An HIT Moment with ... is a quick interview with someone we find interesting. Judy Kirby is president of Kirby Partners of Altamonte Springs, FL (formerly Snelling Executive Search).

How would you characterize the healthcare IT job market and how do you it see changing over the next 1-2 years?

The healthcare IT job market is different than I have ever seen. I entered healthcare IT recruiting during the recession of 1992 and have witnessed its peaks and valleys. With the current economic crisis this country is experiencing, healthcare seems to be relatively stable, compared to other industries such as finance or automotive.

That being said, healthcare organizations have investments that have diminished and are struggling with shrinking reimbursement rates. According to Thompson Reuters, the median profit margin of U.S. hospitals has fallen to zero percent. There is a lot of financial pressure on hospitals and nearly half are operating in the red. Many see hope in the stimulus money that will be available for electronic health records. Right now, there is caution and uncertainty in most organizations. They have needs in their IT departments, but are being very, very cautious in hiring and we have seen the hiring time increase.

If the stimulus money for EHRs has the effect that some like Dave Garets from HIMSS Analytics predicts, there will be a shortage of implementation talent in the future. But that being said, as always, there will be positions that are “hot” and those skills that will be in abundance. Two years ago, we encountered many senior healthcare IT managers and CIOs who were approaching retirement age. They are now saying they will remain in the workforce longer and postpone retirement due to their dismal retirement portfolio performance. Healthcare IT positions, especially higher level positions, that were to open by the retirement of baby boomers will open up later rather than sooner.

There is good news, however. We recently did a survey of healthcare CIOs that showed 31% expect their organization’s IT departments will grow in the next year. 50% said their department numbers would remain the same, and only 19% predicted a decrease in their department staff levels. The survey also indicated that 39% of the respondent’s IT departments are currently actively hiring, 6% will hire in the next three months, and 4% will hire in the next 3-6 months. There are always numerous opportunities out there no matter what the current economic conditions.

The biggest effect the economy has had on our business is the number of possible candidates for positions who cannot relocate because they are upside down in their current homes or live in such a down real estate market that they can not sell their home.

You might think a firm such as ours would have experienced a downturn in the current economy. Just the opposite is true. We are as busy now as we were three years ago. 

What advice would you have for employees to both keep their current jobs and prepare for their next one just in case?

We actually are presenting at HIMSS on this same topic, “Know when to hold them and know when to fold them”, with Jon Manis, CIO of Sutter Health System. The advice for keeping your job is the same for preparing for your next move up on the rungs in your career ladder – you have to be invaluable to your organization and not just taking up space. We have heard from many CIOs they are using this recession as a way to “clean house”, so to speak. All things being equal, they will keep the employees who are doing the best job and have the best attitude. You can train skill sets, but you cannot train attitude, enthusiasm, or a desire to be successful. Those are the traits you need to exhibit.

This is also the time to update your resume. Do it before you are in need of a new position. Don’t list what you have done, but describe what you have actually accomplished in your position. It is much easier to keep track of these accomplishments on a regular basis rather than having to go back and try to remember after the fact. Quantify your results as much as possible. Plus, when having conversations with your boss, it is always nice to be able to talk about your successes.

How is the role of the CIO changing? What should CIOs be doing now?

The CIO role has really changed over the years from a “bits and bytes” individual to a true C-level leader. John Glaser, CIO of Partners HealthCare, and I did a presentation at the CHIME Fall Forum on this very topic entitled “Where are we going? Evolution of the CIO”. Put succinctly, the CIO has to be a true leader, just like any other C level position in the organization. It goes beyond just keeping the systems up and running. That is part of it and a crucial part that can get a CIO fired. But, the role is starting to go way beyond that as CIOs acquire additional departments and different responsibilities.

The CIO of today and tomorrow needs to be reaching out within their organization. They need to learn what leadership “looks like” and become more involved in working on business issues and contribute more than technology. They need to work with colleagues as peers and focus on understanding them and solving their problems. They need to fill domain knowledge gaps and skill gaps. And as we already stated, they never need to rest on their laurels, but focus on future accomplishments and how those accomplishments benefit their organization.

Management of a healthcare IT department requires the same skills as management of any other department. As more and more in the hospital domain becomes “application driven”, CIOs will shoulder more and more responsibilities. We have heard several CIOs mention recently that they have picked up oversight for other departments – even departments such as HR or marketing. You need to know your limitations, and know when and where to find true specialists to handle things you cannot. 

What will the effect of the stimulus package be on the job market?

It will be interesting to see just how the stimulus money does affect the job market. As you reported recently, Wal-Mart is entering the EHR market, and others will jump on the bandwagon to get those funds. The money will have some positive impact on those with strong implementation knowledge and for those in consulting. What the real impact of the stimulus package is will be difficult to predict until all the rules and regulations are ironed out. Any time the government is involved, your guess is as good as mine, but I do see it as a positive for those in healthcare IT.

We have talked with healthcare IT organizations that are already looking ahead to the stimulus monies and planning for the talent they need to embark on the projects that will attract these dollars. 

What kinds of roles and training are available for clinicians who want to get more involved with IT and informatics?

The roles are many and varied, depending on the clinical background. With EHR, lab, radiology, pharmacy, and informatics, depending on the background, there are lots of opportunities for the clinician who wants to be involved in technology. These include everything from a CMIO to nursing informaticist to builder and implementer. The individual needs to look at where they would like their career to take them long term, and then decide the best route to reach that career goal.

We are seeing more physicians and nurses in the CIO role. We are seeing a new position, CNIO (Chief Nursing Information Officer) develop in larger organizations. Consulting firms and vendors are utilizing these skill sets in their business models. As far as training, there are numerous masters’ programs out there and they provide a good education. If at all possible, while pursuing book learning, try to balance that out with hands-on experience. The two paired make a much better skill set than just a degree and no real technical experience. The employment world is a competitive place: degrees, experience, certifications, and a broad range of experiences do make a huge difference in how fast and how far you can move up the career ladder.

On a side note, we would like to mention we will have a name change this month from Snelling Executive Search to Kirby Partners. We feel this name will not create confusion as Snelling has. There are other Snelling personnel offices out there that focus strictly on administrative and temporary employment. Our people remain the same, and our niche remains the same. All we do is healthcare IT recruitment.

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From Evil Knavel: "Re: HIMSS. Do you get special treatment from companies at HIMSS, especially sponsors like athenahealth that seem to get a lot of PR? It seems like it." Guess you missed the part about eating burgers in the hotel and at McDonalds. Only one sponsor knows who I am, so the answer is absolutely not. I am an anonymous peon at the conference, so I’m seeing it just like everyone else (intentionally – I don’t want favors, but yes, I’m sure I could milk the heck out of it if that interested me). In fact, anybody with CIO in their title is going to get treated a lot better than me since they have their own off-limits meetings, vendor giveaways, and fancy event invitations that I don’t get (disclosure: I went to the Cerner CIO event as an anonymous guest of someone, which was cool to a day-jobber like me). FYI, athenahealth is not a sponsor (and disclosure there: they don’t do much marketing, but decided to be an HIStalk sponsor about a year ago just to be nice. I turned them down because that was right after the HISsies and it would have looked suspicious, which we both agreed was the right decision).

From Christi: "Re: reception. I’m ever so grateful to Ingenix for hosting the party. The Trump Towers staff was over the top on customer service – every single staff person was incredible! When I’d ask for directions to something they’d not only tell me where it was, they’d walk me all or part way to it! And the ballroom we were in was gorgeous. What a lovely site and lovely party – thanks for being so cool as to have someone who wants to throw money into doing this." Thanks to Tom for sending over the pictures.

That’s it for me – I’ll be heading home first thing Wednesday morning. I saw quite a few people with suitcases in the hotel lobby today, so I’ll guess that the exodus already started. That astronaut doing the closing keynote tomorrow afternoon may have had more people in his Mir space station than will be in the audience.

My verdict on the conference: nicely done. I actually didn’t mind the weather as much as I thought, but the Saturday start in April really threw me off. The logistics were as good as ever and Chicago and the convention center were fine. My only remaining gripe the cost of hotels. I really wish I had bypassed the Ambassador people and just used Priceline since I paid too much, but couldn’t cancel and re-book without a penalty. 

My favorite giveaway (other than the foam slippers): the tee shirt above from Solution Q, vendors of the Eclipse project portfolio management system. It’s not new humor, but I hadn’t heard it in a while and never from a tee shirt.

VC firm Psilos Group will raise a $450 million healthcare IT fund.

It’s probably just as well that Cerner opted to stay out of town this week since an ugly PR episode might have resulted. This article says that four Chicago mental health centers closed today as a result of billing glitches in the Chicago Department of Public Health’s Cerner system caused it to lose more than $1 million in state funding when bills backed up for over six months.

Someone asked me about ARRA and innovation. They are mutually exclusive terms. ARRA was designed to dump a lot of taxpayer dollars into private hands quickly and forcefully, yet it requires CCHIT-certified products that would take years to develop from scratch. For that reason, it will just boost sales of the same old stuff. If anything, it stifles innovation because all the prospects who might have decided to sit tight and hope for better products will have to spend sooner to get their cut. The most valuable asset any company can have right now is a CCHIT certification, whose value went up multiples with ARRA.

I was chatting with someone earlier this week and he said he hated Citrix. I made my usual comment that it’s like a Denny’s restaurant – always a compromise from what you really wanted. His theory is that the availability of Citrix allowed old, primitive applications live on, providing another layer of workaround that gave vendors an easy out for bad system performance, difficult maintenance, poor security, and lack of a true thin client or Web strategy. The healthcare-only combo of Citrix-MUMPS-Cache is everywhere, of course, and there’s no customer indignation to replace it because it works.

Some guys talking on the escalator this morning said that Rob Kolodner got a standing ovation in his final HIMSS appearance as ONCHIT (and deservedly so). I would be shocked if he isn’t in Atlanta next year, but in the booth of a consulting firm or vendor instead. He confirmed that he’s retiring, but looking for other opportunities. By all accounts I heard, he’s a good guy, humble and fun.

I want to get the autograph of Gay Madden, CIO of The Hospice of the Florida Suncoast, since she’s on the shuttle bus TV every morning (in a Sprint commercial, I think).

I went to a session this morning on digital pathology that was pretty cool. It’s interesting that systems exist to convert slides to massive images that can then be manipulated and studied in a cockpit of monitors rather than through a microscope. The speaker said his company had licensed satellite image processing technology since it works about the same on the cellular landscape as it does the terrestrial one.

UPMC chooses chooses the clinical research management system from mdlogix (the annoying all-lowercase name is their doing, not mine).

Ingenix announces its Care Tracker EMR, priced at $5,000 per year for a solo practitioner. Also announced: RAC software and services that help hospitals comply with the Medicare Recovery Audit Contractor (RAC) program by providing alerts of claims likely to be audited.

Someone told me of an overhead conversation this week in which national drug chain VP said his company hoped to cobble together a simple EMR (enough to claim minimal use) just to get stimulus money.

Jonathan Bush was on FoxBusiness this morning after a late night at the Trump (I don’t know how he does it). The site doesn’t support a direct link, but you can search on athenahealth and look for today’s video. The host opens with a HISsies mention, although not by name: "Jonathan was honored last night as the industry’s figure of the year in healthcare technology." He talks about HIMSS and HIT. The company also announced that its eRX module has received Surescripts certification.

Someone mentioned that it’s ironic that Sun is pitching its NHIN capabilities even as its IBM acquisition went up in smoke, implying that maybe it’s not stable enough to hang the NHIN hat on.

A HIMSS location name that sounds like 1999: "Surf the Net".

The digital pathology session talked about IT as a barrier because of locked down PCs. That reminded me of editorials I’ve written lambasting the lazy IT socialism of treating all users equally (badly) in assuming they are all too stupid and irresponsible to have any control over their PCs. Their ought to be a way to gain responsibility points based on need and ability, allowing higher level users with a defined need to perform simple software installations or OS changes.

Seen on Epic’s booth: every EMRAM Stage 7 hospital uses EpicCare. For a company that says it doesn’t market, that sure kicks the competition where it hurts.

I took a look at iMedica’s new/not new Transition product. It’s the existing product with the knowledge base turned off at a 20% discount, giving an easier and cheaper start. If you want the knowledge base later, you just pay the difference.

The last of the booth observations:

• iMDsoft has a Visicu-like ICU monitoring. I tried to learn more, but the reps were too enamored with each other’s company to want any of mine.
• Corepoint Health (the former Neotool) had a nice booth and seems to have grown considerably in capability and ambition.
• iSoft was demonstrating Lorenzo, which isn’t sold in the US. One rep was, anyway. The others were sitting on the demo station stools playing around with their cell phones.
• AT&T/Cisco Telepresence had a conference room setup in the booth with the big monitors in place, which actually looks like have a conference room since the one side of the table is for virtual participants.
• Medicity had a good crowd.
• I chatted briefly with the ICA person, who explained the company’s CDR and clinical portal that can also be used as an in-house clinical workstation to add capability to existing systems.
• I checked out Bistro HIMSS: $23 (including tax and drink) gets you a paper plate on which to load up pedestrian-looking heat lamp Chinese.
• I miss the blue nametags that distinguished vendors from providers, but that was in a simpler, black and white HIMSS world.
• PatientKeeper had a big rack of smart phones and PDAs running their software to show its versatility.
• I don’t know much about Orchard Software, which had some KLAS information on a booth sign that suggested it’s the highest rated lab system. I’d tell more, but nobody there was paying much attention to my eye-catching glances.
• eClinicalWorks had a bunch of people in the booth.
• There was a good crowd at the Sentry Data Systems booth.
• EDIMS had a nice booth and crowd. Apparently they have a EDIS Lite kind of system with knowledge management, but nobody made an effort to talk to me.

I apologize if you e-mailed an invitation for me or Inga to visit your booth or meet you personally and it didn’t happen. We stayed very busy getting information to write each day’s HIStalk, so we ran out of time.

HISsies 2009 Winners

It’s time now to announce the winners of the 2009 HISsies, the Brutally Honest HIT Awards, as voted by the readers of HIStalk. We don’t claim the results are scientific, but they are always interesting.

• Smartest vendor strategic move: Medicity-Novo Innovations merger.
• Stupidest vendor strategic move: GE Healthcare losing unsatisfied clients.
• Worst healthcare IT vendor: GE Healthcare.
• Best healthcare IT vendor: Picis.
• Best provider healthcare IT organization: Cleveland Clinic.
• Hospital you’d want to go to if facing a life-threatening illness: Mayo Clinic.
• Most promising technology development: Software as a Service.
• Organization you’d most like to work for: Picis.
• Company in which you’d most like to be given $100,000 in stock options: Picis.
• Most overrated technology: speech recognition.
• Biggest healthcare IT related news story of the year: Obama’s position on healthcare IT.
• Most overused buzzword: interoperability.
• “When _(blank)___ talks, people listen,” the person who influences healthcare IT the most: President Obama.
• Best CEO of a vendor or consulting firm: Todd Cozzens, Picis.
• Most effective CIO in a healthcare provider organization: Lynn Vogel, Ph.D., associate professor of bioinformatics and computational biology, vice president, and chief information officer, University of Texas M.D. Anderson Cancer Center.
• HIS industry figure with whom you’d most like to have a few beers: Tom Daschle.
• HIS industry figure in whose face you’d most like to throw a pie: Neal Patterson, Cerner.
• Healthcare IT industry figure of the year: Jonathan Bush, CEO, president, and chairman of athenahealth.

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Thanks to everyone who attended the reception tonight. Thanks, too, to our speakers and presenters (especially Jonathan Bush), our sash wearers, and the Ingenix folks who ran an efficient check-in process. Thanks also Ingenix and Ingenix Consulting for sponsoring the event. I hope you enjoyed it. It was an honor to have you. I’ll get the HISsies winners up soon.

It was a nice day today, actually, with very little snow and some welcome sunshine. Much better than I expected.

No expensive burger for dinner this time. I had a $5 combo from the McDonalds right by the Trump. I bet I’m the only person patronizing them back to back.

I was ruminating (always dangerous) on the shuttle bus today about all the newfound interest in HIT, but minimally focused on the patient compared to the profit. My conclusion: right or wrong, healthcare is set up under the business model, where allegedly nonprofit hospitals have to earn their keep by cranking out the bills and making shrewd business decisions (as someone told me the other day, some of the meanest executives they’ve known were in nonprofit healthcare management). So, vendors are clearly for-profit, no different than defense contractors. Looking back, one might conclude that the charity/compassion model might have made more sense, but that’s not what we have.

Here’s an interoperability idea: after hearing the cell phones of supposedly tech-savvy IT people constantly going off in the HIMSS education sessions, someone needs to invent a door sensor that automatically turns all phones to mute.

Best session of the day (and of the conference so far): Pat Skarulis of Memorial Sloan-Kettering, on developing an oncology order entry system for what I assume is Eclipsys Sunrise. It was quite cool and the way they handle study protocols, sequential orders, and lab alerts is sophisticated. I can see a lot of interest in how they did it since oncology OE is a tough nut to crack and MSKCC is pretty much an authority. Unlike all the other sessions I’ve been to, nobody left, even during the questions (however, the audience members asked atypically knowledgable and concise questions, so kudos to them).

Speaking of Eclipsys, they had a quite effective back-cover ad in HIMSS Daily Insider today, showing their CPOE penetration. A minor quibble is that both dimensions of the quadrant measured pretty much the same thing (number of hospitals and percent of hospitals) and didn’t show percent of orders or doctors, but it still got the message across.

I’m sure it’s just me, but people walking around with those blue-blinking Bluetooth cell phone earphones look like self-important douchebags.

Our new best friend Dennis Quaid gets some nice USA Today press, saying his new GI Joe: The Rise of the Cobra could be the next Independence Day.

Our rumor reporters had the right idea, but the wrong scope: Dell and Perot announce a partnership involving EMRs and hardware. That’s Dell’s second recent announcement: the eClinicalWorks offering through Sam’s Club was the first.

Noticed during the education sessions: nearly no one pronounces HIMSS Analytics correctly. Also, an increasingly large number of presenters use "sort of" as the modern equivalent of "um", such as "We built sort of a data warehouse, with sort of an essential item being real-time extraction."

More booth reviews:

• RelayHealth’s was nice and cheery, also putting out their HIStalk sign.
• Microsoft had throngs of people again for some reason (the coffee table thingie?)
• Nextgen had what might be the largest and coolest booth (forgot to mention it yesterday). It was like the Hollywood Bowl.
• QuadraMed had interesting stations for each product they were demonstrating.
• Emdeon had cool arcs that spanned their booth, although the three booth mimes seemed to be causing passers-by to steer clear (people really dislike mimes and clowns who try to engage them in some kind of hijinks).
• I made Inga push the Enovate-IT carts to show here how smooth and sexy they feel.
• ONCHIT had a booth, believe it or not, staffed by some rather nice civil servants. They have a handout on how to start on the ARRA grants, which is their main reason for being on the show floor. They said Blumenthal won’t be starting until the end of the month. They also speculated that Rob Kolodner will retire instead of going back to the VA.
• Eclipsys had a quite dramatic and open booth. I forgot to mention it yesterday.
• A trend: I saw no two-level booths, so everybody went from traditional to ranch style.
• It was nice to have the sun streaming in floor-to-ceiling windows over in the 3900 aisle.
• BlackBerry had a cool booth (I think my AT&T Bold was drawn to it).
• AT&T had the telemedicine setup that I always like running.
• IBM’s booth wasn’t very big. Maybe they don’t have enough people left in this country to need a larger one.
• Allscripts still had people packing the booth and spilling out into the aisle.
• Greenway was demonstrating Prime Research.
• Cumberland Consulting Group had a nice wood-floored booth and some friendly people who were starting up conversations with passers-by (an art that every vendor needs to perfect if you’re going to spend big money on a booth).
• The folks at Legacy Data Access e-mailed pictures of their vintage, old-school Pong video game, kind of an early 80s version of the Wii or Xbox for all you youthful types I see all over the convention center.

Industry long-timer Scott MacKenzie (RelayHealth, Cerner) is named CEO of revenue cycle systems vendor Passport Health.

LMS Medical Systems of Canada sells McKesson its CALM OB suite. The company’s been in big trouble for some time, so it was a good move and McKesson gets what I think is probably a pretty good specialty system.

Medicity announces its Q1 business wins, raising its total HIE customer base to an astounding 700. Thirteen new Q1 customers are named, some of them very large. Someone asked me about them today and I was explaining how well they were doing, but I clearly didn’t know the half of it.

Sentillion is giving these little guys away in the booth, USB drives loaded with Advanced Authentication Solution for Direct Access to Cerner, Eclipsys, Epic, Mckesson and MEDITECH Applications. The company also announced a do-it-yourself tool for SSO and CCOW. I think I read somewhere that SSO was one of the top priorities of hospital CIOs trying to get clinical applications used, so I imagine these new announcements are timely.

Also announced: Allscripts Prenatal, a SaaS specialized EHR.

Dewey Howell of Design Clinicals gave me a demo of some new software the company is finishing up involving anticoagulant monitoring for physicians (adding to its medication reconciliation functions). I said last year that the med rec stuff was very cool – highly intuitive, functional, and taking full advantage of third-party drug databases. This is at least as cool. I’ve seen big-vendor applications sold for physician use (often meaning that some bean counters and programmers got together in 1985 to figure out how to capture charges without having to hire keypunch people) and this is how it should be done (and would be if it weren’t for the legacy baggage the big boys have to drag around).

From Blinded by the Snow Storm: "Re: Allscripts. Allscripts might need to do a bit more due diligence. dbMotion only has 2 clients in North America that have initiated a real project: 1) The Bronx RHIO, which currently has an RFP on the street to replace their core functionality, and 2) UPMC, which has an equity investment in dbMotion but has yet to announce any significant tangible benefit despite a multi-year relationship. Not exactly the type of track record that proves true interoperability." I think dbMotion’s long suit is having a ton of users, like entire countries in Europe, and a better product than the ones Misys and Allscripts brought to the table. I don’t think Allscripts will regret it.

From Glad I’m In Sunny CA: "Re: Voalte. Interesting product, but how many nurses do you know that carry iPhones?" Not many – yet. However, that’s because there has been little justification for them. Connect a nurse to a real-time alerting and communicating system using them and they suddenly look like a good deal given corporate rates and ease of use (not to mention their use as a recruiting tool).

From Ex-Broadlane: "Re: layoffs. Broadlane, the third largest GPO in the US, laid off 33 employees today, the majority being in the IT department. Ironically, the cuts come just when they are beginning to reinvent themselves as a ‘Technology enabled Service Company’ which is code for ‘we cannot scale as is and need technology’, hence the irony."

So HIMSS finally admits that both registrations and exhibitors were down. I wouldn’t say they necessarily were dishonest in bragging on the registration rate a few weeks ago, but it’s clear that they put the best spin on what they had to know was going to be the first drop in both critical categories in many years (maybe ever), most likely to stave off a last-minute bandwagon effect that would have made it worse. It would have been a complete disaster without the last-minute stimulus interest.

Speaking of positive spin, McKesson’s clinical systems are "gaining momentum," at least according to its PR people. The proof: five hospitals, some pretty obscure, bought products in 2007 (!) You would think McKesson had developed a lot of new, cutting edge clinical apps instead of continuing to sell the old, multi-heritage software bought years ago from Vanderbilt, HCS, etc. from the flowery wording. Nobody’s asking me, but here’s my advice: build something from scratch and finally get the "buyers, not builders" monkey off the corporate back and catch Cerner while they aren’t selling much either.

Susan Hagerty is named CEO and chairman of Noteworthy Medical Systems. She comes from CompuGROUP, the majority owner of Noteworthy. Larry Dolin stays on the board.

Nuance makes a series of HIMSS announcements: 25 new healthcare customers, a Dragon EHR certification program, and a preview of Enterprise Workstation Version 8.

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HERtalk by Inga

It’s Monday afternoon and still snowing in Chicago. So far today I have had a chance to sit in a few sessions, including one featuring the Ambulatory Care Davies winners. Three different groups were represented, including a solo physician practice, a five-doctor group, and an 85-doctor practice. If I were to come up with a common theme, it would be that ROI is not just about the tangible things, but about soft costs as well (reassigned workflow, paper elimination, faster chart access, etc.) Also, that getting up and running is the hardest part: once you have been live for awhile, it gets better.

I have had assorted conversations with folks about what the "buzz" is this year. Aside from ARRA and how everyone has a solution, a oft-mentioned word is interoperability. Of course, given that the government is making interoperability a requirement to obtain stimulus money, vendors seem to be discussing what and how they are working to make their products interoperable with the world. Seems like we have heard that word before and we still see lots of silos, so we will see if times really have changed.

Another issue mentioned is how providers will be able to fund the up front EHR costs before they are able to receive their Medicare carrots. Many hospitals are claiming they can’t afford to help physicians despite relaxed Stark laws. Not hearing any great answers to this issue yet.

As I was walking I saw some great looking boots. I was pretty proud of my ability to walk and take a photo at the same time.

Overheard: "I am not sure how we will be able to be interoperable with our community when we can even interoperate within our hospital walls."

A few people mentioned that Microsoft’s booth looked quite busy, so I will go see what the buzz there is all about.

I took a guided tour of the interoperability booth (there is that word again) and saw a patient’s history flow from her PHR to the physician to the hospital and to another physician. Looks cool, but the cynical Mr. H pointed out that everything on the floor "looks" cool. One day it will happen, right? I have to say the piece that might be the hardest to implement is the PHR. How many people are really going to spend the time to keep their data current? And how many doctors are really going to trust the data?

From the look of the artwork on display in their booth, I would say Epic is making some money. I enjoyed viewing the various non-traditional paintings and statues situated around the booth. In case you were wondering, the fireplace is still there.

A reader shared details of a Perot-hosted party last night at the Hancock building observatory. "Unfortunately with the snow you could not see much from the 96th floor. Perot could have saved some money and had the same party in the basement. Party was still fun, though."

Yesterday, Mr. H and I walked by the Tech Lab (near HIMSS Central) and peeked in on the blogger round table. Mr. H was actually a bit miffed that he was not invited since he sees himself as one of the original HIT bloggers. Probably didn’t help matters that I was invited, though I declined participation in order to maintain my low profile. If the session were in a bigger room that allowed you to stand unobtrusively and listen in, we probably would have stayed, but the room was a bit too cozy for us.

Official HIMSS attendance numbers as of Sunday: 25,672, which is down 5% from last year. That number is fairly evenly split between professional attendees and exhibitors, which is consistent with previous years.The number of vendors (905) is down 15 from last year. HIMSS folks seem happy.

Someone claiming to be "in the know" says that McKesson did not lay off all their ambulatory sales staff, though a few folks were let go.

I saw the famous Matt Holt from afar today. Also Grizzled Veteran, one of HIStalk’s regular posters. Heading back to the exhibits later this afternoon, then primping for the HIStalk soiree!

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It poured the rain all afternoon and now it’s snowing and blowing like crazy. I have to admit it seemed to draw everyone a little closer at the conference – there was nothing else to do but hang around the exhibit hall. That was OK until 6:00 when the hall closed, triggering a mass exodus to the opening reception. Inga and I took one look at the mass of humanity and left since it would have taken forever to get food or drinks. The band was probably good, but you couldn’t tell because the "room" was like a 747 hangar with a cement floor and high ceilings. The heavy rain or snow or sleet or whatever it was sent everyone to the coat check stations, the taxi stand, and the shuttle buses, so there were long lines at all of those, putting a not-so-great end to the day.

I started this morning by tripping over the giant bag of ads piled at my hotel room’s front door. There was a fake TV show on the shuttle’s TVs, complete with HIT commercials, of course. At the convention center, I thought the girls from Healthcare IT News were going to put someone’s eye out the way they were thrusting issues in everyone’s faces at every escalator and hall intersection (with most of the intended recipients using violent body English to avoid having to take one).

Since the "opening" keynote wasn’t until 12:30, I went to three morning educational sessions. Two were OK and one was horrible. Since I was bored, I noticed how many times in the conference guides that EHR came out HER. Someone needs to help those HIMSS folks customize their Word dictionary.

Lots of people showed up for the 12:30 session. HIMSS had a really good jazz band playing live (Skinny Williams Group). Last year’s official theme, "Now Is Our Time," was apparently taken off life support. Good idea. It was the usual multimedia extravaganza, with some violinists in there. They sounded good, but didn’t get to play much. The most ironic moment of the self-congratulatory HIMSS video was a shot of a wall breaking down with the label "Break down proprietary walls," with the irony being that the names of big companies were plastered everywhere and the repeated reference to the exhibit hall made it clear that proprietary has been berry, berry good to HIMSS (perhaps they meant that even more proprietary vendors should be congratulated for working on interoperability of proprietary systems).

HIMSS board chair Chuck Christian had shaved off his beard, so nobody recognized him. He read of a long list of HIMSS accomplishments, pretty much every one of them related to lobbying the government for taxpayer dollars so that organizations who didn’t want software bad enough to pay for it with their own money could buy it with someone else’s. And if you were there for management systems, forget it — there was no effort at all to even mention the MS part of HIMSS (maybe they should just call themselves HIS). They did mention something called HIMSS Plug In that was said to be a consumer technology social network or something, but I wasn’t clear on what it was or how it’s accessed. No figures were given for conference attendance, but someone said they heard 27,000 which would beat last year (if you believe the number).

Since HIMSS wants to break down proprietary walls, who better than to introduce the keynote than an executive from Siemens, the company paying for that session (and whose executives pleaded guilty of fraud for bid-rigging a PACS deal at Stroger Hospital right here in this very same Chicago not long ago). After a longish video with a deep-throat announcer proudly reading some classic Dennis Quaid cinema titles such as The Parent Trap and Innerspace, out came our keynoter.

I’m going to try to be nice here. Dennis seemed likable, happy to be at the conference, and genuinely complimentary of the HIT work done by people in the audience. He was considerably more wrinkled and hoarse than you see on the movies, but that ear-to-ear grin still lights up even a big room. Applause was polite. I didn’t find him all that charismatic like I expected. He read most of his talk from the TelePrompter (stumbling a surprising number of times – I guess he’s used to getting multiple takes). He flashed pictures of his twins and of the heparin vials he said were "deadly similar" (maybe to a layperson, but they were about as clearly labeled as they could be even in the picture, with one saying Hep-Lock and the other labeled Heparin 10,000 units/ml with slightly different colored labels and completely different colored pop tops – the only similarity was that they were both in the standard 1 ml vial). He proudly announced that his family’s incident had motivated Cedars to spend $100 million on HIT, although you’d have to wonder what other pressing projects got shelved to free up the capital. One thing I agreed with: bar codes need to be universal and interoperable (thank a weak FDA for why that’s not the case today). He said bar code technology needs to be affordable for small hospitals, but didn’t elaborate how that’s going to happen. He pitched smart card medical records and inpatient access to charts by TV or cell phone. He barely mentioned his foundation, to which HIMSS gave him a check for $10,000 at the end. I can’t imagine that anyone in the room wasn’t aware of medical errors beforehand, so I have to question why HIMSS thought this would be a compelling opening keynote (a great number of people rushed for the doors when he started taking the couple of scripted questions HIMSS had put together). But, I saw him in my hotel lobby afterward and he was just hanging out, looking good, and being a regular guy. So, I would say Dennis was just fine, but he probably shouldn’t have been put up there.

Then came exhibit time. The hall didn’t seem busy at all, but maybe it was bigger or perhaps because it was Sunday, things still weren’t in full swing. The energy level seemed low, but everybody was relaxed as a result. Some quick perceptions:

• Booths seemed generally smaller and less elaborate. You could count the booth babes on one hand. There were a couple of magicians, a trick pool shot guy, and some mimes (seriously), but otherwise the in-booth entertainment was dialed back.
• McKesson still had some of that wildly electric blue, but it was toned down a lot.
• I still think Medicity’s spaceship-like booth is the coolest, but that’s just me.
• The HMS waitresses are as sassy as ever, at least when you get the ones who are paid actors and not the HMS employees rounding out their number.
• Kudos to OnBase with their usual sports bar theme, who served up soft drinks until 5:00, then rolled out the hard stuff. I was prowling for beer and was told EMC had some, but they had run out. Sentillion filled the bill admirably even though I clearly wasn’t a prospect.
• If I could pick one company and booth to see that’s clearly got new ideas and strong prospects, I would choose Voalte. They were wearing Pepto-Bismol colored bell bottoms, but demoing a very cool iPhone-based communication and alerting application. CEO Rob Campbell, with a long history of developing technology (PowerPoint and Filemaker) is fun. Booth 1481 is worth a visit.
• The busiest booth was Allscripts, which was mobbed from the time the doors opened until after the lights were dimmed. I don’t know what kind of audience they were getting or what products interested them, but it was packed. Second busiest (but in a relatively small booth) was dbMotion, whose people seemed pretty cool.
• Epic’s booth hasn’t changed and neither has Judy. She never left the time we were there, talked to pretty much anyone who wanted to chat, and displayed nothing to indicate her net worth or place in the HIT universe.
• The aforementioned Siemens had a nice, airy booth that I Iiked probably best of those from the big boys.
• Inga and I liked the Risarc people in 7215, who were manning their tiki hut, wearing Hawaiian shirts and sultry tropical dresses, and pouring rum punch. They did a nice job making it fun.
• I liked Sunquest’s booth a lot, very open and attractive in the green color (although the top looked like a big round trampoline to me). Their "Sunquest – we deliver" totes were the best ones I saw, well made in that bright green with black trim, so I’m taking one of those home.
• Most of our sponsors displayed the "We Power HIStalk" sign we made for them prominently, but Virtelligence gets the nod for putting it front and center.
• Somebody gave Inga and me those little chocolate bottles containing rum. Those were just about the best thing I’ve eaten lately. I wish I remember who had them since they deserve kudos – they can’t be cheap. I would like to have had about five of them since I would have simultaneously gotten both a sugar and and alcohol buzz on.

After all that, I rode the shuttle home in the snow, ate a $15 hotel hamburger alone (funny how Inga reports the same thing below), and hit the laptop for what you’re reading now.

We decided we should feature a smaller, lower key booth with people we liked. Introducing Chipsoft (that’s Paulette above, looking like an unseen giant is about to scoop her up), an HIS vendor from the Netherlands in Booth 6560 (not selling to the US, but interested in European attendees). Those yellow things on the floor are the coolest slippers, shaped like wooden shoes. People everywhere were descending on those people carrying them (like Inga), demanding to know where they got them. Chipsoft will put more of them out Monday, they said.

A reader sent this: "One of the pre-Quaid speakers referred to the American Recovery and Disability Act. Does that make it the AR-DUH?" I don’t know if the TelePrompter was acting up or what, but everybody on the stage muffed their speeches several times.

RSM McGladrey has "Official HISTALK Cynic" and "INGA FAN CLUB" badge ribbons at Booth 8039. As far as I know, that’s the only giveaway or goodie (unlike last year’s Fake Ingas, shoeshines, and other badge ribbons).

We’re supposed to get 1-3" of snow tonight with winds tomorrow of 20-30 mph. Thanks, HIMSS. My hotel TV ran an ad for conventions in sunny San Diego, apparently rubbing it in.

The Sun-IBM deal is off, apparently.

The Medsphere folks sent this picture over. "These photos about sum up the difference between Open Source and non interoperable, expensive proprietary models." That’s a cool PR move that must have required a lot of planning to pull off.

We already ran the rumor, but Allscripts announces its iPhone application. Allscripts also announces a joint solutions deal with dbMotion (maybe that explains the booth crowds), apparently replacing the products that both Allscripts and Misys offered previously.

iMedica announces a new PM/EHR system called Transition. We may need to swing by for a look.

That’s about all I have the energy to write today. There were some announcements today (Allscripts, for example), but I expect most of the big ones will be held for Monday when the news is full-on and the stock markets are open.

HERtalk by Inga

Let me start out by saying: My. Feet. Are. Killing. Me. And I even wore the comfy shoes. Right now I am in my lobby bar drinking an adult beverage, having had a couple of Advils to try to make the feet throbbing stop. And, I probably look like a total nerd typing away on my laptop, but who cares. I’m sitting next to a window and watching some huge snowflakes come down and waiting for my $15 hamburger to be served.

First thing this morning, I attended a CCHIT Town Hall meeting led by Mark Leavitt and Alisa Ray. I was struck by the fact that CCHIT clearly sees themselves as the entity that has established "the" standards, though they acknowledge that the standards committee will tweak the final standards required for ARRA funding. In any case, vendors are sending in their certification applications at an unprecedented rate – something like 45 new applications in the last month, with 39% being never-before-certified vendors.

I also went to the opening session to see Dennis Quaid. Cool live music and video started things off, followed by a rather lengthy intro by Chuck Christian of HIMSS. Christian shared all the great things HIMSS has done over the last year – and one might think they were personally responsible for including HIT in the recent ARRA legislation. So, I think Mr. H was a bit cynical about having Dennis Quaid as the keynote, but I personally thought it was an effective reminder that ultimately this whole HIT stuff is about the patient. Quaid admitted he is not an expert on technology or healthcare. Instead, he is a father, husband, and now an advocate. As I was walking out I overheard this comment: "There’s nothing like a human story to motivate IT. Especially when it involves babies"

Mr. H and I also spent time walking the exhibit hall (see note above about aching feet). The good news is that everyone has a way to help you take advantage of ARRA money. Random thoughts:

Allscripts was amazingly busy every time we walked by. Other booths that appeared to be getting good traffic included Google (why?), dbMotion, athenahealth, and McKesson. Not so busy: most of the other vendors in the ambulatory EMR space and all those small vendors are the outermost aisles. Far and away the best giveaway were the slippers from a Dutch company that looked like wooden shoes (I’d be wearing them if I weren’t in the lobby.) Booth babes are for the most part either eliminated due to budget constraints or simply too 20th century (in either case, I am ok with the demise of booth babes). Mr. H and I were so happy every time we saw a sponsor prominently display one of our signs (anyone see them?) Mr. H and I personally autographed each display, so thanks to all who put them out. By the end of the afternoon, Mr. H and I were getting thirsty for cocktails, so thanks to the folks at Sentillion were able to provide both Mr. H and me our beverages of choice.

I took a few photos and will get those posted soon.I have managed to snap a few nice-looking pairs of shoes and was able to educate Mr. H and what shoes were and were not practical for walking the exhibit hall. Also got caught in the Olympic committee 2016 presentation this a.m., so I took a few shots of wrestlers in their cute outfits.

In the Ribbon Race, i.e., the contest to see who can attach the most ribbons to his badge, I have so far seen two individuals tied for first place. Each had five ribbons. One is the CIO for a large health system in Texas and the other is a consultant, also from Texas. (Everything is bigger in Texas, I guess?) Surely there are some New Yorkers or Californians who can come up with six ribbons to take the lead.

Early night for me before some early morning sessions. Can’t wait for the big HIStalk/Ingenix party Monday night!

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It’s a pretty nice day in Chicawgah, with brilliant sunshine and tolerably cool temps. The locals are out jogging and playing shirtless volleyball like they were Canadians. HIMSS is looking pretty smart in choosing its own city for the conference, but I doubt anyone will be saying that as they slog through the snow the storm will bring Monday. If you see someone smiling, it will be a vendor chop-licking at the certain booth traffic that will result since there’s no golf or other outdoor activity as an alternative (coincidence, I’m sure). Good for them, bad for those of us who enjoy the traditionally warmer conference locales. I even heard one of the HIMSS people saying it was convenient, but not as nice as going somewhere less wintry. Look at it this way: because of the schedule-juggling needed to jam Chicago into the mix, it’s only 11 months until the Atlanta conference.

Why is healthcare so expensive? I can’t figure it out as I sit in a $250 hotel room using a $20-per-day Internet connection and ponder the $26 hamburger (including mandatory gratuity and delivery charges) that the hotel’s room service would like to sell me. (Actually, I pay my own way, so I’m not contributing to healthcare inflation). One of the sessions today was full and someone headed out to get more chairs – don’t do that, they were told, only union members can pick up convention center chairs.

That same $250 hotel just about sweated me out last night. My room must have been 85 degrees and the heat was blasting. No AC, naturally, being a historic hotel full of character (meaning: tiny closets, weird bathrooms, and a maze of halls to find each room). I figure there was some forgotten old guy down in the bowels of the basement shoveling coal into the furnace like he’d been doing since the Truman administration. Solution: I opened the window, which was surprisingly not bolted shut (the hotel must not have a legal staff). Other than the racket each time an El train lumbers by, it’s OK (as long as I don’t think how much nicer a $69 Microtel would be if I’d been smarted enough to book once, spend a little on cabs each way, and still save a bundle).

It looked like the Marines stockpiling supplies before a siege at the conference center. Vendors hauling in their exhibit stuff, food and drink people making sure not to run out of wildly overpriced inventory, and AV people setting up an endless number of rooms. The conference center is actually pretty easy to get around and, as is always the case with HIMSS, is well marked. Some sessions are across the land bridge on the west side, most seem to be on the south side, and the opening reception will be on the east side overlooking Lake Michigan (which attracted me to stroll out to the patio for a look, immediately finding myself locked out of the convention center until a maintenance guy reopened the door).

It was pretty dead at the conference center today, at least in the common areas. I walked by the venture fair and it was overflowing, so I assume ARRA has attracted some people newly interested in healthcare but having no clue about the patient widgets with which we deal outside their financial realm.

The schedule still seems odd. You would think that the opening reception would be today (Saturday) since everything moved up a day, but it’s still Sunday. There’s no morning keynote tomorrow – Dennis Quaid isn’t on until 12:30. One thing is like always: the education tomorrow runs only 8:30 until noon, followed by Dennis, followed by the ceremonial herding of the attendees into the exhibit hall like cattle up an abattoir ramp. Nothing conflicts with the exhibit hall hours, of course, since that’s the entire point of the conference (a smattering of time-conflicting educational offerings notwithstanding). Sunday’s education (not counting Dennis): 3.5 hours. Exhibits: 4 hours.

Rumor heard: McKesson’s board had lost confidence in Pam Pure, believing she was in over her head. She fired all of the company’s ambulatory salespeople right before she herself was defenestrated, supposedly. A WSJ article mentions concerns about the technology division. It says John Hammergren is speaking at HIMSS, but I’m not sure where.

An anonymous reader says that Radianse chairman and CEO Manuel Lowenhaupt has left after less than a year. Steve Schiefen is now listed as CEO on the company’s Web page. The reader speculates the RFID asset/patient tracking company will be sold to Hill Rom.

A reader sent a copy of an e-mail that George Halverson of KP sent out company-wide, bragging that 12 of the 15 hospitals that will be recognized as EMRAM Stage 7 at the conference are Kaiser facilities.

HCS president Tom Fahey e-mailed news of a new Interactant sale: the five-hospital Encore Healthcare LLC (MD). They’re in Booth 7834 if you want to extend personal congrats or just say hi (Tom didn’t ask for the plug, but I figured I’d look it up in the HIMSS guide since it’s right in front of me).

I passed former HIMSS CEO John Page in the hall today. Looking good, running a CEO and entrepreneur support organization.

HIMSS is having some kind of blogger session at the conference. I was not invited. I’m insulted even though I wouldn’t have gone anyway.

TeraMedica announces Smartstore-Ultrastream, a storage optimization protocol that improves the efficiency of image storage and routing for its vendor-independent imaging and information system.

GAO names 13 members of the Health Information Technology Policy Committee, the advisory group that will make policy recommendations for a national HIT infrastructure. Some are familiar names: Marc Probst of Intermountain, Paul Tang of PAMF, and Judy Faulkner, who has done more for HIT adoption than any of them because she’s selling the heck out of Epic to big hospital systems (quick: name any big-name hospital that has bought anything other than Epic in the last year or two. Need more time?)

People keep e-mailing me that Perot will be acquired by Dell shortly. Sounds farfetched, but I said the same about Misys and Allscripts right before HIMSS last year (and ran the rumor for the same reason: multiple reports). Purely speculation, but there you go.

Nine Texas patients, most of them homeless, drug abusers, or mentally ill, made 2,700 ED trips in the past six years, racking up $3 million in taxpayer cost. I bet your first reaction was: irresponsible losers screwing up the system. Maybe your second would be: perhaps the healthcare system gave them no alternative, making a business case for using the avoidable cost to fund options for them.

GE Healthcare, whose name is prominently plastered on the quite nice tote bag being handed out to HIMSS registrants, lays off more employees in Wisconsin.

Taking pictures at HIMSS? Send them my way (or maybe I should start an online album). People seem to like them.

A reader is working with a boutique RIS/PACS vendor that is looking for quality resellers. Not my sweet spot, so if you have suggestions, e-mail me and I’ll pass it along.

A study in contrasts (not the same as a contrast study): a NEJM report says that only 1.5% of hospitals have comprehensive clinical systems, but HIMSS Analytics trots out its own stats saying that, hey, they’re pretty close, missing only a couple of key applications to be there. Count on it: any time anybody publishes a high-profile article (even a research one) that seems to indicate less than rosy industry use of technology (or especially that the technology itself may not be up to snuff), HIMSS will circle the wagons with a rebuttal.

Allscripts cuts revenue estimates, blaming a purchaser preference for subscription-based pricing. Overheard today: nobody’s financing companies that drop ship software like in the old days (say, before last year). True partners make money only when their customer makes money and that’s all that’s selling these days. Welcome to the recession.

My guest editorial in this week’s Inside Healthcare Computing e-mail update: Here’s President Obama’s Mandatory EMR Feature List: Firing GM’s CEO Makes it Clear That Federal Money Has Strings Attached. A key sentence: "The CEO of every company right now, right or wrong, is the former junior senator from Illinois who has never had a real job (I don’t count being a professor or lawyer) or run a business."

If you’re at the conference, welcome to Chicago. I’ll be doing some kind of daily report and I expect (and hope) that people will e-mail the good stuff they hear out and about since that’s the fun of being here.

E-mail me.

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