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News 5/29/09

May 28, 2009 News 10 Comments

From Nasty Parts: “Re: Allscripts. They will announce the acquisition of Medfusion and Medem shortly, bolstering their physician connectivity capabilities.” Consider it unverified and, until further notice, untrue. Hypothetically speaking, it seems to make good sense and there’s some history there — Allscripts and physician connectivity vendor Medem have worked together and Allscripts bought 3% of the company and $2 million of its debt in 2004, while the former Misys Healthcare Systems created its consumer portal with Medfusion, which is based in Cary, NC, next to Raleigh.

streamlinemd

From Inside Ohio: “Re: Propractica (StreamlineMD CCHIT-certified EHR). Heard rumors that it has gone out of business.” Not so, according to Sean Mullen, president of the company (who, when I called him, started off by brusquely saying he’d never heard of HIStalk, which I tried to overlook). I got voice mail at the listed telephone numbers, but one of the support reps gave me Sean’s cell phone number, saying they have a new phone system. Sean says StreamlineMD was formed May 1 when EMR vendor Propractica merged with Professional Receivables Control, an Akron practice management systems company. Business is stronger than ever, he says (it might be even stronger if humans answered the telephone numbers listed on the Web site – that’s some pro bono advice).

Listening: Anvil, since I saw a VH1 commercial for what sounds like a great new underdog documentary (not “mockumentary” like Spinal Tap, even though the lead guitarist’s name is Robb Reiner) about this early 80s Canadian metal band that went nowhere, but influenced everyone from Metallica to Megadeth and still trudges on today. Ebert gives the movie three stars, calling out funny-sad scenes that led to their obscurity, like their bad, barely English-speaking management booking them in Japan for a 9:45 a.m. concert. I like to see old has-beens finally win, so I’m rooting for them to make a comeback, even though their music is kind of Whitesnake-y at best.

I always enjoy getting the latest Medicity newsletter, so it was even better to see HIStalk mentioned in it (for naming the company’s booth as the coolest one at HIMSS and also your voting its merger with Novo Innovations as the smartest vendor strategic move). It also included results from a survey of 24 Medicity Novo Grid customers, in which more than 60% of those who connected their EMRs said they saw improvements in patient care, staff efficiency, cost, and hospital relationships. Both of the company’s CHIME focus groups received 100% “top box” scores (excellent or very good). They’re also offering 25 customer video case studies on CD that are free for the asking.

McKesson takes it in the shorts for suing a former pharma sales employee who bolted for medical supply competitor Henry Schein in 2004 even though he hadn’t signed a non-compete agreement. The judge dismissed McKesson’s suit, he countersued, and a jury just awarded the former employee $5 million and his new employer $6 million. McKesson says it will appeal.

New poll to your right: is CCHIT free of influence from HIMSS?

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Greater Baltimore Medical Center (MD) rolls out ED clinical documentation from crosstown vendor Salar, integrated with its Meditech system.

In the least-shocking news I’ve heard lately, Grady Hospital (GA), like pretty much every large medical center buying clinical systems these days, picks Epic for its $40 million project. Losers: Cerner, McKesson, and Siemens (although I certainly would have put Eclipsys above at least one if not two of those). Oddly enough, Grady chose Epic on price, which must be an industry first since they are invariably more expensive than everyone else. Here’s my prediction: Epic’s honest, but I bet Grady made some estimating error that will cost them at least double that $40 million, probably involving labor, maybe their own since they are struggling and may optimistically think they can do a lot of the work without paying expensive outsiders.

NAHAM (National Association of Healthcare Access Management) is having its annual conference right now in Las Vegas. Our friends at SCI Solutions are there, no doubt, and QuadraMed is showing its new consumer portal for scheduling. Reports from the field are welcome.

New insurer payment rankings from athenahealth: Humana goes to #1 as the best payer. The industry as a whole improved over last year as well, with claims paid 5.3% faster and denial rates down 9%.|

 histalkcalendar

I took action on a suggestion readers have made a few times over the years: there is now an HIStalk Calendar to keep track of industry events (there’s also a link at the top of each HIStalk page and links to upcoming events in the right column). Some cool features: users can submit their own events, it accepts rich text and graphics, and each event has a link to see a map and current weather. You can even download an event to your calendar, e-mail it, or share it on Twitter and a bunch of other online services. Feel free to share your events, although you won’t see them until I approve them (to keep out the inevitable spammers).

Cerner names Michael Battaglioli to the newly created role of chief accounting officer.

Jobs: Health Care Revenue Cycle Consultant, Senior Cognos Developer, Meditech Nurse Informaticists.

Atul Gawande, maybe the best healthcare writer there is, covers McAllen, TX in his latest piece in The New Yorker. The issue: the town is poor and rural, but second only to Miami in healthcare costs per person. Local doctors blamed everything from obesity to lawsuits, but analysis revealed something none of them said: overuse of medicine, especially specialists and implantable devices, sometimes for the express purpose of enriching a hospital or a doctor. “Something even more worrisome is going on as well. In the war over the culture of medicine—the war over whether our country’s anchor model will be Mayo or McAllen—the Mayo model is losing. In the sharpest economic downturn that our health system has faced in half a century, many people in medicine don’t see why they should do the hard work of organizing themselves in ways that reduce waste and improve quality if it means sacrificing revenue.” I’ve been far less eloquent and entertaining than Atul, but my motto echoes his conclusion: people and companies are guided by economic principles that will lead them to the most profitable activities, so you can change their behavior only by intentionally or otherwise redirecting their profit motive to something more desirable. If you pay for procedures, you will get lots of procedures. If you pay for quality (assuming you can define it), you will get quality.

University of North Carolina Health Care and IBM create a data warehouse to support projects related to grants, clinical trials, quality statistics, and the study of diseases.

Health officials in a Chinese province are forced to make a public denial after a widespread Internet rumor suggested that many of its doctors got AIDS after having sex with a female drug rep in return for prescribing her company’s products. The press-unfriendly police “briefly detained” a former patient who was believed to have started the rumor, after which he apologized, even though other doctors said it wouldn’t surprise them since medical bribery is standard procedure. A Chinese economics researcher stated the obvious about medicine in both China and the US: drug companies have access to information to tell them who’s prescribing, so it’s not surprising they try to influence the holdouts.

Former IBMer Walter Groszewski is named VP of business development at Medsphere.

Accenture, always geographically creative in avoiding paying US taxes, moves its “headquarters” from Bermuda to Ireland. If you want to buy American, it ain’t them (which you already knew since many of its employees work in cheap labor countries like India and the Philippines). It’s not just them, of course — I’ve been to the Caymans and all those corporations headquartered there must have short executives since their entire corporate office fits neatly in a standard post office box. Not their fault – Uncle Sam should just close the loophole by saying if you do more than $1 million in business here, you’re taxed the same as a domestic corporation.

A CBC article criticizes eHealth Ontario’s contracting practices, claiming that nearly $5 million in deals were signed with Courtyard Group and Accenture (begorrah!) without seeking other bidders. It also criticizes the organization’s salaries, noting that 164 employees make over $100K and hiring consultants keeps other names off that list (the CEO is paid $380K plus she got a $114K bonus five months after she started). Two consultants listed as SVPs on its site cost $1.5 million a year, including flights from their homes, per diem, and hotels. Most personally, it notes that one consultant listed as SVP was charging $3,000 a day as a consultant, while the company his wife owns got $300K in contracts, billing $300 an hour read newspaper articles and check holiday voicemail greetings. The CEO’s rebuttal: we chose single-source vendors because of urgency and we had to pay market rates to get the best people available. You will want to read at least some of the 200+ comments left, one of which notes, “This is one of the many reasons why we have a 50 billion deficit. We are no better than the US….ridiculously high salaries for top level management, high bonuses, over-priced contracts, unnecessary projects, no accountability and worst of all a government that no one has any respect for.”

E-mail me.

HERtalk by Inga

bidmc

John Halamka claims that speech recognition technology and computer-aided medical transcription have saved Beth Israel Deaconess Medical Center $35 million since 2003 and reduced report turnaround time from five days to less than an hour. They have 3,000 physicians using Nuance’s eScription.

New York City agrees to pay $2 million to the family of a woman who collapsed and died on the floor of the psychiatric ward at Kings County Hospital Center last year. The patient had waited more than 24 hours to be treated and lay on the floor for more than an hour while workers did nothing to help her.

Streamline Health Solutions CEO Brian Patsy admits that overall business has slowed during the current recession, but says its hosting business is picking up. Streamline had 10 major deals in 2008 and eight involved hosting. Only one of four major deals in 2007 involved hosting.

HIT outsourcer Phoenix Health Systems partners with Sungard Availability Services to offer hospitals disaster recovery services.

Mayo Clinic finds that when surgical teams participate in preoperative briefings prior to cardiac surgery, communication is improved, errors are reduced, and costs are lowered. Teams participating in the pre-op briefings reduced miscommunication problems during surgery by 53% and decreased their medical supply waste. I’m now analyzing the amazing parallels between surgery and marriage.

McKesson declares a regular dividend of $.12/share of common stock, payable July 1st to all stockholders of record on June 10th.

Optimum Lightpath signs an exclusive agreement with GetWellNetwork to provide the Interactive Patient Care solution to New York metropolitan area hospitals. Optimum will package the Interactive Patient Care solution technology with its 100% fiber optic network to provide television-based communication systems in patient rooms.

dillon1

Elsevier Health Sciences appoints Chris Dillon managing director for its Clinical Decision Support group. Dillon is a former VP of marketing for both Misys and McKesson.

Legacy Hospital Partners (TX) enters a 10-year agreement with PHNS to deploy clinical, EMR, and financial applications.

DeKalb Medical (GA) selects MRO Corp. to provide its ROI Online software and services. In case you are slow like me, “ROI” stands for release of information, as in managing the release of medical record information.

Misys reaches a new three-year financing agreement to help repay the debt created from the Allscripts merger. The $335 million deal involves five different banks and includes a term loan and a revolving credit facility. Funds will be used to repay $150 million in bank debt plus $190 million to ValueAct Capital.

IASIS Healthcare (TN)  signs a two year consulting agreement with Precyse Solutions. Precyse will provide IASIS medical staff with peer-to-peer training for quality clinical documentation.

A West Virginia woman sues a hospital after a parking gate arm comes down on her head, knocking her unconscious. The woman, who was on oxygen and used a walker, claims the hospital was negligent because traffic cones had directed pedestrians to walk near the parking gate arm.

Here’s a curious quiz. The results suggest I am a liberal (since I like the idea of slapping authority figures and don’t have a problem drinking out of anyone’s wine glass).

inga

E-mail Inga.

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Currently there are "10 comments" on this Article:

  1. I heard about the Anvil documentary on NPR. It’s not my kind of music, but I give those guys huge props for staying with their dream and can’t wait to see the documentary!

  2. Atul Gawande is an excellent writer. His work is often thought provoking and clearly articulates both the challenges in the health care system and the context/reasons why it is the way it is. Also, Malcom Gladwell’s articles are very thought provoking and makes you think carefully about technology and society.

    If you want to read a periodical that actually is well written, though provoking and has a mix of politics, science, creative writing and humor then The New Yorker is the best. Plus the cartoon caption contests on the inside back cover is hilarious!

  3. Everyone says Epic is more expensive, but we’ve seen Epic’s prices in the same spreadsheet with McKesson and Meditech – and it was right in the middle and actually closer to the lower one than the higher one.

    Epic seems to run a similar install for most customers and the real variance seems to be based on how dedicated a customer is to just getting through it and done. If they delay or go slow, expenses grow. If they just focus and follow the game plan, they come out on budget or occasionally under. Nemours has been bragging about being on time and 20% under budget.

    At the end of the day, I doubt Epic is as much the variable as the site they are working with. The best indicator for how a site will do budget wise is probably how well they’ve done on their last 10 projects. If there is a pattern of going over, they’ll go over, if on task, they’ll be fine. Their people will push like crazy, sometimes to the point of being annoying, to keep people moving, but at the end of the day, healthcare organizations often have a pretty strongly entrenched culture that rules the day.

  4. RE: Everyone –

    If everyone is saying it, you don’t think it holds truth? We have read multiple times in the news and through communications with other leaders in our industry that Epic is constantly over budget and rarely ontime for a go-live. While Epic prides itself on quoting for business lower than the other companies, what does it say when they almost never meet or beat that number? If they did this type of business as a publicly held company the wouldn’t last a day.

    And you also have to look at the context at what occurred. Grady…one of the most embarrassing healthcare organizations in this country of ours…not through how they care for their patients, but how they RUN their organization…picked a vendor who is NOTORIOUSLY over budget. They are about $200M in the hole at Grady. They expect to be reimbursed for their install of Epic by the government dollars out there, but of course that’s dependent on if they can be live in time. There is no way that will happen using Grady resources…

    Then there is the other issue of the fact that they still do not have a Lab system since Epic has still yet to develop one and a competent revenue cycle product (their AR would you cringe). At the end of the day, there were better choices on the table that would answer their TOP concerns…#1 being budget…#2 being on time. The last thing I want to hear about on the news is another mistake at Grady for a massive delay in the implementation of this project…and somehow all the blame is on Grady. I still to this day have no clue how Epic remains unscathed.

  5. “I still to this day have no clue how Epic remains unscathed.”

    If that’s the case, maybe you should reevaluate your perception of reality v.s., you know, reality. Because the implications of your little rant is that everyone but you is an idiot.

  6. RE: HIT Guy –

    I am not sure if you know what you are talking about…what I was referring to is how Epic is able to still hold high regard in the big vendor world despite their obvious short comings, but if one of the other big vendors were to do the same thing it is just another ding on their record. If Cerner missed a go-live date, they would own up to it and it would be their fault. If Epic misses a go-live date, it is somehow the clients fault? Sure, in the above scenario it could very well be the clients fault in both instances, but how can Epic convince the client of this everytime?

    You obviously do not have an understanding of the specific situation on hand with Grady. It’s not a shock that another hospital chose Epic (as Mr. HIStalk pointed out), it’s just a shock that Grady leadership, who can barely tie their own shoes, ignored their very own key requirements. I am not offbase by this “reality” considering it’s constantly reported on HIStalk that Epic is overbudget and not on time. Just funny and sad Grady screwed up again.

  7. I agree with PezMan (and do NOT think everyone else is an idiot)..the implementation of Epic vs other vendors IS more expensive and rarely (not sure if ever) meets it’s ‘on time’ milestone for activation. Epic does not have a methodology for implementations and it takes more than an army to install, thus the increase in budget. They are against using outside consultants, but want to sell you their consultants at a much higher rate. Somehow they still manage to be the ‘fair haired’ vendor.

  8. “They are against using outside consultants, but want to sell you their consultants at a much higher rate”. In working at some of the biggest EPIC customers, I have never heard anything about this. In fact there were many “outside” consultants there (as PezMan alluded to), who all worked well with EPIC. The fact is EPIC cannot provide all the consultant or programming time it’s current customers need. I have seen these outside consultants openly criticized when they are clearly doing a bad job, but never a pressure to hire EPIC people over independent (or otherwise) consultants. Also there are also EPIC projects that do come under cost, not very news worthy in these part though. I have been fortunate to be a part of two.

    It’s also not to true to say EPIC Consultants are charged out at a higher rate than most consulting companies. They are all in the $160/hr mark. However for the EPIC money you get a real programmer, not just a build analyst as you would with most consulting hives.

    It’s pretty simple, you hire bad people and have bad managers looking after them, then it comes in over budget.

    Now I know for a fact that the EPIC way is “Don’t take on any implementation you don’t think you can succeed in” Yeah it’s subjective and pretty arrogant. But hey look at the other facts. It’s the most successful product for achieving a real money saving and paperless hospital. Is it a case of EPIC getting of lightly or a case of CIO’s seeing the track record?

    Keiser is an outlier in many ways. It’s the biggest single system (except the V.A) in the country, it’s a whole different set of challenges. From what I hear they did a much better job than Cleveland clinic considering the number of doctors and the hospital size. Nobody ever mentions internal politics being a factor of cost on this site, but out in the field it’s a common attribute to overruns both in cost and time. It’s always supplier, not internal staff or the politics of implementation. Even though all suppliers have over runs and implementations that come in over cost, and we have all heard stories of staff revolt and complete re-workings of workflows. The cost/time equation is far more subjective than the supplier. From my experience the sites that hire well and involve clinicians early in the process come in under cost.

    I think EPIC clearly has the best current track record with 2-5 hospital groups in the country. That’s why they get the most sales, for now.

  9. My opinion is that hospital systems give to Epic all the financial gains of moving to an EMR. That is only an opinion with no facts to back up the statement and is based primarily on the overall cost to implement Epic.

    It is also my opinion that Epic has carved out a good niche in the market based on hospital systems loaded with excess cash and have a risk-averse CIO and/or culture. It will be interesting to watch if the market perception of Epic changes with the downturn in the economy and with it the excess cash of those hospital systems who can afford Epic. Will Epic’s niche survive?

    I’m not worried about the other component of Epic’s market niche – risk adverse CIOs. There will always be a ample supply of those. 🙂

  10. Epic doesn’t have an implementation methodology? This would be a huge surprise to many thousands of customer, vender, and consultant staff. In fact, these days, they have at least three methodologies depending on customer choice and size. The methodologies are actually driving implementation costs down.

    Epic prides itself on quoting lower than competitors? WRONG- usually, they pride themselves on quoting higher than competitors, but delivering more.







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