that box to your upper right is calling your name, at least if you want to be among the first to know important stuff. Inga pores over the stats like a CPA, so it makes her happy.

Odd lawsuit: the patient of a plastic surgeon who claims her face-lift surgery was botched has posted an ongoing stream of nasty comments and videos all over the Web, blaming the doctor. He sued her for defamation for doing so and then, according to the patient, called the mental health department claiming she had e-mailed him saying that she planned to commit suicide live on the Internet, getting her Baker Acted. The doctor says she is psychotic and hurting business for his $5,999 Tax Time Special breast augmentation surgery. Here is her site, with a ton of documentation (seems convincing to me, but I’m not taking sides because both parties sound litigious).

The Conficker worm hits University of Utah’s health sciences schools and its hospitals.

Harris Corp. gets a $14 million, one-year contract to provide an imaging system for 65 DoD hospitals, announced at HIMSS. Also announced: Harris donated $10,000 to the Wounded Warrior Project.

E-mail me.

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From Big Bird: "Re: AMICAS. They are closing the former Emageon headquarters in Birmingham. Many layoffs announced today."
 
From Leo Sayers Fro: "Re: I enjoyed Chicago much more than Orlando or Atlanta. Thoughts: (1) is Fourth Hanson Brother really saying that Linux has less capacity, is older technology, creates more pollution, and appeals only to hippies who are kidding themselves? Lots of enterprises employ Linux, although they do use some middleman like Red Hat. Lots of people say that Cache is older (and complain about old technology), but InterSystems is successfully supporting a lot of enterprises across industries in this big world. Old technology is not necessarily bad technology. Maybe Medsphere is the way to go given a lack of access to capital and given that lots and lots of residents like their VistA system. I would have a better idea if the VA and DOD were on the same page (and is there still a question about Medsphere truly being an open source participant?) (2) EMRAM Stage 7. Just how many Stage 7 users really use a unified medical vocabulary underlying their clinical documentation, thereby presumably allowing for meaningful analysis (and comparison) of clinical documentation? How many use LOINC for results, not only for clinical laboratory, but waveforms and imaging? How many fully leverage SNOMED? And how can you really determine efficacy if you really can’t evaluate outcomes fully? Are their cancer registries fully linked to their EHRs and data warehouses or their pathology reporting systems? And to think: a common medical vocabulary is a Level 2 requirement!"

From Vendman: "Re: GetWellNetwork. Johnson and Johnson to invest $25 million for a substantial ownership position." I asked Michael O’Neil, founder and CEO, and he says that’s not exactly true. J&J’s development corporation invested $10 million in the company in January, reported here, and has high expectations of its impact on healthcare. That’s it so far, although the companies continue to share ideas and discuss projects. Michael did mention that GetWellNetwork recently expanded its relationship with Catholic Health Initiative and added new accounts with Norton Healthcare and an Adventist hospital.

From The PACS Designer: "Re: ETIAM CD-in. When patients are at the ER with CD’s or DVDs from previous episodes of care, it is never easy to import the image files. Now, ETIAM has a new version of their CD-in solution with enhancements that make it much easier to do the importing of other institutions’ image files into your PACS archive." Link.

From Mark: "Re: CPOE – A New Conceptual Model. Physicians use the iPhone to dictate orders and approve the transcribed order; view clinical results; and dictate reports. Say ‘Potassium Replacement Protocol’, press Send, receive a text alert with HIPAA-compliant link, click on the link to review order, select Approve. Orders flow to appropriate systems and personnel. Fast, simple, and easy." Link to presentation. 

From Dodele: "Re: EMRAM Stage 7 all being Epic. Sounds great, but I believe there are only two that qualify as Stage 7. Still, kudos to Epic for having a system capable of getting them there." Correct: two organizations (KP and NorthShore) with 15 hospitals (12 and three, respectively). It still makes a killer ad for Epic.

From HIMSS Party Dude: "Re: HIMSS parties. Perot Systems and Dell get high marks, but the one that seemed to be most accommodating was Ivo Nelson’s Encore Pub Night at Fado’s. EVERY NIGHT he hosted folks at the pub to free adult beverages. I’m gonna guess that over 300 people were there on Monday night. Great concept – free beer, free food, come and leave when you want – EVERY NIGHT of HIMSS. Simple. And blue jeans are a welcome alternative to my stuffy suit." Sounds nice, at least if you like chain, Atlanta-based fake Irish pubs (and I’m not saying I don’t). Did you know there’s an entire company that builds fake Irish pubs in this country and others? We’ve probably got more Irish pubs than Ireland.

My only real meal in Chicago was here and it was outstanding (and this beer was mild but amazing).

IBM says China’s healthcare reform will create the need for at least $1.5 billion in software.

Medsphere, Midland Memorial Hospital, and David Whiles get some BusinessWeek love.

Listening: Carolina Liar, pop-rock MTV darlings from Sweden (despite the name). Also: obscure Philly hard rockers Automatic Black.

New poll to your right: if you went to HIMSS, would you like to see the conference return to Chicago at some point?

I’m still getting used to being home from HIMSS. Mrs. HIStalk opened the door for me this morning and I tipped her $1.

It was funny to hear several times at HIMSS and at the reception (Todd Cozzens asked for a show of hands) that many people jump on to HIStalk first thing in the morning or sit by the PC at the time they know I usually post. I don’t know what they’re doing (scooping the competition? hoping not to find their names mentioned?) but that’s pretty funny.

Premise, now part of Eclipsys, earns the Outstanding Portfolio Company award from Connecticut Innovations.

Heard at HIMSS and elsewhere, when some pompous ass was asked where he works: "Oh, I work for this little outfit you might have heard of called Oracle." Nobody should have so little self-identity that they can’t come up with something to crow about except who pays them. I heard it again from someone from a snotty university guy.

A reader asked if I’m convinced that it will be CCHIT alone doing the government’s EHR certification going forward. I am, given its clout, connections, head start, and performance. Anyone else feel differently? I know a different group could theoretically be named, but I don’t see that happening.

The Robert Wood Johnson Foundation announces a call for proposals due June 3 for $2.4 million in grants for Project HealthDesign: Rethinking the Power and Potential of Personal Health Records. Up to five teams will be funded for 24-month demonstration projects for up to $480K each. The topic is how Observations of Daily Life (diet, exercise, sleep, pain, etc.) can be used to infer how patients feel and therefore modify their treatments. I had a great idea for offshore call center operators to call patients and ask how they’re doing, but all Americans ever say is "fine."

GE Healthcare announces its Digital Day One program, a service to get Centricity Enterprise implemented in a year or less.

MEDSEEK will integrate 3M’s CDR and vocabulary capabilities into its community portal, providing comprehensive interoperability.

A new JAMA study finds that Leapfrog Group’s safe practices (CPOE, intensivists, evidence-based surgery referrals) are not predictive for patient mortality. "The results of this study support the concerns expressed by physician groups who have discouraged public use of quality measures that have not been fully validated." Leapfrog cranks out a press release (warning: PDF) questioning the number of hospitals surveyed and citing a study with different conclusions, but admits that process improvements don’t always provide better outcomes.

Incoming national coordinator David Blumenthal says that his office needs to tighten the EHR certification process to include usability and their capabilities to support HITECH’s quality and cost goals.

Jobs: Inside Sales Executive, Sunrise Clinical Manager Consultant, Business Development Executive.

Shared Health will make its HIE technologies available to hospitals in some way, but the press release is so self-congratulatory it never really says how (that I can tell, anyway). I was looking for "free" and didn’t see that.

IBA is looking for US distributors for its iSoft Lorenzo Health Studio, hinting that the Australian company would like to get some stimulus handouts like everyone else.

IntraNexus will remarket Mediware’s Ascend pharmacy system to round out its Sapphire HIS. Ascend was the system sold by Hann’s On Software, the California company Mediware bought in November.

Yale-New Haven’s CEO breaks the $2 million compensation mark in 2008.

Odd lawsuit: A Toronto weight loss surgeon who already lost his medical license after sexual abuse claims now faces a $12 million class action lawsuit along with the hospital that employed him. He pleaded no contest to sexual abuse that included a twin sisters on which he had performed bariatric surgery, reportedly telling them that it was every man’s dream to have sex with twins, which he did in his office along with using illicit drugs he told one of them to buy.

E-mail Mr. HIStalk.

HERtalk by Inga

From Dr. G: "Re: HIMSS/Ingenix reception. Thanks for the invite. Boy, you’ve really become the ‘Fantasy Girl,’ at least with Jonathan Bush!" Even though Jonathan’s comments weren’t exactly politically correct, I must admit I enjoyed being called "luscious".

From Smaller Vendor: "Re: HIMSS impressions. The show was okay – it was really more to meet with other vendors. The most exciting booth I saw at HIMSS was … not there. I was very pleased to see the many infrastructure offerings finally bringing true connectivity (Capsule, among others). The Microsoft booth — folks raved to me about the table demos — left me ho-hum (it was really just a new table-based display). As pretty as it was, it was in reality expensive and not high enough resolution."

From Spice Guy: "Re: reception. That was an interesting night! Was talking with Matthew Holt when ‘Shhhh Inga’ (Deborah Peel) came up. Interesting to eavesdrop on their interaction!" Matt Holt, who was wearing a "Inga 2.0" sash, had the opportunity to chat with Deborah Peel (adorned in a "Shhh, I’m Inga" sash.) Suffice it to say that Matt and Dr. Peel don’t see eye to eye on all matters of privacy, though both were perfect guests.

From C-Note: "Re: Ingenix reception. I spent most of the reception going around and accusing people of being Inga, all of whom were honored at the accusation and resulted in great conversation. One person even watched me carefully as I walked by, then as he got to the ‘toe’ part of his head-to-toe scan of me, he started shaking his head. As I made eye contact with him he grinned real big and said, ‘Nope, you’re not Inga – I can tell by the shoes.’"

I’m recovering from my post-HIMSS fatigue, wondering if my feet will ever return to their original non-puffy form. All in all, I thought the meeting was great: tons of informative topics, good speakers, and a fun city. I loved catching up with old friends, chatting with new folks, and spying on our sponsors’ booths. The HIStalk/Ingenix party was in a gorgeous location atop the Trump Tower and everyone seemed to be having a great time. I got invites to a couple of vendor parties and each was very well done in its own way.

Only complaints: I hate cold. I really hated having to pay $3 each day to check my coat. Wish the shuttle buses ran more frequently. Don’t understand why it has to cost at least $14 to get lunch at a convention center. I’d have liked a few more "surf the net" stations since I chose not to lug my laptop around (the iPhone is great for checking e-mail, but not writing anything of length.)

Probably not worth complaining about, but I didn’t win this cool scooter that a magazine was giving away.

Sunday morning, the Olympic International Committee toured the convention center. Everywhere you looked you saw dancing dragons, wrestlers, and tumblers. Also, these two adorable girls in Native American dress.

I spent a fair amount of time waiting for Starbucks coffee the last few days (not exactly a complaint since I did make a conscious choice to stand in the long lines.) I actually enjoyed the opportunity it gave me to talk with strangers about their HIMSS experience. One IT manager told me his large health system typically brings 30 or so people every, year but this year the employer only sent the five who had speaking engagements.

This year’s buzz words: stimulus, ARRA, meaningful use, and interoperability. The "also-ran" words were iPhone and mobility. In the mix you heard discussion about CCHIT and whether or not they provided the de-facto standard. According to CCHIT and all CCHIT-certified vendors, CCHIT is the inevitable standard. If you had a document management-only system or some sort of EMR-lite offering, you stressed the necessity of your offering to get ramped up. A reader shared that the CEO of a large CCHIT-certified vendor told an audience to expect only five major players to remain after everything shakes out.

I tried to check out as many of the smaller vendors as possible and MedKey PHR Systems caught my eye. I’ve said before that I don’t believe the public is ready to take the time to set up a PHR. However, if you are chronically ill, for example, I liked how this technology looked. The device is a portable and wireless PHR that can be worn like a medical bracelet or be on an insurance ID card or on a key chain. It is supposedly "completely" secure and password protected. Data can be synched with the integrated USB port, or wirelessly. I suppose if a big insurance company pushed the technology, the design is convenient enough that I think people would wear/carry it. Although there is still the question of who is going to input the clinical data.

eClinicalWorks and Sam’s Club release details of their new EMR program, which is targeted for the one- to three-provider space. Check out the Sam’s Web site to see of what is included in the offering.

Greenway Medical Technologies announces a strategic deal with Detroit Medical Center to provide PrimeSuite EHR to physicians across Detroit Medical’s nine hospital network.

Streamline Health Solutions reports a net loss of $146K for the fourth quarter and $1.4 million loss for the year. The company posted a net loss of $736K in 2007.

The Texas Senate is considering raising taxes on chewing tobacco and using the funds to help doctors pay off student loans. New physicians could be reimbursed as much as $160,000 for agreeing to work at least four years in under-served areas.

The University School of Community Medicine and IBM plan to build a primary-care medical home pilot project that connects clinical data between the medical school, 325 physicians, and other area care-givers.

Sprint Nextel and GE Heatlhcare sign a multi-million contract with Methodist Healthcare (TX) for a complete wireless infrastructure across its six sites. The setup includes integration with GE’s Carescape Enterprise Access.

My feet are recovering nicely, thanks to my new slippers from Chipsoft. As I was unpacking, I also found some a frosted Oreo, courtesy of HealthPort. Yummy. Next week, back to reality.

E-mail Inga.

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