From eHealthDC: “Re: the Senate’s plan for making EHR incentives permanent. I had staff follow up on the story. According to a source, there was some misquoting – while there are a few areas of interest in Senate Finance, it does nothing aggressive on HIT. The key areas it touches on are the following: (a) the Secretary will conduct a study on methods to encourage meaningful use by entities offering insurance plans through a state-based exchange; (b) organizations participating in the CO-OP program will be permitted to enter collective purchasing arrangements for HIT-related materials; (c) the bill requires CMS to develop a plan to integrate the PQRI program with the standards for meaningful use; (d) no less than triennially, the Secretary will identify quality measure gaps and may appropriate grants to entities with expertise in developing such measures. These measures specifically include, among others, meaningful use of HIT. To this end, HHS will appropriate $75 million for fiscal years 2010 – 2014; (e) free clinics will be eligible for meaningful use Medicare and Medicaid HIT incentives; (f) the Secretary will incorporate reporting requirements and incentive payments and penalties related to electronic prescribing and EHRs into accountable care organization requirements; (f) the bill creates a bonus payment structure for care coordination and management activities conducted by Medicare Advantage plans. HIT programs are included as eligible activities. Nothing earth-shattering.” Thanks.

From MEDITECH Customer: “Re: Kronos. I guess it isn’t really a rumor since I heard it first from my Kronos sales guy, then verified it in about half a dozen places. Kronos bought Stromberg from Paychex Inc. Stromberg had been beating out Kronos in some of the small hospitals in my area lately.” Paychex sells its time and attendance business to Kronos for an undisclosed sum. Kronos gains 1,400 customers that it describes as primarily mid-market (250 to 1,500 employees). Stromberg was an independent vendor in Lake Mary, FL that Paychex acquired in 2004 after first buying its Time in a Box product for small businesses the year before. It continued to operate under the Stromberg name as a Paychex subsidiary, offering free version upgrades, fixed price implementation, and a 99.7% customer retention rate.

From HITgeek: “Re: Siemens reorg. You can assume that Siemens reorg rumors around this time of year — right at the start of its fiscal year — are based on reality. Siemens’ most dependable product release timing is new org charts every year.”

From Simon Kirke: “Re: Meditech 6.0. I hear Meditech is forcing customers to buy a scanning and archive product with Meditech 6.0, even if they have a current document imaging solution. Can you verify this?” The floor is open.

From VA HIMSS: “Re: HIMSS. Friday night at the VA HIMSS Fall Conference, John Hoyt, VP HIMSS Analytics, said that HIMSS sees itself as matchmakers between providers and vendors. Huh? I thought HIMSS was a professional organization!” I’ve said all along that HIMSS is a highly profitable bar with a business model in which ladies (providers) drink free provided they don’t mind being groped by men (vendors) who pay dearly for the privilege. As evidence, I usually link to the HIMSS Exhibitor Priority Point Opportunities list (warning: XLS) that enumerates what vendors have to buy to earn the right to spend massive dollars on their annual conference exhibit (the cover charge?) 

I’m fascinated by the unintentional insight provided by responses to the poll I did on whether your primary care doctor uses an EMR. The PCPs of 63% of respondents use an EMR, which is astoundingly high and, frankly, hard to believe as representative. However, only 23% feel so strongly about EMR use that they would choose only EMR-using doctors, so those of us in the HIT industry aren’t eating our own dog food.

My doctor uses an EMR and I’m finally buying the concept after longstanding skepticism. I can confirm my appointment online and pay my co-pay online with a credit card (which lets me skip the check-in at the office), I can see my labs online from anywhere with his notes about what they mean, he can pull up my records from anywhere I’ve been seen within the health system, he uses e-prescribing, and he has done a great job in integrating the EMR as part of his patient teaching right in the exam room. Nobody has asked me even once for repetitive information. And most importantly, he says he finds it useful and clinically beneficial. Like most of the respondents, I’d stick with him even without the EMR, but it makes my encounters more convenient, adds clinical value, and gives me the peace of mind that if I show up at another health system facility I won’t be just an empty clipboard to them. I get it, I like it, and I’m looking forward to having more electronic and online services. I figure it’s no different than when I get my $13 haircut from the local cheap chain place since they look up my records by telephone number, their version of an EHR (electronic haircut record).

New poll to your right: are you and/or your employer planning to upgrade to Windows 7? It ships Thursday. I’m riding the fence myself. Microsoft panicked that it would lose impressionable students for good when Apple priced its Snow Leopard upgrade low, so I’ve got a $29.99 upgrade coupon for Windows 7 Home Premium since I have an EDU e-mail address for reasons too complicated to explain. Even then, I’m finding it hard to get excited about displacing XP since the Vista wounds are still fresh and I’d have to install from scratch this time since there’s no XP upgrade. Everything I do is on the Web, so I don’t know that a prettier and allegedly better Windows would change my life since Firefox would still look the same.

I see some folks have added their Webinars and conferences to my events calendar. Just a suggestion: put them up well in advance so those interested folks can lock in. You won’t get many new registrants for an onsite conference if the posting is made the week before.

A reader forwarded an e-mail from Kaiser CEO George Halvorson touting the Archimedes healthcare modeling system. Interesting: it’s an artificial intelligence system that uses computer models of the human body to analyze treatment approaches, rather like a virtual clinical trial. Kaiser did a stroke and heart attack prevention study with it to determine optimal combinations of drugs in a large population. It predicted that a combination of aspirin, lisinopril, and lipid-lowering agents would reduce risk by 71%, darned close to how it turned out in Kaiser’s real-world result of 60%. It has rolled out the protocol to 250,000 patients. Kaiser is the ideal environment for that kind of project since it fully manages its HMO patients and is incented to improve their health.

This isn’t news to us industry types, but an investigative report says EMR stimulus could cost twice the $19.5 billion figure that everybody remembers. Now we all know the real numbers – the incentives are pegged at $46 billion but will supposedly be offset by non-specific savings, giving a net cost of $19.5 billion as a best case. The report quotes a taxpayer group that compares HITECH to irresponsible overeating with a plan of going to the gym later to work off the calories. There’s not much point in debating whether the numbers are right or wrong, however. Once you’ve hitched your wagon to idealistic taxpayer bailouts as a national program despite crushing national debt, you shouldn’t expect the SWAG numbers to be anything more than irrationally exuberant.

UMass Memorial chooses Accenx Exchange for interoperability.

Iowa Health System and Allscripts launch ePrescribe Iowa, in which physicians will be offered a free Web-based e-prescribing tool.

Eclipsys Sunrise Pharmacy customers are on the rise, although exact numbers aren’t given in the press release. It says 80% of them do CPOE on Sunrise (a more interesting stat would be the number of its CPOE customers using their pharmacy system, of course, since Sunrise Pharmacy probably isn’t bought as a standalone system very often). It has some big-name users like El Camino, RWJ, SUNY Downstate, University of Kentucky, and HUP.

University of Iowa Health Care creates a half-time CMIO position and hires otolaryngologist Douglas Van Daele, MD for it. He’ll oversee its new $61 million implementation of — you guessed it — Epic. Their state representative gripes that UI gave the doc a $46K salary boost to $291K, saying, “I can’t think of any justification for adding any position while these cuts are being made that can’t draw down more (grant) dollars or doesn’t save lives. I can’t believe they’ve gone this long and they are adding it into a half-time position — and that couldn’t wait?" Apparently there’s friction over the university’s recent layoffs and some other recently added executive positions.

If you’re a fan of Dr. Gregg Alexander on HIStalk Practice and are attending the American Academy of Pediatrics conference this week, Gregg invites you to stop by the Pediatric Office of the Future exhibit and then join him at the Official Unofficial HIStalk Practice Happy Hour Reception at the President’s Sports Bar in the Renaissance Washington from 5:00 to 7:00 p.m. on Monday, 10/19. It’s a block and a half from the conference center.

Indiana cancels its 10-year, $1.34 billion welfare services contract with IBM and ACS, saying “the system wasn’t working, and it wasn’t getting better, despite best efforts.” The failed effort to privatize the systems was the largest contract in state history. It was supposed to save the state $500 million. ACS call center workers said they were told to lie to welfare recipients whose benefits were delayed, always telling them they’d get them within 48 hours just to get them off the phone. House Speaker Pat Bauer wants IBM to “go away and pay us something.”

Speaking of Indiana, its HIEs band together under a new governance organization called Indiana Health Information Technology to apply for stimulus money.

GE announces ugly Q2 numbers: revenue down 17%, EPS $0.26 vs. $0.54. GE Healthcare’s earnings were down 20%.

Just who you want advocating for EMRs: South Carolina Governor Mark Sanford, who is best known for disappearing for a week to cavort with his Argentine mistress and then lying about it with a lack of skill that is surprising for a politician.

Vanderbilt University Medical Center gets $6.4 million in stimulus money to look for a link between drug performance and genetic factors, matching 67,000 DNA samples in its database to de-identified patient medical records.

E-mail me.

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Sanjeev Arora, MD is professor of medicine, director of Project ECHO, and executive vice-chair of the Department of Internal Medicine at the University of New Mexico Health Sciences Center, Albuquerque, NM.

Please give me an overview of Project ECHO.

Project ECHO stands for Extension for Community Healthcare Outcomes. Our mission is to develop the capacity to safely and effectively treat chronic, common and complex diseases in rural and underserved areas and to monitor outcomes. It’s funded by the Agency for Healthcare Research and Quality, the New Mexico legislature, and the Robert Wood Johnson Foundation.

We started this project about five and half years ago to treat hepatitis C, which is a global health problem affecting 170 million people worldwide, of which 3-4 million are in the US. In New Mexico, we had 28,000 patients who had hepatitis C. In 2004, less than 5% had been treated because there weren’t enough specialists in rural areas to treat them. There were 2,300 prisoners who were diagnosed with hepatitis C and none had been treated. We had the highest rate of chronic liver disease/cirrhosis deaths in the nation, so it’s twice the national average. 

The disease was treatable and it can be cured. Hepatitis C has six main kinds of virus. If people had Genotype 1, we could cure them about 45% of the time. If they had other kinds of genotypes, we could cure them about 80% of the time. The problem was that if patients were given this kind of treatment, which consisted of weekly injections and daily pills, they got severe side effects.100% of patients became anemic. Their white cell count went down. About a quarter of them got depressed. 

Primary care doctors didn’t feel comfortable treating this disease. There weren’t any specialists in the rural areas and in prison. That was the problem that we were trying to solve. 

Rural areas of New Mexico are a very underserved area for healthcare services. Thirty-two of 33 New Mexico counties are listed as Medically Underserved Areas. Fourteen are designated as a Health Professional Shortage Areas. We said we could use this new model to develop the capacity to safely and effectively treat hepatitis C in all areas in New Mexico and to monitor outcomes. We felt, if we could do that, then we would have a model to treat complex diseases in rural locations and developing countries.

We developed a partnership between the University, the prisons, health department, Indian Health Service, and community clinicians who were willing to treat hepatitis C in rural areas. ECHO’s model is based on four key ideas.

One is the use of technology to leverage scarce healthcare resources which may exist only at a university or in a tertiary care center.

We use a disease management model, where we focus on improving outcomes by reducing variation and processes of care. We create a best practice protocol for treating hepatitis C and then we share it widely with our partners. We all manage off the same label. This is to improve quality.

The third key idea is case-based learning. That’s when a rural provider goes to medical school or residency. They learn from real patients and mentors. When they go to the rural area and a new disease like hepatitis C gets discovered in 1989, they’re expected to read books and then treat this disease. They don’t feel comfortable because it’s a very complicated disease. So we said, “Why should we not bring case-based learning back into the lives of the rural provider by co-managing patients with them? We have a centralized database to monitor outcomes.”

We train physicians, nurses and pharmacists in hepatitis C. Then we conduct these telemedicine clinics, which we call Knowledge Networks. Many rural clinicians sign on simultaneously onto an interactive video network with specialists from the university. One by one, they present patients with hepatitis C to experts at the university. The specialists at the university help them manage these patients, tell them what to do, what tests to order, what treatments to take, and help them manage side effects of treatment.

They come every week, once a week, for a couple of hours and present their patients. This creates a learning system which we describe as a Learning Loop, where these clinicians learn from each other as much as they learn from university specialists. They also learn from short didactic presentations.

We give the rural providers no-cost CME credits. We give nurses credits for participation because they are learning from experts at the university. We like to improve their professional satisfaction and we give them access to multiple specialists at the same time.

Everybody gets the chance to present their patients. We use all different kinds of technology, including videoconferencing bridges, videoconferencing recording devices, and electronic records to enhance communication. We described this first for hepatitis C, but it’s applicable to any disease that is common, management is complex, new treatments are coming, high societal impact, if there’s a serious outcome of a untreated disease, and if there’s effective treatment.

We have a few concepts that make Project ECHO work. One is we are trying to provide the same level of care at a community health center as we give at a university. We can do this by means of technology, best practice protocols, and case-based learning.

From the Pareto Principle, the 80/20 rule, if you create Knowledge Networks for just a few diseases, you can have a huge impact on healthcare. You don’t need to have Knowledge Networks for 500 diseases to have a huge impact. A few diseases account for most of the morbidity and mortality.

We use the concept of a Force Multiplier. Because of the specialist shortage in rural areas, we can use existing community clinicians like nurse practitioners and physician assistants and enable then to provide the same level of care as specialist, therefore multiplying the capacity for specialty care in rural areas.

One challenge that comes up is that there is not only a shortage of specialists in rural areas, there’s also a shortage of primary care doctors. This is the next generation of Force Multiplier, which essentially shows you that we are training now community health workers and medical assistants and nurses also in these chronic diseases so they can be part of the chronic disease management team to help the primary care clinicians.

Existing methodology for training and development of widely distributed learners has major limitations. They tend to be expensive and out of sight, out of mind. You call them in for a conference into your city, spend thousand of dollars, they go back, and they forget what you have taught them.

In our model, we help them apply this knowledge and, using technology, we can do this training at a much lower cost. Also, we don’t have the problem of knowledge obsolescence because it’s a weekly interaction where we are slowly making them experts.

We also have a prison peer education program where we train prisoners in New Mexico to teach other prisoners about hepatitis C.

We have 15 separate areas in which we have Project ECHOs going on: hepatitis C, cardiac risk reduction, asthma, rheumatology, chronic pain, substance abuse, high-risk pregnancy. Some are supported by the Robert Wood Johnson foundation. We have many others. Overall, we have more than 140 programs around the state.

With hepatitis C, we have done 375 HCV Telehealth Clinics. More than 3,500 patients have entered the HCV disease management program. We have provided thousand of hours of CME credit at no cost to clinicians.

We’ve taken community clinicians and assessed their skills and abilities on different domains of hepatitis C care. On the question of, “What is your ability to treat Hepatitis C patients and manage side effects?”, on a scale of one to seven, they were two out of seven when they started and it went up to 5.2 in 12 months alone. So, very major improvements occur as they engage with us in this learning process.

Asking if they could serve as a local consultant for hepatitis C in their clinic and area, it went from 2.4 to 5.6. Overall competence went from 2.8 to 5.5. When asked if this kind of activity is of moderate or major benefit to them, it ranged from 94% to 98%.

Subsequently, we did a hepatitis C trial in which we compared the care in the university to the care in the rural areas and prisons by primary care clinicians. Rural primary care clinicians deliver hepatitis C care that is as safe an effective as a university clinic. We can also improve access to care for minorities. Almost 69% of our patients in the ECHO groups are minorities, versus much fewer in the university.

The potential benefits of the model are improved quality and safety, improved access for rural and underserved patients, workforce training and force multiplier, improving professional satisfaction and retention, cost effective care by avoiding excessive testing and travel, preventing cost of untreated disease, for example, liver transplant, and integration of public health.

In 2007, applications were sought for disruptive innovations in healthcare, new models that would change healthcare nationally and globally. This was sponsored by ASHOKA Foundation and Robert Wood Johnson Foundation in a disruptive innovations contest. Project ECHO was selected a winner among 307 applications from 27 countries. We were one of three winners selected.

Using technology, best practice protocols, and co-managing patients with case-based learning is an effective way to safely and effectively treat chronic, common and complex diseases in rural and underserved areas and to minor outcomes.

This is the first program I’ve heard of where the goal wasn’t just to turn over patients to experts sitting on the other end of a monitor, but rather to educate and make local practitioners self-sufficient. Has anybody else done that?

We don’t know of anybody that has done it the way we do it. Basically, that is why it was selected, probably, as the most disruptive innovation in healthcare.

Commonly, technology has been used specifically in healthcare by telemedicine, where there’s a specialist at the university and there’s somebody in the rural area connected by camera. That doesn’t lead to the force multiplication that we’re talking about. We’re interested in long-term capacity expansion of care.

In the passage of time, these healthcare providers become less and less dependent on us as they become good at it. We are not aware of this model anywhere.

Healthcare reform always talks about who’s going to pay and who will be covered, but nobody has addressed the issue of having enough practitioners of the right types in the right places. Are you getting interest from the government or insurance companies about how they might use this model?

We have not focused so far on publicizing at all. This is the first initiative. We got a very large grant from Robert Wood Johnson Foundation and they hired a PR firm, which I think reached you. So I think that this is just the beginning, really.

Very few people know about this program in the way you have just learned about it. We have treated tens of thousands of patients through this methodology, but our focus has been on service, not so much on policy work or convincing healthcare providers. But we hope that some of the work you and your colleagues will do will help us get there.

We think that this is a very valuable tool for healthcare reform because we can train, not only primary care physicians, but community health workers to become experts in very common diseases like obesity and hypertension and diabetes.

Because of the shortage of primary care clinicians, how do you take care of all the chronic disease that is going on everywhere? We thought, if we trained the teams of the primary care clinicians in these very common problems, we’ll do a better job.

When a community health worker is used as a sole diabetes educator — that is, no doctor, no nurse, no certified diabetes educator — HbA1c can drop by 15%. Comparing the care provided by a community health worker and a nurse practitioner in the community versus a university-based primary care clinician, the community-based care does twice as good.

We asked ourselves, “Why is this community health worker intervention effective?’ These people live in the community. They understand the culture. They walk two moons in the patient’s moccasins. They appreciate the economic limitations of the patient and they often know family and can engage other the social resources. But most importantly, they spend more time with the patient.

If you are trying to change a diabetic or and obese patient’s behavior and doctor spends four 15-minute sessions with them over the course of a year, it’s hard to do that, whereas somebody like community health worker can spend seven one-hour sessions for one-tenth of the cost and actually make a bigger impact.

We have developed two tracks. The first one has already launched, the second one is in preparation. The first one we call the CHW Specialist Training Track, where we take these community healthcare workers and train them in diabetes, obesity, hypertension, cholesterol, smoking cessation, and exercise physiology. Then, over time, they start interacting with us on these Knowledge Networks until they really become experts in a very narrow area. This specialty CHW program uses low-cost technology to take specialty training to CHWs, promotoras, CHRs, and medical assistants where they live. It has a very narrow focus but deep knowledge, standardized curriculum.

We give them ongoing support via Knowledge Networks. They become part of the disease management team. Basically, the point that I was trying to make to you with reference to your question is, in healthcare reform, we have to train a much larger health workforce so that doctors work in teams, rather than individuals trying to solve the big problem.

I’m interested in your statistic on how well the community-based caregivers were able to do what they do. Do you think that would be true outside your population of the underserved or on a Indian reservation? Is it translatable to the rest of the United States?

There are some places in the United States where you have a highly trained work force, for example, Manhattan or Boston. There are hundreds of certified diabetes educators. So the moment somebody comes to you, you can refer them to a nutritionist, diabetes educator, or podiatrist. You don’t need a community health worker — you’ve got super experts doing all this work.

But when you go to a prison, a rural area, an Indian Health Service facility, there aren’t any certified diabetes educators. They don’t exist. The nurses there are not experts and there’s a shortage of primary care clinicians who are trying to see 25 patients a day and do it all themselves. In that setting, or in inner city areas whether it be south of Chicago or Bronx … I think where there’s a shortage of these healthcare resources, these models are particularly effective. We’re not trying tot change healthcare where there’s doctors on every street corner and every other health professional fully supplied. Our mission is to provide world class healthcare in cost effective ways in areas where there isn’t enough healthcare workforce.

It seems that there’s not much ego involved. You’re not saying that your organization or your doctors have to get all the credit. You’re just saying, “We’re going to help you and help the patients.” It must be hard to convince people that you don’t have a vested interest.

I think the fundamental issue with Project ECHO, as you have alluded to, is that we have to be willing to break the monopoly of knowledge that exists. The knowledge gets monopolized otherwise. Breaking that monopoly and sharing it freely for public benefit, without necessarily charging anybody for it, doing it at low cost on public dollars, would be much more cost effective.

What if President Obama came to you and said, “This works. This is where we want to go. We want to take this national.” How would you go about doing that and what would it cost?

I think the first thing that would happen is one would have to create some kind of a federal granting mechanism to academic medical centers around the country, in which we would essentially ask them to consider a different mission.

Right now, academic medical centers do three or four things. They basically provide very high quality tertiary care, but they also train doctors and nurses. These federal grants that would be provided to these academic medical centers would ask them to essentially refocus their mission to training a much larger workforce in America to manage chronic disease in a highly cost-effective way.

That is, finding out what is the lowest cost person who can be trained to provide education, behavioral change, and foot exams to diabetics in rural areas without having to have them travel. Right now, people in New Mexico have to travel sometimes five hours to come to an academic medical center.

Most of the academic medical centers are being financed right now by the clinical revenue generated by all these patients travelling. If you redirect clinicians, these highly educated specialists, from providing direct care one on one to instead enabling the workforce around the state in their rural areas to provide world class care by setting up these Knowledge Networks, you can actually get a much more cost effective healthcare system and get much better outcomes at much lower cost.

It means re-thinking how we do healthcare, so it would mean reconfiguration. In order for the federal government to be able to support such an effort, they would need to support this transition in the mission of academic medical centers. I think if federal granting mechanisms were available, large numbers of institutions like ours would jump at the opportunity because they want to do this kind of work if they are made financially whole.

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From Nash Rasty: “Re: HIT Regional Extension Centers. Is there a list of sites that are on the preliminary approval list? Is it your understanding that for-profit vendors can provide technical expertise? I’m foggy on how companies can get involved.” I haven’t seen a list. I believe the original announcement indicated that the non-profit organization that is awarded an Extension Center contract (up to 70 of them will be created using stimulus money) can farm some of the work out to a for-profit company. In fact, Perot has already thrown in with AMGA and MGMA to offer services to them. I assume but don’t know for sure that each Extension Center is free to choose its own partners. That’s an interesting point: there’s going to be a ton of spending by these organizations, so if my assumptions are correct, consulting and other firms should be watching developments there carefully.

From Midwest CIO: “Re: Siemens. Siemens IT is reorganizing. Hospitals here say experienced associates are no longer with the company.” Unverified.

From The PACS Designer: “Re: Microsoft Tag. Using your iPhone to navigate the web will be easier if you use Microsoft Tag. The application is designed to read a color-coded 2D pattern called a High Capacity Color Barcode (HCCB) that is similar to the black and white checkerboard ones your find on packages which are called Portable Data File 417 (DF417). The PDF417 is a stacked linear bar code symbol used in a variety of applications, primarily transport, identification cards, and inventory management.”

I’m looking for a really good writer, preferably with a clinical background, who is on top of the mobile computing market, especially smart phones and caregiver apps that run on them. Let me know if you know of someone.

Patent troll Acacia Research Corporation extracts cash from Sage in return for dropping its nuisance suit against Sage over PACS, which Acacia claims to have invented. Despite having “research” in its name, even the company itself admits that its business is pretty much suing companies who quickly realize that it’s cheaper to buy ridiculous licenses than mount a legal defense. “The subsidiaries of Acacia Research buy patents as well as represent patent owners on contingency basis to generate revenue from licensing and enforcement.”

More hospital IT employees get the axe courtesy of a Cerner outsourcing deal, this time at Naples Community Hospital (FL). Thirty of the IT department’s 75 employees are turfed off to Cerner, nine stay on as NCH employees, and 36 are screwed.

Former ONCHIT head Rob Kolodner joins Open Health Tools, a North Carolina-based non-profit trade association of open source developers working on interoperable health records, as CIO.

A couple of readers e-mailed to say that former Baylor CIO and Cleveland Clinic IT executive Bob Pickton has been named CIO of SEHA, the health authority of Abu Dhabi. I know Cleveland Clinic has a management contract for one of its hospitals (Johns Hopkins has a couple, too), so maybe there’s a connection. Bob starts work Sunday. The high there today: 96 degrees.

A New York Times article says that time pressures, mandatory multitasking, and real-time attention demands (including EMRs) are burning out doctors who no longer have any contemplative time.

Surescripts will adopt the NCPDP SCRIPT 10.6 standard to connect EMRs to pharmacies for prescription information. 

Coastal Communities Hospital is the first site to go live on CalRHIO’s statewide HIE.

Now I won’t be able to enjoy my pork barbeque, thanks to a YouTube-prowling reader: pigs whose foodd is automatically dispensed in controlled portions by their RFID collars are smart enough to look for discarded collars on the ground and carry them in their mouths back to the feeding station, earning a second meal for the effort. I’ll refrain from making witty comparisons to healthcare scanning.

In the UK, the CEO of the Colchester Hospital trust blames poor service numbers on “data issues”, implying that the CIO was fired as a result. According to the article, “a new chief information officer had been appointed to address this.”

Stock publications have a terrible track record of being able to predict the future, so take this for what it’s worth: someone lists the five companies Dell should take over, all of them in healthcare IT. They are Allscripts, Quality Systems (NextGen), CSC, Cognizant, and Citrix Systems. Citrix isn’t technically a healthcare IT vendor, but it’s probably their biggest vertical since the industry is dominated by 1970s time capsule applications that won’t run efficiently and securely without it (my war horse Citrix joke: Citrix is like a Denny’s restaurant – chosen often, but only out of desperation). Actually I use Citrix a fair amount at work and it’s pretty cool – poorly architected fat client apps run a heck of a lot better over wireless or VPN when you’re only painting screens and not slinging massive data packets back and forth.

Michael Dell hints that the services business he’d like to get into is practice EMR hosting. I’d say that boosts the credibility of the Allscripts part of the rumor above. I bet he would love to get his hands on eClinicalWorks if the founders would sell.

Speaking of Quality Systems, it gets the #3 spot on the Top 10 Small Companies list by Forbes.

Senator Mike Enzi (WY) wins the HIMSS Federal Leadership Award. He’s HIT-friendly, of course.

Caritas Christi Health Care will use the Azyxxi part of Amalga and HealthVault, both from Microsoft.

Virginia Governer Timothy M. Kaine creates the Health Information Technology Advisory Commission, charged with spending a lot of federal taxpayer ARRA money. I don’t think I know anyone on the long list of commission members.

Five hospitals and health systems go live on MEDSEEK’s consumer portal: Advocate Healthcare (IL), Connecticut Children’s, EMN Regional (OH), Forrest General (MS), and St. Joseph (WI).

Cardinal Health signs a deal to distribute Orchard Software’s LIS and anatomic pathology systems.

Recombinant Data Corp. and Sun Microsystems sign a $4 million deal to create a translational research and quality improvement data warehouse for Health Sciences South Carolina, made up of the state’s big hospitals.

I don’t know why this popped into my head, but you aren’t a newbie if you know which popular software once had competitors named Quattro, Symphony, and Lucid.

Informatics Corporation of America wins the Best New Technology award at the HealthIT Insight Conference.

Centegra Health (IL) chooses GE Centricity Enterprise.

Everybody wants to get their snout into the ARRA trough. Medical equipment and monitoring manufacturer Welch Allyn launches an EHR preparation and selection consulting program.

Health plan software vendor HealthTrio spins off an independent company, Monument Systems LLC. The same guy owns both companies, so I’m not sure this is really big news, especially since the only thing I know about HealthTrio is that HIT industry pioneer Ralph Korpman used to work there.

The LA Times covers the Cedars-Sinai radiation overdoses, citing “the blind trust of medical machinery” as a key cause since the incorrect dose came up on the screen every time and nobody noticed for 18 months. I’m sure Cedars is doubly thrilled that the Times reminded its readers that the hospital also nearly killed the Quaid twins with massive heparin overdoses.

Interesting: 80% of Taiwan’s citizens are happy with the country’s national health insurance, they have lower infant mortality than we do, and the country spends 6% of GDP on healthcare compared to 15.3% here. Technology is credited, including a nearly universal smart card containing medical data that uploads to central systems (not separate insurance company databases) to provide a real-time view of healthcare. As a result, administrative costs there are 1.5% of the total vs. over 30% here.

Hoboken University Medical Center will implement Medsphere’s OpenVista.

New England Baptist Hospital bans social networking sites, fearing that employees could be posting confidential patient information.

Bizarre: the Minnesota Board of Nursing revokes the LPN license of a man who allegedly encouraged people in suicide chat rooms to hang themselves while he watched via webcam. At least two people did, the board said; the person who alerted police claims there were actually at least eight victims.

ACS gets a $4.5 million, three-year contact to develop the Kentucky HIE. All of us are paying for it: CMS covered the initial amount and the state wants ARRA money to take it statewide.

The Senate’s healthcare reform bill would create Internet-based health insurance exchanges with standard enrollment and make EHR incentives from the stimulus bill and make them permanent. That second item is interesting.

Pitt County Memorial Hospital (NC) says a missing Flash drive contains information on 1,700 former patients. And in Florida, a laptop stolen from the car of an employee of Halifax Health contains billing information for 33,000 patients.

The Health IT Standards Committee will assemble a panel later this month to share best information management practices, bringing in experts from other industries.

Hospital systems vendor Healthcare Management Systems will start selling an ambulatory EMR this month.

This sounds like a good job for you MD or PhD types: University of Missouri-Kansas City’s school of medicine is recruiting to fill a new position to lead a newly created department — Chair, Department of Informatic Medicine and Personalized Health.

E-mail me.

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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.

Embrace the Cloud
By Ed Marx

Friends of mine recently returned from a trip abroad. The advanced wireless infrastructures found in these third world countries both astounded and pleased them. By unintentionally leapfrogging the technological revolution, these cities had bypassed the incremental advancements of the last 30 years and gone straight from laggard to leader. Societies that have not had a telephony infrastructure, for example, are suddenly delivering the highest per capita cellular subscribers.

Leapfrog advancement. Can we do it in healthcare IT? I believe we need to.

Does the fact that we trail our non-healthcare peers by 5-10 years embarrass you as much as it does me? Do you realize that we think of EHR as advanced when in fact it’s an application that’s been around since the 90’s! We have various excuses for our delay of advancement, and some are valid. But they don’t change the reality. We are behind.

We do nevertheless have an opportunity.

Cloud—it’s clearly the future of both software and hardware. And consistent with the past, it draws both resistance and hesitance, which perplexes me. We act as guardians, but have no basis for such. We pontificate more than we lead while the people we serve need us to advance.

I’m tired of employing self-depreciating humor to cover the glaring technology gap whenever I speak to non-healthcare audiences. I’m ready to leapfrog and bridge the gap using technology as a key lever. So let’s embrace the cloud.

Lead!

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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When is “perpetual” not perpetual?

Recent encounters in my practice have required me to carefully explain the intricacies of perpetual software licenses, so I decided to share some thoughts with the HIStalk readership. Perhaps due in part to the economy and in part to the anticipated availability of EHR funding, healthcare executives are asking some very specific and important questions in the HIT acquisition process, such as; “What exactly do I get for my money? How long until I must reinvest? How do I avoid or predict additional fees?”

Unless you are using a Software as a Service (SaaS) model, then you probably have acquired use of your software applications under one of many varieties of software licenses that ultimately grant to the license holder a perpetual right to use the software, subject to certain limitations. These limitations vary widely and would make a good topic for another writing. The purpose of this HITlaw article focuses on the single word PERPETUAL.

Perpetual license grants are never 100% perpetual. There is always a proviso. In most cases, this is fine and good and protects the vendor.

Here is a simple boiled down example: “Provided that the customer licensee abides by the terms of the license agreement, use of the software in perpetuity is permitted.”

Perpetual use is conditioned on abiding by the terms of the entire agreement, so read carefully and understand the license agreement offered by your vendor. Find the conditions under which the vendor can suspend or terminate the “perpetual” license.

And before I start another firestorm (like the non-disclosure clause HITlaw submission in August), let me be clear that there are some very valid and proper conditions for a vendor to suspend or terminate the right to use its software.

My point is to understand the terms of the license grant itself. First, the terms by which the license is granted (typically payment in full of all license fees) and then the events or conditions that could suspend or revoke that license. Make sure you identify the triggers and weigh the consequences as you make your vendor selection. Hard work up front can alleviate heartburn later.

Finally, keep in mind that the perpetual license is granted subject to certain limits, such as number of users, number of acute care sites, or net patient revenues. In that vein, perpetual also means “assuming status quo”. An increase in users, sites, or revenues above the stated maximum, while not a trigger for termination, could trigger payment of additional license fees, which is acceptable as long as the condition is clearly stated and understood up front.

Think of a standard cell phone bill. The customer pays a certain amount per month for up to X minutes of use. If the limit is exceeded, there is an additional fee. This is a simple example, which obviously leads to whole different discussion about being able to accurately predict the additional fees that could potentially arise should the stated limit(s) be exceeded (never leave this term open).

My advice and my mantra are consistent. Recognize and fully understand the terms of use for the license for which you are paying.

William O’Toole is the founder of O’Toole Law Group of Duxbury, MA.

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