From Gamara: “Re: Epic. Random stuff found in Googling Epic.” Good sleuthing, although some have turned up previously The following organizations appear to be going Epic: Stormont-Vail HealthCare (KS – above), University of Colorado Hospital (CO), The Mount Sinai Medical Center (NY), Maricopa Integrated Health System (AZ – old), University of Miami Health System, South Broward Hospital District.

From LookingForAnswers: “Re: Epic. They’re winning deals like Cerner did 15 years ago when they were small. Cerner seems to be a revenue-churning machine that the public can participate in by buying stock. The only people who benefit from Epic are the owners and/or Judy. Which company has made more millionaires? Which company will change the face of HIT for the long run?” Here’s the real question: why can’t Cerner, with all its billions in market capitalization and name recognition, compete with Epic for new sales? As has been asked of other Goliaths (Microsoft, GM, Dell, GE, etc.) how could Cerner, given its ample lead time and resources, let the once-tiny David called Epic beat them year after year? My theory is threefold: (a) even entrepreneurial big companies naturally evolve into highly ineffective corporate bureaucracies that are motivated by fear and executive entitlement, the antithesis of innovation; (b) publicly traded companies let their numbers drive their business instead of vice versa, and (c) corporate Darwinism would have Cerner just buying Epic outright, but Judy throws a wrench into that evolution by refusing to sell the company.

But all is not lost: we don’t know Epic’s profitability, so Cerner may be beating them where it counts. And we know that Cerner has built a business that could weather Neal’s transition or sale to another organization, but we don’t know that with Epic. What I care about most is why Epic beats Cerner for every important deal, which would seem to indicate that Millennium isn’t up to the task. In other words, a $6 billion market cap company with a single, fairly low-rated product line that’s getting hammered by a smaller and much higher-rated competitor should think about developing a better product. Here’s another way to look at the value of ongoing R&D: the only company that beats Cerner consistently in new sales is also the only one with a newer product.

From JA: “Re: Epic. More details on the Yale and Epic adventure.” Yale Medical Group describes their plans for Epic, also mentioning that a CMIO will be hired who will share time with the School of Medicine and Yale-New Haven Hospital. The specific Epic features that seemed to seal the deal were the obvious ones: ambulatory-inpatient integration and MyChart, areas in which Millennium is clearly inferior.

From Dave U. Random: “Re: Epic. Google RGHS+Epic.” Rochester General Health System has chosen Epic.

From SEC Fan: “Re: University of Michigan. CareWeb does many things well (less than they claim), but they have installed Eclipsys Sunrise over the last five years for inpatient. Interesting that after 3+ fails at EMR, they get one right and now replace it.” Thanks for reminding me. That’s another big Eclipsys loss to Epic, six years after the contract was signed and less than two years after Sunrise went live at UM.

From The PACS Designer: “Re: Windows Phone 7. The mobile phone marketplace will have more competition soon, as Microsoft has announced the beta for Windows Phone 7.” It had better be good if it’s going to displace the iPhone, Android, and BlackBerry this late in the game. I don’t see Microsoft as being good at come-from-behind victories; it’s better at running a prevent defense to protect the leads it generated a couple of decades ago. On the other hand, Windows 7 was a hit, so maybe they’re finally getting it.

From Vendor CEO: “Re: HIStalk. I have really enjoyed watching your progression. It’s kind of like watching the New York Times and Murdoch sites (HIT rags) try to get customers to pay for their sites while hordes of readers are rushing to all the free specialty news sites (HIStalk). Fascinating!” Thanks. Maybe I’m the open source alternative, a marginally skilled but enthusiastic spare bedroom pseudo-journalist trudging home to a PC after a long day at the hospital.

Listening: new from Grand Mal, which sounds like the Rolling Stones playing a smoky New York club in 1973.

Tom Ogg is named CIO of Akron Children’s Hospital, coming from Oakwood Healthcare Systems (MI).

Stuff you can do here: (a) put your e-mail in the Subscribe to Updates box to your right and be the first to know; (b) use the Search All HIStalk Sites box to dig through all HIStalk-related sites, including the 7+ years since HIStalk has been around; (c) send me your secret information and rumors via an anonymous Rumor Report, the lifeblood of HIStalk; (d) Friend or Like us on Facebook; (e) support my sponsors by giving their ads an occasional look and click; and (f) send in a pitch-free Readers Write article.

Not many readers think the final Meaningful Use requirements are too hard for providers to meet, but beyond that, it’s pretty much even as to whether they’re too easy or about right. New poll to your right: who benefits most from Most Wired-type awards?

A reader mentioned a JAMIA article last week, eliciting only a general reply from me since I didn’t have access to the full text version. Thanks to the folks at AMIA, who read my comment and hooked me up with anonymous access to their site so I can give a better answer next time around.

This from Weird News Inga: a medical practice sues its landlord over rights to a meteorite that crashed through the roof and into their examination room. The landlord claim it belongs to them, but the doctors say the landlord plans to renege on their promise to sell it to the Smithsonian for $5,000. The doctors say they’ll honor that deal and send the money to Doctors Without Borders for Haitian relief.

These rumors come up all the time, but once again Oracle comes up as a potential acquirer of Cerner. An Oracle VP supposedly claimed the company will spend $70 billion on acquisitions over the next five years, which always leads to talk about vertical markets such as healthcare, which means Cerner.

Duke University researchers develop software to predict MRSA drug resistance, offering it free to researchers.

Interesting: All Children’s Hospital (FL) will become part of Johns Hopkins Medicine (MD). In related news, the governor of Maryland wants to position the state as a health IT leader, citing a statewide HIE, EHR implementations, and recruitment of HIT professionals.

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From Erin: “Re: Medicity and Axolotl. I heard a rumor that both were on the sale block with active participants. That sure would give a new stimulus to the HIE market.” Unverified. The rumors I’ve heard say that Raymond James is shopping Axolotl, with a possibility that RelayHealth will be announced as the buyer soon. Medicity is getting feelers, supposedly, but it’s going to take some serious cash to get their keys and I’d expect the company to do some acquisitions of its own to raise the stakes. It’s a pretty great time to be in the HIE business since everybody wants government money, connectivity, and control of massive amounts of data. The proposed Ingenix acquisition of Picis may be the first signal that insurance companies (like Ingenix parent UnitedHealth Group, market cap $35 billion) are putting their smartest guys in the room on the problem of how to position themselves for healthcare reform.

From Dan Mann: “Re: Epic. Signed LSU’s 10 hospitals.” Unverified, but this is getting ridiculous. Does any vendor other than Epic ever sell a full system to a 400-plus bed hospital these days?

From Flynn: “Re: Most Wired. Why haven’t you mentioned the winners?” Because I don’t care. Hospital IT is not a competitive sport, other than for magazines hoping to sell ads, their vendor advertisers hoping to sell systems, and their participating CIOs seeking a career-enhancing resume credential. Filling out a survey of what you’re doing with computers doesn’t impress me nearly as much as proving your technology-driven superior patient outcomes and lower costs. Unfortunately, the winners can’t usually do that (and in fact, the relationship often seems to be inverse).

From Kelly: “Re: Mike Cottle. The IT director at the former Sumter Regional Hospital has taken an IT director job at Newton Medical Center (KS).” I interviewed Mike after a tornado destroyed his hospital in 2007.

From Laura V: “Re: Picis. What’s up with your sponsors getting bought?” Inga and I were just talking about that. I’m not claiming a relationship, but companies that sponsor HIStalk seem to have a great track record in being acquired under favorable terms. We like to take a small amount of credit for their success even though we usually lose a paying sponsor, so our celebration is short lived. I did get some nice e-mails this week from some investment banker types who appreciate what I do, so thanks to them.

From Ted Nugent: “Re: Ingenix. The Picis acquisition implies they’ll be doing other acute care deals soon. Healthland or SIS, perhaps? Both have a book out.” Unverified. It’s funny how you’ve never heard a phrase, then suddenly you hear it from a bunch of different people. “Have a book out” means a company is seeking a buyer, as I now smugly know.

From Briana: “Re: CPHIT, CPEHR, and CPHIE certifications. Are they worth pursuing? Do hiring managers care? I have 25 years in healthcare IT.” You’ll get different opinions, mostly depending on whether the person you ask holds certifications, but I consider these (and any other certifications, whether it be CPHIMS, certified healthcare CIO, etc.) mostly a waste of time and money unless you have no other credential and are desperate to hide a lack of experience or formal education. I’m not trying to be harsh, just realistic: non-technical certifications don’t mean anything except as an income source to those who offer them, some of which are purely for-profit companies exploiting career insecurity (lack of a degree, lack of work history, lack of US experience, etc.) If in doubt, read a bunch of healthcare IT job listings and count those that require or favor certification (the military is a possible exception since they do in some cases). Nobody’s going to hire you just because you wave some credential they’ve never heard of. We’ll know the industry has lost its mind if it requires a 25-year HIT veteran to prove they didn’t snooze through it by passing a multiple choice test. But certification can’t hurt, so if you don’t mind spending the time or money, do it with appropriately modest ROI expectations.

From Safety Not: “Re: JAMIA article on unintended consequences of e-prescribing. It is not known whether there are advantages over paper in the real world of medical care.” I didn’t see a full text link, but the abstract says the problem is allowing prescribers to enter free text instructions, basically turning e-prescribing into a clipboard with the same inherent risks. I wouldn’t take that as being indicative of a problem with those systems, but rather how they are deployed.

Listening: Scarlet Storm, “female-fronted symphonic gothic metal.” Found them accidentally, like them.

Inga did her usual bang-up job in collecting the thoughts of over 20 vendor executives on the final Meaningful Use rules (and in doing so, earned herself the night off from HIStalk). Some of them are really insightful, offering a fresh take that providers should notice. You can’t ask executives a question without expecting a little sales pitch and she got some of those, but I think every person she interviewed gave some good perspective or advice. Definitely worth a read. You’ll make Inga happy if you add your e-mail address to the Get Instant Updates box while you’re over there since she’s passionate about tracking her stats (she’s insecure in the cutest possible way).

Q2 numbers from athenahealth: revenue up 28%, EPS $0.04 vs. $0.06, beating expectations. Shares are up 7% in after hours trading as I write this.

Microsoft’s Q4 results: revenue up 22%, EPS $0.51 vs. $0.34, beating expectations. Good numbers, helped by Windows 7 and Office 2010.

Weird News Andy goes all culinary in his observational humor, asking of Terra Haute Regional Hospital, “Does their cafeteria serve Haute cuisine?”

Doctors in Australia complain about the new EMR installed in two hospitals, saying that it’s “unfriendly and wastes a lot of time” and “is an awkward electronic and written hybrid.” I can’t swear to it, but I think it’s Cerner, although the doctors say it’s an old version of whatever it is. “It is a US developed system, but in the US they are using version 11 while we are using version three.”

Confirmed: University of Michigan signs with Epic, ditching its homegrown CareWeb. The price was quoted at $20 million, but I would be shocked if that’s all it will cost (although that’s probably software only). The article also said that UM will be eligible for only $2 million in HITECH money, which also sounds way too low for a 930-bed hospital system.

Jobs: QA Engineer, Clinical Product Analyst, Project Manager – Physician Liaison, Web Application Developer.

Tim Thompson’s former CIO job at Methodist Houston is posted. Like many or most CIO jobs, this one requires only a bachelor’s degree and experience.

North Shore-LIJ chooses Skire Unifier for managing its capital projects. I’ll be honest: I hadn’t heard of it, but several big hospitals apparently have.

Harvard Medical School toughens up its conflict of interest rule for faculty, prohibiting them from shilling drugs and accepting free meals and trips. Their consulting and board income is also limited and payments of $5,000 or more must be reported on the school’s Web site. My hero, Senator Chuck Grassley, is largely responsible since he investigated some Harvard docs for taking Pfizer’s money (an excerpt to his letter to Pfizer’s CEO above).

GE Healthcare and Boeing are fighting over a section of the communications spectrum. Boeing uses it to test planes; GE wants it for patient monitoring.

WNA competitor Guy ran across this story. A woman who had just delivered a baby is visited by a group of women who enter her hospital room, shut the door, and start beating her up over comments she made on Facebook. People who’ve never worked in a hospital would be amazed at how often human drama unfolds right in the rooms. I’ve taken guns away from patients, watched a newly delivered 12-year-old mother hitting on a hospital security guard, and declined the offer of patients to share their recreational drugs. There’s a reason they put metal detectors and police officers at the ED door — hospitals are one place other than the driver’s license office where community demographics are proportionately represented.

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Ingenix announced this morning that it will acquire Picis, the Wakefield, MA-based vendor of high-acuity systems for surgery, anesthesia, intensive care, and the emergency department. Terms were not disclosed.

The announcement describes the strategy behind the acquisition:

Ingenix is best known as a leader in health intelligence and analytics throughout the health care system. The combination with Picis significantly strengthens Ingenix’s position in the delivery system, where Ingenix serves nearly 6,000 hospitals in the U.S. with consulting, technology and outsourcing solutions. Picis will extend Ingenix’s capabilities into the high-acuity information systems market.

Ingenix CEO Andy Slavitt was quoted as follows:

This marriage of ‘health intelligence’ and clinical workflow will provide substantial value to patients, physicians and hospitals. Tremendous opportunities exist to use information and technology to modernize the high-acuity area, delivering better care and greater efficiency to these high-volume areas of the hospital, where resource consumption is often at its greatest. Working with Picis’ world-class senior leadership team and talented employees, we believe we can make meaningful change in this critical segment of health care.

I spoke Wednesday morning with Todd Cozzens, Picis CEO and vice-chairman, who explained the rationale behind the acquisition.

”I’m happy with it –  this is a great home for Picis,” he said of Ingenix. “These guys are at the epicenter of what’s happening with healthcare. They know all aspects of reform – data mining and data analytics. Winning the game in reform is about having the best health intelligence. Ingenix has bought into the strategy of hospitals becoming high-acuity centers that need data to drive decisions and to understand the supply chain.”

Cozzens will serve as chief executive of the Ingenix high-acuity business. Most of the Picis management team will transition as well. Operations will remain in Wakefield.

Cozzens says the acquisition was driven by capital requirements. “The minimum market cap to be a serious publicly traded company is now at $1 billion,” he says. “It would have taken 3-4 years for us to get there.”

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From News This Week: “Re: sale. One of your quoted CEOs will announce the sale of his company on Wednesday and hold an all-employee meeting on Thursday. A solid acquisition that will give the company extensibility internationally, although you will scratch your head for 3-4 months on what the purchaser is doing until the strategy emerges over the fall of 2010.” That’s Picis, I assume, although I don’t have solid information on the acquirer if it’s them (one reader says Ingenix, another says it’s a less obvious but unnamed player).

From Htx: “Re: Tim Thompson, CIO at The Methodist Hospital of Houston. He’s leaving to return to Florida.” Unverified. UPDATE: verified – he will be announced as the new CIO of BayCare (FL), Lindsey Jarrell’s old job.

From Cabrini Green: “Re: HIMSS Analytics Europe. HIMSS Analytics staff visited Germany to meet their new colleagues. The picture is funny — it looks like Steve Lieber and Jeremy Bonfini are holding hands.” It does, even though they aren’t.

From Elsie EHR: “Re: IBM. Who remembers ten years ago when IBM (along with Pfizer and Microsoft) sunk a chunk of change into an EMR called Amicore? Amicore was acquired by Misys in 2006, and of course Misys was acquired by Allscripts last year, which will merge with Eclipsys this year. Golly, I can hardly keep my dance card straight!”

Also from Elsie EHR: “Re: Aprima, formerly iMedica. I wonder if they will go after the Allscripts MyWay customers since MyWay and Aprima are the exact same product?” Careful … I don’t have confirmation on the rumor that Allscripts will sunset MyWay in 2012, so I assume it’s not true. Also, just to clarify, MyWay was the same product as Aprima only when that deal was originally signed in August 2007 (see my interview with Michael Nissenbaum, president and CEO, for more background). Since then, Aprima has continued to develop and sell the product separately from Allscripts, so they are no longer the same product even though much of their DNA is identical.

From UK Horlicks: “Re: British Medical Association. It has recognized Horlicks, the drink for HIT, with the slogan, ‘A drink other than Kool-Aid for HIT.” BMA demands that the government suspend access to Summary Care Records, saying it is unreliable since doctors aren’t keeping the uploaded patient records current.

From Anesthete: “Re: University of Michigan Hospitals. Recently signed with Epic to provide enterprise clinicals and financials in a plan to achieve MU.” Unverified. I mentioned that Hurley, which is affiliated with UM, had signed on, but that’s all I know. UM used to have a homegrown system that someone was trying to sell as I recall, but I never heard much about it.

From Zooey Rice: “Re: Amalga. A user of the Microsoft Amalga HIS says the company will exit the HIS market to concentrate on other things, like HealthVault or UIS. Love reading you every morning — smells like … victory.” Verified. Microsoft will announce Friday that its Health Solutions Group will discontinue sales and development of Amalga HIS to focus on Amalga Unified Intelligence System (the former Azyxxi). I didn’t really understand why they bought it in the first place considering it was a Thailand-based product with one notable customer, medical tourism hospital Bumrungrad International in Bangkok. Hanging the Amalga name on it was just plain confusing since in the US, Amalga was just the former Azyxxi product. My comment in 2007: “I don’t know why Microsoft wants to be in this business either, although maybe Azyxxi needs a little brother.” More from the company:

Amalga HIS, based on technology acquired from Global Care Solutions in 2007, is a traditional hospital information system designed to address all of a hospital’s transactional and reporting needs. Working with customers over the past three years, we’ve learned that an all-encompassing solution is not optimal for meeting the varied and dynamic needs of health organizations around the world. As a result, this approach is not well aligned to Microsoft’s broader health IT strategy moving forward. We will continue to develop and sell a RIS/PACS solution based on Amalga HIS and will look at other opportunities to leverage Amalga HIS functionality on the Amalga UIS platform.

HSG will continue to support our customers’ use of Amalga HIS through sustained engineering and support services for at least five years. We are working with each Amalga HIS customer to address their short and longer-term needs – moving them forward to HIS version 6.0 or identifying partner solutions that, together with Amalga UIS, could meet their requirements. Amalga UIS, based on the Azyxxi technology, is a highly flexible solution that enables healthcare organizations to reengineer workflows and get information to professionals when and where they need it.

From Cassie: “Re: St. Luke’s Health System in Boise. They’ve had a data breach in which a significant number of employee records, including SSNs, have gone missing. They are trying to squash the news report, especially given the other recent news from them.” Verified, but it wasn’t the health system’s fault. Mercer, the HR consulting people, loses a St. Luke’s backup tape when moving to a new office. St. Luke’s was in the news last week when its data center lost power, forcing clinicians back to paper.

Listening: Built to Spill, Boise-based, mature, Northwest-style indie rock.

Allscripts’ Q4 numbers: revenue up 14%, EPS $0.10 vs. $0.09, guiding up. The company beat expectations on both revenue and earnings for the quarter, but fell just short on consensus yearly revenue. CORRECTION: Allscripts actually slightly beat yearly revenue expectations – it was the company’s 2011 guidance that came in slightly low in the range of expectations, an announced $780 to $790 million vs. estimates of $787 million. All of these numbers exclude the impact of the Eclipsys acquisition. The conference call transcript is here.

Apple’s Q3 numbers: revenue up 61%, EPS $3.51 vs. $2.01, handily beating estimates. The company sold 3.3 million iPads, 9.4 million iPods, 8.4 million iPhones, and 3.5 million Macs in the quarter. Market cap is $229 billion, $6 billion more than Microsoft, and shares are naturally up on after-hours trading.

Iowa’s HITREC names e-MDs as a preferred EHR vendor.

ONCHIT is looking for a policy analyst to focus on consumer e-health.

Weird News Andy is reduced to puns in describing medical technology put to a seedy use — MRIs of food. Obviously fixated, he adds, “The one I found most interesting was the watermelon. The way the seed groups spiral puts to rest my sleepless nights wondering about their seemingly random distribution.”

HCA Midwest names Sarah Bloom as CIO.

Kingman Regional Medical Center (AZ) chooses SIS for periop.

Another backup tape mishap: South Shore Hospital (MA) determines that backups with 800,000 patient records were lost by the shipper on their way to destruction.

Epocrates files for a $75 million IPO, the same amount it planned to raise in its aborted 2008 attempt. Sales are at $100 million, but the company lost money in the most recent quarter. It plans to bring out some kind of EMR application for small practices this year.

Confirmed, thanks to a reader’s forwarded company e-mail: Kate Kervin joins NextGen as  SVP of marketing and product management, leaving Siemens. Brad Block of IBM (and former Doylestown Hospital CIO) is hired as VP of NextGen Consulting.

Minneapolis-based HealthPartners will use a mobile healthcare communications platform from Toronto-based Diversinet, starting with a two-way secure messaging system for discharged patients with chronic illness and women with high-risk pregnancies.

New Hanover Regional Medical Center (NC) chooses Perceptive Software’s ImageNow for scanning and approval of invoices, integrated with Lawson.

SAP partners with a consulting firm to develop financial and logistics applications for under-400-bed hospitals.

Jersey City Medical Center (NJ) rolls out the Isabel diagnostic checklist system.

Iron Mountain announces its EMR Enablement Solution to help hospitals organize and digitize paper records. It sounds like a marketing repackaging of existing offerings.

Small practice EMR vendor Patagonia Health gets a startup grant from a technology accelerator in its home state of North Carolina. Its product went GA on March 31. Former Misys software director Ashok Mathur is a co-founder.

This fun article profiles some doctors who write medical smart phone apps.

MedPATH Networks announces a marketing agreement with a digital rights vendor to commercialize security technologies that are used for military EMRs, including a secure information exchange based on NHIN standards. I haven’t heard of any of this, but it sounds interesting.

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HERtalk by Inga

HIMSS names three additional finalists for the Davies Awards, including Open Door Family Medical Center (NY) in the Community Health Organization category and Sentara Healthcare (VA) and Nemours (DE) in the Organizational category.

Beaufort Memorial Hospital (SC) says the installation of MEDHOST in its ED increased gross revenues by $1.3 million increase and saved $240,000 annually by replacing dictation with electronic charting. And, Tenet Healthcare has contracted with MEDHOST to add the Care Clock application, which enables hospitals to automatically post current ED wait times to their Web sites.

New from KLAS: a report on homecare finds that three of the top four rated homecare systems are sold by best-of-breed vendors. The top-rated vendors were Homecare Homebase, Delta, and CareAnyware. Meanwhile, Meditech clients find that PTcT is outdated and difficult to use, with 40% saying they’re considering a switch.

HHS wants to use ARRA money to develop a national inventory of research on the most effective treatments and medical interventions. The information would be available as a searchable online tool for physicians and the public.

Huntington Memorial Hospital (CA) selects the Allscripts Community Solution to power its HIE. The Community Record solution is powered by dbMotion. Centra (VA) also plans to implement the Community Exchange platform as well as provide Allscripts EHR for 70 staff and affiliated providers and Allscripts Homecare for its home health nurses.

Globally, wi-fi technology in healthcare grew 60% last year. The US healthcare market will add more than 500,000 additional networks this year, representing a 50% jump over last year.

Giant Mr. Whale has apparently found a new home at Epic’s headquarters, according to the artist. He (Mr. Whale) looks like a happy guy. The artist has a link on his Web site to more attractions on the Epic campus. I think my favorite is the subway.

ITalagen and Medificiency form a partnership to promote a physician practice solution that includes Allscripts EHR and ITegen’s medical billing services and IT support.

No surprise here: an survey finds that EHR implementations are the top priority among the HIT crowd, with 85% saying they are in the  midst of an EHR project or plan to start one within 18 months. More surprising: of the 110 professionals surveyed, 13% reported using Epic, 11%  Cerner, and 8% Siemens. How “random” are these results if Meditech or McKesson weren’t named?

I must ask Matt Holt if this qualifies as Health 2.0. A 64-year-old Pennsylvania woman avoids dialysis after finding a donor kidney via Facebook, getting 197 responses to her plea.

Philips Healthcare’s second-quarter sales were up 4% over last year and second quarter earnings were $280 million, compared to $198 million. CFO Pierre-Jean Sivignon said the US healthcare market was “bouncing back” after a period of financial crisis and regulatory uncertainty.

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Barry Chaiken, MD, MPH, FHIMSS is chief medical officer of Imprivata.

 

According to your LinkedIn profile, you’re CMO for Imprivata, CMIO for Symphony Corporation, and CMO of DocsNetwork. You’re on a couple of advisory boards, you own a vineyard, and you just finished your term as chair of the HIMSS board. I’m not sure exactly what you do all day.

I’d like to say that what I do is try to tend to my grapes, but they’re too far away, so I don’t do that.

DocsNetwork is my personal consulting company. It’s just me. I will contract with companies like Imprivata, who basically are at a size where they really don’t have enough work for a full-time CMO. I make sure that none of the people I contract with cross industries and such.

I essentially work for Imprivata. I’m really their healthcare lead and advise them and help them with their healthcare advisory board and basically function as a CMO as much as they need a CMO at this stage. I imagine if they grow, they’ll need more of my time.

Symphony Corporation is a company out of Madison, Wisconsin. I essentially function as an advisor to them. They currently do have their own CMO who works considerably more time than I do. I just help them with some informatics issues.

My vineyard is Chaiken Vineyards down in Uco Valley in Argentina.

I’m most intrigued by the vineyard thing. How does that work?

It’s really a great deal. Woody Allen once said 90% of life is just showing up. I love to travel down to Argentina. I visited Mendoza and I’ve had a long-standing interest in wine. I collect some, drink some, give away as gifts some.

I just stumbled on this wine project that two Americans and the Argentines started several years ago. I got to know friends and family with them and it’s been a great project. I was one of the original 13 of 14 private vineyard estate owners and investors. Now they have almost 80 and they’re going to go to 100.

They just announced they’re going to build a resort on the property. It’s about 60 miles south of Mendoza. They have a great team, great winemakers, and it’s something that you can do in Argentina which you really can’t do in the US or France unless you have a lot of money, which is not one of the things that I have a lot of.

Let’s get back to business now, although that’s a business for you, too. As a physician who works for an organization whose forte is user access and security, you must be the guy who has to make the argument for convenience versus application security. How do you think most hospitals fall in that continuum of convenience versus IT’s lockdown?

First off, you have to address the issues of security and privacy. I think that’s incredibly important. If we digitize everything, you’re going to need to do more of that.

I’m not sure security and privacy and convenience and ease of use are mutual exclusives. I think you can do both of them together. I think the technology exists that you can do them together. Maybe 10 years ago it didn’t, or maybe five years ago, or even maybe two years ago that didn’t exist, but I think it really does exist now.

We have smart cards. We have other ways of authentication, whether it’s fingerprints and things like that, that can make it easy for people to login and log off, just like we’re spending the time learning about workflow. For clinician workflow, how to present the clinical information for the physicians in a way that is useful for both them and efficient and useful for the patient. I think that we’re also learning about the importance of the workflow, securing a desktop, and we can do that today with a variety of technologies we have.

Imprivata has a lot of those technologies. What made me very interested in Imprivata and wanting to work with them is that I understood there’s clinical workflow that’s within, say, an electronic medical record or a clinical decision support tool. But the reality is you’re bringing together multiple applications either from a single vendor, more than likely from multiple vendors, so that has to be created into a clinical workflow which is what hospitals and consultants work on.

There’s this other piece, which is how do you glue all these pieces together? Single sign-on can clearly happen. There’s an intelligence about how you secure a desktop. How long is a timeout? What devices to use to log on and log off? What makes sense with those devices that you use to log on and log off or back on?

For example, one of the products Imprivata has is Secure Walk-Away. It’s very simple. Basically, when you logon to a desktop and a workstation, it uses a camera — which we know today are very inexpensive — and it doesn’t go to a database to look up your photo or your image. What it does is it takes multiple images of you when you log on. It takes images with you turning your head, it takes images with and without your glasses on — whatever you may focus on that camera, it takes that image. The minute you’re out of the view of the camera, the screen goes blank. It goes black. You walk back in within a specific time period and the screen will come up again as if you were there and automatically you’re logged on.

What’s nice about that is it allows the workflow, right? The doctor might be talking to a patient and then walk back into the view of the camera and wants to be able to enter some information. Walk away, walk back, walk away, walk back — it instantly brings up the screen, but when they’re out of view, it blanks the screen and that secures that desktop, yet still facilitates the workflow.

What’s really nice is that you don’t have to have this database of images of you in different styles of glasses or haircuts or whatever. It’s just for that moment when you log on at that desktop, so it works to facilitate that workflow while securing the desktop.

Even though IT shops spend a lot of time worrying about applications, it seems like a lot of the physician frustration is one of two simple things that are infrastructure-based; either they have to wait in line to get to a device or log in multiple times once they get one. If you were a hospital, how would you choose a single technology? Or, what would you do to assess that situation and resolve it?

Let me give you an analogy. I’m sure you’ve flown. I’m sure almost all of us have gotten to the airport and you had to go fly. We’re waiting on line to go through TSA and security and we don’t get really happy when we don’t have enough people who screen people in screening lines, do we?

The first thing you have to do is do an assessment of how many workstations you need. Not by counting numbers, by looking at the workflow that’s within your existing environment in your hospital. Make sure that they are available, because in reality, those devices are relatively cheap compared to the time of the clinicians — the physician, nurses, and others — who may need to access that. You want to make sure you have enough devices available.

Then, you have to design the clinical workflow within the application to make sure that fits two needs. One, it is streamlined — it makes sense. Also, it produces good outcomes.

The last thing is you should look at the existing technologies to facilitate the workflow between applications — single sign-on, secure authorization, things like that — to make sure you’re able to keep the medical information private and secure, but facilitate the workflow. That technology exists. Every day it’s less expensive to do, but I think the IT department has to focus on workflow. Workflow backs up to enough devices, backs up to a secure way to access those devices. That facilitates, encourages, and makes seamless that workflow. That way, the hospital can focus on the clinical care of the patient and the physicians can focus on the best clinical workflow to deliver the best care to those patients.

How do you think mobile devices are changing the whole security picture?

Big problem. They’re really a big problem. I have to tell you, for years I’ve been speaking to people who’ve talked about that problem of securing those devices. Now we have an iPad and I imagine revision two or revision three of the iPad’s going to have a camera in it too, besides a smart phone.

Now you have these unsecured networks sending personal health information over them. That’s a big problem. I think that problem needs to be addressed. As best as I know, there’s no technology to specifically address it right now. I mean, I guess you can shut off everybody’s smart phone, but still, they can take pictures and when they leave the hospital they can obviously send them.

I think the first thing you have to do is to educate the clinical people about the security issues and privacy issues about using their smart phones or their iPads or whatever else device they may have — or their cameras, even — and understand what the rules are and why those rules need to be followed. Then, over time, I think we’ll develop technology to lock down. I should really use the word ‘secure’ — to secure, whether it’s a smart phone, the iPad, the tablet, the whatever — to make sure that the PHI is protected.

Do you think part of the reason doctors and other clinicians like portable devices is that they bypass a lot of the IT restrictions on devices that aren’t theirs full-time; can’t be personalized, and aren’t really under their control?

You know what? That’s possible, but you know what I think it really is? Let’s think about what a physician does. The physician is the only professional that I know of, the only one I know of, who every single day of their career is never like the day before. I’m not talking about what they see or the work they have to do. I’m talking about where they are, where they physically are. No physician walks into their office and sees patients, room 1, 2, 3, 1, 2, 3 — they don’t do that. They move whatever is happening for the day. They may spend more time in one room or the other, and the same thing in a hospital, they roam all over the place and it’s never the same.

But if you think about an attorney, an accountant, those types of professionals — they walk into their office, they sit at the desk. Their pencil is in the same place, their computer screen is in the same place. Everything is the same for them and they get to do their work.

What happens is doctors have to have their desktop roam with them. The only way today that we do that all over the place is through these smart phones. They have their own personal device they put in their pocket, they have it in their arm, and they can use it for multiple things. You could use it for Hospital A, Hospital B, Hospital C. They can use it for their practice, depending on how they set it up. It’s a very convenient device for them. Applications that allow that desktop to move around with the physician are the ones that will usurp those smart phones and the other things that they carry around with them.

Imprivata has a product that allows them to do that with the roaming. It moves the desktop around the hospital. But for now, it works within the hospital, in the application. At some point we’ll have a device that allows that desktop, in whatever form factor we have it in, it will allow that physician to move around everywhere with that secure desktop and do their clinical work. Then they won’t care about having IT locking it down and wanting to go outside IT. Except the way the applications are implemented and the workflows don’t fit in to how the physician wants to work.

I understand the concerns of the IT departments around security and I commend them for the work they’re trying to preserve — the security and privacy of the PHI. What we need to do is let’s think a little bit outside the box here. Let’s put a couple of things together. Let’s think about the clinical workflow and let’s think of the IT issues in securing the desktop. Let’s get a bunch of people together, those multidisciplinary people together, to figure out what’s the best clinical workflows that we can satisfy both for those stakeholders.

As you look back at your term as chair of the HIMSS board, what would you say the organization is doing right and what would you like to see it do differently?

First off, I really enjoyed being part of HIMSS. I think that HIMSS has been a great experience for me, and probably for a lot of my colleagues. The thing that’s really wonderful about HIMSS is that, really, all the volunteers really decide what happens at HIMSS and things bubble up from committees. A lot of times people on the outside really don’t see that.

When I was on the board, anything that would be presented to the board that we would vote on and endorse, so to speak, or any position that came through, always came from all of these committees of volunteers that were just spread all over the place. As HIMSS chair, I got to review some of those resumes of those people on the committees and then appoint them at recommendations by staff and others. The diversity was enormous. I think the thing that’s wonderful about HIMSS is the fact that it has this diverse group of folks.

In this past year, one of the things I specifically emphasized in my HIMSS keynote was the idea of clinical transformation, which was, let’s see if we can make access to care better. Let’s see if we can make it safer. Let’s see if we can make it higher quality. Let’s see if we can reduce the cost of providing the care. My belief is that IT is able to do that.

I think that I’d love to see HIMSS continue with that and emphasize that clinical transformation and emphasize helping other stakeholders in other disciplines be able to improve healthcare and make it affordable for us. We’re on this cost curve that’s really unsustainable and we need to fix. Our quality isn’t there, our safety isn’t there, and our accessibility isn’t there. I just believe IT can help and I think HIMSS can be a leader for that.

I noticed in your keynote that you were talking about population health and arguing that automation is needed. But what HIMSS does is primarily just work within the four walls of the provider’s office, helping make episodic healthcare delivery more efficient and caring nothing about health in general. Other than the fact that healthcare services delivery is profitable and population health isn’t, why do those areas have to be so different?

Well, let’s look about healthcare policy. It’s, you know, reimbursement.

I just recently had a conversation with a colleague of mine. We were talking about accountable healthcare organizations, talking about medical home, things like that. Currently, providers across the spectrum are incented to provide volume care. They’re not incented to deliver value. I don’t blame any of those providers. We know from studies of human behavior that even if the conscience says, “I want to do X;” if there’s an incentive that’s subconscious, they end up not doing exactly X.

We need to change our reimbursement system that reimburses all of us for quality, accessible, safe care. That’s what we need to do. HIMSS has to and will, with other stakeholders, medical organizations, other hospital associations, medical societies, nursing societies and others, get together and decide what they need to do as stakeholders and push towards changing that reimbursement so it compensates providers for their quality and value that they deliver, as opposed to the number of times they’re able to do a particular test or procedure or have an admission or whatever.

We see, in organizations that have different types of reimbursement models, that we see different utilization patterns. I know the society is very concerned, our public is very concerned, about limiting care, but the one thing you have to understand is more care is not better care. More care is just more care. What we need to do is forget about more or less care. Let’s just get better care.

You also said that the industry needs to create solutions that are so compelling that people want to use them and that it shouldn’t be because an executive order, that demand should be created by the quality of the products. Is anybody doing that? I’m not seeing anything where people are getting excited about somebody’s product to use it voluntarily.

Well, I think we’re still at a tipping point. I think I wrote about that in a piece called “The Glue” recently. People are working and making the applications work better, you know? Let’s be fair to these folks.

You’ve probably used Mac, an Apple product like an iPad or an iTouch, or an iPhone I imagine, right? If you compare that to your experience using some other, whether it’s a Microsoft product or somebody else’s product, clearly there’s something about that user interface that makes it incredibly compelling to people. Look, they sold over two million iPads in the last six weeks. Man, that’s a lot of iPads in six weeks.

We’re still learning, in healthcare, about that user interface. We’re still learning about how to put the applications together in a clinical workflow that’s going to be valuable to the patients and to the people who are providing care. Let’s be patient. Let’s give them a chance to figure out the right way to do this. Let’s give the application providers an opportunity to make this better. Let’s hold them accountable if they don’t. Absolutely, hold them accountable if they don’t; and the marketplace, I hope, will be able to make those choices and hold them accountable when they don’t. But, we’re still learning.

But HITECH has pushed the marketplace into buying today. Everybody’s picking their dance partner now for a lot of years, so everybody’s buying the same stuff that was already being sold. Where’s the market incentive to put out a better product when everybody’s bought what they’re going to be stuck with for years?

Well, there’s still the clinical workflow. You still have to worry about putting together the clinical workflow. It’s not just the app.

OK, but if you’re the vendor, what’s your incentive? If you’ve sold all of the systems you’re going to sell because everybody’s blown their HITECH money and now there’s no market out there, what’s the incentive? How do you get existing customers to convince vendors to improve their product when they’ve already signed on the line which is dotted?

I think you’re going to have to ask the vendor that. I’m not a vendor of an EMR system, so you’re going to have to ask the Epics and McKessons and Cerners and Eclipsys, and Meditechs and GEs of the world what they are doing, I think. I still emphasize the fact that it’s about the clinical workflow, and they need to go — and the hospital has to be a partner in that — to improve that clinical workflow and make it better. You know, the reimbursement systems are a little bit crazy.

I did work for a vendor. It’s really weird. On the one hand, when you have an EMR, for example, it’s really dealing with two masters. One master is I want to be able to record the clinical data on a patient so I can treat them as best as I possibly can. I’m a clinician, I know that. I want to record the data so I can do a better job. I’ve seen plenty of paper records that you don’t know what the heck is going on if you want to do that.

On the other hand, I have to record the data in a way that I optimize my coding so I get paid what I deserve. If you’re an EMR vendor and you have to write code to be able to address those two issues, that’s a real challenge. Then, for the end user, it’s a real challenge. But, I think we can get around that. I mean, there are things that new technologies are coming out all the time.

I think, relevant to the workflow, again, we have to redo that workflow. I think what Imprivata has to offer allows, at least — that single sign-on and the authentication and privacy protection — that allows us to bring these apps in a way that hospitals and the clinicians in those hospitals can work to develop their own effective workflow.

Last question. If you look out five to ten years, what would you predict will happen with healthcare IT versus what you would like to happen?

OK, let me say what I’d like to happen. I think the whole way that we deliver healthcare in the US has to be completely redone. Of course, our incentives — we talked a lot about that, but what I think is we have to really leverage information technology in such a way that doctors no longer do what they do today, nurses no longer do what they do today, other clinicians no longer do what they do today.

In other words, if I have a runny nose, I don’t necessarily need to see a physician to be able to be diagnosed on that runny nose. I can go ahead and see somebody who’s trained at a lesser level who will see hundreds and hundreds and hundreds of thousands of runny noses. Then, if my runny nose is different than the normal runny nose, they know to escalate, to triage me up to the clinician who’d be better suited to treat me.

What we need to do, is if we know best practices, if we know clinical knowledge, we know the things that really make people better that deliver better outcomes at lower cost. Forget about the cost for a moment. Just deliver a better outcome, less morbidity, less mortality, OK? We need to have that, to have everybody access that best care. Right now, we don’t access that best care.

If you want to predict what a physician’s going to do in their practice, all you need to do is look at where they got their medical degree and look at where they did their residency. That will predict the practice patterns that they will follow. We need to change that. We need to choose best practices.

I think IT is the way to deliver, at the desktop, at the point-of-care with the patient, best practices. There isn’t a single best practice most of the time. There may be a couple of different best practices, and for a variety of reasons, you may choose one over the other. The thing that a human being does better than a computer, and will do for some time, is their ability to use disparate pieces of information.

Let’s assume a patient has coronary artery disease, so they have high lipid levels and they have diabetes. Maybe today they also have a cut on their arm and it looks like it’s getting an infection. You can look at best practices for treating that patient. Computers can’t pull those three diseases together today, but a human being can do that. They can look at those best practices and put together a treatment plan for that patient that really will work well for that patient. Oh, and on top of that, the physician or the nurse or the other clinician can motivate that patient to take their medications, to follow their treatment plan to get them better — again, something that a computer can’t do.

What I want to see, what my vision is 10 years from now, is you’re going to see more and more clinicians who are going to be rewarded, who are going to be respected for their ability to synthesize multiple sources of information and then deliver it in a good care plan for a patient and treating their patient, instead of being looked up to because of their ability to remember a long list of facts. Computers are great at remembering facts. We don’t need to do that as human beings anymore. Human beings are great at pattern recognition. We should be able to move in the clinical space where physicians and nurses and others are doing their skill set around pattern recognition and treating the patients. IT is the source of that.

You asked me what I didn’t think was going to happen? Well, what I don’t think will happen, I don’t think it’s going to move as fast as I want it to, you know? I think we should do this now. I think we should be teaching this kind of stuff in medical schools and in residency programs and switching to that type of environment. That’s the way we’re really going to leverage healthcare IT.

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