Paul Meyer is co-founder, chairman, and president of Voxiva.

Tell me about Voxiva.

We’re a mobile technology company that had a crazy idea nine years ago that mobile phones had something to do with health. We’ve spent the last nine years building a platform and building mobile health solutions around the world.

It seems that the premise of the company is that expensive computers and ubiquitous broadband connectivity aren’t really necessary to connect the public to health services and to health experts. Is that true? And is it true in the U.S. as well as in the developing nations that you’ve worked with?

Absolutely. In the developing countries where we started working, the Internet just wasn’t a reality at all. Cell phones were the only game in town. Everyone was thinking about how you extend certain information systems to most of the world’s people. The cell phone is the only tool you’ve got at your disposal.

But over the last couple of years as we’ve started doing work here in the U.S., we’ve realized the same thing is true here. Statistics are pretty amazing. There’s some great data from Pew on relative reach of the Internet versus cell phones. It’s still a pretty striking gap. 

There are a lot of populations, particularly underserved and low-income populations, that still don’t have very good access to the Internet. Yet 90% of people here have cell phones. And, it’s not just that they have cell phones — their cell phones are with them in their pockets and on their bed stands.

If you think about how can technology be leveraged to help drive behavior change and improve patient adherence and compliance, you may as well use the technology tool that’s in their pocket.

Do you think the iPhone got people thinking about the possibility of having a smart phone deliver a fairly rich application?

I think iPhones have done an amazing job of opening people’s eyes up to the possibility. People ask me a lot why the U.S. is thought of as so far behind the rest of the world in terms of mobile health. There are a couple reasons. 

In the rest of the world, in emerging market countries, there was no alternative. There was no Internet to reach those people. Necessity being the mother of invention, people went right to mobile.

Secondly, the U.S. is the only country in the world where you actually pay to receive text messaging on cell phones. That’s also been a barrier to the adoption. Not just to health applications, but mobile applications in general. But I think that’s starting to change. Certainly the iPhone has done a lot to open people’s eyes to the possibility that cell phones could be used in powerful ways to make you healthy.

Now, with that said, when I ask someone what their mobile health strategy is and they say, “We’ll build an iPhone app,” My response is always, “Well, what are you doing for the other 95% of the people?” I think you would do well with an iPhone, but ultimately, if you want to try to reach a big chunk of the population, you need to use other tools — whether it’s SMS or voice response or other ways of using a mobile phone — and not assuming that everyone’s going to have the iPhone, because they don’t.

I think people who travel outside the U.S. are sometimes surprised by that we’re fairly primitive in our cell phone technology. Do you think that’s a barrier, or is it going to improve?

I think it’s getting better. I talked about a couple of the reasons, but in some ways the real reason that the U.S. is behind on mobile is because we have the Web. If you think about all of the innovation that went into the dot-com era, all these Web-based business models, many of our best and brightest minds spent ten or fifteen years innovating on tools to use the Web.

In the rest of the world, where the Web was not a reality, that kind of innovation and creativity went into optimizing mobile devices. That’s why, in some ways, the rest of the world is so far ahead.

After nine years of doing this in places from Peru to India to Rwanda to about 14 countries where we operate, when I’m now spending a lot of time here in the U.S. working with our clients here, my not-so-subtle message is, we’re here to help you learn from what they’ve done in Mexico, what they’ve done in India or Rwanda  in terms of leveraging mobile technology to improve healthcare.

That makes me think of India’s technical advances in the 1990s when they couldn’t afford mainframe computers and therefore created a generation of PC and Web developers that drove the industry. Could the same thing happen with cell phone development?

I think it has. I think you’re seeing that. I think that’s exactly what’s happened.

I think obviously the U.S. is waking up to this. Secretary Sebelius last week gave a great speech. There was a mobile health summit hosted by the National Institutes of Health in Washington. Secretary Sebelius gave an incredible speech talking about the importance of mobile phones in healthcare. It was really refreshing to hear.

I would say there’s so much discussion and focus right now on electronic health records, my fear is, as the government is gearing up to spend all this money on all these high-tech incentives for EHR adoption, is that we’re spending way too much time talking about the plumbing and not enough time talking about how all this technology is actually going to make people healthier.

One of the things I was really gratified to hear in her speech last week was that the importance she attaches to mobile phones as a tool for really informing and engaging your power in patients, seeing the mobile phone as the obvious extender of electronic health records. I don’t want to diminish the power of Web-based EHRs and other tools that are out there, but I think they’re getting a fair bit of attention.

I think that people aren’t paying enough attention to the fact that we already have, in the U.S., 300 million cell phones. In my view, those are 300 million untapped health behavior change devices that are ready to be put to work.

Did you get a sense that the government really understands the difference between just making providers theoretically more efficient as opposed to actually changing health?

I think certainly some people do. I think we’re working with the government on a really exciting initiative that isn’t announced yet. Secretary Sebelius alluded to it in her speech last week. It’s a major mobile health service focused on pregnancy and providing information by text messaging to pregnant women and new mothers to help make a dent in the pretty horrifying maternal and infant mortality statistics in the U.S. We’re working with the mobile phone industry through the CTIA, Johnson & Johnson, and a bunch of federal partners. 

I think the HHS and the federal government partners that we’re working with really see this initiative as a very high-profile demonstration of the power of mobile phones to really improve health and impact one of the biggest health crises facing the country.

There are certainly some real believers in the government in mobile health. My advice to them has been, as the government is spending all these billions of dollars on health IT, they want to be sure that they actually do some things that are actually visible and tangible and beneficial to patients. 

The government is run by politicians who ultimately want to appeal to voters. You don’t want to be the politician that explains how you spent 20 or 40 or whatever billion dollars on improving the technology to improve health care, and yet have none of it visible or beneficial to patients in a way that they can perceive.

I think it’s really important to identify ways — and again, obviously you know my bias — but I really believe that mobile health is probably the best way of extending some of the value of health IT to patients to help support them, engage them, inform them, and help them live healthier lives.

We send much of our public health expertise out of the country since we already have clean water and vaccines, but our healthcare system is still centered around the idea of episodic treatment interventions. Are population-based public health interventions a tough sell here?

We have huge problems here. The United States has the second-worst infant mortality rate in all of the developed world. It’s staggering. It’s unconscionable that we’re about the richest country in the world and have infant mortality rates at such staggering proportions.

We’ve looked a lot at the data and it’s pretty concentrated. The high infant mortality rates are highly correlated to lower-income women, primarily African-American. The Hispanics actually have relatively better birth outcomes. So African-American, lower-income, low educational level, highly concentrated in the South. That’s the part of the country that has the worst birth outcomes.

We then took some of the Pew Research data and looked at the Internet vs. cell phone penetration among the sub-populations with the highest infant mortality. There was just a 20-30% gap between broadband Internet and cell phone penetration in the population that we’re trying to reach.

African-Americans and Hispanics are disproportionately much higher users of SMS and other mobile data services because they have a relatively lower level of internet access. If one is looking at how to extend and improve health services and extend healthcare to under-served and low-income populations, the mobile phone is an even more indispensable tool.

We’re doing a lot of work with people focused on serving the Medicaid population, but as healthcare reform is happening and all of a sudden the country is figuring out — how are we going to actually start extending healthcare to 30 or 40 million people that don’t have it right now?

These tools are really important for a couple of reasons. The lower-income people that don’t have access to healthcare right now are disproportionately high users of cell phones. But secondly, the idea of actually automating some of this interaction and giving people the information and the tools to take care of themselves is a way of actually reducing the burden on the healthcare delivery system.

We already have an over-extended healthcare system. With 30 or 40 million more people coming into it finally at long last, it’s going to be even more of a burden. We’re looking at some of these alternative ways of engaging patients. I think it’s going to be more important.

Do you think it’s counter-intuitive for the average person to understand that poor and less educated people are heavier users of cell phone technology?

I think that people are often surprised when I show them that data. I think people assume that technology usage and income are just correlated on a straight line basis. That just doesn’t actually get borne out when it comes to cell phone usage.

If you were trying to make the case that this technology works for health improvement, what examples would you give?

There have been a lot of really good published data. I was looking at a study just today from Norway on smoking cessation. In a randomized clinical trial looking at people that were involved in a smoking cessation program, half of the study group was also enrolled in an SMS texting support service to enhance the program. It doubled the rate of quitting.

We’ve done a lot of work in improving adherence and compliance in HIV/AIDS care treatment. There have been some really, some good studies showing improved efficacy of weight loss programs when enhanced by a mobile service. It’s still early, but I think there are some good initial studies showing the improved health outcomes in these kinds of interventions.

I think this approach works for everybody, but I think particularly if you start looking at thinking about serving low-income and under-served populations and how to leverage technology and engage with them about their health, the Internet can’t be the end of the story.

There’s another data point from Pew of people with chronic conditions. Only 50% of them have Internet access. If you can get 100% adoption of some Web-based tool, then you’re still only halfway there.

Anyone who is looking at how to engage and support people in their health, particularly but not exclusively in some more under-served populations — I just think people would have to explain why they wouldn’t take this kind of an approach.

Your background in political and humanitarian causes, along with the source of funding for the company’s projects, almost make it sound more like a non-profit public health think tank than a for-profit vendor. How is Voxiva like and unlike the traditional software vendor?

I grant you that I personally and Voxiva have had a somewhat circuitous past to the U.S. healthcare system. We basically just saw big problems to solve. We saw a big opportunity to leverage to solve those problems. We may think a little bit differently than traditional public company, but ultimately, we’re driven by trying to solve problems. Like helping developing world health systems track disease outbreak better or that and things we’re focusing on now, of trying to help give people the information and support to live healthier lives.

We focus on trying to leverage and define innovative solutions for solving important problems. We believe if we can do that, we’ll get paid for it and make money at it. Henry Ford had a pretty good line on this — a company whose only purpose is making money or has no reason for being.

Finding problems to solve and eventually figuring out how you’re going to get paid by people for having and creating value has, I guess, certainly been our philosophy in terms of building a business.

Who’s your customer?

We market to public health and government health. We’ve also got those public health agencies and government healthcare providers. We market it to insurance companies. We’re working with one of the insurance companies. We market to pharmaceutical companies that are paying us to create adherence programs, and also the big employers. We’re beginning a little bit of work with some provider networks.

You were quoted as saying that Voxiva’s ideal employee is part McKinsey consultant, part Microsoft engineer, part Peace Corps volunteer. What are the employees and work environment like?

I said that probably six or seven years ago when it was relevant toward developing world business. We do blend a lot of skill sets. We’ve obviously got a lot of engineers. We’ve got a lot of health people.

We were started by — I guess I don’t know what you’d call me, an entrepreneur — a technologist, and a medical anthropologist. I think the three founders roughly had the very skill sets that we have tried to combine. What makes what we do interesting and also makes it hard is that we really do try to live at this intersection between technology and health and behavior change and sociology.

We’re not your people that write code. We work with our partners and our customers to come up with solutions that are really going to make people healthier. It’s not just a matter of taking, for example, content of a smoking cessation program or pregnancy educational materials and squeezing them into the 160 characters you can fit into a text message. It’s really about developing interactive engagement services that can improve health and change behavior.

I don’t think we have anyone that actually perfectly embodies all of the skill sets we need, but we definitely have tried to attract people that check more than one box and blend some of the various skills from the overlapping the Venn diagram of what Voxiva is.

Any final thoughts?

There are 300 million cell phones in this country that are sitting idle. We use them to vote for American Idol. That’s really what we’re using them for here, other than sending text messages and making phone calls. I think the healthcare system in this country can put them to work and do a lot more. I think people ought to be thinking about how. We’d love to help.

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From Downwit-IT: “Re: HIMSS. Following Cerner and Meditech, Siemens has made the decision to pull out of the upcoming HIMSS conference. No booth, no representatives traveling to Atlanta. Siemens will reach out to its customers and prospects via virtual, Internet-based means.” Unverified, although I don’t see their name on the exhibitor list. Anybody else not going?

From Keenen I. Wayans: “Re: AHA Solutions. Would you look favorably on a product that earned their endorsement?” It wouldn’t influence my opinion, but I’d like to hear what everyone else thinks. It’s a pay-to-play award, but that alone doesn’t make it worthless, I guess.

From Larry Fink: “Re: stock. If you compare the ten year-stock performance of Cerner and Eclipsys, the difference is mind-blowing. Cerner is up 948% over ten years (including 106% this year); Eclipsys is up just 18% over ten years.”

From Nasty Parts: “Re: Sage. Jason Dvorak, most recent VP of sales, resigned last week. Multiple sales execs have also resigned recently. Rumor is that Sage Healthcare is interviewing to hire a new company president.” I invited Sage to respond directly. “2009 was a very positive year for Sage Healthcare. With the opportunities that exist in this marketplace today, Sage plans to expand the leadership team with the hiring of a Division President in the near future.”

From Anon: “Re: Being John Glaser. The title sends a message that the subject is a narcissist.” I made that title up because Being John Malkovich popped into my head, knowing that John is anything but a narcissist. I didn’t see the movie, by the way, but Ebert’s review made me think it was appropriate: “Malkovich himself is part of the magic. He is not playing himself here, but a version of his public image — distant, quiet, droll, as if musing about things that happened long ago and were only mildly interesting at the time.”

From Wounded in Plano: “Re: Dell. The Dell-Perot merger has already started to see the loss of healthcare talent that Dell sees as dead weight. Dell is sending projects overseas (including clinical EMR support), laying off ‘expensive’ talent and focusing on a manufacturing mentality in a consulting world.” Unverified. 

From The PACS Designer: “Re: Sectra’s loss. TPD is deeply saddened upon hearing of the accidental death of Sectra’s president, Dr. John Goble, in a helicopter crash. The selection of Thomas Giordano as acting president is a move in the right direction to continue Sectra’s strong presence in this country.  My deepest condolences go to his family, co-workers, and friends.” Goble, 58, had led US operations for the company since 1997.

From Funny: “Re: SEEDIE. Very. And it could be funnier if it wasn’t so true.” I’ve mentioned SEEDIE and the Extormity EHR before, pretty funny parodies (although also ironic in its criticism of technology — the site is down at the moment with a MySQL error). I didn’t notice until now that they’ve been putting out phony news items, also funny:

After a raucous 3 minute debate, the SEEDIE board of directors voted against PHR standards that would force certified EHR vendors to interoperate with personal health record systems using a common set of data standards.

"Our members advocate a walled garden approach, with a distinct preference for proprietary PHR applications that treat interoperable vendors as untouchable members of a caste system," said SEEDIE executive director Sal Obfuscato. "Like Farmer Brown in the tale of Peter Rabbit, we want to keep all those rapidly multiplying PHR companies from nibbling our electronic health record cabbage."

Today is Veterans’s Day. If you served, thank you. If you didn’t, thank them.

Firefox has been inexplicably bogging down constantly for me, requiring me to three-finger salute it, so I switched back to Chrome. Darned annoying, though: you can’t get Google Toolbar for Google Chrome. Sounds like they have some healthcare IT DNA in there somewhere.

Ingenix will acquire CareMedic, a Florida-based vendor of revenue cycle solutions for hospitals, in an all-cash deal whose terms were not announced. 

Welcome and thanks to Quality IT Partners, new to HIStalk as a Gold Sponsor. The Mt. Airy, MD company, which will be nine years old next month, offers its consulting clients (hospitals, health systems, long term care, payers, pharma, etc.) first rate services at a value-based cost structure. The company almost never advertises, so I was pleased to hear this from Director of Business Development Bruce Werner: “The President of our company (Mark Debnam) and I have been following HIStalk for quite some time and we recently got our leadership team hooked on it as well.  The leadership team unanimously voted to invest in HIStalk. You and your team have done a great job with the site and we are proud to be a sponsor!” Inga and I appreciate that.

John Piano, the founder and CEO of tissue and organ EMR vendor Transplant Connect, is named Better Man for 2009 by GQ Magazine, which recognizes “charitable work, volunteerism, and/or community involvement.” He received the award at the Gentlemen’s Ball (really). I don’t know if physical appearance was judged (it’s GQ, after all, not that I have any idea whether he’s attractive or not) but his company helpfully included lots of flattering photos.

The Carolina eHealth Alliance will use Oacis HIE from TELUS to power its health information exchange, starting with 12 EDs in South Carolina’s Lowcountry. The product includes an EMPI and the Oacis Clinical Viewer.

Weird News Andy hacks this story up: researchers funded by a Gates Foundation grant say their cough-analyzing software, which will run on cell phones or MP3 players, can diagnose disease by measuring coughs.

Kronos announces several new Q4 sales, along with financial results that include $672 million in FY revenue and $143 million EBITA.

Being a non-profit wage slave, I don’t pretend to understand the “variable prepaid forward contracts” that Cerner founders Neal Patterson and Cliff Illig just exercised ($64 million worth). Somehow they get money now for shares to be sold in the future (three more years in their case). All I know is it’s one of those fancy hedging strategies that sometimes gets people in big trouble with the IRS.

Mayo Clinic and Steelcase study the influence on the latter company’s computer furniture, which was designed for Mayo to help doctor and patient view a computer monitor together for teaching.

Idiotic lawsuit: a man goes into a deli and claims he was bitten by the owner’s cat. He’s suing for $5 million.

HERtalk by Inga

The VA Heart of Texas Health Care Network expands its collaboration with CliniComp, adding the company’s Esentris Critical Care solution.

Jordan Hospital (MA) selects ClaimTrust InSight Denials for claims denial management.

eClinicalWorks adds another IPA to its client list with the signing of Catholic Independent Practice Association (NY). The IPA purchased 150 PM/EMR licenses to connect community physicians and will work with eCW to tie into the HEALTHeLINK RHIO.

Former Allscripts-Misys and Emdeon exec Ray DeArmitt takes over as the executive VP of sales for NotifyMD.

Hoag Memorial Hospital Presbyterian (CA) expands its partnership with Surgical Information Systems with its purchase of the SIS’s anesthesia, BI, and tissue management products.

NextGen Healthcare just completed its user group meeting in Washington DC, reporting attendance of over 2,700 and featuring keynote speakers Newt Gingrich and Howard Dean. The hot topics: ARRA, healthcare reform, interoperability, and patient-centered medical homes.

iSirona appoints John Cooper chairman of the board, replacing iSirona founder Dave Dyell, who will continue to serve as CEO. Cooper’s previous gigs executive roles at Sungard, Eclipsys, and SMS. Totally off subject, but am I the only person who thinks of that song by the Knack every time I see the iSirona name?

The healthcare sector added 28,500 new jobs in October, 10,000 of them in hospitals.

OhioHealth selects ProVation Order Sets to automate its creation and management of evidence-based order sets.

If you are a regular HIStalk reader, the details in this report will not surprise you. Scientia Advisors expects the global HIT market to grow 11% over the next four years, with the US setting the pace. Most new investment will go towards EHRs. Lower-cost remote hosting will increase in popularity for smaller hospitals and clinical decision support systems will continue to impact the clinical diagnostics area. SaaS and open-source models will drive down pricing, they say.

HealthBridge selects Mirth Meaningful Use Exchange for its interoperability infrastructure. Once implemented, HealthBridge will become one of the first HIE’s to enable physician access to the NHIN.

CSI Tech wins the implementation contract for Grady Health System’s (GA) $40 million Epic installation. The inpatient and ambulatory installations will take 18-24 months. CSI Tech already handles Grady’s ongoing internal IT needs.

Here’s an iPhone application I don’t need but wouldn’t mind seeing one day. Lit: A Game Intervention for Nicotine Smokers is in development at Columbia University’s Teacher College and will be released within two years. The application is designed to emulate the physiological responses smokers get from smoking and would involve blowing into the device’s microphone. The RWJF is funding $150,000 for the project. With cigarettes costing an average of $5 or more a pack, it will be interesting to see how the application is priced.

Hayes Management Consulting announces it will be offering services for ARRA-funded Regional Extension Centers, including EHR readiness assessments and planning, clinical workflow redesign, EHR selection, and HIE development.

MEDSEEK honors seven clients who earned a total of 15 eHealthcare Leadership Awards at the company’s 13th Annual Healthcare Internet Conference. They were selected from over 1,100 applicants.

Kaiser Q3 numbers: operating income $336 million; net income $569 million. These numbers are significantly higher than last year’s when the company suffered major investment losses. Meanwhile, enrollment dipped about 63,000 to about 8.58 million.

E-mail Inga.

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While waiting for my annual physical, I enrolled in a research study. (About every other year, I participate in a research study. Two years ago, a sleep apnea study involved me spending the night in an iron lung with electrodes in my mouth and all over my head and chest. Not conducive to a good night’s sleep).

My current study centers on healthy behaviors. The study is intended to improve the health behaviors of people who are fundamentally healthy (my blood pressure, cholesterol, weight, etc. are fine) through a set of pretty modest interventions. Armed with a pedometer, a Web site for recording progress, and an every-other-week call from Maria (my “health coach”), I am supposed to:

Have one multi-vitamin each day. Duck soup.

Eat three or fewer servings of red meat each week. This takes some thought and planning, but is not that hard.

Eat five to seven servings of fruit or vegetables each day. Since I usually eat one meal a day, this has proven to be a real challenge. I tried to persuade Maria that onion rings were a vegetable. As was a cup of coffee (coffee beans come from plants) and vanilla ice cream (vanilla beans also come from plants). She wasn’t buying it. But I have been able to drink some fruit juice during the day and toss down a banana and apple, allowing me to meet this goal.

Walk 10,000 steps a day. During a normal day “at the office”, I will walk 3,000 steps. This means I have had to find an hour each day to walk to get the other 7,000 steps. Finding that hour takes some planning — for example, getting up early to walk before work. (This has turned out to be an enjoyable experience — it’s quite cool to watch the sun come up over the Capitol Building and the Washington Monument).

So far, three months into this six-month study, I have been pretty good at meeting my goals. Maria has not scolded me.

This experience has reminded me that maintaining health, restoring health, or ensuring that a disease does not progress requires that patients engage in “health behaviors.” And it has reminded me that instilling such behaviors is a multi-faceted undertaking. I am not as well versed as those that have deep experience in this area, but this study experience seems to indicate that four factors must be present.

Focus. You have to know which behaviors are the ones that must change or be performed. This can be different — lose weight, take medications, take it easy after surgery, or stop smoking — across patients and situations.

Information. The patient needs information. This information is diverse — the linkage between the behavior and health, specific data about the behavior (e.g., coffee is not a vegetable), and behavior alternatives (how many steps is a game of racquetball?)

Tools. For example, my pedometer and the Web site to daily record whether I met my goals. Depending on the behavior, there can be other tools. Some do not involve IT, like nicotine patches. Some do involve IT, such as measurement and transmission of blood pressure.

Motivation. The desire to alter one’s daily routine to adopt a more healthy routine is probably the most important factor. It is also the most complex and difficult factor. Why would I get up an hour earlier to walk when I can use that valuable time to sleep? Motivation requires motivators (desire to please, guilt, basic type A behavior to achieve a goal, interest in living long enough to play with grandkids). It requires the removal of barriers that could discourage a motivated person, such as limited access to providers. It requires feedback on progress. It requires a social structure of family or friends that are supportive. And it requires the other three factors.

We will never have a reformed or transformed health care system unless we are broadly able to engage patients in managing their health. Cost reductions and outcomes improvements in treating chronic diseases require a motivated patient. Reducing unnecessary treatments is greatly facilitated by an informed patient. Improvements in the quality of care are helped by patients who make good decisions about which providers and health plans to choose.

We can help engage patients. Clearly we can provide tools and support access to information. While recognizing its complexity, we can also help with motivation.

Motivation opportunities range from making whatever IT is involved easy to use (reducing a barriers for a motivated person) to offering graphs of progress and corny but effective “attaboy” generated phrases to avatars that exhibit motivating emotions such as disapproval to online communities of others who can offer support.

While the opportunities can be listed, we have limited understanding of how to apply IT to motivate.

I need to go eat an apple. Otherwise Maria will yell at me.

 

John Glaser, PhD, FCHIME is vice president and CIO at Partners HealthCare System and is also on temporary assignment as Advisor to the Office of the National Coordinator. He describes himself as an "irregular regular contributor" to HIStalk.

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I decided it was time to update the About page, which answers questions I’m sometimes asked (why did I start HIStalk, why am I anonymous, how I decide what to write about, etc.)

Respondents to my most recent poll have a slight preference for not having the FDA regulate clinical software. That’s pretty close considering that vendors usually have the strongest feeling about that and are likely to click No. New poll to your right: what do you think about a hospital with over $1 billion in revenue paying its CIO over $500K? That’s not a loaded question – I’m just curious. Note: if you’re still seeing the old poll, clear your browser cache. 

HIStalk interviews are highly educational, depending on who I’m interviewing, anyway. If you have someone in mind (and, better yet, if you can hook me up), let me know. The ideal subject: someone who works for a non-profit organization on the front lines of something HIT-related, is doing creative work that the industry could learn from, and comes across as interesting on the telephone since that’s how I do them.

Meditech held its Physician/CIO workshop recently (I assume it was recently, anyway, since the write-up doesn’t say when or where it was held). Paul Egerman was one of the speakers, meaning I would have enjoyed it.

Meditech also just filed its 10-Q. For the quarter, revenue was down 4%, but net income swung from a $27 million loss to a $20 million gain (EPS $0.57 vs. -$0.76), mostly due to investment write-offs last year. Product revenue was down a slightly alarming 16%.

The Chicago Department of Public Health (CDPH) still can’t bill for mental health services because of Cerner problems (the article is in some kind of union publication, but it seems solid). They are using a different system for billing since fixing Cerner remains “an active process.” This conversion says it all. [Alderman]: "You’re saying that after 18 months you’re unable to work out technical glitches that prevent us from billing the state?” [CDPH commissioner]: “That is correct.”

Some nuggets from the just-published 2009 HIMSS Security Survey (thinking ahead to ARRA, since stimulus dollars are tied to privacy and security, not just Meaningful Use): 

• 61% said information security gets less than 3% of the IT budget, nearly unchanged from 2008.
• Fewer than half of the organizations have a C-level security officer.
• 74% have conducted a formal risk analysis, of which 52% found patient data to be at risk. Those problems took longer than six months to correct, said 40%.
• Most of them collect audit logs (firewall, application, server, intrusion detection, etc.) and review them manually.
• Electronic data sharing is already big (91%) and about to get bigger (HIEs, other hospitals, PHR vendors, and NHIN led the list), with 41% adding new security controls for that reason.
• Most used wireless security and electronic signature, with 67% encrypting transmitted data, 60% encrypting e-mail, 44% encrypting stored data, and 39% encrypting mobile device data. Only 29% had single sign-on.
• A third said their organization had experienced medical identify theft, although most reported no consequences.

From the Eclipsys earnings call: Sunrise 5.5, due out in the first quarter, will have a “more intuitive user interface”; the company is banking on heavy CPOE use by its customers to influence new ARRA-related sales; margin improvement efforts, much of them related to internal procurement costs, will consume $1 million in outside consulting fees each quarter but will pay for itself starting in the second quarter; they will target 600 hospitals of greater than 150 beds that do not have a recent-vintage clinical system; MediNotes / PeakPractice underperformed because it was run as separate businesses; demand for Premise / Patient Flow has slowed; 60% of their sales were to existing customers.

Cardinal spinoff CareFusion sells MediQual Systems (the Atlas clinical database vendor) to quality database vendor Quantros.

Speaking of Cardinal, neither it or CareFusion is doing all that great after the spinoff. Cardinal lost money (EPS -$0.11 vs. $0.69) and CareFusion’s Q1 profit was down 28%. Optimism was expressed.

Wound Management Technologies will buy the healthcare assets of VirtualHealth Technologies for $1 million in cash, 4 million shares, and royalty payments. I’ve written about the latter company before, surely one of the most bizarre business combos around: medical office software and gold mines (insert your own joke here). 

Interesting: Microsoft Research develops the $800 SenseCam, a low-res, wearable camera that takes two pictures per minute. It’s designed to help Alzheimer’s patients by letting them review pictures of their day, which seems to help them remember events long term since Alzheimer’s patients may store memories normally but can’t access them.

Henry Schein CEO Stanley Bergman on EHRs: “Electronic medical records will reduce the cost of health care, errors will be reduced, the quality of health care will go up. We don’t know exactly how long it will take, but it’s going to happen in the next few years. And we are the exclusive distributor for the number one player in this field, Allscripts.”

A Commonwealth Fund survey of primary care doctors finds that the US is way behind in several healthcare categories: access to care, providing financial incentives for healthcare quality, and using IT. Only 29% of practices provide after-hours care (other than the hospital ED). Less than half use electronic medical records, well behind the 90+ percent of several other countries. That’s despite spending twice as much per person as other countries.

Cleveland Clinic launches a site to teach student nurses how to use EMRs.

Some AMA members are upset that the organization’s trustees endorsed the House’s health reform bill without asking its members first (doesn’t HIMSS do that all the time?) Delegates will vote Monday on whether the endorsement should be withdrawn.

TELUS announces availability of its new mobile solution, TELUS MobileCare, for homecare providers.

HCA International wins the 2009 Innovation Award for its use of PatientKeeper Physician Portal.

HHS will award contracts to build out the Nationwide Health Information Network by the end of the year.

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From Ryan Nichols: “Re: CIO salaries. In 2004, you posted salary data for a number of CIOs, including some fairly high ones like Shands. How accurate was that data? Was there some other reason for some salaries to be off the scale, >$500K?” The salaries came directly from IRS reports, so they show exactly what a CIO was paid in one year, skewed only if that person quit and got lump sum benefits. Not true in most cases, including Shands — 2008 tax records show they paid Joan Hovhanesian $708K, more than everybody except the CFO (who made barely more) and the CEO, who got $1.26 million. Sweet, although not up there with what they pay Urban Meyer to coach football ($24 million over six years).

From Jerry Seinfeld: “Re: Tampa General. Heard a rumor that they will move to Epic from Siemens. Going to the board for final approval.” Unverified.

Listening: Travis, alternative rock from Scotland that sounds like an upbeat, pop-tinged Radiohead.

Eclipsys announces Q3 results: revenue down 5%, EPS $0.07 vs. $1.58, although most of the Q3 2008 earnings came from a one-time tax treatment. Without that, earnings were down 47%. The company also announced that North Mississippi Medical Center has chosen Sunrise.

QuadraMed announces its Q3 numbers: revenue down 7%, EPS $0.02 vs. $0.12.

Cleveland’s MetroHealth has had Epic for ten years, so Judy was there Thursday for the celebration.

An undercover journalist in England buys detailed medical records of British patients from two chat room “salesmen”, apparently provided by India-based transcription center employees. One said, “We can do really good business with these leads. These leads will give you diagnose, entire diagnose of all the customers, what the customer is facing … The floor managers, they are working as freelancers for me.” The records came from London Clinic, which doesn’t outsource transcription, but some of its doctors hired a local firm and may not have been aware that their information was being sent to India. In a quick marketing reaction, Atlanta-based Webmedx assures customers that all of its employees are US-based and therefore aren’t out of the reach of US laws.

HuffPo covers EMR stimulus money and the vendor marketing techniques being employed to go after it: “cash for clunker” rebates, interest-free loans, Walmart sales, and the Stimulus Tour. John Glaser is quoted as saying that ONCHIT will start tracking EMR prices and marketing claims, looking for any stimulus-related misstatements like the ones Siemens claimed Cerner user to steal its customers (and sued them over it, although it has settled, which I’m not sure I know until I read it in this story). HIMSS was invited to comment but, not surprisingly declined, knowing it might step on some diamond toes. I was amused that John Halamka was identifed as “John D. Halambra” in the article.

USA Mobility announces GA of I-LAND, a two-way emergency messaging system for hospital and government campuses that gets through in emergencies because it doesn’t use public networks.

Over 97% of healthcare organizations say they have behavior problems with doctors and nurses, according to an ACPE survey. Examples: yelling, cursing, insulting, refusing to work with each other, throwing objects, trying to get someone fired or disciplined unjustly, and harassing sexually. Many of the problems happen in public or in front of patients. Here’s an interesting one from the respondent comments: male surgeon says to female nurse, “You must be deliberately screwing up. No one could be so stupid as to be this incompetent.” Nurse replies, “If you don’t stop insulting me, I am going to drag you out into the parking lot and kick your ass.” Surgeon reports nurse to administration, nurse gets fired. Only 22% of respondents said doctors had been terminated over incidents, while 61% said nurses had.

Maybe this is related: a couple of readers Googling for the doctor road rage story may have uncovered an important trend — there are a lot of those stories in the news. Doctors have beaten motorists with Thermos bottles, punched women drivers in the face, and pinned a pregnant woman against a wall with an SUV. Do they teach anger management in medical school?

Dann from RelWare says the Fall Technology Conference of Midwest HIMSS in Grand Rapids this week drew over 400 registrants. He took a picture of someone reading HIStalk during the sessions, which creeps me out the couple of times I’ve seen that at HIMSS (I write it entirely alone with only e-mail contact, so seeing someone read it in person makes me feel exposed).

I missed a couple of graphics from Mark Moffitt’s Web services article (you code geeks will love it because it shows a little bit of programming and some XML). I also ran across this video in which doctors talk about it and give a quick glimpse or two.

NHS is threatening its suppliers CSC and BT with termination if they don’t hit the November dates that were set earlier this year for bringing patient systems live. Sounds great, other than the previous suppliers it tried to hardball walked away. I tried to suppress the sophomoric cackling as I read the name of the hospital that went live this morning on Lorenzo, but I couldn’t — NHS Bury. 

My UCSF sources told me in August that it was stopping its Centricity project (finally verified by UCSF in mid-October). They also said that Epic would be brought in as soon as the lawyers killed the GE contract. Right again, apparently, as negotiations with Epic are underway and, if all goes well, implementation will start in the first quarter. I snooped around and found a copy of the e-mail online (warning: PDF). The GE experience must have been ugly: “I understand the frustration in our prior efforts over the past several years, and the concern that we are facing another two years of this work. However, because we are going with an established, proven system, we can have much greater confidence that in two years we will have the tools that our clinicians need to improve the quality and safety of the care they provide.” Wonder what that Strike 1 cost them?

Speaking of Epic, I got a nice note from Dr. Lucy, aka #1 Dinosaur, who was surprised to find that people assumed her EPIC FAIL line in her anti-EMR blog post that I mentioned referred to that Epic (she’s a fan of FailBlog and was riffing on that about EMRs in general). She does, however, stick to her guns in not buying an EMR for her practice, with her reasons listed in this post:

A man in the back spoke of the new EMR he had just purchased for $30,000. Once all the numbers were crunched, though, it turned out he was only going to see about $3,000 in P4P bonuses. The response, delivered somewhat more softly than the stentorian tones of the main presentation, was that his return was more likely to be in the areas of quality and lifestyle. I imagined presenting a proposal to an insurance company — actually to any kind of business — and saying, "Now, you’ll only make back about 10% of your initial investment, but you’re likely to see improvement the areas of quality and lifestyle."

And speaking of EMRs, cost is a big concern for doctors, but 58% of them know nothing about ARRA. 

Philips and the biggest insurance company in the Netherlands start a pilot project to develop home monitoring programs there.

This strikes me as bizarre: the MyMedicalRecords people engage a clinical trials company to help bring its monoclonal antibodies assets to market. An earlier announcement says it acquired the technology when it did a reverse merger with Favrille, Inc. in January 2009, although all the Phase III trials results I could find indicated that all of Favrille’s products were flops. The news didn’t seem to help the parent company’s share price, now down to less than eight cents, about a quarter of what it was worth in May.

Pharmacy OneSource acquires the MedBoard in-hospital drug delivery tracking system from MedKeeper.

Strange: a Phoenix doctor’s office gets 1,000 hang-up calls a day from a man angry at a former practice employee with whom he had a relationship. He’s done it for months and says he will keep it up for 25 years. They can’t block the calls because he’s in Jordan.

eHealth Ontario’s $236 million contract, signed quietly a few weeks after its CEO and board chair quit after a bidding scandal, will give 5,700 doctors a connected EMR – less than a fourth of those practicing in the province. The backlash over Ontario’s problems has stalled approval of a request from Canada Health Infoway for $500 million of what is basically stimulus money, although its audit was clean. That non-profit has spent $1.5 billion so far.

State government in India, annoyed that private hospitals obligated to treat poor patients are turning them away, directs them to post a count of empty beds daily on the Web page of the Director of Health Services. The newspaper article concludes that “If this works as planned, it will mean that patients will no longer have to share beds, limiting cases of infections.”

David Grant USAF Medical Center (CA) goes live in six weeks on ClinicComp Essentris CPOE, repository, and alerts.

Seton Family of Hospitals (TX) says its Sychron desktop virtualization saves caregivers 30 minutes each per day since the “roam button” allows them to save a session, leave, and then pick up where they left off on another PC without logging in again.

IMS, the big seller of patient and prescription data, sells itself for $5.2 billion, the largest buyout of the year. Thank them if you believe drugs are too expensive since they specialize in telling drug companies how to wring the most profit out of their products.

The SEC settles with imaging vendor Merge Healthcare and its former CEO and CFO for improper revenue recognition that overstated net income by 230% for three years, resulting in a $500 million hit in market cap when it was discovered. The former suits will pay a combined $870K. I read the original complaint and it said Merge did what an insider told me that HBOC did in the 90s — shipped empty boxes to customers when products weren’t ready so the revenue could be recognized anyway.

The whistleblower who turned in a Texas hospital group for paying doctors kickbacks for referrals gets a 20% share of the settlement amount — $5.5 million. Anybody know a really crooked hospital that’s hiring?

Q3 results for AMICAS: revenue up 121%, EPS $0.05 vs. -$0.02, handily beating estimates of $0.01 and guiding up. The one-year share price graph is above (they’ve nearly tripled).

Odd lawsuit you’ve already seen: the woman mauled by another woman’s pet chimpanzee has already sued its owner for $50 million, but now her family wants to sue the state of Connecticut for another $150 million because it didn’t prevent the attack.

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