From Across the Pond: “Re: Alert Online Healthcare, Portugal. Delays all over the place in their first Netherlands implementation of their flagship hospital. It seems they couldn’t deliver the Dutch-specific adjustments in their software on time. Testing was delayed, causing the testing squad of physicians, nurses, and administrative staff to be sent home. Needless to say, the atmosphere is less than sparkling and vibrant right now.” Unverified.

From Nasty Parts: “Re: Sage Healthcare. A new sales approach.” Sage seeks 40 to 50 more solution providers to sell Intergy and Medical Manager, adding to its direct-only channel because it doesn’t have the resources to meet demand.

From Peony: “Re: WellStar. The former cardiology practice of fired CEO Dr. Simone was recently purchased by WellStar for a lot of money. I wonder if this had anything to do with him being fired?” Unverified. I assume that practice is WellStar Cardiovascular Medicine, the 30-doc group he founded. Showing him the door will cost the hospital group $1.8 million, though, since his contract guarantees a paycheck for two years if he’s canned. Ditto for the also-fired general counsel, who will get an $856K parting gift. What the hell are boards thinking when they sign these contracts?

From Cable Cutter, Here: “Re: Verizon. Verizon workers severed a fiber optic cable near Pittsburgh Monday afternoon, affecting businesses and hospitals from Pittsburgh to Steubenville, Ohio and cutting all IT and phone service to thousands. Several call centers were out and emergency calls from hospitals went unanswered.” Unverified. Frontier in Illinois, which took over the old Verizon lines, had the same problem, with hospitals forced to use cell phones for several hours. 

From Situation: “Re: MyChart. Now available on iTunes.” Here’s the link.

Related: Dean Clinic (WI) says it became the first hospital to offer Epic on the iPhone Tuesday. The lady in the pink top really chews the scenery with enthusiastic overacting.

From Cmon Man: “Re: FDA regulation of smart phone apps. Patient safety and innovation are intertwined. Usability and efficacy would be escalated by FDA regulation, contrary to the protests of the industry.” FDA is watching app stores for imaging-related smart phone software, saying that anything that sends images to a medical facility requires FDA approval. They also supposedly called out iStethoscope and Instant Heart Rate as apps that might pique their interest. They say they’ll be issuing guidance.

Cmon Man also weighs in on HHS’s spending taxpayer money to design a trademarked phrase and logo for Connecting America for Better Health, saying it’s cutesy, presumptuous, and expensive. He also finds it uncanny that “better health” is part of the name, making it reminiscent of the UK’s Connecting for Health flatlining boondoggle, or the “HIT Devolution” as he calls it. I guess I don’t agree about the cost since the pallets of stimulus cash being shoved out of the HHS plane make this a non-issue, although I agree with the assessment that government-run HIT projects that cost billions are almost always colossal failures. And if you’re going to spend all that money, you might as well give the project an identity.

From Pretty Kitty: “Re: CPHIMS. Tupelo Honey was right. I have come to believe the same and it’s apparent that even HIMSS isn’t investing much effort or support in it. Although I knew I had passed walking out of the testing center, it took two months to receive notification from HIMSS and a year to get notification to my company. Other than a hearty congratulations, the certification has meant nothing. I will not be renewing.” I think HIMSS does OK with CPHIMS, but the bottom line is that generalist certifications aren’t worth much to employers. You can be pretty dense and still pass if you’ve been around awhile and do well on multiple choice tests. But, feel free to weigh in on that survey to your right asking about the value of CPHIMS. It’s still more relevant than CHIME’s Certified Healthcare CIO program, which makes no sense at all (other than the “cents” the related revenue stream brings to CHIME and the anemic ego boost it gives CIOs sporting unimpressive educational backgrounds). If you can show me even one hospital CEO who will state in writing that they hired a CIO because the candidate waved a CHCIO paper in his or her face, I’ll say so publicly (and that would be a terrible reflection on that CEO). In fact, what’s next, a certified CEO?

Listening: new from Stone Sour, the Des Moines band with some Slipknot personnel overlap. And as an intermezzo sorbet, speed punk from Lazy Cowgirls.

Paging Dr. Pronovost: a survey-based study finds that about half of healthcare workers think it’s a good idea for patients to remind their caregivers to wash their hands, yet a third of those respondents say they would not personally appreciate such a reminder. A third also said they would refuse to wear a badge inviting patients to question their handwashing.

The New York Times agrees with my assessment of Hewlett-Packard’s board for firing CEO Mark Hurd on shaky grounds, then suing Oracle for snapping him up. Its conclusion: “The HP board can now lay claim, officially, to the title of Most Inept Board in America … The whole world will know Mr. Hurd walked away with $40 million of HP shareholders’ money, and joined a multibillion-dollar competitor with HP in its sights — and there wasn’t a thing HP could do to stop him. Confidence-inspiring, this ain’t.” It points out that California courts don’t buy the validity of non-compete agreements, which is what HP is suing Hurd over. McKesson CEO John Hammergren, formerly viewed as ept, is one of HP’s board members.

CapSite sent me a copy of their 2010 US Remote Radiology Study. The big players are Nighthawk and Virtual Radiologic, but their share is not very large. It’s still mostly a preliminary reads business, but remote radiology is chosen for other interesting reasons (cost savings, mostly, but also turnaround time). CapSite provides reports and services that help healthcare organizations make informed capital expenditure decisions.

Outpatient imaging center operator RadNet acquires Image Medical Corporation, which owns PACS vendor eRAD of Greenville, SC, for $10.75 million in cash and notes. The publicly traded RadNet, which has $500 million a year in revenue, is forming a software development team for its newly created radiology information technology division. They say they’ll save up to $20 million over ten years by owning their vendor, plus eRAD is bringing in $5 million a year in revenue.

Weird News Andy notes that the last person a surgeon would want to leave a sponge in would be a lawyer. Or a judge, as in this case in Florida, where a surgical sponge and its metal ID tag were repeatedly misidentified over five months as it became infected in the judge’s abdomen, measuring a foot long by a foot wide when doctors finally took it out. Neither the hospital or its owner, Tenet, responded to his questions about how they would prevent the same problem in the future. The judge settled with the hospital, but he’s suing the radiologists and surgeons.

Stuff you can do right here: (a) stick your e-mail address in that Subscribe to Updates box to your right so you’ll be the second to know hot news (after me, of course, since I have to write it); (b) use the Search All HIStalk sites to … well, search all HIStalk sites; (c) Like us on Facebook with that widget to your right or search us out (Tim Histalk and Inga Histalk) and Friend us to support our pathetic illusion of popularity and acceptance; (d) send me a scandalous rumor via the garishly green but soothingly secure Rumor Report box; (e) add your two cents’ worth by leaving a comment or writing a guest article. And indulge me as I profusely thank the companies that sponsor HIStalk, which I think you’ll agree even though you may complain about the number of ads, do perform a service in bravely supporting an anonymous, abrasive, and hard-working blogger who toils by night after sometimes crappy days in the hospital (not usually, fortunately) to bring you news and opinion you wouldn’t hear otherwise (at least until tomorrow when the next rag or blog passes it off as their own creation). Mostly, thank you for reading.

eHealth Ontario signs a $46 million contract with Canada-based CGI Group to develop and manage a diabetes management portal.

Modern Physician names Amazing Charts CEO Jonathan Bertman, MD as its Physician Entrepreneur of the Year. He says he got into the EMR business because of the money, buying Visual Basic for Dummies in 2001 to create a simple, easy-to-use EMR that costs $995 upfront and $500 a year for maintenance (he says, “I like having a car and a house, but I don’t think you need to extort money from colleagues just because you can.”) I’m not sure I’d want him as either a doctor or a vendor given his admission that “In between patients, I would literally run back to my office to write code”, but I assume he’s got people to do that now since the company is up to 30 employees and 3,500 customers and has won some awards. I like his marketing pitch: “Is Amazing Charts crap? Um. No. But don’t take it from us. Try it yourself. As we’ve repeated ad nauseam, you can try it now without any payment or even giving us your name.” In a sideline business, he’ll also sell you a Male Genitalia Guide for $12, which he notes makes a great stocking stuffer (the guide, not the genitalia). Bet you can’t get that from Allscripts or Epic.

Dubai is having an mHealth Conference and Expo this week. Not to be confused with the mHealth Summit in Washington, DC in late October, or the mHealth Ecosystem in Chicago in December, or the mHealth Summit in Washington, DC in early November. The last one is most notable in my opinion because (a) Bill Gates is speaking; (b) the Foundation for NIH is involved; and (c) I’ll be attending and reporting (anonymously and at my own expense and taking time off from work, just in case my mentioning of it is suspect). It’s got a global health emphasis, of which I’m a fan.

The New York State Department of Health funds $109 million worth of HIT grants for 11 organizations, hoping to build an IT infrastructure to support the patient-centered medical home model of care.

A Mayo bioinformatics researcher gets a $3.1 million NIH grant to develop an EMR that will tie drug response to genomic information.

Odd: a hospital in India buys an MRI machine, but shuts it down a month later when it fires the only doctor who knows how to use it. He was on contract from a private lab and was accused of sending patients there instead of doing the work at the hospital. The hospital can’t get radiologists for the “meagre salary” it offers.

E-mail me.

HERtalk by Inga

Kadlec Regional Medical Center (WA) will deploy Wolter Kluwer Health’s Medi-Span for its Epic EMR.

Also integrating with Epic: Mediware and its HCLL blood transfusion management software.

HIE vendor Availity extends a multi-year contract with Prematics for e-prescribing services and the Prematics Care Communication messaging service.

3M Health Information Systems says its ICD-10 Code Translation Tool is now fully integrated with its medical vocabulary server, the 3M Healthcare Data Dictionary.

Benefis Health System (MT) outsources its HIT functions to Precyse. Sixty Benefis employees, including those in IT, transcription, coding, and medical records, will be offered jobs with Precyse.

Corepoint Health and IPeople partner to offer a bi-directional interfacing solution for Meditech hospitals.

Boston Medical Center will lay off 119 people, including 44 nurses and 30 managers. The hospital is attempting to reverse its projected loss of $175 million for the year. Dartmouth-Hitchcock (NH) will eliminate 300 jobs to stave off its $50 million deficit, but hopes to avoid layoffs.

I see Praxis EMR  is applying for HITECH certification through the Drummond Group. I can’t help but wonder if CCHIT is second-guessing its decision to wait until September 20th to announce its final certification and testing plans.

HIT purists: move to the next item while I share healthcare fashion news with our more couture-conscious readers. I do wish HIT involved more fashion-related stories, but this is about as close as it gets. Cleveland Clinic premieres a new Diane von Furstenberg-designed hospital gown that features an elastic waistband (which I don’t think is particularly fashionable, though better than the Johnny gown), wrap-around closure, and a wide V-neck. There’s also a “signature” von Furstenberg element: a bold, graphic print that incorporates the clinic’s logo. Some male patients think it’s too girly-looking, but I bet the Voalte guys would wear it.

AHIMA comments on HHS’s proposed rule-making for HIPAA privacy, security, and enforcement. Key concerns/questions: allowing individuals to restrict the release of certain health information to health plans compromises data integrity and could affect reimbursement; it’s unclear how best to cover costs for the release of information within the context of privacy and security regulations; should consumers have the right to decide if their health information should be transferred to a new entity when the ownership of a health organization changes; and, further clarification is need regarding the definition of “agents” as it relates to covered entities and who should be covered.

The Reading Hospital and Medical Center selects TeleHealth Services and its TIGR interactive patient education and entertainment system.

Mr. H isn’t too big on surveys that include lots of percentages that are suppose to indicate certain things, probably because his analytical mind finds too many flaws in their methodologies. However, my simple mind spent years calculating things like my percent over quota or what my commission percentage would be when I closed the next big deal, so I have an affinity for percentages. That’s a long way of saying I liked reading that 62% of CHIME member respondents are optimistic they’ll qualify for Stage 1 HITECH stimulus funds. However, a bit of Mr. H has rubbed off on me because I question what that figure really tells us about anything. CHIME says 152 of its 1,400 members took part in the survey. Heck, if I knew I was nowhere close to qualifying, I would have ignored the survey too — that’s like salespeople not turning in their forecast when they know they won’t make their numbers. Also, CHIME members as a whole tend to be some of healthcare’s top-tier CIOs, so you would expect this bunch to be ahead of the curve compared to the rest of the industry. So my take on these results is that perhaps the survey provides insight into how CHIME members are positioned, but I don’t think you can extrapolate the results.

Sponsor Updates:

• Hayes Management Consulting announces a new EMR Conversion and Migration Management service.
• Sunquest Information Systems releases its Diagnostic Intelligence BI solution, which provides lab managers a dashboard view of their financial, clinical, and operational performance.
• MEDecision makes the list of the 100 Best Places to Work in Healthcare by Modern Healthcare magazine.
• Cass County Memorial Hospital (IA) begins implementing the e-MDs EHR/PM solutions across its 11-provider practice. e-MDs says an endorsement by Iowa’s HITREC helped seal the deal.
• RelayHealth expands its portfolio of HIE options with the introduction of its Connected Orders solution. St. Luke’s Health System (MO) is live on the program, which allows physicians with or without EMRs to electronically order tests, meds, patient care, and referrals. 
• Picis says it implemented its LYNX revenue management solution at 29 US healthcare facilities in the second quarter.
• Orange Regional Medical Center (NY) hires Orchestrate Healthcare to provide implementation and migration services for its Epic EMR rollout.
• EMR vendor SRS will offer its customers an integrated PACS solution from Medstrat, which specializes in orthopedic PACS.

Odd: Skyridge Medical Center (CO) briefly closes its ER after a patient knowingly brings in a radioactive rock. A hazardous materials team later it was determined the rock’s radioactivity was relatively low and posed no danger. No word on why the patient was carrying around a radioactive rock.

For some reason, images of dogs and fire hydrants came to mind when I read this story. A gynecologist uses a cauterizing tool to brand the patient’s name on her removed uterus. He says he “felt comfortable putting her name on the uterus” since the patient was a  “good friend.” The patient says she never met the doctor until the first consult and she’s suing. Her lawyer called the branding “inexcusably bizarre behavior.”

E-mail Inga.

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Hamid Tabatabaie is president and CEO of lifeIMAGE of Newton, MA.

Tell me about lifeIMAGE.

lifeIMAGE is a company that got started a few years ago with Amy Vreeland, my co-founder. The two of us had finished a successful career at Amicas. After we decided that the market was on its way to adopting PACS entirely, we decided there was a gap between what happens inside the facility with their PACS and what the needs are outside the facility to have access to that data.

We spent some time and came up with a product design and a marketing approach to make it practical to essentially create a network on which anyone can exchange information with anyone with relative ease. We are in the market primarily offering services that let people deal with outside images. We allow hospitals to receive outside images electronically. If they receive them on CD, we have a workflow that addresses the complexities that exist today with the CDs.

Over time, we will add services to enable people to deal with consumers when necessary, to deal with community physicians whenever possible, and generally bridge the gap that exists today, all the way to having access to anyone’s images at the right time and the right place. Specifically, having a smart network.

I hope that’s who lifeIMAGE ends up being. We’re doing everything we can to get it there.

What’s the general state of interoperability and data sharing with diagnostic imaging systems?

It’s really not good. It’s spotty at best. There is an underground world of image sharing that goes on today that no one really has the right applications for, no one is responsible for. People have CDs and thumb drives and still film, primarily, as the way they exchange imaging information.

It used to be that the useful life of an image ended when the report was done. Now that images are much more pervasive, especially among whom we call image intensivists. The real useful life of an image starts when the report ends. People receive the report to know what they need to know, and they use images for where they need to go anatomically and otherwise.

There’s a huge need, unfortunately, today that is being satisfied with various manual routines and workflow, and/or at best, a Home Depot-style of putting parts and pieces together to accomplish specific use cases.

When you look at the financial and clinical impact of that lack of access or that substandard way of accessing images, what is the impact of having these workarounds?

The financial impact, to start with, is tremendous. In that, everyone agrees. Various different research shows that somewhere between 10-20% of all exams are duplicate exams. Arguably, a larger percentage may be unnecessary exams, but physician support capabilities will hopefully affect the unnecessary exams. The duplicate exams we can stop by having a reliable network. If you believe those numbers, the financial impact starts somewhere around $10-20 billion to our healthcare system.

Then there are financial impacts outside the system. Every time Liberty Mutual is in the middle of a case for workman’s comp, they spend a lot of money getting images from the patient, and to their experts, and to their lawyers, and to the surgeons that afterwards see the lawyers. Those costs are ultimately passed on to the consumers via more expensive insurance bills. We can avoid those costs and hopefully even have an impact in that arena.

Self-insured companies that have a direct relationship with their healthcare expense assume that self-insured companies simply has a rule that says if you ever imaged one of my employees, you have to give me back the images and report somehow that I can avoid the next doctor who would want to otherwise order the duplicate exam. You can imagine that you can extend that to the Medicare and Medicaid patients, to the Blue Cross and Aetna patients.

All together, the cost really starts at $20 billion when you want to look at it from a macro point of view.

At the micro level, the duplicate exams used to be a revenue point for radiology departments, but the new financial arrangements between radiology departments and payers even erode that value.

I would assume there’s patient impact because of lack of timely treatment or over-radiation with retakes.

That’s absolutely a side effect. The financial impact of that alone is all the mistakes that can be made, all the delays it can cause, additional costs and complications. Simply avoiding the duplicate exam is a great deal of value, never mind the negative side effects of it.

You’re selling your offering as service. Who pays for the service and how is it priced?

That is, I think, a compelling point to get people to want to initiate connection to these potential exchanges. We charge the hospitals and imaging service providers, but they have a cost themselves, whether it is for the ingestion of the CD or for delivery of results to the patient or community physicians. We simply replace those costs with better services and less expensive approaches, much more effective at the same time.

Our business model is very much on a per-month basis. You effectively become a subscriber to whichever one of our services. You can almost think of us as a cable box that you choose to have various channels on, and for each channel you pay a monthly fee. Sometimes it’s dependent on the number of exams, sometimes it’s dependent on the size of facility you are. But invariably it’s always less expensive than the current costs.

You just signed Moffitt and Memorial Sloan-Kettering. How do you market to hospitals like that to get such prestigious clients?

We have them on our mind when we design products, when we design services, and when we design our pricing.

We are very mindful of the fact that specialists and sub-specialists are the ones who want to have access to these images more than anyone else, so we target those with the most intensive specialty population. Cancer centers, as you can imagine, are not only a great focus of a lot of specialists and sub-specialists, but also their patient population migrates in and out back to their local communities. That itself is a primary need for imaging exchange between the centers for specialty, like the cancer centers, and the patient and the community physicians.

Tell me a little bit about the size of the company.

We are a relatively young company. We started officially two years ago almost. Unofficially, three of us founders have been doing this for another three years designing things. Today, we are just under 40 people, full-time employees, and perhaps another 20 people in various contract positions.

A lot of the management team came from Amicas. What lessons did you learn working there that you’re using at lifeIMAGE?

I think Amicas, without question, was one of the early innovators of using Web technology for imaging access. We’ve continued the culture of innovation at lifeIMAGE. Our focus is on doing the right thing, and in the process, creating yet another disruptive technology. This time around, you learn both operationally how to run a much more efficient company and you learn how to more effectively market.

At Amicas, we learned a lot about radiology and radiologists. What we’re doing in lifeIMAGE is to focus on the specialists and the sub-specialists in their relationship with the radiologists. I can compare Amicas and PACS companies to the ‘local call’ equivalent of an imaging system, and lifeIMAGE is the ‘long-distance call’. You need to think about the outside world, and the need of the outside world, in order to design a system.

The lesson we’ve learned is how to focus on one constituent for one reason and other constituents for other reasons.

When you look at some of the other imaging companies like Amicas and Merge and Emageon, how do you hope the business evolves for lifeIMAGE?

They will continue to have their great place in the industry. PACS systems have been very much adopted universally and there’s almost nowhere that PACS doesn’t exist. These are complex systems that over time need to be revamped, rewritten, and bells and whistles added and so forth, so they have plenty of backlog to satisfy their markets.

We are an innovative company outside of the market. We start our life with the long-distance aspect instead of the local aspect. I think there’s a tendency to have a cooperative relationship between the ‘local call’ and the ‘long-distance call’ and similarly, our relationship with the PACS companies will be that way. Invariably, the lifeIMAGE environment can be used by smaller settings as the Salesforce.com model for some of the imaging functions that one can assume companies will offer in the future.

Your Web site uses common internet metaphors such as ‘inbox’ and ‘dropbox’. How important is it that your system be easy to use?

I believe after security and reliability, usability is by far the most important aspect of the system. Every time you try to change the current habits of busy people like doctors — or anyone, for that matter, who’s terribly busy — you have a challenge of introducing yet one more thing they’ve got to get used to. The easier you make that experience, the more likely it is to have adoption. Obviously, the choices of our naming conventions are not an accident. I invite you to take a look at some of our products to see that the design and the usability criteria for our systems follow that design.

I was interested in the company’s vision statement that is built around the concept that there will be health record aggregators that will be the equivalent of banks for consumers; and also, that there will be some sort of incentives offered like there is for Meaningful Use for providers to share images. Can you explain how that all fits together?

I think if we fast-forward some years — I don’t know how many years that exactly will be, but it won’t be too long and it won’t be very quick — we will be at a place where a patient walks into a facility and their medical record will be available to their new care providers just as easily as the current and local records.

In order to satisfy that, you have to envision a lot of social economics, political, regulatory functions will get a hold of something like this and bend and twist it to the satisfaction of how you can practically use environments like that. As a result, it’s very much likely that these will have regional flavors. I can see various networks have the capability of reaching across one another’s network so an AT&T subscriber can make a call to a Verizon subscriber — that sort of analogy. But yet among the Verizon users and among the AT&T users, they may enjoy a certain kind of behavior that is unique to them. That will satisfy some of the pressures that will come from various constituents I named and alluded to earlier.

Ultimately, I think the insurance companies and the payers stand to benefit from the exchange and the networks that enable these sorts of exchanges. But ultimately, I think we will have a way for them to either entirely or partially subsidize the costs of these kinds of networks.

I can see a relationship very much like the banking system between the Federal Reserve and the private banks. There will be some overwhelming and overarching missions for the new networks that will be governed by some hopefully good practices. But yet there will be some private providers like lifeIMAGE which will satisfy either regional or national requirements.

Any final thoughts?

From what I’ve read on your blog, you know the market well enough to put this in the right context. But really, somebody needs to kick-start the ultimate goal of healthcare information exchange. Those of us who’ve been around healthcare IT like you know that the concept of boiling the ocean never works. You have to have very, very clever, deliberate places and then you market the technologies in order to achieve some end goal. Imaging tends to be a very good, sticky one. 

The question that I would have wanted to answer if you had asked was, why start with imaging?

The answer may be obvious to you, and that is it already enjoys a great deal of standards. It is a very expensive component of our healthcare expense, and probably just second to pharmaceuticals. It is a growing expense even if we control the expense and utilization.

We are at the infancy of the benefits imaging bring to medicine. We better learn how to take advantage of this, while on one side, not bringing the costs up; or on the other side, choking innovation because it is an incredibly important component of diagnosis. Imaging to me: is a good place to start because there are a lot of good standards and it is very much universal — it exists in almost all sub-specialties.

Patients are already used to touching their CDs and being the courier from one point to the other. Finally, it can act as a catalyst for some of the rest. For instance, we allow attachments to be sent with images. So not only are you looking at somebody’s echocardiogram, but you’re also looking at their EKGs and their medication history.

That’s what’s really needed to have meaningful information at the other end. Hopefully there will be CCR- and CCD-type of standards that govern how to ingest those documents as well. But in the mean time, let’s satisfy the clinical needs.

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From Slinky Nighty: “Re: JPS in Fort Worth. They have definitely chosen Epic. They attended the Epic Texas Collaborative meeting this past quarter and are moving forward and looking for assistance.” Thanks for both the info and the name imagery.

From Old IS Person: “Re: Siemens. They’ve started a second help desk for radiology and PACS products, so those of us with multiple products are supposed to use two different systems just to report problems.” Don’t get me started on vendor help desks. Like the one from one of our key vendors who brags on how fast we’ll hear from an analyst, but it takes days to weeks to get anything other than the automated e-mail response that says “I have your case and I’ll get to it when I get to it” (I’m paraphrasing slightly). Not that it really matters since 90% of the time, the answer is, “Oh, we know about that problem and it’s on development’s list,” which paraphrases into, “It’s kind of a pain for us to fix that, so we’ll just add it to an Excel worksheet that nobody ever looks at.” Do some of the issues vendors ignore in this way endanger patients? No question. I bet if they were forced to go public with their open issues list they’d be a lot more responsive.

From Tupelo Honey: “Re: CPHIMS. I got an e-mail from HIMSS asking them to send me a glowing letter about all that having CPHIMS has done for me, which is mostly nothing. I am guessing that not so many people are signing up or renewing.”

From The PACS Designer: “Re: OpenMRS. TPD has posted about the third world medical record system called OpenMRS and how it was being used in Uganda, where Brigid O’Gorman is presently trying to educate their countrymen. Now they have improved their Web site and expect to release a new version OpenMRS 1.7 soon.” I noticed they’re having their Implementers Group Meeting in Cape Town, South Africa this weekend (group pic above).

From EHR Geek: “Re: HISsies. PLEASE do those again! The ones you posted today are still relevant and hilarious! ROTFL!” Thanks. I’ll try to crank out some cynically funny stuff again since I miss doing that, although someone always complains if I write anything that isn’t just a bullet list of facts addressing only those precise news stories that interest them personally. Meanwhile, you can check out the 2006 HISsies recap or one of my phony news items, of which here are a couple for old times’ sake.

HIMSS Announces 2008 Conference to Be Held in Baghdad
(CHICAGO, IL) HIMSS has announced that its 2008 Annual Conference & Exhibition will be held in Baghdad, Iraq, following a successful 2007 stop in New Orleans. Steve Lieber, CEO of HIMSS says that HIMSS has learned that it can benefit disaster-stricken cities by flying in planeloads of attendees with large expense accounts, a concept first tested by bringing conventioneers to New Orleans shortly after it was virtually destroyed by Hurricane Katrina. "We’ve proven that we can all have a great time at a site mostly known for death, civil disorder, and senseless violence. We’re going to have a blast in Iraq, no pun intended," said Lieber. HIMSS sources indicate that the surprise speakers for the "View from the Top" session may be Saddam Hussein, Donald Rumsfeld, and Neal Patterson.

Hospital Trainer Collapses During Class
(DAYTONA BEACH, FL) Todd Cleaver, a 41-year-old computer trainer at Halifax Hospital, was stricken this morning with an apparent heart attack while leading a computer class for nurses. He is reported in stable condition and is expected to recover. Debbie Dallas, a registered nurse attending Cleaver’s electronic clinical documentation course, said he was working with her one-on-one when he collapsed. “He was starting to tell me how to make a flowsheet entry and I just reached over and did it correctly. Then, he was going into switching between Windows tasks and minimizing windows, and I showed him I could that, too. That’s when he went down.” Cynthia Roda-Tiller, education manager for Halifax, says she believes that Cleaver suffered a strong physiologic reaction upon seeing a nurse use a computer intuitively. “Usually they just stare at the screen like it landed from Mars or they start clicking everything in sight like it was Whack-A-Mole. You’re thinking, ‘they let you use medical equipment?’ I’d like to think I could have handled it myself, but it’s making me shake even now. I’m not sure I even believe she’s really a nurse, at least not one I’d want working my bedpan.”

Somebody must have gotten to the Forbes writer who wrote a generally negative article called Bribing Doctors To Go Electronic. Its implications: North Shore-LIJ and Allscripts are struggling with their $400 million to implement EHRs for 9,000 doctors, it’s taking doctors longer to get their work done, they’re pawns of the government, EHRs are a tough sell culturally, and community docs don’t like hospital-hosted EMRs because they don’t trust hospitals. Careful readers may have noted that he talked to a grand total of two docs (both recently implemented) in writing the lengthy piece. Now he’s backing off in a mea culpa that says he wasn’t trying to write a definitive article on the value of EMRs and that those complaining early adopters recognize their value because they volunteered. I guess the two pieces cancel each other out, other than the time it took to read both.

As New York, Nashville, and Cleveland race to book tenants for their medical trade center buildings, the Nashville group says it’s not worried despite not signing anyone except HIMSS for its 1.5 million square feet of space scheduled to open in 2013. Reason: it says HIMSS will bring 85 to 125 companies to lease space in their building, with a handful taking up to 15,000 square feet.

Hey, it’s only $20 million, which is a HITECH rounding error, but ONC throws more money at RECs, this time as a little extra to help critical access and rural hospitals.

Stanford’s Lucile Packard Children’s Hospital appeals the $250K fine levied by the state’s health department when the hospital waited 11 days before reporting a stolen PHI-containing laptop. They fired the employee who took it home against policy.

Ivo Nelson, chair of Encore Health Resources, joins the board of Health Care DataWorks. That’s the Ohio State spinoff whose CEO is former OSUMC CIO Herb Smaltz.

The Bethesda Hospitals’ Emergency Preparedness Partnership (Hopkins Suburban Hospital, National Naval Medical Center, and NIH) chooses Versus Advantages RTLS for patient tracking in emergency care areas during mass casualties. The Versus product met its requirement for 95% accuracy down to the room level and also links patient information to location for emergency responders.

Not many folks think that the average EMR will give providers enough information to manage population-based risk. New poll to your right: if you were filling a position, what impact would a candidate’s CPHIMS credential have on your decision? Tupelo Honey wants to know.

Ken Rardin, former CEO of Merge Healthcare, IMNET Systems, and a couple of non-healthcare companies is named CEO of telemedicine provider REACH Call of Augusta, GA.

This could make a an interesting novel: the former CFO of Danbury Hospital pleads not guilty to scamming the hospital by approving phony invoices for contract management software from a software company he ran from his house. He adds witness tampering and harassment to his list of charges after e-mailing the hospital president begging him to make the charges go away despite a hospital-requested court order to keep him away for fear he would go postal. He closed his plea with, “I got no place else to go (quote from An Officer and a Gentleman)” The judge nearly put him back in jail for that, but the man’s attorney made a convincing argument: “He would have to be a total idiot to do this again.” Ever the CFO, he showed up in court with a sports coat over his jail coveralls.

One of two winners of IBM’s SmartCamps start-up competition: CareCloud, a Miami company offering physician practices a $499 per-doc-per-month practice management system with social networking thrown in and revenue cycle services optional. I’ve mentioned the company a few times previously when they won an award and were pitching at the Health IT Venture Fair at HIMSS. Points off for their latest blog entry extolling the virtues of Twitter, which they summarize in a grammatically incorrect manner as, “… us enlightened folk know that the conversations on Twitter are insightful and illuminating.” They must be living in an alternate Twitterverse than the one I’ve seen, which combines the worst aspects of text messaging and Facebook but at least allows only 140 characters of time-wasting, stream-of-consciousness preening (if they would ration the number of tweets like they do the number of characters, they’d be on to something). Do we really need to hang on the every un-profound word of vapid celebrities, self-appointed pundits, and a guy having a heart attack?

Here’s another example that healthcare is different when you have money: a new startup called ExpertConsensus will take your tough medical problem to a group of big-name doctors who will teleconference and make their collective recommendations. The company’s minimum charge: $20,000. I hated that concept until I thought about it: they’re offering convenience for those willing and able to pay, but patients on a non-$20K shoestring could find these docs on their own and pay just a consultation fee to get the same opinions (or pay Cleveland Clinic a few hundred dollars for an electronic second opinion, which I can’t believe isn’t more popular than it seems to be). ExpertConsensus offers other services seemingly unrelated except for their common denominator of buck-making opportunity: research reports, care management, on-site clinic setup, physician referrals, wellness, and personal health records.

Louisiana doctors will have to pay back $17 million in Medicaid overpayments because the state’s Department of Health and Hospitals just now got their computers programmed to handle budget cuts that went into effect 13 months ago. Said one doc who says the cut will put him out of businesses, “We’ll gut it out and when it’s obvious that we aren’t making ends meet, we’ll all retire.” I need to give docs some PR advice for those situations where they’re complaining about making less money: don’t say “retire,” but instead say “find another line of work.” People hearing “retire” assume that means you’ve milked your medical practice to the point of not needing to work any more, which doesn’t exactly bolster the “we’re poor” argument.

Interesting: doctors at McGill University in Montreal administer anesthesia electronically for a surgery being done in Italy, a pilot project for “teleanesthesia”. They managed the patient using video cameras and remote dosing computers that make up what they call “an anesthesia cockpit.”

I’ve written before about the UK’s hospital radio stations, charities run by volunteers and featuring patients and family requests. London’s Radio Marsden, which runs 24 hours a day for patients in two cancer hospitals, will move its service to the Internet this month to allow patients, friends, and families to listen together. I’m listening to Bowie’s China Girl on it right now, followed by the Talking Heads doing Burning Down the House and an announcers’s suggestion that patients ask for hospital pens and paper to write letters home. Hot on their playlist based on patient requests and favorites: Lady GaGa, 30 Seconds to Mars, Alicia Keys, Kinks, Billy Ocean, The Clash, and The Saturdays, among others. It’s kind of addictive.

Former Sun CEO Jonathan Schwartz, who replaced Scott McNealy for a short time before selling the company to Oracle, gets involved with a healthcare-related startup, Picture of Health. He’s not saying what the company will do. 

A hospital ED patient is arrested for assaulting another patient and then pulling a knife on an ED nurse. The man’s occupation: minister.

E-mail me.

A Mr. H Book Review
Safe Patients, Smart Hospitals
By Peter Pronovost, MD, PhD and Eric Vohr

A reader asked me to review this book, so I bought a copy. I interviewed Peter a couple of years ago, before he won the Genius Grant. It’s still one of my favorite interviews, with this as my favorite quote from it:

That’s the tension that we have. How much evidence do I need to give up my autonomy? We’re still uncertain about that. As an industry, healthcare is grossly understandarized. Compare that to pilots who have to use checklists or they won’t be flying. Healthcare is still very much like the Wild West or like Chuck Yeager in The Right Stuff, where we have this cowboy mentality and we’re just beginning to accept that standardization is a key principal to making care safe.

That frames up the book nicely.

My first thought when seeing the book (published just this year) was, “Hey, I get it, providers need to make lists … why do I need to buy the book since I already know the ending?” There’s a lot more to it than just making lists, however. The book is really about translational medicine, rigorous measurement of healthcare quality, and the patient harm caused by the toxic culture of hospitals and physicians. Here are the takeaway points.

• Doctors and hospitals harm patients because of poor communication, not following rules that are indisputably beneficial to patients, and not using proven research in their treatments.
• Culture dictates that doctors and hospitals pretend that they don’t mistakes and to avoid admitting them when they do.
• There is no wisdom of crowds in hospitals. Doctors are trained to be sole decision-makers and to lash out if anyone questions their decisions. Not to mention that Peter’s background is in academic medical centers, where the problem is tiny compared to community hospitals with their non-employed doctors who are always complaining to administration and trying to get employees fired for looking after the best interests of patients.
• In terms of communications, even on his own rounding team, only 5% of residents and nurses could articulate the care goals for a patient who had just been the topic of a 15-minute team discussion. You wonder what they would have concluded without the team discussion and armed only with a paper or electronic medical record, given that academic medical centers are a small percentage of hospitals and others don’t do that kind of rounding at all.
• Overworked doctors will break rules for a single patient if they think the greater good is served. Every doctor knows to wash their hands before and after seeing each patient, but only 30% actually do it because they’re busy or supplies aren’t available.
• Communication in the OR is especially bad, where the nurses know everybody’s name but the surgeons see just a sea of scrubs and have no interest in names and roles. The pecking order is inviolable.
• Some tasks or procedures can be summarized into a checklist of no more than 5-7 evidence-based items, no different than a pre-flight checklist. The list can be developed locally to encourage ownership.
• Even though Peter’s work has saved thousands of lives and hundreds of millions of dollars, most of that came from just one checklist (central line placement) out of thousands upon thousands of medical procedures and tasks. That’s either a wide-open field or a depressing commentary on modern medicine, depending on your perspective.
• Non-clinicians, like administrators and probably IT executives, aren’t usually comfortable getting out on the floors but can play a big role on offering a fresh perspective for problem-solving and in understanding how projects are financed, staffed, and run.
• Doctors practice as they were originally taught in school using the “see one, do one, teach one” model that tells them to ignore everybody else’s opinion and go with their own. Good teamwork means a nurse doing what the doctor says. Doctors are not taught to communicate or to manage stress. They do not have time to keep up with the literature. There is no standardization, even within one organization. Residents make mistakes because they don’t want to look stupid by asking questions.
• Checklists worked in aviation because the industry admitted that pilots make mistakes and took the attitude that every crash is preventable. That hasn’t happened in medicine, where hospitals and doctors refuse to admit that they are not infallible. Even Hopkins (arguably the best hospital in the country) defended its catheter infection rates (among the worst in the country), using the “our patients are sicker” argument. After using Peter’s methods, their infection rate dropped from 19% to near zero, saving an estimated eight lives and $2 million.
• Quality requires central analysis of data. You don’t know what’s working without data. No other industry would tolerate healthcare’s sloppy data practices.
• Making the list is easy. The hardest and most important parts, which hospitals always want to skip, are evaluating the culture, making sure every patient is treated using the list, and measuring the results.
• State-wide projects don’t always work. They took shortcuts, made data reporting voluntary, and let turf wars (infection control docs vs. intensivists) compromise the plan. But in Michigan, their infection rate dropped from 2.7% to zero when they swallowed their pride and followed the plan.
• Medical research gets all the funding, while patient safety research hasn’t. Part of healthcare reform is creation of the Office for Patient Safety Research.
• The only profit to be made in patient safety is for insurance companies.

I extrapolated his thoughts into IT:

• Peter said in my interview that errors will go up when CPOE is introduced because it’s a change, nothing is standardized, and CPOE is set up to look like the paper it’s replacing.
• Decision support is the real value of CPOE, but it’s not usually added until afterward.
• Every hospital has to develop its own clinical decision support rules, which is like each airport having to build its own air traffic control system.
• IT systems can support enforcing the lists and reminding providers about them.
• Use shared decision support rules to begin standardization and using best practices.
• Look at data collection, reporting, and transparency. Peter found that virtually no hospitals have the right information in their databases to be able to know their infection rates.
• Use these methods for IT project rollouts and maintenance to reduce mistakes and to remove vendor and IT pressure to do something harmful.
• Find ways to get research into practice. Why is research a science, but the practice of medicine is an art?
• For vendors, build support for lists and reminders into applications, where they can be cued by workflow.

It’s a bit disconcerting to see just how inconsistent healthcare delivery is. It’s based on science, but often is a long way from being delivered in a scientific way. The major point of the book is that nobody’s head is big enough to hold all the information about medicine and research findings, so practitioners often are endangering patients by what they don’t know or don’t practice.

Few would doubt that the book outlines incredible opportunity for improvement in every kind of patient care setting. We’re talking saved lives, not just saved dollars. The good news is that’s exactly what computers are good at. Giving providers access to lists, providing immediately usable reference material (how-to videos, audio instructions, etc.), linking to the evidence, and offering collaboration platforms could all be key elements in implementing the quality measures called for in the book.

This is an excellent book, although it will make providers question their core beliefs about the healthcare system they work in. It’s pretty screwed up, as we know, and getting worse. The goal isn’t perfection, it’s improvement, and that won’t be easy (if it were, everybody would already be doing it). Are there enough providers who can look beyond the knee-jerk reaction of just making a Pronovost list and claiming mission accomplished to actually improve healthcare quality? Maybe or maybe not, but if enough at least try to tackle their problems in a rigorous way, they’ll probably avoid killing a few patients.

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From A. Nonnie Mouse: “Re: Kadlec Regional Medical Center (WA). Turfing McKesson inpatient and GE Centricity and moving to – surprise! – Epic. The number of Epic customers in Washington and Oregon make Epic CareEveryWhere something of a de facto HIE.” Unverified, but the hospital is running Epic recruitment ads, so your information may well be correct.

From FortWorthFan: “Re: JPS Health in Fort Worth, TX. I noticed they are hiring Epic Revenue Cycle analysts, but I don’t recall ever reading that they selected Epic as their replacement clinical system.” I’ll guess they’re going Epic since this position listing seeks Epic clinical analysts. From this job opening, it appears they are seeking a CIO as well.

From Tina LaBoeuf: “Re: HISsies. I miss your hilarious write-ups of the awards announcements that went away when you started the awards party ” Tina’s comment sent me to the search function to find and relive those moments. I did find them amusing, especially since I mixed in actual winner quotes with my phony recap. You can read it here if you enjoy these snips from 2007, featuring as host my alter-ego, former HIT sales jock Billy “Biff” Jutjaw:

Imagination at Work? Must be talking about their Carecast guys porn-surfing at their desks! Zow! Rimshot! BA-DUM-PAH. GE guys … hey Jeff … we need one of your lightbulbs over here … yeah, a replacement for that faulty one that went off over your head when you bought IDX! Owwww! But I kid. What a great evening! What a constellation of industry stars! What a rack on that broad at Table 3! … Say, Chuck, let’s see who’s here. Hey, are we in the Ying or the Yang side of the house? Judy must have been having a Woodstock flashback when she laid this place out. Where did she get compost-powered PCs, anyway? That Kool-Aid they drink here must have been from Ken Kesey’s original recipe! … Yeah, it’s like a CHIME meeting – you can’t swing a golf club without hitting two CIOs and four sales VPs clinging to their underbellies like remoras on a shark. … Come on up here, Howard Messing. Nice suit! Must be nice to keep getting awards for doing nothing! But I kid, old friend. MEDITECH was an established company when some CEOs were still backdating options in Monopoly! Booyah! Boston community swimming pools always hate it when MEDITECH starts hiring because they take all their lifeguards! Kapow! You know the first thing a MEDITECH employee says after getting home from work? "Mom, is dinner ready?" BAD-DUM-PAH. I’m like butter, baby, I’m on a roll!

Listening: new from singer-songwriter Sara Bareilles, thoughtful pop-tinged heartbreak music if you’re in the mood for that sort of thing. Watching on Netflix streaming: Studio 60 on the Sunset Strip, a stupendous 2006 dramedy series about a Saturday Night Live-type program (think 30 Rock played mostly straight with an amazing cast).

An expert tells South Shore Hospital (MA) that 800,000 patient records that were on lost backup tapes of their Meditech system can’t be easily accessed, so they decide against sending out breach notices to individual patients. They’re just going to run newspaper ads, which given the state of American intellect and newspaper circulation these days, means about a hundred people will see them, especially if they ads don’t appear in the sports or entertainment sections. This is the incident where the hospital paid Iron Mountain to destroy the tapes, only to find out afterward that the company subbed the work out to another company and lost the tapes in shipping.

In England, the dismantling of NPfIT appears to be underway, as the government cuts its total cost by $2 billion to $17.5 billion and decentralizing the project. Said the co-director of the Royal College of Physicians Health Informatics Unit, “One of the dirty secrets of the NHS is the regrettable state of medical record keeping. Earlier reports have shown that this compromises patient safety and clinical care. If IT in the health service is going to regain the confidence of the medical profession, then more emphasis has to be placed by the Department of Health on making sure that the new systems accurately capture the dialogue between doctor and patient. Everything else flows from getting that right.”

Speaking of NPfIT, an NHS Foundation Trust invites bids for a new patient care and e-prescribing system, opting out of NPfIT’s iSoft Lorenzo option because of concerns it’s not ready for prime time.

The latest ISMP Medication Safety Alert (from Institute for Safe Medication Practices) has a fascinating article about why the CMS rule requiring hospitals to administer drugs within 30 minutes of their scheduled times endangers patients. ISMP only posts excerpts online, but it was truly revealing as real-life nurses (thousands of them, in fact) describe why it’s unreasonable to meet that goal. The IT-related gist: we’ve put in eMAR and bar-coding systems and written cool “overdue” functions for clinical documentation systems, but hospitals have done nothing to address the challenges of nurses trying to meet a staggering variety of patient needs without turning into medication-pushing robots. This is one of those areas where non-clinical IT people would struggle with the idea that it’s not just calculating a “med overdue” time and dinging the nurse on a report. Everybody in involved in any capacity with clinical systems should read the full text of this article – it is a tremendous eye-opener for folks who’ve never trodden the uncarpeted areas of the hospital where the real work gets done.

Athenahealth CEO Jonathan Bush tends to be a “love him or hate him” kind of guy, but he’s still eminently quotable either way. He was definitely wound up for The New York Times. On why the company was in the birthing center business in the early days: “You know, Bush family noblesse oblige. I wanted to take advantage of all this education and support I’ve had and do well by doing good, and health care seemed like a place that no one else in my family had been much. A new approach to health care seemed to me to be the oil fields of 1997.” On the company’s competitors: “We are the only cloud-based service in an industry segment full of sclerotic, enormous, personality-free corporations that have been in business making 90 percent margins doing nothing for decades and decades.” On the cost of healthcare reform: “Oh, it’s going to go through the roof! It’s widely accepted that this is not a cost-reform bill — it’s an access bill … Eventually, consumers will need to eat a big part of their health care cost, because health care will fundamentally consume the entire G.D.P. in the not-too-distant future.”

It’s interesting that WellStar Health (GA) apparently fired its CEO after it was fined for excessive Medicaid billing, but it named the CFO as the interim president. Wouldn’t the CFO be the person most accountable for billing mistakes? Mostly unnoticed: they fired their general counsel as well. And from an IT standpoint, the CEO blamed their billing system (McKesson Star, I think). Does it get the axe, too?

We like Encore Health Resources a lot since they threw one heck of an HIStalk bash in Atlanta this year (as many of you told Inga and me afterward and we saw first-hand ourselves – that’s Ross Martin in the pic). Dana and Ivo are fun at work too, apparently — the company is named as one of Modern Healthcare’s Best Places to work in Healthcare 2010. That’s pretty cool for a new, small consulting firm.

Jobs on the sponsor job page: Project Manager – Healthcare Implementation, Eclipsys Activation Consultants, Technology Account Executive. On Healthcare IT Jobs: Metadata Administrator, McKesson Horizon Consultants, IT Applications – VP. That reminds me to mention that I made a Google Gadget that you’ll see to your right that has tabs for the Events Calendar, Healthcare IT Jobs, news headlines, and posts from HIStalk Mobile. I did that for two reasons: first because the WordPress events widget wasn’t displaying the calendar entries correctly, and second because I was looking for an excuse to build something.

I always like to highlight badly written press releases, so it’s imperative that I recognize this gem from a home monitoring technology company, which leads off with: “Cytta Corp’s CEO Stephen Spalding is pleased to announce that, after a series of well received presentations and demonstrations, Cytta has been invited to provide its first major proposal to a major healthcare payor/provider to develop an individualized monitoring system.” It’s a penny stock, but the price would need to go up fivefold to actually reach a penny, closing today at $0.0018 for a market cap of $1.83 million, doubling in price since April.

The North Carolina sheriff’s association proposes that the state give its members access to its doctor shopper database of known drug seekers, saying they “can better go after those who are abusing the system.” Privacy advocates are less enthused by the idea.

iMedicor launches its National Healthcare Communications Network, which offers practices secure messaging, peer collaboration, referrals, and CME. The company changed its name from Vemics last year, which seems like a good idea since that sounds like worm medicine. According to the site, it costs $24.95 per provider per month. It looks pretty cool to me. I can think of several business models that would work if they get enough subscribers.

Jim Bradley, former CEO of RXHub and Abaton.com, is named chairman of the board of e-health connectivity vendor VisionShare.

Let’s hope they aren’t big cloud computing or ASP users. Local hospitals (along with everybody else in four Tennessee counties) lose their Internet, cable TV, and telephone access for two days when some goober takes a shot at a bird sitting on the only cable line connecting that area to the rest of the world.

E-mail me.

HERtalk by Inga

Streamline Health Solutions releases its Q2 numbers: revenue of $4.7 million (15% better than last year) and a net loss of $76,000 (versus an $18,000 loss last year). The company attributes the higher loss to increased investments in marketing and hosting operations and the reinstatement of bonuses. Streamline also announced the promotion of Gary Winzenread from SVP of product development to COO.

CIO C. Martin Harris, MD of the Cleveland Clinic and former FTC commissioner Deborah Taylor Tate join HealthStream’s board of directors.

Hard to believe, but registration for HIMSS11 is now open. If you are a HIMSS member and pay before December 7th, registration is only $695. Mr. H and I are already strategizing about all the fun HIStalk-related things we’ll be doing. If you have ideas, let us know.

HHS unveils CuidadodeSalud.gov, a Spanish-language website to provide consumers with public and private health coverage options.

Mediware doubles its fiscal year profits to $3.24 million. Revenue for the year grew 17% to $47.6 million.

KLAS adds five new members to its advisory board, including HIStalk’s own Edward Marx, CIO at Texas Health Resources. Other new members include Alastair MacGregor, MD from Methodist Le Bonheur Healthcare, Kara Marx of Methodist Hospital of Southern California, Dan Morgan from Bay Medical Center, and HCA’s Noel Williams.

Forbes magazine profiles North Shore-Long Island Jewish Health System and its $400 million effort to help 9,000 employed and affiliated physicians move to Allscripts EHR. Though North Shore is taking advantage of relaxed Stark laws to subsidize up to 85% of system costs, so far only 175 of the system’s 7,500 community physicians have signed up. The health system’s chief executive admits there’s been resistance around “cultural stuff,” including concerns about North Shore’s hosting of the EMR data and discomfort with having to make work flow changes.

Wayne State University Physician Group (MI) chooses Orion Health Rhapsody Integration Engine to help create patient data exchange between their offices and other providers and facilities.

McLeod Health (SC) contracts with Merge Healthcare to integrate Merge’s cardiology workflow solutions with McLeod’s existing radiology product.

Perioperative employees at Southwestern Vermont Medical Center explain to the local press how their Picis system works, noting it “soothes some of that anxiety” felt by family members while loved ones are in the operating room.

Stamford Health System (NY) says its MedAssets Charge Capture Audit tool helped recapture $1.9 million in lost charges last year. It will also use group purchasing contracts, consulting services, and BI tools from MedAssets.

St. John’s Hospital (IL) selects Amelior Tracker from Patient Care Technology Systems for automated medical equipment tracking.

HHS awards a $980,000 grant to the University of Kansas Medical Center, University of Missouri, and University of Oklahoma to create the Heartland Telehealth Resource Center. The center will help physicians treat rural patients using telehealth technology. Almost 90% of the counties in those three states are considered rural with limited access to healthcare.

Sponsor Update:

• The Massachusetts eHealth Institute (MeHI) REC releases a list of certified EHR vendors and Implementation and Optimization Organizations. EHR vendors include Allscripts, eClinicalWorks, eMDs, Greenway, MedPlus, NextGen, and Sage. Implementation organizations include Culbert Healthcare Solutions, eClinicalWorks, eMDs, and MedPlus.
• San Juan Regional Medical Center (NM) will use the Universal Document Portal from Access to share information between its MetaVision ICU system and Meditech CIS. San Juan also uses the Access Portal to interface perinatal documents from its GE Centricity system into Meditech’s scanning and archiving product.
• Bridgehead Software and Dell introduce an enterprise medical archiving solution that combines Dell hardware with Bridgehead’s healthcare data management software.
• Nuance Communications introduces Dragon Medical Enterprise Network Edition for  large practices and hospitals. The new release includes a centralized management console and enhanced support for Citrix-based EHRs.

Medical office employees in Colorado smell a strong odor and discover the source is a dead animal stuffed into a filing cabinet. The clinic owner believes the incident was the result of a break-in, likely by a former employee. He does not indicate whether or not he suspects the prank was some sort of statement about the clinic’s need to move to an electronic filing system.

E-mail Inga.

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The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

Does IT Matter: Six Years Later

In a 2003 opinion piece for the Harvard Business Review, Nicholas Carr threw a grenade on the IT dinner table. Carr argued vehemently that IT no longer mattered. He leveraged this high-profile editorial into a best-selling, thought-provoking book in 2004, Does IT Matter?

Carr’s central argument states that the strategic importance of IT has diminished over time; that IT has become nothing more than a commodity providing little competitive advantage. Consequently, according to Carr, companies should rethink their investment in IT. He also laid out his agenda for IT management, examining implications for business strategy and organization. Carr’s thesis was both embraced and vilified.

Written in the IT boom years, post-Internet “bubble,” does the economic downturn change the game? What about healthcare reform implications? Are we any different?

As I observe and research, I see fatalists and opportunists at odds.

The fatalist has accepted Carr’s pronouncement as fact and has become complacent, allowing the administration to marginalize IT. Opportunists, on the other hand, see the circumstances as the tipping point to reinforce, or for the first time, to position IT as strategic.

I interpret Carr’s compelling arguments as a call to action.

During these dour economic times and the uncertainty of healthcare reform, IT has a heroic opportunity to be a catalyst for prosperity, a key differentiator. This means I cannot sit back and accept current fate, allowing IT to dissolve into a simplistic commodity or back-office function.

To advance my organization, I hunt for and seize strategic opportunities. The economy will not determine my destiny if I choose to leverage it as a clarion call and make every effort to expand our services while lowering costs.

Our department reaches out to select vendors, changing our value proposition from transactional to transformational relationships. I shared this in-depth in Maximizing Vendor Relationships. It’s not about broad generalizations. Success is about the individual organization; its circumstances; and ultimately you, the IT leader.

As organizations look to cut spending, IT is not immune. Continual across-the-board expense reductions will underscore IT as a commodity and a cost center to be managed — Exhibit #1 for Carr.

Call me competitive, but I believe that companies that lay low and marginalize their IT will have a much lengthier recovery period. Especially when it comes to seizing the initiative on healthcare reform dynamics that are fundamentally changing the value equation of cost, quality, and revenue.

In contrast, those companies that seize the opportunity and invest in IT strategically will not only perform better, but will do so at the expense of their competitors. Some of our current work is going to change the competitive dynamic.

Think. Brainstorm. Mashup. Research and develop strategies that will propel your organization forward. Even if your company is panicking and relying solely on expense reduction tactics, present ideas that demonstrate bottom-line reduction, improve clinical outcomes, and support top-line growth. Innovation that will set your organization apart in dealing with the nuances of future payment and care delivery models. Insist on having your voice heard. Demonstrate ROI through IT’s transformative and innovative power.

For competitive reasons, I cannot share details, but we are doing these things. A risk-free example from my past happened at a community hospital. Our historic 45% market share in this two-hospital town was starting to plunge. Our cross-town rival was replete with cash, given their enviable position as part of a regional health system. Our board decided that the best antidote was not to reduce expenses, but rather to make strategic investments in IT.

One year after the implementation of affiliated practice-based EMRs, clinical inquiry application, and software to link referring physicians, our market position flipped. We saw a 20% swing, especially in our target areas of hearts, births, orthopedics, and neurosurgery. We were featured nationally.

I have additional career examples, but I believe the point is made. Yes, the economy is tough. Healthcare reform is a bit fuzzy still. Fatalists seek to marginalize IT. But the time is right to forcefully lay hold of this opportunity and (re)establish IT as strategic and foundational for your organization’s long-term success. IT is not back office!

Demonstrate the strategic power of IT.

It matters.

Update 9/14/10

Good debate on IT value. My leadership team just started on our next book, also by Carr, entitled The Big Switch…Rewiring the world from Edison to Google. Whether you agree or not with Carr, it is healthy to debate his ideas and come to grips with his messages. Is IT strategic? Will cheap utility-supplied computing change the game? Does the Internet take away our ability to think deeply? Are we losing our capability for concentration and reflection?

I still maintain that we can leverage even the most common of tools in a strategic fashion. It comes down to culture, risk, vision, innovation and leadership. Give me two organizations that each implement the identical EHR and I can show you two radically different approaches…and executed well, one can be a strategic differentiator over the other.

I do not agree that IT is purely a support function. Sounds good on the surface but, short sells the innovation and passion we have been endowed with. I have been fortunate to work with incredibly talented individuals who have taken common tools and developed these to improve patient safety and increase the quality of care. I have also witnessed similar gains on the business side. As a by-product, these have helped grow IT and proven to help us differentiate ourselves from competitors.

Not everyone will adopt or deploy it as strategic, nor should they. But it can be done.

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook, and you can follow him via Twitter – User Name “marxists.

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