From: Samuel C. “Re: Yesterday’s health care bill. After yesterday’s health care bill it is safe to say: ‘It could probably be shown by facts and figures that there is no distinctively native American criminal class except Congress.’ – Mark Twain.” The Senate health committee approves legislation that includes a plan to provide nearly every American with health insurance, regardless of income or medical condition. The program also calls for a government program to compete with the private insurance companies. Opponents include the private insurers, as well as small business owners who fear the financial burden of providing healthcare for all employees.

From: Little Birdy “Re: MED3000. I hear that in addition to Tom Skelton, another former Misys VP is coming out of retirement to join the company. Look for an announcement in the next couple of weeks.”

HERtalk by Inga

Yesterday we published an interview with Mr. H, which is a must-read for any HIStalk fan. I’m not sure he revealed too many secrets, but the piece does re-iterate how hard he works and how humble he is (am I gushing?)  I must admit I didn’t know the interview was coming and was a bit surprised by it. I’ve long asked Mr. H to do an interview, but he always turned me down. So, thank you Dr. Gregg Alexander for being a better arm-twister than me. Mr. H actually skipped town for a bit, leaving me at the helm. I am pondering if there is any correlation between the kind words he had for me and his delegation of all the HIStalk chores for a few days.

Wake Forest University Baptist Medical Center selects Patient Care Technology Systems to provide hospital asset tracking. The Amelior Tracker system will track and manage hospital assets throughout Wake Forest’s 4.1 million square foot campus.

Senator Jay Rockefeller orchestrates a donation of almost $2 million in medical equipment to Welch Community Hospital (WV). Rockefeller had asked staff members last year to prepare a wish list of the hospital’s greatest needs. GE Healthcare helped make wishes come true with donation of an anesthesia machine, EKG monitor, portable X-ray machine, and more.

Meanwhile, GE wins a $12.5 million from LSU Health System (LA). GE will provide LSU the technology to digitize its central database and radiology image repository. The GE contract is just the first phase of LSU’s $116 million, five-year plan to add EHR throughout its 10 public hospitals and 500 clinics.

Boston Medical Center is back in the news, this time for filing a law suit against the state of Massachusetts. BMC accuses officials of illegally cutting payments made to the hospital for treating thousands of poor patients. The state says it has done nothing wrong, and officials are quick to point out that BMC has received $1.5 billion in state funding over the past year.

Sunquest Information Systems introduces a new release to its lab and POC solution suite. The updated version incorporates new modules for molecular testing, along with increased functionality and workflow enhancements for existing applications.

The University of Ottawa Heart Institute cuts its hospital readmission rates 54% for patients participating in a home telehealth monitoring program. The program is also attributed with saving $20,000 for each patient not re-admitted.

Providence Health & Services (CA) names Peter Spitzer CMIO. Spitzer will oversee clinical IS systems in this newly created role.

Henry Ford Health System extends its IT outsourcing agreement with CSC for another 63 months. The value of the new contract is estimated to be $115 million.

Netsmart Technologies acquires Crown Software, a provider of pharmacy management software. Netsmart sells software and services for health and human service providers.

Ingenix subsidiary The Lewin Group launches The Lewin Group Center for Comparative Effective Research. The new entity will focus on providing fact-based, comparative effectiveness research to improve patient care and optimize resources.

United Health Group and Cisco Systems announce a national telehealth network to bring remote medical care to rural and underserved areas. The Connected Care network will use Cisco videoconferencing to simulate an in-person doctor visit.

The American Medical Informatics Association (AMIA) submits comments to the ONC and HIT Policy committee, stressing that EHR certification does not necessarily equate with effectively using the system’s available functions, nor does it assure changes in clinical practice or patient outcomes. AMIA does not believe the current certification process is sufficient and stresses that certification should focus on process and care improvements over time.

Meanwhile, the ONC’s HIT Policy Committee approves the latest revised definition of EHR “meaningful use.” Since the initial definition last month, the committee made a few tweaks to its draft, including:

• Establishing a 10% threshold of CPOE for hospitals in 2011 (rather than the original and less specific requirement for “CPOE for all orders”)
• Allowing the 2011 criteria apply not just for 2011, but for the provider’s first adoption year. In other words, rather than 2011, 2012, 2013 requirements, change to Year 1, Year 2, Year 3 requirements
• Starting clinical decision support sooner
• Making access to personal health records a requirement earlier than originally proposed.

More here.

The information storage vendor Iron Mountain sponsors a white paper recommending the federal government maintain a 10-year retention policy for paper records. The 10-year retention window would give providers plenty of time to migrate to electronic records. And, perhaps give Iron Mountain plenty of time to fully migrate its business model from its original off-site document storage roots.

The Nashville Area Chamber of Commerce names ICA to its list of Future 50 Award winners, based on its projected growth in revenues and employees over the next three years.

iMedica changes its name to Aprima Medical  Software to avoid confusion with several other similarly-titled healthcare companies. The company also rolled out a new website, aprimaehr.com.

Two former executives from Province Healthcare launch a company to acquire and operate rural hospitals. Marty Rash and John M. Rutledge have created RegionalCare Hospital Partners, leveraging $300 million in startup funds from Warbug Pincus.

HIMSS gives Dr. Regina Benjamin a thumbs up following her nomination for Surgeon General. After Hurricane Katrina, the HIMSS Foundation actually provided Dr. Benjamin’s clinic a $5,000 grant to acquire EHR hardware and services. Dr. Benjamin and her staff are featured in this short video about EHR and the HIMSS Katrina Phoenix Project.

Target considers following Wal-Mart’s lead and support mandatory health insurance coverage by large companies.

Nuance Communications purchases startup company Jott Networks, a provider of mobile voice-to-text technology.

A Florida mans sues a physician at the Age Defying Surgical Center in Florida after he was denied a hair transplant. Apparently the 28-year-old hair-challenge patient is HIV positive and Florida law forbids denying medical treatment based on HIV status. The lawsuit is for at  least $15,000. I’ve said it before, but I don’t get why men get so hung up on hair loss. Bald is sexy.

E-mail Inga.

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

Legacy Leaders
By Ed Marx

How can so many of us hold the title of leader, yet never be remembered? Why do some leaders make a difference while others do not? Fear.

Fear keeps us from making a difference. Too often leaders fade without notice or with merely a modicum of fanfare because of their longevity in a company, because they stuck with tradition, and perhaps they achieved small wins. Conversely, legacy leaders stick their necks out and occasionally go against the flow. They spin the roulette wheel while their peers play it safe. Anyone can play safe – status quo. But legacy leaders fight fear, calculate options, then jump in with both feet. Leaders who leave legacies take risks.

No risk, no legacy. Our founding fathers pursued a risky mission, and look at the legacy they left us. Martin Luther King Jr. took risks that prematurely ended his life, but his legacy endures. Pause for a moment and think of a legacy leader who advanced with nothing at stake? Thought so.

I overhear leaders say they want to make a difference, want to transform healthcare locally and nationally. Yet healthcare is stuck in neutral, if not reverse. Decision makers are overly conservative in their approach to innovation and opportunity. Paradoxically, some I know in management were risk takers early in their careers and enjoyed success. For whatever reason, they shifted gears into a risk-averse posture and ran out of gas short of their destination. We as healthcare leaders must intrepidly drive forward, or surrender the wheel to someone who will.

I want to encourage and reward the courageous, and the best way to do it is to lead by example. Push the envelope. Try new programs, systems, and services before they are mainstream. I don’t settle for giving lip service, I fund and staff risk ventures. Then I reward my risk takers publically, even in failure, because they gave it their all. Perseverance will eventually pay off.

Risk provides a competitive advantage. Do you want to create separation and differentiation in your marketplace? Risk. Tap into the creativity of those employees with a passion to innovate and transform. Yes, there will be failure. Use failure as a catalyst to increase your risk tolerance, not shy away from it. Learn and embrace failure. Edison did.

Stop analysis paralysis. Adopt Colin Powell’s leadership lesson #15, “P@40 to 70.” P stands for the probability of success; the numbers indicate the percentage of information acquired. Once the information is in the 40 to 70 range, go with your gut. Procrastination in the name of reducing risk actually increases the potential of failure or falling behind.

To those who favor remaining conservative. Do you fear losing your job? When you play safe, you’re rewarded with keeping your position, right? But if you don’t rock the boat or challenge the status quo, do you lose part of your soul?

A board vice chair told me, “Ed, if you do your job right, you won’t be here a year from now.” I took his comment as encouragement to take risks on behalf of our patients and providers. If I lose my job in the process, so be it. I do not operate under the fear of man but under the fear of not influencing my part of the world.

Risk is a lifestyle not just a work mode. When hiring like-minded staff, determine the risk quotient of potential candidates by finding out what they do outside of work. If they stick to the standard fare, move on. If they play it safe, move on. They won’t act any different in the workplace.

What about you? Are you a legacy leader making a difference? Will anyone remember your years of effort? Will healthcare be transformed because of your actions?

What are you doing today that is risky? What are you doing today to encourage risk?

Demand it. Live it.

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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Let the record show that I didn’t want to do this since (a) it looks like a vanity piece even though I resisted and am intensely uncomfortable with the idea of featuring myself; (b) I don’t really have much to say that I don’t say every couple of days; and (c) HIStalk is about news and opinion, not about me. However, Dr. Gregg Alexander was persistent, and since he writes for HIStalk Practice, I felt bad after saying “no” the first handful of times. So, I’m disclaiming all responsibility and turning it over to Gregg. This is my first and last interview.

An HIT Moment with … is usually a quick interview with someone “we” find interesting. Today, I have been granted the unusual and tremendous honor of turning the tables upon Mr. HIStalk, HIS-self. As you know, Mr. H is founder and chief organizer of HIStalk.

You are a humble guy, but even you must admit the breadth of HIT industry folks who read HIStalk on a regular basis is pretty impressive. What’s your take on the not insignificant impact HIStalk continues to have upon this multi-billion dollar industry?

It’s hard for me to say. I just sit alone in an empty room and type onto an empty screen. I’ve never heard anyone at my job mention HIStalk. Nobody there knows I do it. I could count on one hand, probably, the number of people I’ve heard say the word HIStalk to me directly. That’s fine since it’s kind of creepy for me to hear people talking about it. It’s a private activity for me. As you know, I didn’t want to do this interview and tried to ignore your request until you asked a second time. I figured I owed you since you write some fine articles for HIStalk Practice, but otherwise, I probably wouldn’t have done it. I’ve turned down quite a few people before.

I know a fair number of people read HIStalk and I’m really happy about that, but in terms of impact I really don’t know. The only reaction I get is the occasional e-mail. I’m like the guy who throws the morning paper in your driveway. I don’t really know what you do with it, why you read it, or what affect it has had on you. I just keep doing my job and hope you find it useful enough to keep reading. If so, I’m happy to keep right on doing it.

I hope it has been fun for the people who read it. I hope it provides a virtual industry water cooler to chat around since so many of us are far-flung and maybe on the road most of the time. I hope it has educated a few industry newcomers. Most of all, I hope it has provided a dialogue, not just my monologue, on what a cross-section of industry savvy readers think about new developments and concepts that affect healthcare IT and, ultimately, patients.

Just keeping up with all you and Inga write is challenging enough, so how do you manage to work a regular day job, keep current with all the diverse news you gather, find time to write about the news you find of note (and include some insight and humor,) plus still have a family life? (I’ve heard you are actually 5 people; it would make more sense.)

It helps that I work in the industry in a non-profit hospital. Most healthcare IT writers don’t, so they don’t really know what’s important, what’s BS, and how it all fits together. They are good at crafting clever sentences, but they don’t know what they should contain. I’m pretty efficient at bringing all the information I have together and hopefully presenting it in a concise and entertaining way. There’s nothing phony or contrived about the way I write, so it’s just me, no different than what it was six years ago, so I can crank it out pretty fast. Readers help me immensely by e-mailing when they hear something new or have an opinion to share and I value that a lot. I spend hours putting together something that looks like a quick, easy read. The longer I work, the easier it looks.

I’ve gotten pretty organized at how and when I write HIStalk, but it’s still a time crunch sometimes. I’m out at least 10 hours a day at work. When I get home, we eat dinner and I head off to the computer. I’m there every evening for at least three hours, sometimes more than five. It takes a lot of time to read and reply to e-mail, to do the primitive recordkeeping I do for sponsorships and all that, and to do the actual writing. I spend a bigger chunk of time on Saturday and Sunday, sometimes more than eight hours each. Luckily, nothing invigorates me more – even after six years and many millions of words written – than sitting down fresh and starting off on another HIStalk.

Thank goodness I got Inga to help me awhile back with the writing, the research, and working with our sponsors. I was getting pretty frazzled, especially right around HIMSS time when it all comes to a head. She keeps me sane. We worked together for almost a year before we ever met in person, having decided after a five-minute phone call that we were a good match. She made it fun again.

I hope I don’t ignore my family in doing HIStalk. I worry about that. Will I look back someday and wish I’d spent more time doing something more profound? Is it really worthwhile or just a comforting distraction from reality? Or, should I be some kind of astute businessperson and make it bigger or better even though I know next to nothing about starting or running a business and I’m chronically lazy? Until I figure those things out, I’ll just keep doing what I’ve been doing.

Speaking of keeping up, there’s so much HIT hubbub these days with ARRA, HITECH, CCHIT, evidenced-based, meaningful use, etc. As you keep a pretty tight finger on the pulse of the goings on in HIT, I’d be curious to hear what your take is on the overall state of the industry.

The government wanted IT activity in healthcare and it’s getting it, albeit at a high price. Based on recent activity with the banks and auto industry, I think this administration expects to be an active partner in healthcare, not just a quiet financier of IT systems. IT will give it a way to collect information and develop policies around it. Good or bad, Uncle Sam is the biggest customer of many or most hospitals and doctors and he’s not happy about the value received, so opening the healthcare kimono via IT should be interesting.

I would be more excited about using billions of taxpayer dollars if there were at least incentives for vendors to develop new products. It’s mostly the same old systems and same old potential customers, only with federal money forcing their awkward introduction. I hope vendors use some of their new revenue to create new systems based on paradigms and technologies from this millennium instead of just patching up the old ones. I worry that all systems are starting to look and work alike since vendors keep swapping former employees with each other, ensuring cross-pollination instead of innovation. CIOs hate IT risk, though, so maybe everybody will just keep running what they always have except for some of the more exciting niche systems and technology platforms like the iPhone.

When it comes to physician practices, I’m not convinced that most of them will take the bait after comparing the potential rewards with the perceived effort required. The government hasn’t been all that reliable and supportive of a partner when it’s tried doctor programs like that before. Doctors know that everybody gets value from EMRs, but they’re the ones on the hook to actually use them. They have nothing to sell but time, so if EMRs are perceived to take more of it, I don’t think the incentives will be enough – except maybe for the small practices that have to count every penny. I would have preferred a rewards system based on sharing patient data, where you get paid extra for making your lab results, prescriptions, and notes available electronically to other providers. Then, let the providers choose whatever tools they want to support that. The final definition of "meaningful use" will most likely include that, so it will probably be fine.

All the rewards require a very short time frame for implementation and productive use, which I worry is more than either vendors or providers are ready to tackle. Resources may be an issue. We’re dealing with patient systems, so let’s hope we don’t see unintended consequences from quick and dirty implementations.

Some vendors, especially those with marketing machines that can capture the attention of prospects in the small window in which they’ll be buying products, will do very well. Those not so fortunate will have a tough time since HITECH will front-load a lot of sales that would have taken years, so those that don’t succeed in that small time window will find the pickings slim for years afterward. I think a lot of second- and third-tier vendors will scale back, close down, or sell out as a result. There’s a big wave coming, but the trough right behind it could be ugly.

We’ll get our critical mass of EMRs, at least assuming everyone gets implemented. The real job is to do something useful with them. That requires focus and change management capabilities, qualities that are hard to come by in many organizations. Without quality reporting, data interchange, and some element of practice standardization, we won’t have gained much by planting all those EMRs. They don’t provide enough efficiency benefit for that alone to be the driver. That could create a new demand for analytics, add-on tools, and formally trained informatics people who can do more than just flip the go-live switch. EMRs might eventually become a commodity as CCHIT, or whatever certifying body is named, expands their functionality checklists to become what could be a full set of specs for an EMR. Maybe you don’t need dozens or hundreds of vendors if they all meet the same basic requirements.

Overall then, I would say everybody’s going to be busy for the next five years at least. We’ll probably see mini-Gartner Hype Cycles as new customers buy systems, find them disappointing for one reason or another, but eventually gain benefits they wouldn’t have expected. Way down the road, the power will be in the connection, not the tool used to connect, so EMRs may be as unexciting as buying a PC today — just a generic tool you need do real work by connecting with everybody else on the Internet.

Your newest “offspring,” HIStalkPractice…what prompted your address of the physician practice world?

Inga came from the physician practice side of the industry, but I was a hospital guy. I knew we weren’t covering everything in HIStalk, but I wasn’t sure that audience was really interested in what was happening with practice management systems, EHRs, CCHIT, and all that kind of detailed discussion. I also knew there were a lot of potentially influential voices that weren’t being heard, such as yours, and I wanted to see if we could cultivate an audience interested in the usual HIStalk style news recap and opinion for that somewhat different market, along with more interviews and guest articles. It has been slow going, but nothing like the years it took to get a few readers of HIStalk.

Inga does pretty much all the writing for it other than what our guest authors put together, now that I’ve convinced her she has the knowledge and the ability without me looking over her shoulder. I do nitpick about how she punctuates and structures her sentences sometimes and I know she’s just neurotic enough to let that bother her, so I try to leave her alone.

On the “About HIStalk” page, you give a fairly complete background on why you started HIStalk and of your general operating standards. Pretty straightforward about your approach and principles. However, you have a sardonic wit and are often quite blunt about your opinions. Both of these traits make for a great read, but from what you do post from readers, you are often also slammed for your perspective. Do you receive more pointed or insultatory jabs for your writing that don’t make it onto the printed screen?

I run most of the e-mails I get on HIStalk if they would interest readers. I do get the occasional viciously nasty and insulting comments, usually for something silly, like years ago when I mentioned some notoriously phony schools where healthcare people were sporting MBAs and PhDs from. I got some threats over that more than once. Those were the only truly angry comments. Sometimes someone complains that I’ve been unfair to a company, have sold out to sponsors, or think I know it all. I do a little self-analysis to see if they have a point that I can learn from, then move on one way or another.

I really do try to be fair. I encourage comments that disagree with my opinions. If I rip a company one day, I try to remember to say something nice about them another day. I see my job as being a moderator who introduces a topic, maybe throws out some controversial statements to get the discussions going, and then makes sure everyone plays nice together as they debate. I like it when people get along, but I understand that some of the most valuable stuff comes from heated discussion.

I’ve heard a buzz that you and the lovely Inga might be unmasked at the HIStalk reception during HIMSS in Atlanta next year. Just wishful rumor mongering or is there any such possibility?

You never know. Inga is a lot more of a schmoozer than me. Sometimes I think she’s about to burst trying to keep the secret that she’s Inga. Unlike me, I think she would probably bask in whatever limelight there is and readers would like her even more than they do now. So, maybe we will arrange her coming out in some fashion at HIMSS. She’s probably already shopping for new shoes.

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From Ex-Cerner Guy (among the many): “Re: Banner’s Cerner pricing. The pricing for the full HIS, @ $30M or so, looks pretty accurate. It likely started in the $45-50M range, then someone from KC came in and probably cut the SW pricing to get the deal. KC types will cut the pricing until the prospect says yes. From a customer perspective, there’s no value in saying yes until the SW fee is $0 and hourly rate is $125 or less. Banner probably said yes a little early.” The paper actually said each of their smallish hospitals was spending $30 million, so that’s what I questioned. Good negotiating tips, by the way.

From Bob in Accounting: “Re: sometimes you keep track of these things.” A doctor at Fletcher Allen Health Care (VT) is reprimanded by the state medical board after admitting that he improperly accessed the medical records (presumably paper ones) of eight women, one of them a previous acquaintance who found about it and turned him in. The article refers to “breeches of patient medical record confidentiality,” which either means someone makes little pants to keep records safe or the reporter trusted his spellchecker instead of his dictionary.

From Mark Moffitt: “Re: ARRA. Is anyone else viewing the ARRA as an investment opportunity v. subsidizing IT? GSMC is spending $1.3 million to net $2.7 in Year One and using the proceeds for other non-IT clinical needs.”

From The PACS Designer: “Re: SAML. The porting of applications to the web has increased the need for security enhancement solutions. To address this need, there’s a specification called Security Assertion Markup Language (SAML). SAML provides the means for multiple organizations to exchange security information to protect each other’s security requirements. Also, security software promoting federation and the use of single sign-on solution for multiple systems through the use of SAML enhances the user experience and removes the need for multiple IDs and passwords.”

From Wayne Panera: “Re: strong passwords. Pretty good paper from Microsoft called ‘Do Strong Web Passwords Accomplish Anything?’ discussing the fallacy that strong passwords produce additional security.” Link (warning: PDF). The article says that passwords are stronger than they need to be to thwart brute force attacks (as long as you don’t allow more than three incorrect login attempts) and yet do nothing to prevent phishing and keylogging. Interesting idea: it suggests making user IDs longer is easier for users to remember and equally effective in preventing brute force guessing. Their example: PayPal requires an eight-character password that isn’t in the dictionary, uses mixed case, and has at least one special character, despite the fact that even a six-digit PIN has only a 1% probability of being cracked after a 10-year brute force attack. With regard to lockouts, the article also suggests that instead of a fixed lockout, like 24 hours, that the application simply geometrically increase the lockout time between each unsuccessful login attempt and, to prevent bot attacks, consider setting the lockout by IP address.

From Lynn Devine: “Re: Healthport. They’re looking to outsource their EMR development to integrate it with their PM product. They project a year to do this – it’s only been suggested for the past five years.” Unverified. Inga is attempting contact the company.

University of Florida says it will invest $70 million in clinical and translational research over the next 5-7 years, with “a large portion of those funds” being used to roll out Epic’s EMR to the faculty practice.

Listening: Lady Ga Ga, hopelessly trendy and way outside my usual genres, but it sounds pretty good now that I’ve listened to the CD three times.

A 50-provider medical group in California drops two CCHIT-certified (“point-and-click”) EMRs, replacing them with the EMR from SRSsoft after a free pilot.

A BlackBerry executive grudgingly admits that docs love the iPhone, confirms that the Chalk Media technology BlackBerry acquired will be used for medical education, and urges healthcare customers to take advantage of their BlackBerry Enterprise Server and client licenses to push data. He also touts BlackBerry’s App World and says customers have an appetite for it “and other app stores”.  Basically, he thinks Apple is promoting innovation that BlackBerry has had in place for years. If there’s an App Store … er, App World … application to measure the sourness of grapes, it’s time to roll it out.

Thanks to the reader who sent over the BMJ article from Kaiser Permanente Hawaii on its use of HealthConnect to proactively generate risk-based nephrology referrals instead of waiting on generalists to do it. Last-minute nephrology referrals by primary care providers occurred 30-42% of the time in the pre-study population, causing missed clinical opportunities for patients. The targets and results: (a) reduce late referrals, defined as being within four months of the onset of end-stage renal disease, aka ESRD (dropped from 32% to 12%); (b) creating the “life line” arteriovenous fistula in time for it to mature (increased from 18% to 36%); and (c) start dialysis as an outpatient (increased from 35% to 56%). How they did it: HealthConnect was used to identify at-risk patients, looking at glomerular filtration rate, urinary protein, and serum creatinine lab results in a monthly download. Those patients were assigned a numerical risk rating for ESRD. HealthConnect was used to recommend the referral, capture notes about whether the PCP and patient followed through, to deliver electronic messaging between the PCPs and nephrologists, and to issue alerts for patients showing a deterioration trend from one monthly download to the next. The result was that 280 patients were referred and some of the PCPs learned how to manage the patients themselves better after electronically reviewing the work of the nephrologists. Interestingly, the original plan was to let the PCPs do all the managing themselves, but they pushed back, saying they were too busy and worried about the impending HealthConnect implementation. Good work by Kaiser, a nice example of physician collaboration, a great reminder of how medical practice can change positively once information is available electronically, and a fine service to patients who surely had better outcomes as a result.

This from Weird News Andy, who says, “They took him to get a blood test at a hospital to prove he was drunk. He proved they were right.” A DUI suspect flees Research Medical Center in a stolen ambulance before his ride is ended by “stop sticks” and a police dog’s bite. As you might expect, he was not a first-time offender, with a rap sheet that included three previous alcohol-related convictions and a revoked driver’s license.

Michael Sinno is promoted to VP/CIO of Cooper University Hospital, which is in some hitherto unknown state called South Jersey.

Thanks to IntraNexus and CEO Rick O’Pry for supporting HIStalk as a brand new Platinum Sponsor. The Virginia Beach-based company offers the Sapphire Web-based (or client-server, if you prefer that option) hospital information system (still the coolest product name ever if you ask me), a complete single-database system with patient access, document imaging, revenue cycle, scheduling, general financials, EIS, clinical care, imaging, CPOE, critical care, ED, EMR, lab, LTC (!), pharmacy, point of care, radiology, and other modules. Here’s a writeup about beta site Oswego Hospital, who said “Sapphire was the best go-live we have ever had.” They just went live at St. Luke Hospitals (KY). Thanks to IntraNexus for supporting HIStalk.

Bad news for Microsoft: a survey says that 60% of its business customers won’t buy Windows 7 because of cost and compatibility concerns (the same reasons those customers passed on Vista, in other words). Microsoft’s real problem, if you ask me (and you didn’t), is that its cash cow products aren’t strategic – everybody can live without new versions of Windows and Office. And in tough times, they apparently will.

The American Heart Association will donate $50,000 toward creation of an open source CPR learning application for the Wii.

AMDIS announces its 2009 award winners: Michael Dominguez (University San Antonio), Fallon Clinic, Cynthia Herzog (MemorialCare Orange County), Kaiser Permanente, Steve Margolis (Orlando Health), Jon Morris (Wellstar), Matt Sprunger (Dupont Hospital), and the UPMC interoperability team.

The New York Times highlights Cook Children’s Health Care System (TX), a 350-physician practice that will install a Web-based EMR from athenahealth and Microsoft’s HealthVault. It will also open an Innovation Clinic with two or three doctors that will operate under the capitation model.

Cardinal Health’s debt ratings are lowered to near junk levels because the upcoming spinoff of its clinical and technology products business means there’s not much left except low-margin drug distribution. I guess analysts weren’t distracted by the CareFusion jazz festival.

China’s health ministry puts a halt to a clinic’s rather extreme program of Internet addiction therapy in teens, saying it will no longer allow “freaky treatment” that included electroshock therapy, kneeling in front of parents, and forced confessions of wrongdoing.

While everybody’s salivating over stimulus money, here’s a sobering fact: the US budget deficit just hit $1 trillion so far this year, the first trillion-dollar deficit ever, but nothing special considering estimates are now at $2 trillion for the year (not counting the new calls for another round of stimulus money because the first one didn’t really do much, with unemployment even higher than the level threatened if the stimulus wasn’t passed).

The Terminator fires three of the six members of the California Board of Registered Nursing and its executive officer quits after a nonprofit investigative newsroom found that it took years to get dangerous RNs off the job. Newspapers run by bad businesspeople (big corporations saddled with acquisition debt) keep getting smaller, stupider, and more reliant on wire service celebrity gossip, so this example of a non-newspaper doing real investigative work in the public interest is sure to raise the debate about what journalism really is.

Odd hospital lawsuit: frightened by stories of a hospital’s hepatitis-positive surgery nurse who replaced OR needles with her own dirty ones while stealing drugs, a patient files suit against the hospital even though her own test results aren’t back yet. The patient’s attorney wants the court to oversee patient testing for hepatitis. He also says he has people who are “literally scared to death,” which even an ambulance chaser should know means they are six feet under instead of trying to jump on a class action lawsuit.

E-mail me.

HERtalk by Inga

I am back from my big vacation, a little more rested, tanned, and a new fan of rum punch. Oh, and I made time for wee bit of shoe shopping. The vacation gods made me forget the power cord to my laptop so I was forced to keep my Internet surfing to a minimum. And, low and behold, the HIT world continued without me!

Providence Associates Medical Laboratories rolls out a new billing system built on the InterSystems Cache’ database. The lab reports that month-end processing time has been slashed by 88%.

Novant Health (NC) hires CareTech Solutions to manage its web content and provide secure hosting for its 10 Web sites.

e-MDs announces the release of its 6.3.0 Solution SeriesTM, which incorporates First DataBank’s drug database solution, enhancements to its Surescripts e-rx application, support of continuity of care documents, and other features.

The National Rural Health Association’s Services Corporation selects Virtual Radiologic as its provider of choice for teleradiology services.

Image On Call, another provider of teleradiology services, promotes COO MIchael Lampron to CEO. Lampron was VP of services and GM of the Vision Series Financials Group at Amicas.

Allscripts announces it is working with the AMA to offer an AMA-branded e-prescribing tool. The tool will be available at no cost to subscribers of a new online solution being developed by the AMA, with help from Covisint.

Sales from wi-fi enabled healthcare products will total almost $5 billion by 2014, a 70% increase over today’s numbers, according to a new study.

Healthland appoints Odell Tuttle to the role of CTO. He was previously with Gearworks, focusing on  the company’s mobile healthcare product OnCare.

The financially struggling Shriners Hospitals for Children will begin accepting insurance reimbursement rather than close six of its 22 hospitals. This follows a plunge in endowments from $8 billion to $5 billion during the economic downturn. For 87 years, the Shriners have provided free care to children without billing insurance providers.

Boston Medical Center is also in financial straits, anticipating a $175 million loss in the fiscal year that starts October 1. The hospital laid off 250 people earlier this year and took other measures to cut costs by $40 million. It’s the state’s largest provider of care for the poor and also offers a food pantry for patients with special diets and legal aid. What happens when the nets collapse at safety net hospitals?

The local paper highlights EnovateIT and the niche it is building with its computer wall cabinets and moveable carts. The company, which last month announced plans to manufacture its own cart in the USA, employs 46 and has revenues of $46 million. I interviewed company president Ron Sgro last year and found him to be pretty fun (medical carts make for a pretty dry topic, but he was entertaining), plus I like their green approach to business.

Scotland becomes the first country in the UK to deliver e-prescribing services. More than 90% of all prescriptions are now submitted electronically using the national Acute Medical Service (eAMS).

Maine plans to go live on its statewide HIE later this month. HealthInfoNet will connect 15 hospitals, three health clinics, and the Maine CDC. Health information from more than 400,000 patients has already been loaded into the HealthInfoNet system, which is powered by 3M Health Information Systems.

GE announces a new partnership to integrate the Medicalis CDS-DI solution with its Centricity Imaging IT and EMR products.

The HIMSS Electronic Health Records Association (EHRA) sends a letter to the ONC recommending, among other things, that CCHIT be “the single certifying entity to avoid duplication of effort, unnecessary expense and confusion in the market.”  Uproars from the anti-CCHIT folks to follow.

E-mail Inga.

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William Bria III, MD is chief medical information officer at Shriners Hospital for Children, Tampa, FL, and  chair of the Association of Medical Directors of Information Systems (AMDIS).

What kind of response have you received from the AMDIS recommendation to not include CPOE in the first round of the HHS”meaningful use” criteria?

It’s been excellent. I’ve gotten response from our membership, but I’ve also had a number of discussions with everybody from the press to those that are in high places, shall we say, and other organizations, like the American College of Physicians. What I’ve gotten back is that both the caveat that we put in our response and the emphasis that we put the patient consideration up front was very well appreciated.

Considering the vast majority of hospitals in the country don’t yet have a fully implemented EMR, I think the concern in this economic climate of what it means to individuals personally as well as organizationally was the biggest impact, particularly when they saw how much they were going to be asked in 2011 to come up with in the draft proposal from Paul Tang and his group.

I think the patient focus of it gives us a way of balancing that concern with a very important political consideration, if I may, in that if this change in American healthcare is painted as a regulatory or a governmental imposition on the practice of medicine which some, as you well know, in the press were already doing, then it actually aligns physicians and patients against it rather than what we really believe is true, that this is one of the tools. It’s not an answer to all of the problems, but it’s a tool that can act in a very fundamental key change kind of way to empower patients and give patients the information they’ve needed forever.

My most recent experience was this afternoon at around four o’clock when my son, who has a chronic illness, a very serious one, called me and said his doctor had broken his leg in an accident. My son — he’s in his twenties — is very fastidious about seeing his doctor and careful about follow-ups, but he called the office and was told that the next appointment with his doctor was in 2010. He was trying to make an arrangement for something that was within the next two weeks before the doctor had his accident.

You know, that’s a real basic patient communication aspect that should be as difficult as saying, "Your flight was cancelled, but you can select these other flights," or "Your hotel reservation is not possible, but we can take care of you at this other hotel." The idea of some of the basic communication in the business of delivering care in America, because of the lack of automation at the level of the patient, is still far too frightening and daunting, and don’t even get into how much it’s costing to have a mostly non-automated process for delivering care in America.

Do you think ARRA encourages organizations to move too quickly in ways that may have unintended consequences when it comes to patient care? 

I think there’s no question about that. I think the first draft — and that’s all it was, it was a draft, and I think it would be wrong to make out that it’s more than that — the first draft on this saying we are going to accomplish CPOE adoption, a full EMR adoption, EHR adoption, and then successful reporting on quality and metrics out of the same system, that really speaks to me from a point of view of someone who hasn’t really done it yet. If you think it’s that mechanical that you can drop these systems in even a modest-sized healthcare setting, and moreover, settle down and actually be able to generate data, and then be able to automate a process of quality and safety reporting, it doesn’t speak to folks that actually have the experience of having to do that.

So I think that was perhaps a challenge, perhaps a way of creating controversy that levels it, because as we all know, it’s really going to be CMS that’s going to make the final decision on this, and the idea of sending the wrong message about reasonable expectations in what timeframe that should be done at some point, no question about it. Absolutely. If we didn’t put quality reporting and safety reporting as part of the expectation of the entire delivery on meaningful use, absolutely. That would be crazy. That would be a major mistake.

However, saying that it all can happen in a two-year time frame, that really puts a concern about reality testing.

Are you concerned that, since it’s an economic stimulus that requires the money to get out quickly, that they’ll just chuck out everything except the minimal criteria and say, "Look, just think of it as a slightly encumbered grant"?

Well, could that happen? Could that be a reaction formation that goes all the way or the other way? Yes. Is that what we want? Absolutely not.

From the standpoint of insisting on the introduction of tools, on the introduction of preparedness and analysis of concept redesign and genuine commitment to achieving success in introduction of the basics — departmental systems, scheduling, reporting, and data acquisition and reporting– is the key to starting the engine of information for an organization — large, medium or small — to even approach the challenge of subsequent data reporting and analysis.

So we think that dumbing it down too far is a risk, but we are anything but that. We are definitely for steadfast introduction and insistence on introduction, which I think the CMS — part of its leadership — makes it clear to most organizations, even ones that haven’t been familiar with the idea of clinical data systems as being central to their business.

Interoperability seems to have been traded off in favor of just getting systems put into offices. Do you think there will be enough emphasis on exchanging data and rewards for doing that?

I think there’s been emphasis on it, but I don’t think there’s been enough clarity about who’s responsible for doing that. If you consider the scope of the introduction of any of the existing systems, and then start to consider the scope of interconnection through interoperability of information, the systems themselves don’t need to be interoperable, the database contained must be interoperable. Who is responsible for doing that?

The idea that while you’re trying to understand and implement and accommodate the introduction of an information system into your practice — in a large, medium or small clinical setting — that you’re going to have the persons and the skill set to interconnect that data seamlessly with the rest of your community, that’s not very realistic, I don’t think, in anybody’s perception.

There has to be the identification of HIEs or other entities that are going to, in fact, have that as their main focus as communities and regions start to introduce electronic health records.

Where do you see that interoperability push coming from?

I think the notion of saying that entities — and there needs to be more clarity on what entities are going to be charged — is it going to be the small, two-doctor office that’s going to have to worry about interoperability with their region? No. That’s not reasonable or realistic, and it’s my experience that then we will have a bunch of silos, where we now have paper silos, we’ll have also electronic ones.

But the notion of making that much more explicit about in what way and in what timeframe are those considerations going to be made, will there be clear standards with regards to data exchange to the vendors? Not to the customers, but to the vendors, in order to receive approval for certification and implementation in this national scheme. That’s a whole dimension of this discussion and the response to the first draft of meaningful use. I don’t think we’ve really spent enough time with it yet as a country and in applied medical informatics as a discipline.

Since it was an economic stimulus, the bill seems to push EHR adoption as opposed to EHR benefit. Do you think those two are inseparable? Should we be trying to bring up the laggards who have no technology at all or should we be rewarding the results of the technology and let them pull themselves up accordingly?

I really believe that the idea of a critical mass of American healthcare using information technology will so tremendously change the national dialogue and the national expectation about the practice of medicine using that technology — that is the first, second and third priority.

We have to get a greater penetration. That doesn’t need to be 90% — no, it’s not going to be 90% in the next five years, but what it needs to be is greater than 17%, or 15%, or 20% even at this point. It has to be at least twice that for us to start to say that this is truly an unstoppable transformation from the standpoint of the infrastructure necessary to practice medicine and for physicians to no longer be bystanders.

I’m not talking about informatics positions, I’m talking about rank and file practitioners to no longer be bystanders in this discussion in their offices, in their hospitals, and their communities, but to be active consumers defining what is needed first, second, and third in their improvement and then moving forward.

I’ve been talking about this and speaking to physician groups on this subject since 1982 when I finished my fellowship and took my first job that included both of these paths. So the idea, I think, of really making the case that there is a critical mass and that introduction — I won’t say adoption, because that apparently is considered a bad word — of information technology in the American healthcare to a significant degree is long overdue and absolutely essential to get to the next level.

You mentioned certification. Does AMDIS support certification, and if so, do you have an opinion on whether it should be CCHIT as the certifying agency?

I think the way in which CCHIT has operated in the past has been good for that stage. I think now with the money that has been directed towards it, the idea of being anything other than an objective certification body that has at its core both the timeline and the elements of the goal of the ARRA, the HITECH portion, is essential.

What do I mean? For a number of years, since I was the chairman of the HIMSS Physician Community group, we have been asked to review the criteria that were being used at CCHIT, since HIMSS is a major partner in that. Every time, me and my colleagues, many of them from AMDIS, that were part of that re-review before CCHIT spins out its next version of criteria for certification, we said why are we delaying CDS for some future time? Why isn’t there an insistence on the existence of elements of data exchange and interoperability mandated as part of the standards of being able to have a certification of your electronic health record product?

The usual answer was that yes, they know that’s important, but they thought that that was a future development rather than an immediate necessity. That never sat well with me nor my colleagues in our review process. I would be very anxious to see that whatever new body or whatever new group was constituted that there was clearly no confusion about connection with the status quo, that it was directed towards the actual goal, the stated goals, of the ARRA itself.

You’re working on some formal informatics training programs. What do you think the industry needs in terms of the quality and quantity of people who have real informatics training, not just on-the-job training?

A lot more. (laughs) I think since the bar’s been set in this first discussion very high, I’m saying that it’s not enough to put in systems then say, "Congratulations, everybody can go home and rest," but rather data reporting and actually then make that the reason, the raison d’etre, of healthcare informatics, the quality and safety reporting and performance reporting in a national scale.

I think you’re going to need a lot more people that not only understand the information technology, which is an entry level issue, and rather get on to those who really know how to evaluate large data sources, be able to guide and manipulate information systems as necessary in order to improve performance, and a last but not least, we’ve talked for so many years about, "Are you up on CPOE yet, or did you just do results reporting? Anybody can do that results reporting stuff, but CPOE — that’s a real man’s job”.

But you know what the real man’s job? It’s to get data out of the system that is of sufficient quality, and have a dialogue with the clinicians in an organization to actually improve and change practice. There are examples of this, but boy, there’s not a lot of them. The ones that have done that as a production line, the same way we used to think about the production line of order entry and results reporting, those organizations – Cleveland Clinic, Mayo Clinic, Partners, Kaiser, etc. — those are the leadership healthcare organizations in this country. I don’t think that’s a mistake.

What are the most important projects you’re working on in Shriners and what challenges are you seeing?

We are working on clinical decision support. We are working on CIDSS, clinical information decision support services. The first one, as a practical matter, improvement in medication ordering and administration safety and quality care sets, tuning our alerts environment and refining it for the particular care line that we have — we’re a very specialized pediatric hospital system–and the CIDSS project is a data warehouse installation, evaluation, and targeting towards actual safety and quality necessities and reporting within our healthcare systems. Those are our important projects.

Do you think that outcomes analysis or process analysis in the data warehouse is going to make the underlying tool that created that data less important or more of a commodity?

Not yet, but that’s exactly what we have to get to. And again, the organizations that are leading — I don’t think people sit back and say, "Well, they did all this because of this vendor." Well, yes, it was important to have a product that had sufficient functionality and a data model and environment that could be leveraged for these reasons, but it’s really the organization and their ability to use data to make them more successful and make them appear demonstrably better than competitors. That’s the name of the game.

I truly believe that we’re going to head, in the next decade, from a time of talking about these elements of automation in the actual process of healthcare into saying, "This is the necessary tool, but that’s all it is." This is the instrument to allow leadership in organizations that are the most forward-thinking and the most attractive to the people who seek care, this has provided in the necessary grist, the fundamental data, to be able to demonstrate and succeed in innovation.

There are probably going to be a lot of organizations that are going to be pushed into buying technology only to realize that was only the little step, and the big one’s yet to come.

(laughs) Well, you know that’s how life is. Human beings need to take it a little bit at a time. If you knew how difficult it was to get married, have two kids, raise them well, help ensure that they’re going to be good people, you never would have done it. (laughs)

Anything else that we should talk about?

I just want to say that our organization, AMDIS, is for physicians and other clinicians that have now the challenge ahead of them of actually starting to deliver on all of its promise. We are so excited that the stars have come into alignment to make what we’ve been working on for many, many years now become one of the major agendas with the rejuvenation, and hopefully reinvention, of healthcare in America.

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