Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Health 2.0’s Social Networks Get Down to Business!
By Deborah Kohn

Forrester predicts that by 2013, social networking will account for nearly half of the $4.6B market it forecasts for all Web 2.0 products (or, as we in healthcare refer to these products, Health 2.0).[1]

Web 2.0 / Health 2.0 products are the suite of online technologies and applications (e.g., blogs, wikis, Really Simple Syndication [RSS], content communities, mashups, podcasts – in addition to social networks) that are used to share information via text, images, audio, video in a participative, communicative environment. They are based on users’ opinions, expertise, insights, interests, or work activities.

Social networks (e.g., Facebook, LinkedIn, Twitter) can be differentiated from the other Web 2.0 / Health 2.0 products because they give users the ability to create individual profiles that foster interaction among many people (“many-to-many” as opposed to “one-to-many”). First made available on the consumer-oriented MySpace site, in general, Web 2.0’s social networks finally are finding a solid niche in the business world, and, in particular, in healthcare. The reasons are that social networks can assist information workers in collaborating and accomplishing work more quickly, productively, and cost-effectively than current collaboration tools.

Information workers spend an inordinate amount of each day collaborating in e-mail. Where e-mail was once considered a “messaging system” — the electronic equivalent of the Post-it note, replacing paper office memos and telephone messages — eMail evolved into a “communication system”, essential for a healthcare organization’s business processes. While soliciting and sharing information via e-mail is effective, relying on an e-mail system for collaboration and compliance is risky. Version tracking becomes nearly impossible, and visibility is limited to those on the “To:” and “cc:” lines. If a worker is hoping to find and re-purpose an e-mail or its content at a future date, it’s not practical. Same for using file shares.

However, Twitter, for example, gives information workers the unprecedented ability to tap into customer-driven feedback loops and turn them into message amplifiers, focus groups, and even goodwill ambassadors! In addition, all workers inside the organization, not just selected groups, can create, edit, and distribute ever-increasing volumes of ad hoc and informal information. Even with limiting posts to 140 characters, many-to-many can still efficiently link to educational podcasts, budget decisions, and quality and safety videos as well as search for the information.

If healthcare organizations have a receptive culture, a clear business strategy, and a clear technology strategy that allow for social networks to be appropriately integrated into established healthcare business processes, I predict that, like e-mail, social networks will become integral to a healthcare organization’s activities and will achieve a level of legitimacy and value that will rate them a secure spot. In other words, instead of sending one-to-many e-mails for certain collaborative activities, the ability to post announcements many-to-many using social networks will become the next generation of e-mail and file shares.

[1] Owyang, JK; The Future of the Social Web, April 27, 2009

Deborah Kohn is the principal of Dak Systems Consulting of San Mateo, CA. 

Survival of the Fittest
By Mark Steele, MD and Jack Callahan

Any highly adaptive species will thrive on its evolutionary journey; any species that is not responsive to its environment will inevitably come to extinction. The EMR and its more adaptive descendent, the hybrid EMR, offer a clear example of this process of natural selection in the digital world.

As the name implies, the hybrid EMR represents a synthesis — in this case, between the traditional EMR and how doctors actually practice medicine in reality. The hybrid EMR is a highly flexible adaptation that has split off from its original species and continued to evolve, while its ancestor, the traditional EMR, still struggles to survive. The incontrovertible success of the hybrid EMR in the marketplace is a perfect illustration of the survival of the fittest.

When the EMR first emerged from the primordial swamp of legacy code, it was poorly adapted to the healthcare IT environment. Its genetic inheritance of hard-to-use, rigid data entry syntax and non-intuitive navigation kept it from thriving, particularly with demanding, high-performance practices. But because it had a few attractive features, along with some colorful-looking plumage and no natural competitors, it did gain a toehold in the market. Still, no matter how many tried to domesticate the primordial EMR, few succeeded.

Later generations of the EMR species made clear the need to regulate its unstable genetics. CCHIT engineering was engaged, with government funding, to control the breed. Yet despite Herculean efforts and even crossbreeding with the PM species to deliver a combined, integrated entity with a single DNA set, maladaptation continued. High-performance practitioners and specialists, who demand a stable, productive, usable species of EMR, were not consulted, and they were not convinced. They did without, waiting for the species to evolve still further.

Finally, it did. The hybrid EMR emerged, with new genetics and usability, and met with huge acceptance and adoption.

This meant that the traditional EMR species had reason to fear for its survival. Its only hope of getting off the endangered species list was a cataclysmic event that might give it a chance to catch up to its competitor. Eventually, the dire state of healthcare led to unprecedented funds being allocated to encourage medical practices to adopt traditional EMRs. This was supposed to benefit the practices, but since EMR genetics remained the same, maladaptation continued, endangering the very practices that adopted them.

The beginning of the end of the traditional EMR species is at hand and the government health IT stimulus program will hasten the demise of the woolly EMR mammoths. As physicians realize that complying with government EMR "meaningful use" protocols requires significant productivity losses, the traditional EMR will be relegated to a minor role for low volume and non-fee-for-service practitioners … or even to extinction.

Natural selection favors species that can evolve and adapt to the demands of a changing environment. Such is the hybrid EMR. Its strength is a fundamentally simple, strong, and very nimble DNA architecture that can accommodate the changing requirements of its users. Unlike traditional EMR systems, which force the user to conform to their structure and syntax, the hybrid EMR thrives because it conforms to the unique needs and productivity requirements of the healthcare provider, even the high-performance healthcare provider. The hybrid EMR is the highest state of EMR evolution; its survival is assured.

The Green Provision to the America’s Affordable Health Choices Act of 2009?
By The Alchemist

In the year 2010, the global economy is on the brink of absolute collapse with overcrowding in the cities, rampant unemployment, and a mandated rationing of healthcare resources because of the increased demand and the sudden swollen health insurance membership. Hospital palaces from around the world are converted to efficient and effective government-run bureaucratic clinics for the delivery of appropriate metered care according to the QARY paradigm.

The United States of North America has implemented a novel solution to scarce healthcare resources by augmentation of the Patient Self Determination Act 1991 (PSDA) within the America’s Affordable Health Choices Act of 2009. The purpose of PSDA is to relieve the burden on the healthcare delivery system by introducing a process that might produce the desired “green” effect by reducing the supply impact to our environment of care.

PSDA is re-crafted and claimed successful within the green movement for scarce resources and has become known as the Solyent Green Movement where tired citizens can “go home” to their favorite government clinic for care. Solyent Green is for people!

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From Just wondering: “Re: Eclipsys. More Professional Services leadership cuts at Eclipsys, VP Linda Lockwood and RVP Gaye Fright.” Unverified.

From Lucky13: “Re: Healthland. A letter from our account rep today – we are a Healthland (formerly Dairyland). Thanks! Love the blog … I have learned so much about our industry through it.” Healthland (the former Dairyland) announces that it has acquired small hospital HIS vendor American Healthnet. A snip from the letter: “Not only are we staying the course with Healthland solutions and our product roadmap, we expect to continue improvements across the board in how we support and service your hospital and staff. This includes launching new modules and enhancements you’ve been waiting for — like Emergency Department, Long-Term Care, Home Health, and others.” Thanks for sending it over.

From Kyle: “Re: conference. I’ve been a reader for a little bit now and found out about an event through my school. Loma Linda’s School of Public Health is hosting the Southern California Health Care Summit on October 29 at the Ontario Convention Center. The conference will be a chance to earn FACHE credits and learn about some the latest trends in HIT. They are billing it as the West Coast’s version of the World Health Care Congress.” Thanks.

Listening: Tindersticks, British and obscure, a lush mix of dark vocals, lounge music, and jazz. Kind of like Leonard Cohen or Nick Cave, rainy night music.

She’s not a doctor, but she plays one on TV: an Obama campaign volunteer admits that she claimed to be a doctor in praising Obama’s health reform plan at the town hall meeting of Congresswoman Sheila Jackson Lee of Texas.

A Congressional Budget Office report (warning: PDF) gives the VA’s VistA good marks (above), although it cites conclusions from elsewhere that EHR adoption incentives should specifically require quality improvements.

Picis announces an enhanced ED PulseCheck: more clinical rules, alpha paging, and standard integration with bed management systems.

Former A4/Allscripts executive David Bond gets out of healthcare to develop a social networking site for teen athletes, earning kudos from former boss John McConnell (who did the same, now running his string of high-end golf courses).

El Camino Hospital goes live on the first phase of its Medicity-powered HIE. The Medicity Novo Grid is delivering real-time information to physicians, depositing ADT, insurance information, lab results, and transcribed reports into their EHR systems.

Mercy Medical Center (IA) will implement PatientKeeper’s Physician Practice Connector to give doctors a view of inpatient data, connecting the PatientKeeper Physician Information System with Sage Intergy EHR.

A couple of readers wisely suggested that I not consider running nondisclosure language from vendor contracts. Reasons: (a) it might identify the client since terms are often customized; (b) it might violate vendor privacy requirements and get a client or me in trouble; (c) clients might not want to share anyway since they may like the idea of being prohibited from sharing patient safety information. A couple of vendors e-mailed to say they don’t include such terms. I’d  be very surprised if Cerner and Epic don’t based on my limited history with them.

Jobs: QA Engineers, GE Centricity CPOE Project Manager, Strategic IT Consultant, Eclipsys SCM Systems Engineer.

A hospital in Taiwan implements a PBX-to-Skype gateway that allows free calling between nursing stations and its computers-on-wheels. Each COW has a USB handset tied into the hospital PBX so that employees can make and take Skype calls on regular phones. I Googled around and the four simultaneous calls version of the VoSKY appliance costs $1,500.

API Healthcare announces availability of its Business Analytics solution, which covers Staffing Solutions (staffing ratios and schedules) and Overtime Cost Control. MemorialCare (CA) is running it now.

The federal government rolls out a very Web 2.0-ish IT Dashboard that gives a quick green-yellow-red report like that of the VA above.

Chicago hospitals spent $32.4 million on advertising in 2008.

German HIT vendor CompuGROUP’s Q2 numbers (warning PDF): revenue up 61%, earnings up 19%.

In Australia, iSoft reports a 50% increase in revenue and 143% increase in profit, also predicting 10% sales growth for 2010.

Oracle’s Larry Ellison made $557 million in compensation in 2008, but was still #2 to the CEO of Blackstone Groups, who took home $702 million.

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“Tap-tap-tap, is this thing on?”

I’d like to thank the Academy, Mr. HIStalk, and Inga for allowing me the chance to post on a regular basis. Starting today, I’ll be writing a column sharing the Wall Street/investor perspective on HCIT, so I first thought I’d briefly share my background to give an idea of why Mr.HIStalk thought I’d be a good regular contributor.

I began my Street career on a crisp autumn day as a sell-side stock analyst (well, I was an associate analyst first) covering healthcare IT companies, most of which seem to have been acquired by HBO & Co. (now, of course, known as McKesson). Spending about a decade as a research analyst, I covered the stocks of around 25 companies such as Cerner, HBO, Sunquest, Eclipsys, etc. As the dotcom/e-health era arose, I covered those stocks as well, helping to take companies like Allscripts, Healthstream and others public.

After ten years, it was time for a change, so I went to what many called “the dark side” and became an investment banker. I spent six years doing both M&A and public offerings, primarily in the healthcare IT sector that we all know and love.

Wall Street has a few things to recommend it as a career, but the ability to speak truth isn’t always one of them. So, in March, I left the Street to become an independent strategic advisor to healthcare IT and other companies. So far, so good …

Yes, but just what does an analyst do and what’s the sell-side and how is it different from banking? For my first few posts, Mr. HIStalk and I thought a brief tutorial on the industry might be interesting to you, gentle readers. Let’s start with equity research.

There are two sides of Wall Street, the “buy-side” and the “sell-side”. Buy-side means the entities that actually purchase stocks (mutual funds, hedge funds, pensions, etc.). These institutional investors are what typically drive stock prices and through their commission dollars, sell-side behavior.

Sell-side analysts work for brokerage firms, aka investment banks. The other key difference is where buy-side analysts might cover hundreds of stocks or even the entire healthcare sector (from Merck to Mediumune and from McKesson to Medtronic), sell-side analysts typically focus on much smaller swaths of the economy such as biotech, big pharma, or healthcare IT and distribution, covering 15-25 stocks.

It’s the sell-side analysts’ job to know how the companies in their sector perform, what’s driving their growth, and to predict what their income statements will look like each quarter for the next few years. Why? Because it is viewed as axiomatic that earnings drive stock prices and so an analyst will model what they expect the company to earn and then try to determine if its stock price is appropriate. If it’s not, the analyst puts a coveted “buy” rating on it and proceeds to pitch the idea to the buy-side. If a buy-side client likes your idea, there’s the usually unspoken assumption that their fund will try to buy the stock through your firm and you get some credit for the commission dollar.

Earnings might drive stock prices, but I think John Maynard Keynes had a better assessment. He said, in effect, that picking stocks is like judging a beauty contest, but you are trying to figure out who the other judges would find the most attractive. This is why companies that care about their stock prices (and given that CEOs tend to own a lot of stock, most seem to care about this), care about the care and feeding of their sell-side analysts, trying always to paint the rosiest picture possible without (hopefully) crossing the line into fabrication or outright dishonesty.

I say “hopefully” because in my research days, I had countless CEOs telling me how their company was kicking competitive butt, taking market share, etc. All too often (especially early in my tenure), I’d then stand in front of my sales force and call clients to say, “we’re feeling very confident in HIStalkCo’s upcoming quarter”. Usually other analysts were saying the same thing (conformity is typically rewarded) and a “whisper number” began to circulate, meaning analysts are in print saying earnings will be $0.12 this quarter, but they’re all really expecting $0.15. This is why stocks would sometimes drop after hitting analysts’ consensus. This rosy feeling would often last until the company in question reported its quarter and, instead of the $0.12 – 0.15 expected, they reported $0.05 and the stock (of both the company and the analysts) fell.

I should note that it wasn’t always outright dishonesty. CEOs, by their nature, tend to be optimists and salespeople at heart, and the best salespeople, in my experience, believe their own stories.

A few questions might arise.

What does share price mean to me, the customer? In my view, often more than it should. Assuming your vendor has a decent amount of cash on their balance sheet and has a market capitalization high enough to remain somewhat relevant to investors (say, over a few hundred million), let investors and vendors obsess over share price and you can obsess over implementation and support issues.

Why the focus on quarterly results? When I was on the banking side, I had a client who was private and had just missed their internal quarterly budget numbers. The CFO, however, felt “great” about the year. Wanting to go public in the worst way, he asked me why they couldn’t just give annual guidance (like some companies were starting to). The answer is analysts are required by both their firms and their clients to develop quarterly estimates, which are then published. That means an expectation has been set, regardless of whether the company has endorsed it.

The company then achieves, exceeds, or disappoints on those expectations and, in my experience, its stock price reacts accordingly. Discussing what it would be like if this weren’t so is like discussing how pro baseball would be like if they switched to softballs. It might make an interesting conversation over a glass of cabernet or two, but it’s not terribly relevant to the real world. The fact is that quarterly results matter to stock prices here in America, at least in the short term. (incidentally, the company than proceeded to go public in the worst way, missing their forecasts within a few weeks of its IPO. The stock never again saw the IPO price and the management team didn’t get half the kicking around they deserved).

Should I chose a vendor that’s public or private? I’ve never selected a vendor, but IMO, you should choose the one that offers the best product for the best price (sorry to state the obvious). Recognize that there are certain incentives that drive public companies and this quarterly earnings game can impact the amount they spend on R&D, customer service, or other areas you care about. Recognize also, however, that this access to capital and currency allows them to invest in ways private companies often can’t and also is often a recruitment and retention tool (assuming the stock price goes up).

What else matters when dealing with public companies? There was an interesting Readers Write posting a few months ago where a customer complained that they were being ignored by a vendor for reasons having to do with their need to make quarterly numbers. Now as I mentioned, companies really care about their stock price and what investors are saying about them, perhaps more than they should.

Further, analysts (at least good ones) love to have any kind of proprietary morsel about the companies they cover. It’s always great to go to the buy-side and share special information — a key form of currency on Wall Street, and customer insights are always some of the best. It shows the analysts are doing some research away from the companies they follow.

Were I the ill-used client in question, I’d draft a lengthy e-mail detailing all these issues and send it to the vendor’s CFO saying, I’ll be forwarding this and similar views to one or two analysts that follow the company. I’ve not tried it, but it might improve your care and feeding as no company should want to have anything but a good reputation for customer service. Recall how the stock of Cerner fell after CEO Neal Patterson wrote his scathing “parking lot” e-mail and it surfaced on Yahoo! a few days later.

Thanks for your attention, I very much appreciate it. If interest warrants, we’re hoping to make this a regular column. Please let me know what topics you’d like to see discussed or just e-mail or leave a comment. Other areas Mr. HIStalk and I thought might be well received are:

A similar view of investment banking
How does an IPO work?
What exactly is private equity and what is it doing in healthcare IT?
An M&A watch – who’s buying whom, why, and does it make even a modicum of sense?

Ben Rooks is the founder of ST Advisors, a strategic consultancy offering long-term and project-relationships to companies and financial sponsors. He earned an MBA in healthcare management from The Wharton School of the University of Pennsylvania, has done healthcare IT equity research, and has worked as an investment banker in over 25 successfully closed healthcare and medical technology transactions valued from $40 to $365 million.

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The National Alliance for Health Information Technology announced this morning that it will cease operation on September 30. COO Jane Horowitz says NAHIT has accomplished its mission of moving HIT “front and center” to reinvent the US healthcare system.

The NAHIT announcement says the challenge of implementing and using technology can be better met by other organizations. It named those as the American Hospital Association and the College of Health Information Management Executives, both of which were NAHIT founding members.

NAHIT was founded in 2002 as a technical standards organization. CEO Scott Wallace resigned in early 2008 as the group explored “new strategies and tactics and a different operating structure.” According to federal records, NAHIT took in $3.5 million in 2007, but had net liabilities of over $600,000. Scott Wallace was paid $679,000 that year.

NAHIT, along with HIMSS and AHIMA, found CCHIT in 2004. It also funded a controversial project to define five common healthcare technology acronyms, paying BearingPoint $500,000 for the job. The organization had begun calling itself “The Alliance” in 2005.

The HIMSS Web site refers to NAHIT as one of its sister associations, along with AHIMA, AMIA, CHIME, and eHI.

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From Don Money: “Re: West Michigan HIE article.” Here’s the link, but you have to be a subscriber (the reader sent me a PDF). The Grand Rapids Business Journal covers an HIE created by three hospitals, all of which are using technology from the former Novo Innovations (now Medicity). Medicity’s Robert Connely: “It’s not designed to create the next generation of applications. It’s designed mostly to solve work and save tons of money, and that’s the reason they’re willing to pay for it.” The hospitals’ HIE is replacing the community-based model advocated by Alliance for Health, which found providers unwilling to pay third-party usage fees. Trinity Health will use the Medicity approach for all 45 of its hospitals, according to the article. Medicity says its technology and business models can be adapted to any connectivity scenario: a hospital-owned HIE servicing its doctors, a RHIO/HIE with third-party governance, and (as in this case) a RHIO/HIE without third-party governance.

From Stan Pacifica: “Re: PROMIS pain scale. This is an adaptive testing methodology that contains 120 items in the item bank, but far fewer than 120 are used to assess pain.” That makes sense, although the reporter specifically said “asks patients 120 pain-specific questions, as well as hundreds more that probe the physical and mental effects of pain.”  

Here’s the layoff letter from Philips Healthcare, citing lower profitability and “risk of further deterioration in several of our markets.” The usual “simpler, leaner, more flexible organization” mantra is recited, oddly enough by the same CEO who originally oversaw its regrettable transformation to more complex, fatter, and more rigid organization in the first place. He’s making $2.5 million a year for 20-20 business vision, which would value it at $5 million if it worked in foresight and not just in hindsight.

It’s clear from Friday’s excellent recommendations to HHS by the Certification and Adoption Workgroup of the HIT Policy Committee that they want major changes made to EHR certification. Some of the high points:

• HHS certification (notice they didn’t call it CCHIT certification) is not intended to be a seal of approval.
• A new certification process should be developed that focuses on Meaningful Use rather than specific functionality points (that change will let specialty EMR vendors certify their products).
• Certification should include all privacy and security policies that are in ARRA and HIPAA.
• New highly detailed interoperability and data exchange specs should be created.
• “Test harnesses” should be created so that providers can test their own software.
• Multiple certification organizations should be allowed, with NIST accrediting them.
• ONC should define certification criteria, not the organizations performing the certification testing.
• Certification criteria will be updated no more frequently than once every two years and certification should be good for four years.
• “Lock down” requirements should be eliminated to level the playing field for open source systems.
• Since Meaningful Use definition is imminent, HHS should create a preliminary certification that would be valid through 2011.
• Interesting quotes: “There has been criticism that CCHIT is too closely aligned with HIMSS or with vendors. While we did not see any evidence that vendors were exerting undue influence on CCHIT, we also understand that the appearance of a conflict is important to address … Most vendors advocated for a minimal approach to certification, complaining that CCHIT has ‘hijacked their development effort’ and that they are developing features/functions that nobody will use.”

The takeaway: if the recommendations are accepted, CCHIT’s role will be diminished and shared with other certification bodies, none of which will be allowed to create certification criteria; certification will move away from a detailed product design to focus instead of how EHR products are used; and CCHIT cannot shake its reputation for being controlled by a few big vendors and HIMSS. It’s pretty clear that CCHIT may well have an ongoing role in the government’s HIT policies, but not at the level of influence it has enjoyed until now. Finally, someone says no to HIMSS.

The Colorado Hospital Association and the Colorado Behavioral Healthcare Council select Qwest Communications to provide broadband services to create one of the largest health information networks in the country, connecting 400 providers and supporting telemedicine initiatives. The Colorado Telehealth Network will focus on rural areas, giving them 100-megabit connectivity via Qwest’s fiber-optic network.

Ross Koppel pointed out that hospitals probably can’t sign software vendor contracts containing non-disclosure language without running afoul of the Joint Commission’s accreditation requirements, which require hospitals and providers to share information about known patient safety risks. Here’s my challenge to you providers: send me a copy (scanned or copied and pasted) of the non-disclosure language in your contracts and the vendor involved. I’d like to run some of them here anonymously (nothing but the wording and the vendor) so new customers will recognize those terms and insist they be removed.

Recondo Technology announces EligibilityPlus, a SaaS insurance eligibility application. I mentioned the defunct (well, acquired by Sybase, which is pretty much the same thing) New Era of Networks the other day and, what do you know, founder Rick Adam is now chairman and CEO of Recondo. It’s a small world, this healthcare IT stuff.

A Florida medical magazine covers the history of EMR vendor DoctorsPartner, which says its PM offering was Best in KLAS 2007 and its EMR #2.

A London Times article compares US healthcare to the NHS, quoting a patient who moved from Britain to the US. “Every time you go for any treatment here, they want to see your insurance card and check every detail they have about you and that is wearisome. But I’ve had some terrific treatment. There are all sorts of things you have to be aware of: some treatments you part-pay for and you have to choose a doctor who is approved by your insurer. But it’s not all about money here. The doctors are doctors – they really want to help you.” Another insightful comment from a UK cancer patient who sought treatment here: “Most doctors in Britain, if they’ve worked overseas, will admit that somewhere like America has the best of the best. What it doesn’t have is the breadth of coverage. Ours is an equitable, morally cogent way of doing things. But looking at the amount and quality of research into my cancer, there was a clear difference between Britain and the United States.”

A pharmacist who didn’t catch a technician’s IV mixing mistake that killed a child at Rainbow Babies & Children’s Hospital (OH) is sentenced to six months in jail for involuntary manslaughter, to be followed by six months of house arrest, three years of probation, a $5,000 fine, and 400 hours of community service. His pharmacy license was also revoked. It appears from the newspaper’s description that the technician mixing the chemo IV used sodium chloride concentrate 23.4% instead of sodium chloride 0.9%, related to the fact that the hospital’s computer system had been down for some time. The tech was charged, but not indicted. I don’t know that putting healthcare providers in jail for making an honest mistake is a good idea, especially if you want to keep enough providers providing.

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