William Cameron Powell, MD is president, chief medical officer, and co-founder of AirStrip Technologies of San Antonio, TX.

Tell me about yourself and about the company.

My name is Cameron Powell. I’m actually an OB/GYN physician by training. I don’t practice any more; I haven’t for about two years. I currently serve as the president and chief medical officer of AirStrip Technologies.

We are a medical software development company that is completely focused on remote patient monitoring and telehealth, with a focus on mobility, primarily in our niche capabilities and technologies to deliver a real-time historical waveform information to physicians and nurses anytime, anywhere, on mobile devices like the iPhone, Blackberry, and mobile Google Android.

The company was actually founded about six years ago. We think we really started this past June when Apple chose to feature AirStrip during the Worldwide Developers Conference in their keynote address. Things really changed for us at that time.

Six years ago, we had a focus on trying to develop a technology that would clearly work to mitigate risk and improve patient safety and improve communication between physicians and nurses when physicians are temporarily away from the caregiver environment. Given my background in obstetrics, we started with the AirStrip OB product.

Tell me about the components of AirStrip Observer.

The AirStrip Observer suite is really built off of a platform referred to as AirStrip RPM or Remote Patient Monitoring. AirStrip OB was the first product that was built off of that platform. That platform is basically a completely reusable and scalable software platform that we spent many, many years developing, which allows us to very rapidly roll out additional mobility solutions.

AirStrip OB is actually the first FDA-cleared solution build off of the RPM platform, but we have additional solutions that we’re awaiting FDA clearance and have already been submitted. Those are the AirStrip Critical Care and AirStrip Cardiology products that are currently submitted to the FDA.

We have several other products that are currently in our pipeline that are being built off of that RPM or Remote Patient Monitoring platform that we developed.

How hard is it to get FDA approval?

It’s challenging. We certainly don’t mind that challenge from a competitive standpoint.

The thing that we like about FDA clearance is it really forces us to maintain a level of quality and control around our software designs that ensures that our hospitals and our physicians, as our end users, benefit from just a great solution that has a great user interface, is HIPAA compliant, and is very secure. But to get FDA clearance, you do have to know what you’re doing. You have to have the right people involved. So it’s challenging, but I will say the FDA’s been a very good group to work with.

Can you tell me more about the actual technology and what kind of folks you have to maintain and develop on it?

We do all of our development in-house. My senior partner, Trey Moore, is actually our CTO, and he is the lead architect behind the entire platform. He is supported by a team of in-house software developers that have really built out the rest of our platform and help us to support all the different mobile devices and the interfaces to various HIS vendors or CIS vendors that are required to operate the solution.

Our application works by interfacing to various vendors or device manufacturers. There are several different architectural formats, but essentially, there’s a system in the hospital that’s pulling that data real time and then securely exposing it through the Internet to our mobile client. I think where our real uniqueness is in how we handle the presentation and the user experience behind the waveform data; the ability to see and interact dynamically with virtual, real-time waveforms, to be able to scroll back over time and pinch and zoom and analyze those waveforms.

One thing that’s important to realize in healthcare, especially with the problems that we’re trying to solve, is that so many decisions are made based off of visual interpretation of data, especially with obstetrics. For example, a vast majority of adverse outcomes in labor and delivery are directly related to communication errors involving the fetal strip, or the fetal heart tracing. So the ability to close that communication gap and deliver that real-time historic data to the physician anytime, anywhere, we think will have a significant impact on patient safety.

The reality is we live in a world where there’s a relatively decreasing number of physicians and an increasing number of patients that need to be monitored. Anything we can do from a technological standpoint to allow physicians to be able to adequately monitor these patients makes a huge difference. We’re in nearly 150 hospitals right now across the U.S. with AirStrip OB and are beginning our international efforts with several large partners.

It’s great in the field of obstetrics to go to trade shows, to go to hospitals, and the physicians and the risk managers and the executives. They all know about AirStrip OB and they’re asking about it. That’s been very rewarding for us. If you look on our Web site, I think one other thing that’s really rewarding is just the enormous volume of unsolicited emails and stories we get from doctors that tell us how AirStrip OB is making a significant difference in their lives, and especially in the lives of the patients they care for.

We’re seeing large hospital systems actually create their own videos about AirStrip OB and promote them on YouTube and through other social networking efforts in the markets, to patients where doctors are talking about how great the technology is. That’s also quite rewarding for us to see that kind of take off in sort of a viral nature.

Do you see the boundary of your product being those applications that involve waveform data, or do you see yourself advancing beyond that at some point?

Oh no, not at all. Currently, if you look at the AirStrip OB product even just at its base technology, when a physician logs on …  First of all, no data’s ever stored on the device, it’s just available during the view session, but they’re able to see the labor and delivery census; the patient name, the cervical exam status, the most recent blood pressures, the admitting diagnosis, and vital signs. They can then drill in further and review all the nursing notes, they can look at medications, they can look at trended data, and then all the waveform data. 

Currently, we present a voluminous but focused amount of data to the obstetrician. When you get into the Critical Care and Cardiology applications, we also provide a whole host of patient monitoring data beyond the waveforms.

Now with the platform, the platform also allows us to pretty rapidly extend this technology to encompass imaging solutions, solutions outside of the hospital. For example, there’s a lot of interest right now in AirStrip with regards to what we can deliver on the ambulatory cardiology front, and in the home health monitoring front. 

We built our solution to truly be data independent. We don’t really care what the data is as long as we have access to the data through our partners or vendors / device manufacturers that we’re able to effectively AirStrip that data in the back end and expose it to the mobile client, really, in a way that hasn’t been done before.

Do you think it will be competitively important to be the one-size-fits-all single solution for doctors, or do you think there can be several niche applications that doctors run separately?

I think there’ll be niche applications, but we think from the broader remote patient monitoring standpoint, I think a single solution that would apply to everybody is very likely. Our idea is that our client changes dynamically depending on who the physician is logging onto the system. We eventually envision the obstetrician logging on to the client and they’re presented with what they have access to in labor and delivery; whereas the intensivist or the neurosurgeon logs on and they’re presented with the information they want to see in the ICU.

In the L&D market where you started, there probably wasn’t much competition when you started it. Do you think once you get into the cardiology and critical care modules that you’ll be competing against a broader array of competitors and also have to figure out how to transition the company into a whole different target market?

Certainly we’re not naïve enough to think that we’re not going to have legitimate competition, but the reality is what we’re really focused on is being first to market and continuing to advance our first mover advantage, from a software standpoint and a UI standpoint, try and stay several years ahead of the curve. I think we’ve done a good job at that and that’s our focus is to try and just stay out in front and continually iterate, continually innovate, listen to our customers, listen to our physicians.

One thing that’s nice about our development team and our development platform is that we can very rapidly iterate and make changes and dynamically adjust to what the market’s demanding, rather than going through traditional software development life cycles that require extensive rewrites. We have some proprietary technology that allows us to do that and adapt.

You’ve also got an advantage in that you have a big footprint in a small segment of healthcare, which I assume then can fund the development and also provide the experience to move outward as opposed to trying to develop the whole package and then sell it to the world.

Yes, sir. Our focus was if we can deliver a solution to the market that works really well that is fast, that is secure, that the doctor is able to use with relative ease that has … For example, even just delivering a solution that can be installed quickly. I mean, a lot of our installations can take a day or two at the most and most of them are done remotely, so it’s not like installing an entire HIS system in a hospital.

We knew if we could deliver something like that to the market from end to end, from the requirements of the hospital IT staff to the CIO, to how hard is it for a doctor to get logged on, to managing all that — if we could deliver all that and do a really good job of it with AirStrip OB, that we would be 80% done with every other solution that we ever wanted to create. Reusing and repurposing what we developed, that’s how it was architected from the very beginning.

Was the plan up front to do more than just L&D?

Yes. We had some very good senior executive guidance that forced us to put the blinders on and really focus on delivering AirStrip OB to the market first, and doing a really good job.

I think where some people fail … they’re tempted to go down every rabbit trail that’s presented to them. It’s really hard to maintain focus to get that last 5-10% done and to really do it right. We had some really good guidance and help along the way that coached us in how to do this just from a philosophical standpoint. It’s probably one of the best decisions we ever made, was to make sure we did AirStrip OB and did it right and made it available to anybody who wanted it.

I have seen the throughput from our company as we roll out these additional applications. It’s just been incredible to watch. I’m so proud of my team and my developers and everybody that I get to work with, to see them have such success as they’re having now. Really, they’re standing on the shoulders of a giant, Trey Moore, who knew from the very beginning that if this was architected in the right way and done correctly, and learning from mistakes he had seen other companies make in his previous career, that we would be able to do this some way. I’m now seeing that come to fruition and it’s really humbling actually, to work with such a great team.

How hard is the integration piece for hospitals to accomplish?

From the OB standpoint, fairly easy, because once we go to the hospital, we’ve already had that integration done with the perinatal vendor.

We have good relationships with almost all the perinatal vendors in the U.S. So if a hospital has any perinatal system — let’s just say it’s the Hill-Rom NaviCare WatchChild system — we can go and tell the hospital that, “You know what? We have an interface. The NaviCare WatchChild, it will handle it all for you. We’ll install the server, or we’ll virtualize it, or we’ll host part of it. The vendor will remotely install their piece, and we will remotely install our piece, and it’s very little required from your IT staff.” That’s one thing that the hospitals, I think, really, really like.

You definitely run into different environments, but from the OB standpoint, it’s pretty straightforward. For the Critical Care/Cardiology solutions, of course we’re not installed anywhere yet, but as those roll out of the FDA we have our beta site that’s already lined up and we will try and replicate the success that we’ve had with AirStrip OB.

Certainly, I think we’ll learn along the way, but we have some really strong partnerships with some great vendors and device manufacturers. They’ve been really great to work with. We think that makes it a lot easier on the hospitals if you can go in and present to them a solution that works, and it’s a breath of fresh air for them to install an AirStrip system.

How is the product licensed and hosted?

Currently, it’s a Software-as-a-Service model; a hybrid software and service model. Currently, the application server resides on site at the hospital. There have been some very large IDNs that will host the Web server component at a central location. That Web server will serve all the hospitals in that IDN around the country. We also virtualize so the hospitals are installed in a virtual environment.

As far as a fully hosted solution, that is definitely something that we’re looking to move towards. With some of our partners, that’s how it’s being designed from the beginning. But it is a subscription model — a hospital, they will pay a certain amount per physician, per month or per bed, per month depending on the product and size of the hospital, the number of physicians, and whether or not they belong to a GPO. There are a lot of different variables.

I think you mentioned earlier that you have applications for other caregivers, like nurses.

We currently have a lot of interest from nurses right now using AirStrip OB, but using it in a hospital. For example, a charge nurse who’s responsible for all of her nurses. Or, she may be in the middle of a C-section, or in a meeting, and she wants to keep track of what’s happening in labor and delivery. She can also use AirStrip OB even though she’s actually in the hospital.

But yes, we see a broader remote patient monitoring-based solutions being able to be used by a variety of healthcare givers in a variety of settings. Right now, the focus is really on physicians and nurses, but I could clearly see applications beyond that scope as we expand. I think those markets and those needs; some are already making themselves available to us just from a recognition standpoint, so we’re certainly interested in providing the technology wherever it’s useful.

I saw on the Web page that the application supports a ton of mobile devices. Which ones are the most popular?

Well, the most popular right now is the iPhone, but we also see markets where there’s a lot of strong demand from BlackBerry users, and some strong demand from Windows Mobile users. Our goal is not to be necessarily focused on the device, but to remain device agnostic. The reality is the market demands change and at this point and time, a large majority of our users are iPhone users.

Mobile applications, in general, improve the quality of life for providers. What’s the impact been for your users, and what opportunities do you see there in the future?

Honestly, because of our regulatory requirements and the nature of our application, we’re not really so much focused on the quality of life of a physician. The reality is where AirStrip becomes most useful, is when the demands of a physician’s day necessitate their periodic absence from the bedside. We’re not trying to ever keep a physician from the bedside.

However, the reality is that there are several times, and often, when a physician has to be away from the bedside. They may be at another hospital, they may be at the surgery center, they may be on call. In those instances, currently they’re limited to having to listen to an interpretation of what is going on over the phone. If they’re away from the hospital, we just want to be able to provide them with this data virtually in real time so they can better assess a situation.

I think, from a quality of life standpoint, that mainly helps them have peace of mind knowing that they’re looking at the same data that a nurse is looking at; and therefore, until they can get back to the hospital, they can more clearly understand the situation and hopefully, it provides a meaningful advice in the interim.

Now, do doctors tell us this does dramatically improve their overall quality of life having this access to this information? Yes, absolutely.

Where do you see the company going, strategically, over the next few years?

We really want to set the standard of care, both domestically and internationally, for remote surveillance from a mobility standpoint — for remote surveillance in healthcare. We currently are relatively agnostic to the market. We want to raise the bar as far as remote surveillance goes. We see ourselves helping to establish that standard of care.

Do you see that happening under the current business form, or do you see either being acquired or acquiring someone else?

I don’t really want to speculate on those types of events. Currently, we’re in a high-growth mode; really growing the company to make sure that we deliver the best technology that we can possibly deliver to both our doctors, who are the end users; and the patients, who quite frankly, deserve the technology. In that effort towards growth, certainly there are a lot of different things that could happen to a company like ours. We remain focused on growing the company, but also keep an open mind as to what might come.

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From Luke O’Voron: “Re: Privacy and Security Standards Workgroup. Their meetings are now open to anyone by teleconference. This week, Judy Faulkner of Epic was in fine form, defending her 30-year-old product as the only way to go. Look for transcripts.” They haven’t been posted yet, but I’m watching for them.

From All Hat No Cattle: “Re: Looks like HIStalk is now a source of news! Congratulations.” Healthcare IT News has been openly scornful of HIStalk in the past (“a sorry commentary on journalism today”), so I’m not sure how I feel about having them cite HIStalk (I know it didn’t result in many incoming hits). I don’t claim to be a journalist, so I likewise assume nobody there claims to be a healthcare IT expert. I sometimes glance at it during the more boring educational sessions at HIMSS, especially since early print deadlines mean I can read what the keynoters will say before their sessions are even held, making me feel temporarily psychic and opening up the possibility of a “Dewey Defeats Truman” collector’s edition if the speaker would happen to cancel or go off script with an unplanned rant.

From Kiley: “Re: CEO. You should check out this guy’s past. Nobody seems to question his background when he’s speaking or writing.” We’re on journalistic thin ice here, even for a non-journalism major. I did some extensive Googling and it seems the individual named recently pled guilty to big-time federal income tax fraud. I got copies of the court records, but received no response when I sent details (twice) to the organization’s PR e-mail address and asked for confirmation. I can’t decide if that’s fair game or not, although I’m leaning toward no.

Long-range weather forecasts are notoriously inaccurate, but the Atlanta 10-day version predicts highs in the lower 50s for the start of HIMSS. If it’s not too cloudy, that should be pretty nice, especially compared to Chicago last year (or Chicago right now – snow and highs in the 30s).

Looks like Sully’s HIMSS audience will be about the same size as when he made that “we’re going down in the Hudson” PA announcement, with 88% of us planning to be long gone from Atlanta by the time he hits the podium on Thursday. New poll to your right: given the government’s track record in fulfilling its financial promises to providers, do you think ARRA money will be paid as stated?

Listening: Crucified Barbara. Sometimes you just need beautiful, non-English speaking Swedish women playing nasty biker metal hard rock.

Inga asked our BFF Tammi from AT&T a reader’s question about iPhone presentations at HIMSS, of which there are basically none on the education track since annual conference proposals are due nearly a full year before the conference (it’s ludicrous to be paying to sit through year-old presentations just because HIMSS can’t shorten its lead time, but that’s always been the case – this year’s sessions were finalized by May 29, 2009). Anyway, she mysteriously suggests dropping by the AT&T booth to check out “exciting developments.”

Thanks to MedVentive for supporting HIStalk as a Platinum Sponsor. The Waltham, MA-based company provides a wide range of solutions that include pay-for-performance systems, registries, evidence-based algorithms for quality management, point-of-care decision support for physicians that integrates information in its repository with claims data, managed care tools, and scorecards and provider profiling for payers. It was started by CareGroup and BIDMC in1997, expanded for a broader audience as MedVentive in 2005. If you want to connect with their folks at HIMSS, shoot them an e-mail. I appreciate their support.

Inga has been working her pretty fingers to the bone getting ready for HIMSS. Somehow she found time to prepare this guide to what our HIStalk sponsors will be doing at HIMSS, complete with booth and contact information, a description of their products and services, and their message to you about their HIMSS activities (including some giveaways, charitable projects, and the all-important snacking opportunities). You can download a PDF version to print and take to Atlanta if you like. If you enjoy HIStalk or benefit from it, please click their ads, check out their HIMSS activities, and drop by their booths and say thanks. We have some super-nice people and companies who are fans of HIStalk, which we as amateurs with day jobs sure do appreciate.

I don’t know about your hospital, but mine is packed to the gills. It’s a good thing flu activity was a lot less than expected or we would be having patients sleeping in the hall instead of just the ED holding area.

England’s Accountancy and Actuarial Discipline Board will conduct hearings this week on an accountant for iSoft Group, whose former executives are themselves are the subject of an investigation related to accounting irregularities alleged to have occurred from 2003 until 2006.

Former RelayHealth VP Bob Katter joins First DataBank as VP of sales and marketing.

The Racine paper weighs in on the EMR implementation at Wheaton Franciscan-All Saints (IL), saying some doctors anonymously told reporters that its $67 million McKesson Horizon Clinicals implementation is “one of the cheapest, worst systems available.” The docs complain that Wheaton spent nearly as much as nearby Froedtert, which installed #1 KLAS-ranked Epic for $70 million. The hospital defends itself, saying its McKesson system (#7 ranked in KLAS, the paper says) is comparable to Epic and the #12 ranked Cerner system that another nearby hospital bought, neither of which had extensive problems (actually, that sounds to me like they defended their vendor pretty well, but themselves not so well). Since the hospital and its doctors were already fighting about unrelated issues, I’d take anything said there with a grain of salt. Other places run Horizon Clinicals just fine.

Strange: why is the non-profit Cleveland Clinic buying Google ads to brag on its technology and IT people on its own EMR site? This ad came up when I Googled “healthcare technology.” 

I’ve mostly quit reporting on government HIT handouts, you may have noticed. Truth be told, it makes me sick to my stomach to read, much less write, about all those undisciplined politicians bragging to the locals about how great it is they managed to snare taxpayer money to pay for local projects. Enjoy the economic party because it can’t last; the generations-long hangover is going to be brutal.

The Louis Stokes Cleveland VA Medical Center (OH), concerned about medical residents who clutter up the EMR with copied-and-pasted information, audits the notes of first-year residents and gives movie tickets to the best one. The newspaper article quotes a journal article: “The copy-and-paste function has led to a number of unexpected problems and concerns about electronic note writing and its impact on the culture of medicine, including reducing the credibility of the recorded findings, clouding clinical thinking, limiting proper coding and robbing the chart of its narrative flow and function.”

Facing a threatened libel countersuit, GE Healthcare drops its libel lawsuit against a Danish radiologist who had shared research findings unflattering to one of GE Healthcare’s contrast agents at a medical conference. The suit was featured Tuesday in The Globe and Mail in an article called London, sue capital of the world, describing “libel tourism” in which suits involving no English parties are tried there, mostly because unlike in the US, the burden of proof rests on the defendant and a libel defense costs 140 times anywhere else in Europe, leading to pocket-lining settlements for lawyers. At stake: self-imposed medical censorship, such as the Danish radiologist, who says, “I am not giving lectures any more in the U.K., where it seems you can be sued for telling the truth.” I liked this quote: “It’s acutely embarrassing for the government that various American states have passed laws to protect their citizens from English libel law.”

WebMD finds itself on the wrong side of Senator Chuck Grassley, who wants to know why the company’s TV ads pitch a pharma-sponsored depression screening test while it claims to provide objective medical information to consumers. WebMD claims editorial independence, but the Senator wants it to provide details on its drug company connections. Chuck’s all over the place, but I usually like his choice of targets.

Bizarre: the FBI gets involved in the case of a Pennsylvania school system that remotely activated the webcams of school-issued Apple laptops used by students. The school supposedly accused a student of selling drugs, providing as evidence a photo snapped by his school laptop from inside his house. The school claims the webcams were used only to recover laptops that had been stolen.

E-mail me.

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James K. Lassetter, MD is chairman and CEO and Robert Connely is senior vice president of Medicity of Salt Lake City, UT.

  

What caused the dissolution of CalRHIO and what are the prospects are for the new group?

(KL) It’s really pretty straightforward. A lot has been made of it, but the reality is that CalRHIO was formed at a time when there wasn’t any federal funding. The mission that CalRHIO was working on was how to create a fully connected California. A big part of that was how they could build a sustainability model.

They woke up one morning in the spring to the announcement that the states were going to get funding to do HIE activities. CalRHIO’s business model was such that it would have had to be the SDE, State Designated Entity. They competed in that process. You can imagine that there was a lot of politics involved.

The state decided that they were going to form a new entity. At that point, it was a simple decision that CalRHIO would fold itself into that new entity. That’s the reality of what happened.

Technically, there was no purpose in keeping a staff on for an HIE model that wasn’t going to be deployed. The board remains intact and continues to meet. In fact, CalRHIO recently won the second largest Social Security Administration grant and has retained consultants to roll that out. We’re the participating vendor in that grant.

The whole concept that CalRHIO folded and went away makes for good blog content — not referring to your blog, of course. It really doesn’t reflect reality at all.

What’s Medicity’s role going forward with the new group?

(KL) The new group is moving forward. It’s essentially in the formation phase. We expect some announcements out of the state fairly soon. We anticipate that they will go to vendor selection. We hope to have a very good shot at that relationship.

It must be frustrating to have to win the business all over again.

(KL) When the funding came out for the state, we knew it was going to be good news/bad news. You go to bed playing football and you wake up and realize it’s now baseball and you look a little funny out on the field in your football uniform. [laughs]

Because there was no funding out there, if you wanted to be a sustainable HIE, you had to build a business model. CalRHIO had developed what I thought was a very innovative and substantive business model that was endorsed by CalPERS. Many of the largest health plans in California had looked at it and validated it. They were the ones being asked to fund the HIE because it was speculated that they would derive the biggest benefit from reduced utilization, thereby lowering medical cost.

We had RAND involved, Mercer, Watson Wyatt, and CalPERS as one of the largest purchasers of healthcare services in the country, many of the largest payers that have a national footprint. All were engaged and supportive of the model. However, when the federal government came out with the funding, then the game changed.

The business model as laid out by CalRHIO had a focus on bringing information as a starting point to the emergency room, where you have the highest acuity meeting the lowest amount of information. If you were to look at the one point in the healthcare ecosystem where information will have the biggest impact on both cost and quality of care, I think everyone would agree that the ED is ground zero. That was picked as the first point because the information could have the highest impact in lowering the cost of care. That was certainly something the health plans were very interested in as being a starting point.

With the funding, it was much more about pushing HIE for broad physician meaningful use adoption. There’s a significant shift in the first phase. The big problem right now is the states are going to go out and pick a vendor and deploy. Unless they’ve thought through a sustainability model, these are going to be a lot of bridges to nowhere.

Are business models still important or are people forgetting that fact?

(KL) Business models are absolutely still important because the federal government has given no indication that there is going to be a continuity of funding. What’s happened is that it’s taking a back seat. Before the funding became available, all the entities had to focus on how they would get started. Now they know how they can get started, but what many of them have not yet figured out is how they can remain functional.

Is it easy to get the money but then have to figure it out later?

(KL) Everyone is in different phases. There are people in the planning phase, people that are in an operational phase. The ones we work with emphasize building a sustainability model. I can’t speak to the ones we haven’t seen, but I know that some are very focused on that.

If you look at the big picture of where the federal government is spending money on interoperability and the Nationwide Health Information Network, how would you describe where the money is going and what means to the industry and your business?

(KL) There’s a broad picture. If you look at the first phase of meaningful use, there’s a real emphasis on getting the physicians prepared to exchange data. Simultaneous to that, they’re trying to get the infrastructure in place so they can exchange data.

While the meaningful use requirements for information exchange are coming later in the process, the government knows that these infrastructures can’t be built overnight. They need to begin in earnest right now to be building the infrastructure capable of exchanging that data.

There’s a lot of innovation going on, and I think we’re in the middle of a lot of it, that should have an impact on changing that paradigm. The money specifically is being distributed to the states for both planning and operation of all different flavors of HIE. When you talk to the states, it’s lot like the fable of six blind men and an elephant — depending on whether they felt the trunk or the tail or the side, it was a tree, a rope, or a wall. There’s still a lack of consolidation around the concept of what an HIE really is. A lot of that came through in the recent KLAS report.

How would you characterize the difference between an HIE and a RHIO in contemporary terms?

(KL) There’s a verb HIE, which is the act of exchanging clinical information. There’s a noun HIE where you are an entity that is trying to create the functionality or the action of exchanging information. A lot of people do health information exchange without an HIE or RHIO.

It really is the difference between talking about the noun, an entity that’s called a health information exchange, or the actual action of health information exchange where you move clinical data between one provider and another.

Obviously, you don’t necessarily need a third party. Many of our clients are hospitals doing health information exchange with their affiliated physicians. Many of these are rural areas, where there are not competing hospitals. De facto, it becomes a full community exchange without the need for a third party body to mediate that.

Where does Epic’s private exchange among its users fit in?

(KL) It is a special class or consideration. If two entities are sharing the same technology platform, then it would seem fairly straightforward to exchange that data. Unless those facilities are juxtaposed to each other in a geographical sense, I don’t see the real value in it, but if two facilities are across the street from each other and full Epic shops, then clearly it seems to make sense for them to exchange data.

(RC) One of our bigger efforts across the country is to integrate HIEs and sub-HIEs, small HIEs, and it’s amazing how many of them we are connecting to. Epic’s going to be another life form that is out there. I think we’ll be interconnecting them.

It will kind of resemble the Internet in the end — networks are not nice and pure and harmonious, but they do move data back and forth. I think you can only go so far. Once they reach the edge, even they are getting involved in standards-based exchange. So, they’re part of it. It’s not a model that scales.

Are you seeing new market entrants with all this money flowing in?

(KL) We have a joke — the HIE costumes are flying off the Halloween store shelves. Before there was federal funding, there were few true HIE vendors out there. Now, anyone who’s ever moved a lab result electronically is an HIE vendor. Or for that matter, anyone who has exposed eligibility or done claims processing is now an HIE vendor.

Tell me about the patent for the Medicity Novo Grid.

(RC) It was a patent to move data in a different way, in a distributed fashion, how we create these linked objects that can move data from Point A to Point B and keep the level of synchronicity. It’s actually the core technology around a new platform that we’re introducing at HIMSS called iNexx.

It gave us that architectural underpinning that we can build a massive amount of business on without having to worry about patent trolls coming along and taking it away. We have that core architecture that we’re building the next generation product set on, how we can share information and built systems on top of that open platform.

Where does iNexx fit?

(KL) We believe we have the largest HIE platform deployed in the US and I think the KLAS report substantiates that. We decided to open it up to third-party development. We think this is a really bold move because it allows many different applications to share the same connectivity into a physician’s office, whether it’s demographics or connectivity to the practice management system or clinical CCD connectivity to the EMR system, and it’s bi-directional.

Typically those connections serve one application. Typically they’ve served our infrastructure, but by opening it up, it becomes plug-and-play. We’re taking a page out of the iPhone playbook and exposing an application store, but these applications are certified to safely and securely run on the platform, can be downloaded … there may be three or four e-prescribing solutions. There may be many different components that are together.

One of the big victories we felt we won was when the meaningful use criteria came out and allowed for a modular approach as opposed to a monolithic application. Different vendors can participate and create the modules that in totality allow the eligible provider to qualify for meaningful use, which we believe is a big paradigm shift. We’re calling it, for a lot of reasons, the first Health 4.0 platform.

(RC) Health 1.0 is about content, Health 2.0 about community, Health 3.0 about commerce, and then Health 4.0 about coherence. This is where we tie it back around the patent we got.

What that patent allows us to do is to create a different type of record, a linked object, that we can distribute across the community and tie it together. Everybody has a copy of it and can see what others do. The patient can even be involved in this exchange. In fact, we’re about to undergo some projects in California that bring patients into this shared record that the care team can maintain and conduct business across. It’s a private social network, if you will.

That new thing where we’re tying everything together as Kipp described earlier, bringing in data from the PM systems and the EMRs, from the hospital distribution of things from reference labs … all this data coming together and then shared in a coherent fashion between the various care team members and the patient at the center of this universe. Because this whole platform is structured that way, it’s not a relational database. It’s really designed for distributed object community.

It’s a new approach. The whole concept behind the platform is the way it manages information exchange, making that a natural part of the data structure, not an add-on interface. It’s built at the core. We believe we can bring it to market at a very low price that is a disruptive innovation.

(KL) The iNexx platform creates a virtual, Kaiser-type infrastructure. Historically, to do that full bricks and mortar IDN, everyone needs to be under the same ownership and practices are owned and insurance companies, hospitals, etc. This model allows organizations and affiliated physicians that are not part of the same entity but work together in related health plans to collaborate on a platform and in effect, create a high level of collaborative and coordinated care, much like what happens in the top IDNs across America.

We think the technology has gotten to the point where you don’t necessarily require single equity ownership across an entire IDN. Unrelated entities can collaborate around a single patient and achieve similar results.

From a physician’s perspective, one of the very powerful things about the iNexx platform is that when I bring a patient in view, I have a lot of different applications that could be exposed by many different vendors that I can use to perform actions, such as e-prescribing. Running in real time and next to that view of the patient in focus is a real-time view of activities going on by the care team of that patient that are all on the grid. Whatever lab results, whatever pending actions are on that patient by other practitioners and other specialists, I have that view. That is, from a physician who used to practice, some of the most useful and helpful information you could put in front of a doctor.

We’re in the middle of healthcare reform and a real pressure to lower the cost of care. The average cost of care per capita in the US right now is around $8,000. As the US looks outside the country for models to emulate, when you look inside the US, there’s a massive disparity in spending and quality indicators between the different regions within the United States. If you were to look at California, most people would intuitively say that California’s cost per capita is higher than the national average. The reality is that it’s much lower.

One of the contributing factors is what some people call the Kaiser Effect, which is that highly coordinated, collaborative care IDN. In order to compete against Kaiser, you have a unique delivery model mostly unique to California where you have IPAs that are doing risk contracting, functioning at a higher level of coordination of care, contributing to the net effect of a much lower cost of healthcare per capita than the national average.

If you look at the states that have the lowest per capita cost and the highest quality indicators, it’s the state of Utah. Besides the fact that there are other contributing social factors, that’s also the effect of the IHC network and the dominance of that network in Utah. We believe this infrastructure can create virtual IDN infrastructures that allow that same collaboration and coordination of care. That’s a high-level macroeconomic look at what we’re trying to achieve within the company.

What was your reaction to the KLAS HIE report?

(KL) I think it’s a reasonable start. I don’t think any one vendor is probably completely satisfied with how they got presented.

Obviously we feel we came out of the KLAS report very well. We’re very happy with how we came out. We obviously don’t feel the full scope of what we’re doing or how we’re doing it was represented in that report, but I don’t think that’s unique to us.

The market is moving so quickly that they probably ought to generate one of those reports every other month. With all the federal funding coming in, there’s so much changing. From the time that report got printed, in our opinion, it was way outdated.

What will interoperability look like in five years?

(RC) I personally think it will change significantly, that the technologies that we and others I’m sure are working on will negate some of the higher cost elements of putting together HIEs. EMRs will evolve from the state of recording everything a physician does to get more inserted into the collaborative areas.

I think HIEs will evolve to a Google-like search engine. I think with the technology and the focus on nursing and staffing being more coordinated is going to have a big impact. It’s not really coming from the government as I think the private sector that’s putting the pieces together. The money’s going to just chum up the water for a while.

I believe we’re going to evolve to another state and it’s going to be much simpler, much more distributed, and much more organized. I think the future will be much more Internet-like than the large, monolithic architecture they’re trying to assemble today.

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Thomas R. Yackel, MD, MPH, MS is chief health information officer at Oregon Health & Science University in Portland, OR.

Tell me about your background and what you do.

I’m a general internist by training. I continue to practice outpatient and inpatient medicine about 30% of my time, but 70% is in a relatively new position here at OHSU called chief health information officer.

I started out at informatics. I actually came out to Oregon to do a fellowship with Bill Hersh in medical informatics, one of the National Library of Medicine fellowships. Did that for two years, got a master’s degree, and then was lucky enough to stay on at OHSU.

At the time, we really weren’t doing too much in health IT. We had Siemens Lifetime Clinical Record, we had a scanning system, and so we had a pretty good repository, but we weren’t doing any CPOE or anything really challenging or interactive.

After I was here for about two years, the medical group got interested in EMRs when they were building a new building and realized that record rooms would cost too much per square foot. That really kicked off our adventure into enterprise electronic health records.

I guess six years or so later, here we are and we have an almost fully-deployed enterprise electronic health record and the full suite of Epic applications; including e-prescribing and MyChart, and rolling this out to affiliates and all the billing and scheduling and good stuff that goes with it. Reporting, too. It’s just been kind of a neat and fun ride.

How important do you think it is for your credibility that you continue to practice medicine?

I think it’s important for a lot of reasons. Credibility, I think, is one thing, just in terms of making contacts with people outside of the context of the EHR is super helpful to me. Having some people actually come to me as their patients, who I also work with, is kind of an honor and something neat.

I don’t know how other people do this if they don’t actually use the system that they work with, but I would have to spend a lot of time learning a lot of details that you just kind of learn as a user. So I find it immensely helpful and fun to continue practicing.

What are the most important lessons you learned from the Epic rollout?

You pretty much have to do everything right. Health IT is not fault-tolerant, in terms of big projects. You really have to get all the ducks in a row in order to be successful. There are some exceptions to that you make and do better at some things versus others, but I think you really have to cover all your bases to keep the thing moving forward. It’s an uphill battle to do it.

Truthfully, a lot of it is attention to detail. Details are critically important in this. Keeping an eye on those details, making sure all the ducks line up, and trying to acquire the best talent that you can. People that appreciate those details that have a passion for doing informatics-type work. Pairing up with a vendor that shares that same attention to detail and understanding that you have, to get everything right in order to be successful, that has smart people.

Having leadership/ownership buy-in to everything that you do is crucial. We don’t implement health IT for health IT’s sake, we implement it for health systems’ sake. Getting executives behind that and understanding they need to understand a lot of the details too, because sometimes you look under the hood in health IT and it’s a little bit frightening what you see under there. They’ve got to be comfortable with that and be there to back you up when things get tough.

How is your project structured, in terms of ownership, and how did IT fit in the mix?

In terms of the rollout, IT was the project. I don’t want to say ‘owner’, but maybe we’ll say ‘steward’. We organized everything around IT. Once the project was done, we delivered things back to operations. In places where we didn’t have an operational owner, we created one.

The interesting part of this whole project was that initial kickoff. It was our medical group that actually wanted to do this and put up the money to do it. It was the physicians actually paying more than half of the cost. That was instant ownership for them.

Then we organized around IT for the project and for getting it rolled out. When we were done, really wanted to, again, turn the keys back over to the owners and say, “This is your tool, and now it’s yours to use and IT is here to help you.” In the places where we didn’t have an owner, we created one.

As chief health information officer, what I oversee now is a new department called the Department of Clinical Informatics. That group was created because as we sat around the table figuring out OK, now that we’re done, what goes where, we realized there was no owner for all the workflows that we had created in the EHR. There was no group that fronted the customer to IT, or owned the institutional organizational issues that basically came to light as a result of the EHR. So, we created a new department for that.

We also created the Department of Learning and Change Management too, because we didn’t have an operational institutional owner for projects of this magnitude and the ongoing training and change management that would be required for it. That was kind of neat because all of that bleeds out beyond just the EHR and you realize, “Wow, having an informatics department is helpful not just for EHR, but for things that you want to accomplish with electronic systems, or when you need to organize people together around an electronic system to make something happen.”

Likewise, in the learning and change management department, there’s operational changes that may be somewhat enabled by IT. But really, now you’re teaching people how to do their job differently. Not just the new tool, but really do what they’re doing differently, and then how to use the tool to do that. To achieve quality objectives, for example. That’s been kind of neat to watch.

The Department of Clinical Informatics, does that cover just the practice side or the whole facility? Also, what’s the structure and composition of that group?

It’s the whole, what we would call ‘OHSU Healthcare’. It’s both ambulatory and inpatient. It’s multidisciplinary. My title, chief health information officer, was chosen … we didn’t want to make it a chief medical information officer. We didn’t want to create separate silos of medical informatics, nursing informatics, etc. Put it all under one umbrella.

I have two roles. One is this operational person who has this department that I oversee; but then also, I chair one of the four subcommittees of our professional board, our governing structure. We’ve got four subcommittees: safety, quality, operations, and the new one, informatics. People really recognized how important informatics was, and that it really stood up against all those other things that we needed to work on.

In the informatics department we’ve got a director. Then underneath that we’ve got three main groups. One is our clinical champions: physicians, nurses, pharmacists, etc. that work on the project. Our entire HIM department, including coding, was brought in as well.

Then we’ve got a group that came from IT. The systems experts — people that were involved with workflow, design, clinical content creation, and reporting  — all came in as well. We created this team to try to make sure we had people covering the entire lifecycle of project changes and implementation, delivering stuff to users, and reviewing the contents of the quality of the record, which is obviously an important task for HIM.

That’s probably a bigger scope than the average CMIO, or even IT department, to have all of HIM plus the functional IT people. Was that difficult to sell, clinically?

I should point out that we also have about a dozen people that came from IT, and yet we’ve still got our whole IT department which is separate from us. We’ve divided up the responsibilities where we’re more content-oriented, we’re more workflow-oriented and we front the customer. So, we’re the ones that run all the subcommittees of the professional informatics board to figure out OK, well, what are the requirements that people need? How do we prioritize projects?

Then the idea is that we hand off to IT well-spec’d out details of, “Here’s what we need the system to do”, or “here’s what we need built”, or “here’s what we need you to work on with the vendor so they can do their IT role and not get too bogged down in trying to figure out what does the customer really mean when they say, we want this.”

But I think you’re right, in terms of the HIM part of it and really seeing HIM as  now part of informatics. I don’t know that everybody’s doing that, but we thought it was crucial. I think HIM is the glue that holds your record together. They’re the ones who are charged with doing quality reviews of the record.

People complain all the time, “I don’t like the record. I don’t like the notes. People cut and paste too much.” HIM oversees that. They have a huge role in scanning, and scanning’s another piece of glue that keeps an electronic system together because we’re still in a paper world and we interface a lot with paper systems.

Then coding, too — we create clinical content in informatics. The doctors use it, and then the coders read every single thing that they create. It would be a missed opportunity if we didn’t have the coders able to talk to the people that created the content in the first place and say, “Hey, I’m noticing people are using this well” or “They’re not using it well.” Or, “We could do a better job in our templating to accomplish our documentation requirements.” That’s how we thought about it when we put it together.

When you started the project, I’m sure you had some metrics in mind to measure before and after. What kind of measurements have you done, and have you seen the results that you had hoped to?

Looking back, I always feel like we could have done a better job with metrics; and also recognize that a lot of the things that you’d love to know when you do this, you never measured before. We looked at some of the standard things, and a lot of times, the data that we had.

I think one of the most easily available metrics that we had was our dictation. We were dictating pretty much 100% for all outpatient visits, all H&Ps on inpatient, all discharge summaries, all operative notes.

We watched each clinic as we went live and saw what happened to their transcription. It was so interesting. In primary care, it went from 100% to about 2% within a calendar month. In specialty care, it dropped down to more like 10% of what it was previous and then just kind of hung out there. It was an interesting marker of use of the system for me. To think, “Wow, people went from 100% dictation to 2% dictation. They must really be using the system.”

Although I learned that wasn’t really a statistic I should really share with my physician colleagues, because when they looked at that, they said, “Yeah, now we’re typing all our notes. We’re doing all this work. See that? We’re busting our chops to get this done. We don’t like that number.” So, I stopped showing them that. But to look at it as a measure of adoption, I thought it was pretty dramatic.

We saw that happen on inpatient, too. The same thing. We left transcription on. We didn’t take it away. Providers don’t suffer a penalty for using it, other than a workflow penalty of “now I’ve got to read this and authenticate it later”. But they were naturally drawn to it in just about every case, except the one area where it’s only fallen about 50% has been procedure documentation. Surgeons are still dictating a fair number of their procedures, but everything else fell pretty quickly.

Obviously, the financial people watched all those metrics very carefully. I’m probably not as versed in them as maybe I should be, but my gestalt of that is they’re all extremely pleased and happy with what happened. Then a lot of the other things that folks look at, I think, are more subjective and we’re still trying to actually figure out how to measure.

One of my major projects this year has been developing what we’re calling the Informatics Dashboard. There was this great article a couple of years ago that looked at how you measure the success of an informatics project. They looked to the management information systems literature and came up with these six dimensions.

So we looked at them and said, “It would be great to have a couple of metrics that we could describe, relating to each of these dimensions of system success.” Things like system quality — how good is it? Does it turn on when you turn it on? How’s the up time? How’s the response time? Information quality — sure it turns on, but is there information in there that you want and is accessible and you can use? The third one is usability, and how much usage does the system actually get? If it’s a really great system, people use it a lot, right?

Then there’s metrics for organizational impact and individual impact. Organizational impact like quality and how are you impacting that? And then individual impact, which is the thing I think physicians get very concerned about with an EHR, and it’s also the hardest one to measure. How much time am I spending documenting? Is this taking away from teaching or research? What about all this time doing notes at night when I go home?

We’re still struggling a little bit to figure out how do we measure that type of stuff and make it objective. When people complain about it, can we say, “Yeah, we really have a problem.” Or is this a problem of one instead of a problem of many, and how do we prioritize all those?

When you look at that, in context of the proposed Meaningful Use criteria, do you feel good about where you are?

Oh, yeah. I’m thrilled with where we are for Meaningful Use. In some ways, we got lucky. In some ways, it was vision. But for us, I think achieving Meaningful Use is going to be about crossing some Ts and dotting some Is. It’s very, very attainable for us, and so for that part, I’m really happy.

What are you doing with form factor stuff like mobile computing, or anything creative with nurses?

I don’t know how creative we are. We’ve got our devices on wheels. Pretty standard, like other folks have. We committed to having fixed devices in every patient care room, both inpatient and outpatient.

Being an academic center, we shied away from devices that could walk. Anything that wasn’t tethered. When you’ve got students and residents and people rotating through, our experience is if it’s not tied to the wall, it won’t be in the room for too much longer. It’s the same reason we have ophthalmoscopes tethered to the wall. Because after a year, if we handed out a bunch, they’d all be gone and nobody would know where they are; they wouldn’t be charged. So we focused a lot on fixed devices and trying to have them ergonomic so you can move around and stuff, but you couldn’t walk with them.

I think that’s been pretty successful. We’ve had some good luck with that, although there is always a lot of interest in the latest hand-held stuff. We had a lot of people who were interested in tablets when we started out. Of course that died because tablets weren’t really usable. Now it’s the iPhone and the iPad. I don’t know, maybe Apple will crack that nut a little bit better than some of the early PC tablet people did. We’ll have to see.

The industry is struggling a little bit to digest a couple of recent studies that tried to prove that the clinical information systems don’t improve outcomes or save money. Do you believe that those conclusions are accurate?

Yes, but I think we’re asking the wrong question. When we ask a question like, “Do EHRs work?” It’s kind of like asking, “Does surgery work?” What surgery? For what problem? In who’s hands? With what training? All those details are the things that determine whether or not surgery works, you know?

It’s the same thing with EHRs. Do they work? Well, they can work if you do the right things. The other problem with it is we wrap everything up and call it the EHR, but it’s really not. It’s not the software; it’s a process that we’ve developed. It’s a way of taking care of patients that we’ve codified, to some extent, in an electronic system. But when we look at all the studies that show effectiveness — or lack of effectiveness — what I try to look at is, OK, but why? What was it that made this one place really effective at doing this and not another?

I think informatics, as a science, is still pretty much learning those things. What are the necessary and sufficient conditions for success? It’s obviously not just about having a piece of software that does a certain thing. Otherwise, everybody’s experience would be the same with it. I’m not sure we fully understand … I know we don’t fully understand all the things that make it successful or make it not successful; such that we could develop a checklist and say, “Okay, as long as you do these 50 things, or maybe it’s these 500 things, you’ll be 100% successful.” I don’t think we have that yet.

What would you say your goals are for the next five years?

Oh boy, five years? I seem so focused on today. I think for us, it’s to build out the house that we’re ready to create. We’ve laid a great foundation here to do some really amazing things in medicine with the technology that we have. Over the next five years, I’m really excited to see how we will build that. What will it look like? Who will need to be involved? How will we fully engage caregivers? Operational departments like quality and safety to really see this as a tool that is their tool to use and operate and manipulate to achieve the ends that they want to see. I think that’s the most exciting part.

The other is to continue to refine the system, such that my colleagues who are nose to the grindstone, incredibly busy, by and large see this as a positive thing that enhances their ability to do a good job. Right now we see a lot of variability in people’s opinions along that line and we still don’t fully understand what the factors are that result in that variety of opinion.

I tend to think it’s that we still have a somewhat coarse tool that needs to be refined before people say, “Aha, this just works the way I expect it to. It works like Google, or it works like my iPhone.” I don’t know if we’ll get there in five years, but I’m sure we’ll be a lot closer than we are today.

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From Pliny: “Re: Herb Smaltz, CIO of Ohio State University Medical Center. He is leaving the job on February 28 to run an OSU spinoff, Health Care DataWorks.” The company offers an off-the-shelf, pre-loaded data warehouse.

From Keanu: “Re: CCHIT. Has anyone heard of CCHIT events at HIMSS? Isn’t it a bit odd that they haven’t posted a town hall or something? With all the sessions on Meaningful Use, you would think they would have something to say.”

From The PACS Designer: “Re: disease outbreak alerting. The population of high quality healthcare apps for the iPhone keeps expanding. Outbreaks Near Me, an app introduced in 2006, recently created an iPhone version for mobile users. Software developer Clark Freifeld and epidemiologist John Brownstein started HealthMap in 2006 and designed Outbreaks Near Me for Childrens Hospital Boston."

From IKnowPlenty: “Re: AHA. Every day, more news comes out undermining Al Gore’s global warming hypothesis. For AHA’s upcoming Leadership Summit, they’ve added Newt Gingrich to share the stage with Gore. Now if we could just get someone who actually understands healthcare.” Newt makes good money from his Center for Health Transformation, so he must know something. In fact, he’s running an American People’s Online Health Summit as a counterpoint to President Obama’s meeting and most likely as an early step in a 2012 run for President (that’s my guess, anyway, now that his presumed opponent is obviously vulnerable).

Eclipsys announces Q4 results: revenue up 5%, EPS $0.07 vs. $0.06. Non-GAAP EPS of $0.17 beat expectations of $0.12.

Mary Horan, MD, chief of staff of Northwest Hospital (WA), will present “Med Rec: It Doesn’t Have to Hurt” at the AHA booth at HIMSS on Tuesday, March 2 at 3:30 p.m. She will talk about the use of MedsTracker from Design Clinicals, who will also offer private demos by request (at HIMSS or otherwise).

Picis announces a new version of ED PulseCheck and the launch of LYNX CareBridge, a documentation solution for medical necessity.

The Adoption/Certification Workgroup of HHS’s HIT Policy Committee will examine the safety of healthcare IT systems at an all-day meeting (warning: PDF) next Thursday from 9 until 3 Eastern. Executives from Cerner, Epic, and the VA will present, along with Ross Koppel, David Classen, and ePatient Dave (among others). You can participate remotely here without pre-registering. That should be interesting.

Thanks to Access, a new HIStalk Platinum Sponsor (actually Double Platinum, since they are also a Platinum Sponsor of HIStalk Mobile). The Sulphur Springs, TX company offers solutions that address patient flow, electronic forms, electronic signature, an e-Forms Repository, and portals that connect to media such as fax, e-mail, images, and universal documents such as EKG strips and other device output. We found out about each other when I did an HIT Moment with VP Chuck Demaree last week, which taught me stuff I didn’t know about electronic patient signatures and the capabilities of the Universal Document Portal for populating the EMR with data from biomedical equipment or even other applications. Being a barbeque connoisseur, I would find a reason to visit them at their place and then drop by Big Smith’s Bar-B-Q, but if that’s a stretch, they will be at Booth 4333 at HIMSS. Thanks to Access for its support of HIStalk and HIStalk Mobile.

Speaking of HIStalk Mobile, my colleague David Brooks is filling up his dance card to visit companies with mobile offerings (actually, he’s already got 20 appointments for Monday and Tuesday, so lay claim to Wednesday while you can). If you have the coolest mobile solution on the market, David says he will make time for you. I should also mention the fourth Founding Sponsor of HIStalk Mobile, 3M, which joins Vocera, Voalte, and another company not quite ready to be named. We really appreciate it.

I guessed wrong on the 2010 Grammy winner that MEDecision will bring to its HIMSS party. It’s Colbie Caillat, who has charted several times with some good pop tunes. Live video here. Their event is 6-9 Monday night at the Georgia Aquarium, It’s open to everybody, including those coming to the HIStalk reception who will need to leave early to hit Max Lager’s by 7:00. RSVP here to see Colbie.

And speaking of the HIStalk reception, thanks to sponsors Encore Health Resources, Evolvent, and Symantec. In fact, I notice that Ivo must have liked the looks of Max Lager’s since he’s hosting a Healthlink Alumni Pub Night there Sunday night.

Inga and I have done some good interviews that I’ll be posting each day for the next several. I want to get caught up before HIMSS and then feel free to collapse immediately afterward.

And Inga has obviously been a busy lady, putting together HIT Vendor Executives on HIMSS10, which features some fascinating executive predictions about the conference. How she got the top people at 42 companies to share their thoughts is beyond me (charm, I’ll assume).

Noteworthy Medical Systems is chosen by The Camden Coalition of Healthcare Providers (NJ) to power the Camden Health Information Exchange.

Strange: disgraced former Tour de France winner Floyd Landis, stripped of his title for doping, is the subject of a French arrest warrant for trying to hack into the anti-doping agency’s lab system to prove their results can’t be trusted.

General Dynamics wins a five-year contract worth up to $154 million to support the Army’s MC4 battlefield EMR.

Wacom launches a pen-on-screen display for healthcare professionals who need to annotate images.

An odd survey result: over 50% of Americans think other people’s health is going in the wrong direction, but only 17% said their own is. A third of respondents give themselves an A in the major health categories, while more than 90% of doctors grade them a C or lower. No amount of technology is going to fix that perception problem.

Jackson Memorial Hospital (FL) will lay off over 1,000 of its 12,000 employees, trying to avoid missing payroll by May.

You can tell HIMSS is upcoming. The fluff news is everywhere, but all the good stuff is being held to announce from Atlanta.

E-mail me.

HERtalk by Inga

Orion Health will use Merge’s Cedara WebAccess technology to bring images and information into its Orion Concerto Physician Portal.

The ONC selects Acumen Solutions to implement a cloud computing CRM and and project management from Salesforce.com. The solution will be used across all RECs nationally to help manage interactions with medical providers.

The ONC, by the way, names Joy Pritts, JD as its first chief privacy officer. Pritts will work with David Blumenthal to advise on privacy, security, and data stewardship issues. She was formerly on the faculty at Georgetown University.

athenahealth makes Fast Company Magazine’s “Fast 50” list of the world’s most innovative companies. I noticed that PatientsLikeMe and GE were also in the top 50, while Sermo, Kaiser Permanente, and Walgreens made the “also-ran” list.

Here’s something that sounds fun. Buzz Aldrin will be at the MMR Information Systems booth, taking commemorative photos with HIMSS attendees. Look for him March 1st, complete with a moon surface background in the Sea of Tranquility. If you participate, be sure to send us a copy.

EHR adoption in physician offices is up 3% over last year, according to a survey of 180,000 doctor offices. The numbers suggest a 36% adoption rate, with doctors using EHRs primarily for electronic notes. Not surprisingly, the larger the practice, the more likely the practice uses EHR. Hospital or healthcare system-owned practices are also more likely to EHRs that physician-owned groups.

A few sponsor updates:

• MED3OOO will incorporate data management and analysis tools into its MED3OOO Quality Management Suite. The application will be integrated  into MED3OOO’s InteGreat EHR to facilitate clinical data collection, help providers in determine HCC and PQRI scores, and meet other P4P reporting requirements.
• Sage Healthcare appoints Tony Ryzinski SVP of marketing. He previously worked for Misys in a similar role.
• MedAptus announces an expansion of its consulting services team to help providers and hospital to optimize financial and operational performance.
• e-MDs President and CEO Michaels Stearns, MD agrees to serve as board president of the newly formed Texas e-Health Alliance.
• Shore Sound Health System (NY) plans to undergo an accelerated activation of Eclipsys’ Sunrise Enterprise suite at two of its hospitals.
• Marietta Dermatology Associates (GA)  select the SRS hybrid EMR for its 13 providers.
• Sunquest completes a seven-hospital implementation at Cleveland Clinic.

I’d like to think that first there was Inga, then there was Barbie. Mattel introduces Computer Engineering Barbie, who carries a smartphone, a Bluetooth, and a laptop, plus wears stilettos. Any resemblance to me is pure coincidence.

E-mail Inga.

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